WO2024030645A1 - Compositions pharmaceutiques et leurs utilisations pour le traitement du gliome - Google Patents

Compositions pharmaceutiques et leurs utilisations pour le traitement du gliome Download PDF

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WO2024030645A1
WO2024030645A1 PCT/US2023/029534 US2023029534W WO2024030645A1 WO 2024030645 A1 WO2024030645 A1 WO 2024030645A1 US 2023029534 W US2023029534 W US 2023029534W WO 2024030645 A1 WO2024030645 A1 WO 2024030645A1
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compound
subject
cancer
dose
treatment
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PCT/US2023/029534
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Joshua Edward Allen
Allen MELEMED
Varun Vijay PRABHU
Andrew Kang-Kang Lee
Phiroze Behram Sethna
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Chimerix, Inc.
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    • 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
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D221/00—Heterocyclic compounds containing six-membered rings having one nitrogen atom as the only ring hetero atom, not provided for by groups C07D211/00 - C07D219/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents

Definitions

  • ONC201 (7-benzyl-4-(2-methylbenzyl)-l,2,6,7,8,9-hexahydroimidazo [l,2-a]pyrido [3,4-e]pyrimidin-5(lH)-one) is the founding member of a class of anti-cancer compounds called imipridones that is in Phase II clinical trials in multiple advanced cancers. Since its discovery as a p53-independent inducer of TRAIL gene transcription, preclinical studies have shown that it has anti-proliferative and pro-apoptotic effects against a broad range of tumor cells but not normal cells.
  • ONC201 is orally active with infrequent dosing in animal models, causes sustained pharmacodynamic effects, and is not genotoxic.
  • H3 K27M a specific mutation in histone H3 proteins
  • H3 K27M a specific mutation in histone H3 proteins
  • DIPG diffuse intrinsic pontine glioma
  • Gliomas in the midline of the brain belong to the most aggressive types of primary malignant brain cancers.
  • the disease arises from glial cells, which form the tissue that surrounds and protects other nerve cells found within the brain and spinal cord.
  • Standard therapy for midline gliomas involves neurosurgery, when feasible, followed by fractionated external beam radiotherapy. Due to location in the brain, aggressiveness and low survival time, gliomas in the midline of the brain are considered as part of the most lethal forms of cancer.
  • No medical therapies have been shown to prolong survival in H3 K27M mutant adult and pediatric glioma patients. Standard-of-care DIPG treatment, 55Gy focal radiation fractionated over 6 weeks, is associated with a 9-11 -month overall survival.
  • Adult H3 K27M glioma is often treated with the same regimen as glioblastoma that involves radiation with concomitant and maintenance temozolomide. Despite its use to treat this newly defined disease in adults, this regimen’s efficacy has not been evaluated specifically in adult mutant H3 K27M glioma patients.
  • histones are predominantly protein-DNA and protein-protein interactions; they do not function as enzymes, which represent the bulk of targeted cancer therapy (kinases, HDAC inhibitors, etc.).
  • kinases, HDAC inhibitors, etc. kinases, HDAC inhibitors, etc.
  • no therapies directly target the mutant H3 proteins itself (such as the case for mutant BRAF); instead, therapeutic efforts have focused on targeting features of tumor cells with H3 K27M mutations, such as their epigenetic- and transcription-dependency.
  • Inhibition of proteins involved in epigenetics such as histone deacetylates, histone de-methylases, or bromodomains have yielded efficacy in preclinical models, however their ability to improve clinical outcome has not been shown.
  • H3 K27M glioma therapies A major challenge for effective H3 K27M glioma therapies is the need to penetrate the blood-brain barrier, a rare feature of current cancer therapies. This is further enhanced by the location of these tumors in midline brain structures, which has been shown to be harder to penetrate than other brain locations.
  • the H3 K27M mutation also tends to occur in midline gliomas with dopamine present and DRD2 expression prevalent in the tumor environment.
  • Ri and R2 are independently selected from H, alkyl, cycloalkyl, cycloalkylalkyl, heterocycloalkyl, heterocycloalkylalkyl, aryl, heteroaryl, arylalkyl, heteroarylalkyl, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, and acyl radicals.
  • R2 when Ri is CH2PI1, R2 is not CH2-(2-CH3-Ph).
  • Ri is CH2PI1 and R2 is CH2-(2-CH3-Ph) (ONC201).
  • Ri is CEbPh and R2 is CH2-(2,4-di F-Ph) (ONC206).
  • Ri is CIFPh and R2 is
  • Ri is CH2 Ph and R2 is CH2-(3,4-di F-Ph) (ONC213). In one embodiment, Ri is CH2-(3,4-di-Cl-Ph) and R2 is CH2-(4-CF3-Ph) (ONC234). In one embodiment, Ri is CH2-3-thienyl and R2 is CH2-(4-CF3-Ph) (ONC236).
  • kits to treat or prevent cancer in a subject in need thereof comprising: administering to the subject in need of such treatment a pharmaceutical composition comprising a therapeutically effective amount compound (1) or a pharmaceutically acceptable salt thereof, wherein the cancer involves a midline structure of the brain and has a histone H3 K27M mutation.
  • kits to treat or prevent cancer in a subject in need thereof comprising: administering to the subject in need of such treatment a pharmaceutical composition comprising a therapeutically effective amount a compound of formula (10) or an analog thereof, or a pharmaceutically acceptable salt thereof, wherein the cancer has a histone H3 mutation.
  • kits to treat or prevent cancer in a subject in need thereof comprising: administering to the subject in need of such treatment a pharmaceutical composition comprising a therapeutically effective amount a compound of formula (10) or an analog thereof, or a pharmaceutically acceptable salt thereof, wherein the cancer involves a midline structure of the brain.
  • One embodiment of the present disclosure includes a method of treating or preventing cancer in a subject in need thereof, comprising: administering to the subject in need of such treatment a pharmaceutical composition comprising an amount of compound (1) or a pharmaceutically acceptable salt thereof, according to a weekly regimen cycle of oral administration comprising a twice weekly dose on two consecutive days, day 1 and day 2, followed by a rest period, days 3 through 7.
  • the weekly regimen cycle is repeated.
  • the dose is one or more of 125 mg, 250 mg, 375 mg, 500 mg, or 625 mg.
  • the dose is 625 mg.
  • the dose selected is based on a mg/kg calculation based on subject weight (kg).
  • one or more subsequent dose is reduced from an initial dose.
  • each dose is administered to the subject on an empty stomach, no food within two (2) hours before or after each dose.
  • the weekly regimen is modified after one or more cycles to comprise a once weekly dose, day 1, followed by a rest period, days 2 through 7.
  • the method further includes a treatment of radiation prior to initation of the weekly regimen cycle.
  • the radiation is 54 to 60 Gy at 1.8 to 2.2 Gy/fraction.
  • the cancer involves a midline structure of the brain.
  • the cancer has a histone H3 K27M mutation.
  • the cancer is a central nervous system tumor, a brain tumor, a glioma, a peripheral nervous system tumor, a pheochromocytoma, a paraganglioma, an adrenal cortical carcinoma, an adrenal tumor, and a neuroendocrine tumor.
  • the cancer involves the thalamus, medulla, hypothalamus, basal ganglia, pineal gland, midbrain, cerebellum, pons, or spinal cord.
  • the histone H3 K27M mutation is H3.3 K27M or H3.1 K27M.
  • DRD2 is overexpressed in tissue
  • DRD5 is underexpressed in tissue, or both.
  • the subject is a human.
  • the subject is a pediatric subject and the dose is calculated based on weight of the pediatric subject. In one aspect, the dosage is rounded to the nearest increment of 125 mg. In one aspect, administration is initiated 2, 3, 4, 5, or 6 weeks after completion of radiation. In one aspect, the administration includes of one or more dose of temozolomide. In one aspect, the method further includes administration of one or more dose of bevacizumab. In one aspect, the method further comprises one or more treatment of radiation after initiation of administration.
  • One embodiment of the present disclosure includes a use or a compound for use in preparation of a medicament for the treatments outlined herein.
  • the present disclosure includes a compound (1) or a pharmaceutically acceptable salt thereof, for use in treating or preventing cancer in a subject in need thereof, in an amount according to a weekly regimen cycle of oral administration comprising a twice weekly dose on two consecutive days, day 1 and day 2, followed by a rest period, days 3 through 7.
  • the weekly regimen cycle is repeated.
  • the dose is one or more of 125 mg, 250 mg, 375 mg, 500 mg, or 625 mg.
  • the dose is 625 mg.
  • the dose selected is based on a mg/kg calculation based on subject weight (kg).
  • one or more subsequent dose is reduced from an initial dose.
  • each dose is administered to the subject on an empty stomach, no food within two (2) hours before or after each dose.
  • the weekly regimen is modified after one or more cycles to comprise a once weekly dose, day 1, followed by a rest period, days 2 through 7.
  • the use or compound for use provides a treatment of radiation prior to initiation of the weekly regimen cycle.
  • the radiation is 54 to 60 Gy at 1.8 to 2.2 Gy/fraction.
  • the cancer involves a midline structure of the brain.
  • the cancer has a histone H3 K27M mutation.
  • the cancer is a central nervous system tumor, a brain tumor, a glioma, a peripheral nervous system tumor, a pheochromocytoma, a paraganglioma, an adrenal cortical carcinoma, an adrenal tumor, and a neuroendocrine tumor.
  • the cancer involves the thalamus, medulla, hypothalamus, basal ganglia, pineal gland, midbrain, cerebellum, pons, or spinal cord.
  • the histone H3 K27M mutation is H3.3 K27M or H3.1 K27M.
  • DRD2 is overexpressed in tissue
  • DRD5 is underexpressed in tissue, or both.
  • the subject is a human.
  • the subject is a pediatric subject and the dose is calculated based on weight of the pediatric subject. In one aspect, the dosage is rounded to the nearest increment of 125 mg. In one aspect, administration is initiated 2, 3, 4, 5, or 6 weeks after completion of radiation. In one aspect, the use or compound for use further comprises administration of one or more dose of temozolomide. In one aspect, the use or compound for use further comprises administration of one or more dose of bevacizumab. In one aspect, the use or compound for use further comprises one or more treatment of radiation after initiation of adminsitration.
  • One embodiment of the present disclosure includes a pharmaceutical composition comprising a compound (1) or a pharmaceutically acceptable salt thereof, comprising a dose for twice weekly administration on two consecutive days, day 1 and day 2, followed by a rest period, days 3 through 7.
  • the dose is one or more of 125 mg, 250 mg, 375 mg, 500 mg, or 625 mg.
  • the dose is 625 mg.
  • the dose selected is based on a mg/kg calculation based on subject weight (kg).
  • the subject is a pediatric subject and the dose is calculated based on weight of the pediatric subject.
  • wherein the dosage is rounded to the nearest increment of 125 mg.
  • FIG. 1 Tumor type sensitivity of the Genomic of Drug Sensitivity in Cancer program (GDSC) cell line collection. The average sensitivity was determined by average estimated IC50 values from cell viability assays conducted at 72 hours post-treatment. Numbers above the bar indicates indicate the number of cell lines per tumor type.
  • GDSC Genomic of Drug Sensitivity in Cancer program
  • FIG. 3 GBM cell lines with higher DRD2 or lower DRD5 expression are more responsive to ONC201.
  • A Inhibition of NCI60 GBM cell lines as a function of ONC201 concentration.
  • B Log ONC201 GI50
  • M vs DRD2 expression for each GBM cell line.
  • R 2 0.8707.
  • C Low DRD5 expression significantly correlates with improved ONC201 efficacy in NCI60 panel of cancer cell lines.
  • ONC206 and ONC212 demonstrated anti-cancer efficacy across various tumor types in the NCI60 cancer cell line panel.
  • ONC203 is an inactive negative control.
  • Figure 5. Bone cancer is more responsive to ONC206 than ONC201.
  • FIG. 1 Ewing’s sarcoma is the most ONC206 responsive bone cancer subtype.
  • Figure 7. ONC206 anti-cancer efficacy is in the nanomolar range in 14 out of 16 Ewing’s sarcoma cell lines; it showed superior efficacy compared to ONC201 in all cell lines.
  • Figure 8. Leukemia is more responsive to ONC212 than ONC201.
  • ONC212 shows anti-cancer efficacy (and superior efficacy compared to ONC201) in the nanomolar range in 55 leukemia cell lines regardless of subtype.
  • FIG. 10 Anti-cancer efficacy of ONC212 in acute myeloid leukemia (AML) cell lines.
  • A Comparison of cell viability of MV411 AML cells treated with ONC212 or cytarabine.
  • B Comparison of cell viability of M0LM14, MV411 AML cells, MRC5 lung fibroblasts and Hs27a bone marrow cells treated with ONC212.
  • C Viability of M0LM14 and MV411 AML cells treated with ONC212 (250nM) for 4, 8, 24, 48, 72 and 96h.
  • ONC213 has an in vitro anti-cancer potency in HCT116/RPMI8226 cancer cells similar to ONC212, but its in vitro toxicity to normal cells was reduced compared to ONC212.
  • Figure 15 A 74-year-old woman with recurrent H3 K27M glioblastoma. First on- treatment 8 week MRI shows complete disappearance of tumor lesions.
  • FIG. 16 A 10-year-old girl with H3 K27M diffuse intrinsic pontine glioma has improvement in facial palsy and shrinkage of lesion after 16 doses.
  • Figure 17 A 3 -year-old girl with H3 K27M diffuse intrinsic pontine glioma. First on- treatment 6 week MRI shows stable tumor lesion.
  • Figure 18 Progression-free survival of patients with recurrent high grade glioma present at baseline by MRI before initiating ONC201 therapy.
  • the cohort is divided into two groups: one with known H3 K27M mutation (red curve) and the other with wild- type or unknown H3 status (blue curve).
  • FIG. 19 Waterfall plot for adult recurrent H3 K27M-mutant glioma patients treated with ONC201. Change in tumor size calculated as the best on-treatment change in the sum of products of perpendicular diameters of all measurable enhancing lesions compared to baseline. PD - progressive disease by RANG; SD - stable disease by RANG; PR - partial response by RANG; NE - not evaluable for response by RANG ( ⁇ lcm multi-focal lesions). [0040] Figure 20.
  • Figure 21 Gadolinium-enhanced MRI at baseline and 8 weeks post-GNC201 (625 mg once a week) initiation in a recurrent H3 K27M-mutant glioma patient.
  • Figure 22 Gadolinium-enhanced MRI at baseline and 15 weeks post-ONC201 (625 mg once a week) initiation in a recurrent H3 K27M-mutant glioma patient.
  • Figure 23 is a graphical respresentation of the testing results of K27M mutant compared to wild type with the compound of the present disclosure.
  • Figure 24 illustrates the results of a ONC201 Washout Experiment in U110 Glioblastoma Cells.
  • RNA Interference Nuts and Bolts of RNAi Technology, DNA Press LLC, Eagleville, PA, 2003; Herdewijn, P. (Ed.), Oligonucleotide Synthesis: Methods and Applications, Methods in Molecular Biology, Humana Press, 2004; A. Nagy, et al., Manipulating the Mouse Embryo: A Laboratory Manual, 3 rd edition, Cold Spring Harbor Laboratory Press; 2002, ISBN-10: 0879695919; Kursad Turksen (Ed.), Embryonic stem cells: methods and protocols in Methods Mol Biol. 2002; 185, Humana Press; Current Protocols in Stem Cell Biology, ISBN: 9780470151808, as well as US Patent 8,673,923.
  • the content of each of the references above is hereby incorporated by reference in its entirety.
  • substituted means that one or more hydrogens on a designated atom is replaced with a selection from the indicated group, provided that the designated atom’s normal valency is not exceeded, and that the substitution results in a stable compound.
  • 2 hydrogens on the atom are replaced.
  • variable e.g., R 4
  • its definition at each occurrence is independent of its definition at every other occurrence.
  • R 4 at each occurrence is selected independently from the definition of R 4 .
  • substituents and/or variables are permissible, but only if such combinations result in stable compounds.
  • C1- 6 When an atom or chemical moiety is followed by a subscripted numeric range (e.g., C1- 6), it will be appreciated that this encompasses each number within the range, as well as all intermediate ranges.
  • C1-6 alkyl is meant to include alkyl groups with 1, 2, 3, 4, 5, 6, 1-6, 1-5, 1-4, 1-3, 1-2, 2-6, 2-5, 2-4, 2-3, 3-6, 3-5, 3-4, 4-6, 4-5, and 5-6 carbons.
  • Alkyl includes both branched and straight-chain saturated aliphatic hydrocarbon groups having the specified number of carbon atoms.
  • C1-6 alkyl includes C1, C2, C3, C4, C5, and Ce alkyl groups.
  • Non-limiting examples of alkyl include methyl, ethyl, n-propyl, i-propyl, n-butyl, isobutyl s-butyl, t-butyl, n-pentyl, s-pentyl, neopentyl and n-hexyl.
  • a straight or branched chain alkyl has six or fewer carbon atoms in its backbone (e.g., C1-Ce for a straight chain, C3-C6 for a branched chain); in other cases, a straight or branched chain alkyl has four or fewer carbon atoms.
  • cycloalkyls may have from three to eight carbon atoms in their ring structure; in some cases, cycloalkyls have five or six carbons in the ring structure. Most preferred is C1-6 alkyl, particularly ethyl, methyl, isopropyl, isobutyl, n- pentyl, n-hexyl and cyclopropylmethyl.
  • substituted alkyls include 2,2-difluoropropyl, 2-carboxycyclopentyl and 3 -chloropropyl.
  • lower alkyl is an alkyl group, having one to six carbon atoms, preferably one to four, in its backbone.
  • Lower alkenyl and “lower alkynyl” have chain lengths of 2-6 carbon atoms and preferably 2-4 carbon atoms.
  • alkenyl includes unsaturated aliphatic groups analogous in length and possible substitution to the alkyls described above, but that contain at least one double bond.
  • alkenyl includes straight-chain alkenyl groups (e.g., ethenyl, propenyl, butenyl, pentenyl, hexenyl, heptenyl, octenyl, nonenyl, decenyl), branched-chain alkenyl groups, cycloalkenyl (e.g., alicyclic) groups (e.g., cyclopropenyl, cyclopentenyl, cyclohexenyl, cycloheptenyl, cyclooctenyl), alkyl or alkenyl substituted cycloalkenyl groups, and cycloalkyl or cycloalkenyl substituted alkenyl groups.
  • a straight or branched chain alkenyl group has six or fewer carbon atoms in its backbone (e.g. , C2-G, for a straight chain, C3-C6 for a branched chain).
  • cycloalkenyl groups may have from three to eight carbon atoms in their ring structure; in some cases, cycloalkenyl groups have five or six carbons in the ring structure.
  • C2-C6 and “C3-C6” includes alkenyl groups containing two to six carbon atoms and three to six carbon atoms, respectively.
  • Alkynyl includes unsaturated aliphatic groups analogous in length and possible substitution to the alkyls described above, but which contain at least one triple bond.
  • alkynyl includes straight-chain alkynyl groups (e.g., ethynyl, propynyl, butynyl, pentynyl, hexynyl, heptynyl, octynyl, nonynyl, decynyl), branched-chain alkynyl groups, and cycloalkyl or cycloalkenyl substituted alkynyl groups.
  • a straight or branched chain alkynyl group has six or fewer carbon atoms in its backbone (e.g., C2-C6 for a straight chain, C3-C6 for a branched chain).
  • C2-C6 and C3-C6 includes alkynyl groups containing two to six carbon atoms and three to six carbon atoms, respectively.
  • cycloalkyl refers to a monocyclic or polycyclic non-aromatic radical, where each of the atoms forming the ring (i.e. skeletal atoms) is a carbon atom. In some cases, the cycloalkyl group is saturated or partially unsaturated. In other cases, the cycloalkyl group is fused with an aromatic ring. Cycloalkyl groups include groups with from 3 to 10 ring atoms. Examples of cycloalkyl groups include, but are not limited to, the following moieties:
  • Monocyclic cycloalkyls include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, and cyclooctyl.
  • Dicyclic cycloalkyls include, but are not limited to, tetrahydronaphthyl, indanyl, and tetrahydropentalene.
  • Polycyclic cycloalkyls include adamantine and norbomane.
  • cycloalkyl includes “unsaturated nonaromatic carbocyclyl” or “nonaromatic unsaturated carbocyclyl” groups, both of which refer to a nonaromatic carbocycle as defined herein, which contains at least one carbon carbon double bond or one carbon carbon triple bond.
  • cycloalkylalkyl refers to an alkyl group substituted by a cycloalkyl group.
  • Example cycloalkylalkyl groups include cyclopropylalkyl, cyclohexylalkyl.
  • heterocycloalkyl refers to a non-aromatic heterocycle where one or more of the ring-forming atoms is a heteroatom such as an O, N, or S atom.
  • Heterocycloalkyl groups include mono- or polycyclic (e.g., having 2, 3 or 4 fused rings) ring systems, as well as spirocycles.
  • Example heterocycloalkyl groups include morpholino, thiomorpholino, piperazinyl, tetrahydrofuranyl, tetrahydrothienyl, 2,3-dihydrobenzofuryl, 1,3-benzodioxole, benzo- 1,4- dioxane, piperidinyl, pyrrolidinyl, isoxazolidinyl, isothiazolidinyl, pyrazolidinyl, oxazolidinyl, thiazolidinyl, and imidazolidinyl.
  • heterocycloalkyl can be moieties that have one or more aromatic rings fused (i.e., having a bond in common with) to the nonaromatic heterocyclic ring, for example, quinolyl, isoquinolyl, and benzo derivatives of heterocycles.
  • a heterocycloalkyl group having one or more fused aromatic rings are attached though either the aromatic or non-aromatic portion.
  • moieties where one or more ring-forming atoms can be substituted by 1 or 2 oxo or sulfido groups.
  • the heterocycloalkyl group has from 1 to about 20 carbon atoms, and in further case from about 3 to about 20 carbon atoms. In some cases, a heterocycloalkyl group contains 3 to about 20, 3 to about 14, 3 to about 7, or 5 to 6 ring-forming atoms. In some cases, a heterocycloalkyl group has 1 to about 4, 1 to about 3, or 1 to 2 heteroatoms. In some cases, a heterocycloalkyl group contains 0 to 3 double bonds. In some cases, a heterocycloalkyl group contains 0 to 2 triple bonds.
  • heterocycloalkylalkyl refers to an alkyl group substituted by a heterocycloalkyl.
  • Example heterocycloalkylalkyls include morpholinoalkyl and piperazinylalkyl.
  • aryl refers to monocyclic or polycyclic (e.g., having 2, 3 or 4 fused rings) aromatic hydrocarbons, such as phenyl, naphthyl, anthracenyl, phenanthrenyl. In some cases, an aryl group has from 6 to about 20 carbon atoms.
  • arylalkyl refers to an alkyl group substituted by an aryl group.
  • Example arylalkyl groups include benzyl and phenylethyl.
  • heteroaryl refers to an aromatic heterocycle having at least one heteroatom ring member such as an O, S, or N atom.
  • Heteroaryl groups include monocyclic and polycyclic (e.g., having 2, 3 or 4 fused rings) systems.
  • a ring-forming N atom in a heteroaryl group can also be oxidized to form an N-oxo moiety.
  • heteroaryl groups include pyridyl, N- oxopyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, tiazinyl, furyl, quinolyl, isoquinolyl, thienyl, imidazolyl, thiazolyl, indolyl, pyrryl, oxazolyl, benzofuryl, benzothienyl, benzthiazolyl, isoxazolyl, pyrazolyl, triazolyl, tetrazolyl, indazolyl, 1,2,4-thiadiazolyl, isothiazolyl, benzothienyl, purinyl, carbazolyl, benzimidazolyl, indolinyl.
  • a heteroaryl group has from 1 to about 20 carbon atoms, and in some cases from about 3 to 20 carbon atoms. In some cases, a heteroaryl group contains 3 to about 14, 3 to about 7, or 5-6 ring- forming atoms. In some cases, a heteroaryl group has 1 to about 4, 1 to about 3, or 1-2 heteroatoms.
  • heteroarylalkyl refers to an alkyl group substituted by a heteroaryl group.
  • An example of a heteroarylalkyl group is pyridylmethyl.
  • halo or halogen refer to a fluorine (F), chlorine (Cl), bromine (Br), or iodine (I) atom; preferably, F, Cl, or Br; more preferably, F or Cl.
  • perhalogenated refers to a moiety where all hydrogens are replaced by halogens.
  • haloalkyl refers to alkyl groups with a halogen replacing a hydrogen on one or more carbons of the hydrocarbon backbone.
  • C1-Ce haloalkyl includes a straight chain or branched alkyl with six or fewer backbone carbon atoms and a halogen replaces a hydrogen on one or more backbone carbons.
  • alkoxy or “alkoxy!” includes substituted and unsubstituted alkyl, alkenyl, and alkynyl groups covalently linked to an oxygen atom.
  • C1-Ce alkoxy refers to moieties having six or fewer carbon atoms in the hydrocarbon backbone.
  • alkoxy groups or alkoxyl radicals
  • alkoxy groups include methoxy, ethoxy, isopropyloxy, propoxy, butoxy, and pentoxy groups.
  • Preferred are (C1-C3) alkoxy, particularly ethoxy and methoxy.
  • substituted alkoxy groups include halogenated alkoxy groups.
  • hydroxy or “hydroxyl” includes groups with an -OH or -0 .
  • pharmaceutically acceptable salts refers to derivatives of compounds that are modified by converting an existing acid or base moiety to its salt form.
  • Non-limiting examples of pharmaceutically acceptable salts include mineral or organic acid salts of basic residues such as amines; alkali or organic salts of acidic residues such as carboxylic acids.
  • Pharmaceutically acceptable salts include conventional non-toxic salts of a parent compound formed, for example, from non-toxic inorganic or organic acids.
  • Pharmaceutically acceptable salts may be synthesized by conventional chemical methods from a parent compound that contains a basic or acidic moiety.
  • such salts can be prepared by reacting a free acid or base form of these compounds with a stoichiometric amount of an appropriate base or acid in water or an organic solvent, or in a mixture of the two; generally, nonaqueous media like ether, ethyl acetate, ethanol, isopropanol, or acetonitrile are preferred.
  • nonaqueous media like ether, ethyl acetate, ethanol, isopropanol, or acetonitrile are preferred.
  • Lists of suitable salts can be found in Remington’s Pharmaceutical Sciences, 17 th ed., Mack Publishing Company, Easton, PA, 1985, p. 1418, Journal of Pharmaceutical Science, 66, 2 (1977), and P. Stahl and C. Wermuth, editors, Handbook of Pharmaceutical Salts: Properties, Selection and Use, 2 nd Revised ed., Weinheim/Zurich: Wiley - VCH/VHCA (2011), each of which is incorporated herein by reference in its
  • suitable inorganic acids include hydrochloric acid, sulphuric acid, phosphoric acid, or hydrobromic acid
  • suitable organic acids include carboxylic acid, sulpho acid, or sulphonic acid, such as acetic acid, tartaric acid, lactic acid, propionic acid, glycolic acid, malonic acid, maleic acid, fumaric acid, tannic acid, succinic acid, alginic acid, benzoic acid, 2-phenoxybenzoic acid, 2-acetoxybenzoic acid, cinnamic acid, mandelic acid, citric acid, maleic acid, salicylic acid, trifluoroacetic acid, 3 -aminosalicylic acid, ascorbic acid, embonic acid, nicotinic acid, isonicotinic acid, oxalic acid, gluconic acid, amino acids, methanesulphonic acid, ethanesulphonic acid, 2-hydroxyethanesulphonic acid, ethane-
  • suitable inorganic bases include sodium hydroxide, potassium hydroxide and ammonia
  • suitable organic bases include amines, e.g., tertiary amines, such as trimethylamine, trielhylamine, pyridine, A(-V-dimethylaniline, quinoline, isoquinoline, a-picoline, 0-picoline, y-picoline, quinaldine, or pyrimidine.
  • antibody encompasses the structure that constitutes the natural biological form of an antibody. In most mammals, including humans, and mice, this form is a tetramer and consists of two identical pairs of two immunoglobulin chains, each pair having one light and one heavy chain, each light chain comprising immunoglobulin domains VL and CL, and each heavy chain comprising immunoglobulin domains Vn, Cyl, Cy2, and Cy3. In each pair, the light and heavy chain variable regions (VL and Vn) are together responsible for binding to an antigen, and the constant regions (CL, Cyl, Cy2, and Cy3, particularly Cy2, and Cy3) are responsible for antibody effector functions.
  • full-length antibodies may consist of only two heavy chains, each heavy chain comprising immunoglobulin domains Vn, Cy2, and Cy3.
  • immunoglobulin (Ig) herein is meant a protein consisting of one or more polypeptides substantially encoded by immunoglobulin genes. Immunoglobulins include but are not limited to antibodies. Immunoglobulins may have a number of structural forms, including full-length antibodies, antibody fragments, and individual immunoglobulin domains including Vn, Cyl, Cy2, Cy3, VL, and CL.
  • intact antibodies can be assigned to different “classes.” There are five-major classes (isotypes) of intact antibodies: IgA, IgD, IgE, IgG, and IgM, and several of these may be further divided into “subclasses,” e.g., IgGl, IgG2, IgG3, IgG4, IgA, and IgA2.
  • the heavy-chain constant domains that correspond to the different antibody classes are called alpha, delta, epsilon, gamma, and mu, respectively.
  • the subunit structures and three-dimensional configurations of different classes of immunoglobulins are well known to one skilled in the art.
  • antibody or “antigen-binding fragment,” respectively, refer to intact molecules as well as functional fragments thereof, such as Fab, a scFv-Fc bivalent molecule, F(ab’)2, and Fv that can specifically interact with a desired target.
  • the antigenbinding fragments comprise:
  • Fab the fragment which contains a monovalent antigen-binding fragment of an antibody molecule, which can be produced by digestion of whole antibody with the enzyme papain to yield an intact light chain and a portion of one heavy chain;
  • Fab fragment of an antibody molecule that can be obtained by treating whole antibody with pepsin, followed by reduction, to yield an intact light chain and a portion of the heavy chain; two Fab’ fragments are obtained per antibody molecule; (3) (Fab’)2, the fragment of the antibody that can be obtained by treating whole antibody with the enzyme pepsin without subsequent reduction; F(ab’)2 is a dimer of two Fab’ fragments held together by two disulfide bonds;
  • Fv a genetically engineered fragment containing the variable region of the light chain and the variable region of the heavy chain expressed as two chains
  • SCA Single chain antibody
  • scFv-Fc is produced by fusing single-chain Fv (scFv) with a hinge region from an immunoglobulin (Ig) such as an IgG, and Fc regions.
  • Ig immunoglobulin
  • an antibody provided herein is a monoclonal antibody.
  • the antigen-binding fragment provided herein is a single chain Fv (scFv), a diabody, a tandem scFv, a scFv-Fc bivalent molecule, an Fab, Fab’, Fv, F(ab’)2 or an antigen binding scaffold (e.g., affibody, monobody, anticalin, DARPin, Knottin).
  • binding refers to compositions, directly or indirectly, having affinity for each other.
  • Specific binding refers to selective binding between two molecules. For example, specific binding occurs between an antibody and an antigen. Typically, specific binding can be distinguished from non-specific when the dissociation constant (KD) is less than about lxlO -5 M or less than about lxlO -6 M or lxlO“ 7 M.
  • KD dissociation constant
  • Specific binding can be detected, e.g., by ELISA, immunoprecipitation, coprecipitation, with or without chemical crosslinking, and two-hybrid assays. Use of appropriate controls can distinguish between “specific” and “non-specific” binding.
  • “Affinity” is the strength of the binding interaction of two molecules, such as an antigen and its antibody, which is defined for antibodies and other molecules with more than one binding site as the strength of binding of the ligand at one specified binding site.
  • a “high affinity” ligand binds to an antibody or other molecule with an affinity constant (Ka) greater than 10 4 M -1 , typically 10 5 -10 11 M -1 ; as determined by inhibition ELISA or an equivalent affinity determined by comparable techniques, such as Scatchard plots or using Ka/dissociation constant, which is the reciprocal of the Ka.
  • binding with respect to binding, inhibition, stimulation, or modulation means preferential binding, inhibition, stimulation, or modulation, respectively, of a first activity relative to a second activity (e.g., preferential binding of one receptor to another receptor; preferential inhibition relative to other receptors; or preferential inhibition of a mutant to a wild- type or vice versa).
  • binding is greater than two times, greater than five times, greater than ten times, greater than fifty times, greater than 100 times, or greater than 1000 times more selective for the desired molecular target or pathway versus an undesired molecular target or pathway.
  • a compound will bind a first molecular target or affect a pathway by at least 2-fold, at least 5-fold, at least 10-fold, at least 20-fold, at least 50-fold, at least 100-fold relative to a second target or pathway under the same conditions. It will be appreciated that in preferred embodiments, binding to the D2-like family of dopamine receptors or a member thereof, will be selective with respect to the DI -like family of dopamine receptors or a member thereof by one of the foregoing amounts.
  • the in vitro or in vivo activity of a molecular target or pathway may be measured by any suitable reproducible means.
  • modulating refers to “stimulating” or “inhibiting” an activity of a molecular target or pathway.
  • a composition modulates the activity of a molecular target or pathway if it stimulates or inhibits that activity by at least 10%, at least about 20%, at least about 25%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 75%, at least about 80%, at least about 90%, at least about 95%, at least about 98%, or about 99% or more relative to the activity of that molecular target or pathway under the same conditions but lacking the presence of the composition.
  • a composition modulates the activity of a molecular target or pathway if it stimulates or inhibits that activity by at least 2-fold, at least 5 -fold, at least 10-fold, at least 20-fold, at least 50-fold, at least 100-fold relative to the activity of that target or pathway under the same conditions but lacking the presence of the composition.
  • the activity of a molecular target or pathway may be measured by any reproducible means.
  • the activity of a molecular target or pathway may be measured in vitro or in vivo by a suitable assay known in the art for measuring the activity. Control samples (untreated with the composition) can be assigned a relative activity value of 100%.
  • an antibody, antigen-binding fragment, or affinity tag binds its target with a KD of 0.1 nM - 10 mM, 0.1 nM - 1 mM, or within the 0.1 nM range. In one embodiment, it binds its target with a KD of 0.1-2 nM, 0.1-1 nM, 0.05-1 nM, 0.1-0.5 nM, or 0.1-0.2 nM. In one embodiment, it binds its target directly. In one embodiment, it binds its target indirectly, e.g., secondary antibody binding to an antibody bound to the target.
  • label refers to a compound or composition which is conjugated or fused directly or indirectly to a reagent such as a nucleic acid probe or an antibody and facilitates detection of the reagent to which it is conjugated or fused.
  • the label may itself be detectable (e.g. , radioisotopes or fluorescent labels) or, in the case of an enzymatic label, may catalyze chemical alteration of a substrate compound or composition, which is detectable.
  • probe refers to synthetic or biologically produced nucleic acids that contain specific nucleotide sequences which hybridize under stringent conditions to target nucleic acid sequences.
  • labeled probe refers to a probe which is prepared with a marker group or “detectable label” for detection.
  • the marker group is attached at either the 5’ end, the 3’ end, internally, or a combination thereof. That is, one probe may be attached to multiple markers.
  • a preferred group is an identifying label such as a fluorophore.
  • a labeled probe may also comprise a plurality of different nucleic acid sequences each labeled with one or more markers. Each marker may be the same or different. It may be beneficial to label different probes (e.g., nucleic acid sequences) each with a different marker. This can be achieved by having a single distinguishable group on each probe. For example, probe A is attached to group X and probe B is attached to group Y. Alternatively, probe A is attached to goups X and Y while probe B is attached to groups Z and W. Alternatively, probe A is attached to groups X and Y, while probe B is attached to groups Y and Z. All probes “A” and “B” above would be distinguishable and uniquely labeled.
  • tissue sample is meant a collection of similar cells obtained from tissue of a subject or patient, preferably containing nucleated cells with chromosomal material.
  • the four main human tissues are (1) epithelium; (2) connective tissues, including blood vessels, bone and cartilage; (3) muscle tissue; and (4) nerve tissue.
  • a tissue sample source may be solid tissue as from a fresh, frozen and/or preserved organ or tissue sample or biopsy or aspirate; blood or a blood constituent; bodily fluids such as cerebral spinal fluid, amniotic fluid, peritoneal fluid, or interstitial fluid; cells from a time in gestation or development of the subject.
  • a tissue sample may be primary or cultured cells or cell lines.
  • a tissue sample may contain compounds that are not naturally intermixed with the tissue in nature such as preservatives, anticoagulants, buffers, fixatives, nutrients, or antibiotics.
  • a tissue sample “section” is meant a single part or piece of a tissue sample, e.g., a thin slice of tissue or cells cut from a tissue sample. Multiple sections of tissue samples may be taken and subjected to analysis.
  • a “cell line” refers to a permanently established cell culture that will proliferate given appropriate fresh medium and space.
  • a target receptor e.g., a dopamine receptor or a GPCR
  • Targets are detected by contacting a sample with a target detection reagent, e.g., an antibody or fragment thereof, and a labeling reagent. The presence or absence of targets are detected by the presence or absence of the labeling reagent.
  • a sample is contacted with the target detection and the labeling reagents concurrently e.g., the detection reagent is a primary antibody and the labeling reagent is a fluorescent dye conjugated to it.
  • the biological sample is contacted with the target detection and labeling reagents sequentially, e.g., the detection reagent is a primary antibody and the labeling reagent includes a secondary antibody.
  • the detection reagent is a primary antibody and the labeling reagent includes a secondary antibody.
  • a sample is incubated with a detection reagent, in some cases together with a labeling reagent, under conditions that allow a complex between the detection reagent (and labeling reagent) and target to form. After complex formation the sample is optionally washed one or more times to remove unbound detection reagent (and labeling reagent).
  • the sample When the sample is further contacted with a labeling reagent that specifically binds the detection reagent bound to the target, the sample can optionally be washed one or more times to remove unbound labeling reagent. The presence or absence of the target in the sample is then determined by detecting the labeling reagent.
  • the methods described here provide for detecting multiple targets in a sample. Multiple targets are identified by contacting the biological sample with additional detection reagents followed by additional labeling reagent specific for the additional detection reagents using the methods described.
  • a detection moiety i.e., detectable label
  • Detection moieties are directly observed or measured or indirectly observed or measured.
  • Non-limiting examples of detection moieties include radiolabels that can be measured with radiation-counting devices; pigments, dyes or other chromogens that can be visually observed or measured with a spectrophotometer; spin labels that can be measured with a spin label analyzer; and fluorescent moieties, where the output signal is generated by the excitation of a suitable molecular adduct and can be visualized by excitation with light that is absorbed by the dye or can be measured with standard fluorometers or imaging systems.
  • a detection moiety can be a luminescent substance such as a phosphor or fluorogen; a bioluminescent substance; a chemiluminescent substance, where the output signal is generated by chemical modification of the signal compound; a metal-containing substance; or an enzyme, where an enzyme-dependent secondary generation of signal occurs, such as formation of a colored product from a colorless substrate.
  • the detection moiety may also take the form of a chemical or biochemical, or an inert particle, including colloidal gold, microspheres, quantum dots, or inorganic crystals, such as nanocrystals or phosphors.
  • detection moiety can also refer to a “tag” or hapten that can bind selectively to a labeled molecule, such that the labeled molecule, when added subsequently, is used to generate a detectable signal.
  • a tag or hapten that can bind selectively to a labeled molecule, such that the labeled molecule, when added subsequently, is used to generate a detectable signal.
  • HRP horseradish peroxidase
  • a chromogenic substrate e.g., tetramethylbenzidine
  • fluorogenic substrate such as Amplex Red or Amplex Gold (Molecular Probes, Inc.
  • the tag can be a hapten or antigen (e.g., digoxigenin), and an enzymatically, fluorescently, or radioactively labeled antibody can be used to bind to the tag.
  • hapten or antigen e.g., digoxigenin
  • an enzymatically, fluorescently, or radioactively labeled antibody can be used to bind to the tag.
  • Numerous labels are known by those of skill in the art and non-limiting examples include particles, fluorescent dyes, haptens, enzymes and their chromogenic, Anorogenic, and chemiluminescent substrates.
  • a Auorophore is a chemical group that exhibits an absorption maximum beyond 280 nm, and when covalently attached in a labeling reagent retains its spectral properties.
  • Fluorophores include pyrene, anthracene, naphthalene, acridine, stilbene, indole or benzindole, oxazole or benzoxazole, thiazole or benzothiazole, porphyrin, cyanine, perylene, 4-amino-7-nitrobenz-2- oxa- 1,3 -diazole (NBD), carbocyanine, carbostyryl, salicylate, anthranilate, azulene, pyridine, quinoline, borapolyazaindacene, xanthene, oxazine or benzoxazine, carbazine, phenalenone, coumarin, benzofuran and benzphenalenone and derivatives thereof.
  • the Auorophore may be a Auorescein, a rhodol, or a rhodamine.
  • Fluorescein includes benzo- or dibenzo Auoresceins, seminaphtho Auoresceins, or naphthoAuoresceins.
  • rhodol includes seminaphthorhodaAuors.
  • the Auorophore is a xanthene that is bound via a single covalent bond at the 9-position of the xanthene.
  • Preferred xanthenes include derivatives of 3H-xanthen-6-ol-3-one, 6-amino-3H- xanthen-3-one, or of 6-amino-3H-xanthen-3-imine.
  • Fluorophores include xanthene (rhodol, rhodamine, Auorescein and derivatives thereof) coumarin, cyanine, pyrene, oxazine and borapolyazaindacene.
  • the Auorophore can be sulfonated xanthenes, Auorinated xanthenes, sulfonated coumarins, Auorinated coumarins and sulfonated cyanines.
  • the choice of Auorophore in the labeling reagent will determine the absorption and Auorescence emission properties of the labeling reagent.
  • Physical properties of a Auorophore label include spectral characteristics (absorption, emission and stokes shift), Auorescence intensity, lifetime, polarization and photo-bleaching rate can all be used to distinguish one Auorophore from another.
  • a Auorophore contains one or more aromatic or heteroaromatic rings that are optionally substituted by one or more substituents, including halogen, nitro, cyano, alkyl, perfluoroalkyl, alkoxy, alkenyl, alkynyl, cycloalkyl, arylalkyl, acyl, aryl or heteroaryl ring system, benzo, or other substituents typically found on Auorophores known in the art.
  • substituents including halogen, nitro, cyano, alkyl, perfluoroalkyl, alkoxy, alkenyl, alkynyl, cycloalkyl, arylalkyl, acyl, aryl or heteroaryl ring system, benzo, or other substituents typically found on Auorophores known in the art.
  • the detection moiety is a Auorescent dye.
  • Fluorescent dyes include, for example, Fluorescein, Rhodamine, Texas Red, Cy2, Cy3, Cy5, CyO, Cy0.5, Cyl, Cyl.5, Cy3.5, Cy7, VECTOR Red, ELFTM (Enzyme-Labeled Fluorescence), FluorX, Calcein, Calcein-AM, CRYPTOFLUORTM'S, Orange (42 kDa), Tangerine (35 kDa), Gold (31 kDa), Red (42 kDa), Crimson (40 kDa), BHMP, BHDMAP, Br-Oregon, Lucifer Yellow, Alexa dye family, N-(6-(7- nitrobenz-2-oxa-l,3-diazol-4-yl)amino)caproyl) (NBD), BODIPYTM, boron dipyrromethene diAuoride, Oregon Green, MITOTRACKERTM Red, Di
  • enzymes In addition to fluorophores, enzymes also find use as detectable moieties. Enzymes are desirable detectable moieties because amplification of a detectable signal can be achieved resulting in increased assay sensitivity. The enzyme itself does not produce a detectable response but breaks down a substrate when it is contacted by an appropriate substrate such that the converted substrate produces a fluorescent, colorimetric or luminescent signal. Enzymes amplify a detectable signal because one enzyme on a labeling reagent can result in multiple substrates being converted to a detectable signal. This is advantageous where there is a low quantity of target present in the sample or a fluorophore does not exist that will give comparable or stronger signal than the enzyme.
  • fluorophores are preferred because they do not require additional assay steps, and thus reduce the overall time to complete an assay.
  • the enzyme substrate is selected to yield the preferred measurable product, e.g. colorimetric, fluorescent or chemiluminescence. Such substrates are extensively used in the art.
  • a preferred colorimetric or Anorogenic substrate and enzyme combination uses oxidoreductases, such as horseradish peroxidase and a substrate such as 3, 3 '-diaminobenzidine (DAB) and 3-amino-9-ethylcarbazol-e (AEC), which yield a distinguishing color (brown and red, respectively).
  • oxidoreductases such as horseradish peroxidase and a substrate such as 3, 3 '-diaminobenzidine (DAB) and 3-amino-9-ethylcarbazol-e (AEC), which yield a distinguishing color (brown and red, respectively).
  • colorimetric oxidoreductase substrates that yield detectable products include: 2,2-azino-bis(3-ethylbenzothiaz-oline-6-sulfonic acid) (ABTS), o- phenylenediamine (OPD), 3,3',5,5’-tetramethylbenzidine (TMB), o-dianisidine, 5-aminosalicylic acid, 4-chloro-l -naphthol.
  • ABTS 2,2-azino-bis(3-ethylbenzothiaz-oline-6-sulfonic acid)
  • OPD o- phenylenediamine
  • TMB 3,3',5,5’-tetramethylbenzidine
  • o-dianisidine 5-aminosalicylic acid
  • 4-chloro-l -naphthol 4-chloro-l -naphthol.
  • Anorogenic substrates include: homo vanillic acid or 4-hydroxy-3 -methoxyphenylacetic acid, reduced phenoxazines and reduced benzothiazines, including Amplexe Red reagent and its variants and reduced dihydroxanthenes, including dihydro Auoresceins and dihydrorhodamines including dihydrorhodamine 123.
  • Peroxidase substrates that are tyramides represent a class of peroxidase substrates that can be intrinsically detectable before action of the enzyme but are “fixed in place” by the action of a peroxidase in the process described as tyramide signal amplification (TSA). These substrates are extensively utilized to label targets in samples that are cells, tissues or arrays for their subsequent detection by microscopy, Aow cytometry, optical scanning and Auorometry.
  • Additional colorimetric (and in some cases Auorogenic) substrate and enzyme combinations use a phosphatase enzyme such as an acid phosphatase, an alkaline phosphatase or a recombinant version of such a phosphatase in combination with a colorimetric substrate such as 5-bromo-6-chloro-3-indolyl phosphate (BCIP), 6-chloro-3-indolyl phosphate, 5-bromo-6-chloro- 3-indolyl phosphate, p-nitrophenyl phosphate, or o-nitrophenyl phosphate or with a Anorogenic substrate such as 4-methylumbelliferyl phosphate, 6,8-diAuoro-7-hydroxy4-methylcoumarinyl phosphate (DiFMUP) Auorescein diphosphate, 3-0-methylAuorescein phosphate, resorufin phosphate, 9H-(l,3-dichloro-9,9-di
  • Glycosidases in particular 0-galactosidase, 0-glucuronidase and 0-glucosidase, are other suitable enzymes.
  • Suitable colorimetric substrates include: 5-bromo4-chloro-3-indolyl 0-D- galactopyranoside (X-gal) and similar indolyl galactosides, glucosides, and glucuronides, o- nitrophenyl P-D-galactopyranoside (ONPG) and p-nitrophenyl P-D-galactopyranoside.
  • Preferred substrates include resorufin P-D-galactopyranoside, Auorescein digalactoside (FDG), lluorescein diglucuronide and their structural variants, 4-methylumbelliferyl P-D-galactopyranoside, carboxyumbelliferyl P-D-galactopyranoside and Auorinated coumarin P-D-galactopyranosides.
  • Other enzymes include hydrolases, e.g., cholinesterases and peptidases; oxidases, e.g., glucose oxidase; and cytochrome oxidases and reductases for which suitable substrates are known.
  • Enzymes and their substrates that produce chemiluminescence are preferred for some assays. These include, for example, natural and recombinant luciferases and aequorins.
  • exemplary substrates are luciferine, ATP, Ca ++ and coelenterazine
  • Chemiluminescent substrates for phosphatases, glycosidases and oxidases such as those containing stable dioxetanes, luminol, isoluminol and acridinium esters are also useful.
  • haptens such as biotin are useful detectable moieties.
  • Biotin is in an enzyme system that can further amplify a detectable signal, and can serve as a tag in affinity chromatography for isolation purposes.
  • an enzyme conjugate that has affinity for biotin is used, such as avidin-HRP.
  • a peroxidase substrate is added to produce a detectable signal.
  • Haptens also include hormones, naturally occurring and synthetic drugs, pollutants, allergens, affector molecules, growth factors, chemokines, cytokines, lymphokines, amino acids, peptides, chemical intermediates, or nucleotides.
  • a detectable moiety is a Huorescent protein.
  • they include green Auorescent protein (GFP), phycobiliproteins and their derivatives, luciferase or aequorin.
  • GFP green Auorescent protein
  • Fluorescent proteins, especially phycobiliprotein, are particularly useful to create tandem dye labeled labeling reagents. Tandem dyes comprise a Auorescent protein and a Auorophore to obtain a larger stokes shift, which is farther shifted from the Auorescent protein’s absorption spectra.
  • a Auorescent protein and Auorophore function as an energy transfer pair where the Auorescent protein emits a wavelength the Auorophore absorbs, and the Auorphore then emits a wavelength farther from the fluorescent protein than could be obtained with only the fluorescent protein.
  • a particularly useful combination is phycobiliproteins and sulforhodamine fluorophores, sulfonated cyanine fluorophores; or sulfonated xanthene derivatives.
  • the fluorophore is an energy donor and the fluorescent protein is an energy acceptor.
  • a sample is illuminated with a light wavelength selected to give a detectable optical response, and observed with a means for detecting the response.
  • Equipment useful for illuminating fluorescent compounds include hand-held ultraviolet lamps, mercury arc lamps, xenon lamps, lasers and laser diodes. These illumination sources are optically integrated into laser scanners, fluorescent microplate readers or standard or microfluorometers. The degree or location of signal, compared to a standard or expected response, indicates whether and to what degree the sample possesses a given characteristic or desired target.
  • An optical response is detected by visual inspection, or by using one of the following devices: CCD camera, video camera, photographic film, laser-scanning devices, fluorometers, photodiodes, quantum counters, epifluorescence microscopes, scanning microscopes, flow cytometers, fluorescence microplate readers, or by means for amplifying the signal such as photomultiplier tubes.
  • CCD camera CCD camera
  • video camera photographic film
  • laser-scanning devices fluorometers
  • photodiodes photodiodes
  • quantum counters epifluorescence microscopes
  • scanning microscopes scanning microscopes
  • flow cytometers fluorescence microplate readers
  • illuminating typically includes adding a reagent to produce a detectable signal such as a colorimetric enzyme substrate.
  • Radioisotopes are also considered indirectly detectable where an additional reagent is not needed, rather the radioisotope is exposed to X-ray film or other mechanism to record and measure the signal. This is true for some chemiluminescent signals that are observed after exposure to film.
  • ONC201 (compound (1)) , its analogs, and their pharmaceutically acceptable salts, as well as their syntheses, are provided herein.
  • ONC201 has broad anti-cancer activity, low toxicity including few, if any, adverse effects, low genotoxicity, and high bioavailability including orally. These features make ONC 201 and various analogs well suited for a variety of applications.
  • ONC201 can be synthesized as shown in Scheme 1.
  • Step 1 Synthesis of an ONC201 dihydrochloride salt starts with commercially available intermediary N-Benzyl-3-carbomethoxy-4-piperidone hydrochloride, compound (3).
  • compound (3) is neutralized with a base (Step 1) to yield compound (4), a free base.
  • compound (3) is neutralized with an inorganic base to yield compound (4).
  • it is neutralized with an organic base to yield compound (4).
  • compound (3) is neutralized in the presence of an alcohol (e.g., n-butanol).
  • compound (3) is neutralized in the presence of at least one organic solvent (e.g., n-butanol, ethyl acetate or both).
  • compound (3) is neutralized in the presence of n-butanol and triethyl amine (EtgN).
  • the synthesis includes reacting compounds (4) with (5) (Step 2) to produce intermediary compound (1).
  • Step 2 includes heating compounds (4) with (5).
  • Step 2 includes refluxing heating compounds (4) with (5) in the presence of a solvent.
  • Step 2 includes use of Dean- stark trap to remove water and/or methanol (MeOH) formed in the reaction.
  • an ONC201 dihydrochloride salt is synthesized (Step 3).
  • Step 3 includes treating ONC201 with HC1 in dioxane.
  • Step 3 includes treating ONC201with 4N HC1 in dioxane.
  • the synthesis optionally includes recrystallizing the ONC201 di-salt.
  • an ONC201 dihydrochloride salt is synthesized as shown in Scheme 2.
  • TRAIL IL TNF-RELATED APOPTOSIS-INDUCING LIGAND
  • TRAIL protein can be assayed in a sample obtained from a subject to detect TRAIL expression induced by compounds and their salts described herein.
  • Immunoassays can be used, including enzyme-linked immunosorbent assay (ELISA), flow cytometry, enzyme- linked immunofiltration assay (ELIFA), immunoblot, immunoprecipitation, fluorescent immunoassay (FIA), immunohistochemistry, immunocytochemistry, luminescent immunoassay (LIA), , and radioimmunoassay. Qualitative and/or quantitative results may be obtained.
  • TRAIL assays are used to monitor a subject. For example, a sample is obtained from a subject before treatment with a pharmaceutical agent and at one or more times during and/or following treatment to assess treatment effectiveness. In another example, a sample is obtained from a subject at various times to assess the course or progress of disease or healing. In one embodiment, death receptors from circulating tumor cells are assayed to see if a treatment described here increases the amount or type of death receptors.
  • Cancers treated using methods and compositions described herein are characterized by abnormal cell proliferation including pre-neoplastic hyperproliferation, cancer in-situ, neoplasms and metastasis. Methods and compositions described herein can be used for prophylaxis, as well as amelioration of cancer signs or symptoms.
  • Cancer “treatment” in a subject includes: preventing, inhibiting or ameliorating cancer in the subject, such as slowing cancer progression or reducing or ameliorating a cancer sign or symptom.
  • Examples of cancers treated using methods and compositions described herein include breast cancer, CNS cancers, colon cancer, ovarian cancer, prostate cancer, leukemia, lung cancer, and lymphoma.
  • Ri and R2 are independently selected from H, alkyl, aryl, cycloalkyl, cycloalkylalkyl, heterocycloalkyl, heterocycloalkylalkyl, heteroaryl, arylalkyl, heteroarylalkyl, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, and acyl radicals.
  • Ri is CH2PI1 and R2 is CH2-(2-CH3-Ph) (ONC201).
  • Ri is CH2PI1 and R2 is CH2-(2,4-di F-Ph) (ONC206).
  • Ri is CH2PI1 and R2 is CH2-(4-CF3-Ph) (ONC212). In one embodiment, Ri is CFFPh and R2 is CH2-(3,4-di F-Ph) (ONC213). In one embodiment, Ri is CH2-(3,4-di-Cl-Ph) and R2 is CH2- (4-CF3-Ph) (ONC234). In one embodiment, Ri is CH2-3-thienyl and R2 is CH2-(4-CF3-Ph) (ONC236).
  • Ri and R2 are independently selected from H, Cwalkyl, C1- 4alkylphenyl, Chalky Iphenylketone, Ci-abenzyl-piperazine, C1-4alkylthienyl, C1- 4alkylpyridinyl, C1-4alkylisoxazolidinyl, C1-4alkylmorpholinyl, C1-4alkylthiazolyl, and C1- 4alkylpyrazinyl wherein C1-4alkyl, C1-4alkylphenyl, Cwalkylphenylketone, C14benzyl- piperazine, C1-4alkylthienyl, Chalky Ipyridinyl, C1-4alkylisoxazolidinyl, C1-4alkylthiazolyl, Cwalkylmorpholinyl, and C1.4alkylpyrazinyl are optionally substituted with C1-ralkyl, C1- 4alkoxyl, hydroxyl, perhalogenated C
  • Ri and/or R2 is a substituted or unsubstituted, arylalkyl or heteroarylalkyl.
  • the heteroarylalkyl is selected from Cwalkylpyrrolyl, Cwalkylfuryl, Cwalkylpyridyl, Cwalkyl- 1,2,4-thiadiazolyl, Cwalkylthienyl, C1-4alkylisothiazolyl, C1-4alkylimidazolyl, C1- 4alkyltetrazolyl, C14alkylpyrazinyl, C14alkylpyrimidyl, C14alkylquinolyl, Cwalkylpyrazolyl, C14alkylisoquinolyl, C14alkylthiophenyl, C14alkylbenzothienyl, Cwalkylisobenzofuryl, C1- 4alkylindolyl, Cwalkylpurinyl, Ci ralkylcarbazolyl,
  • Ri and/or R2 is a benzyl optionally substituted with one or more of the following substituents on the benzyl ring: X, -CH3, -NO2, -OCH3, -CN, -CXH2, - CX 2 H, C2-C4 alkyl, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , -C p X 2p+ i, -OCX 3 , -OC p H 2p+ i, - OC P X 2p+ i, OR m , SR m , NR m R n , NR m C(O)R n , SOR m , SO 2 R m , C(O)R m , and C(O)OR m ; R m and R n are independently selected from H or a C1-C
  • Ri is selected from H, CH 3 , CH 2 Ph, CH 2 -(4-CF 3 -Ph), CH 2 -(4- F-Ph), CH 2 -(4-Cl-Ph), CH 2 -(OCH 3 -Ph), CH 2 -((2-Cl)-Ph), CH 2 -(2-thienyl), CH 2 -(3 -thienyl), CH2-2-pyridinyl, CH2-4-methyl-2-thiazolyl, CH2-2-pyrazinyl, CH2CH2PI1, CkhCfhM-N- benzyl-piperazine), CH2-(2,4-di F-Ph), CH2-(3,4-di Cl-Ph), CH2-(3,4-di F-Ph), CH2-(3,5-di F- Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CH(OH)Ph, (4-F-Ph)-4-oxobuty
  • R2 is selected from H, CH3, CH2PI1, CH 2 -(4-CF 3 -Ph), CH 2 -((2-Cl)-Ph), CH 2 -((2-F)-Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH 2 (4- N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -(2,4-di Cl-Ph), CH 2 -(3,4-di Cl-Ph), CH 2 -(3,4- di F-Ph), CH 2 -(3,5-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 (2-CH 3 , 4-F-Ph), CH 2 -((4-OCH 3 )-Ph), CH2-(3-pyridinyl), CH2-(3-isoxazolidinyl), CH2CH2-(4-morpholinyl), CH2-(2-F, 4-
  • Ri is H.
  • Ri is an unsubstituted or substituted arylalkyl, e.g., a benzyl (CFFPh) or phenylethyl (CH2CH2PI1) group.
  • the arylalkyl is substituted with Cwalkyl, Cwalkoxyl, hydroxyl, perhalogenated C1-4alkyl, or halo.
  • R2 is a substituted or an unsubstituted arylalkyl, e.g., benzyl or phenylethyl.
  • the arylalkyl is substituted with Cwalkyl, C1-4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • the arylalkyl is substituted with one or more substituents selected from halo, CH3, CF3 or OCH3.
  • R2 is a substituted or an unsubstituted heterocycloalkylalkyl, e.g., piperazinylalkyl or morpholinoalkyl.
  • R2 is a substituted or an unsubstituted heteroarylalkyl, e.g. , pyridylmethyl or isoxazolidinylmethyl.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with Cwalkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with at least one substituent selected from halo, CH3, CF3 or OCH3.
  • compound (10) has the structure of formula (80): wherein Rai, Ra2, R a3 , Ra4,
  • Ra5, Rbi, Rb2, Rb3, Rb4, and Rb5 are each independently selected from the group consisting of H, X, -CH 3 , -NO2, -OCH3, -CN, -CXH 2 , -CX 2 H, C2-C4 alkyl, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , - C(CX 3 ) 3 , -C p X 2p+ i, -OCX3, -OC p H 2p+ i, -OC p X 2p+ i, OR m , SR m , NR m R n , NR m C(O)R n , SOR m , SO2R 111 , C(O)R m , and C(O)OR m ; R m and R n are independently selected from H or a C1-C4 alkyl; and where p is
  • compound (10) has the structure of formula (90) wherein R 2 is as defined above, and wherein Rbi, Rb2, Rb3, RM, and Rbs are each independently selected from the group consisting of H, X, -CH 3 , -NO 2 , -OCH3, -CN, -CXH 2 , -CX2H, C2-4 alkyl, -CX3, -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 )3, -CpX 2p+ i, -OCX3, -OCpH 2p+ i, -OC P X 2p +i, OR m , SR m , NR m R n , NR m C(O)R n , SOR m , SO2R 111 , C(O)R m , and C(O)OR m ; R m and R n are independently selected from the group consisting of H
  • compound (10) has the structure of formula (40)
  • Ri is H.
  • Ri is a substituted or unsubstituted arylalkyl, such as benzyl or phenylethyl.
  • the arylalkyl is substituted with Cwalkyl, C1-4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • the benzyl is substituted with one or more halo.
  • the benzyl is substituted with one or more substituents selected from halo, CH3, CF3, and OCH3.
  • the benzyl is substituted with one halo, e.g., F at an ortho or para position.
  • the benzyl is substituted with two halogen, e.g., F at both meta positions.
  • compound (40) has the structure of compound (45):
  • Ra5 are as defined above.
  • the benzyl is substituted with one or more halogens.
  • the benzyl is substituted with one or more substituents selected from halo, CH3, CF3, and OCH3.
  • R ai or R a s is a halo, e.g. , F.
  • both R a2 and R a 3 are halo, e.g., F.
  • compound (10) has the structure of compound (50) wherein R b is selected from H, X, -CH 3 , -NO 2 , -OCH 3 , -CN, -CXH 2 , -CX 2 H, C 2.4 alkyl, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , -C P X 2p+ i, -OCX3, -OC P H 2p+ i, -OC P X 2p+ i, OR m , SR m , NR m R n , NR m C(O)R n , SOR m , SO 2 R m , C(O)R m , and C(O)OR m ; R m and R n are independently selected from H or C1-4alkyl; and where p is an integer from 2 to 20 and
  • Ri is H.
  • Ri is a substituted or unsubstituted arylalkyl, such as a benzyl or phenylethyl group.
  • the arylalkyl is substituted with C1- 4 alkyl, C1- 4 alkoxyl, hydroxyl, perhalogenated C1- 4 alkyl, or halo.
  • R b is selected from halo, CH3, CF3, and OCH3.
  • one or more of R ai , R a2 , R a4 , and R a s is selected from halo,
  • R a i, R a2 , R a4 , and R a s are H, and R b is selected from halo, CH3, CF3, and OCH3.
  • R b is halogen, e.g., F, and R ai is CH3.
  • Rb is F or Cl
  • R a 2 is F or Cl.
  • Rb is CF3.
  • Rb is OCH3.
  • Rb and R ai are Cl.
  • compound (50) has the structure of compound (55): one embodiment, one or more of R a i, R a 2.
  • R a 4, and R a s is selected from halo, CH3, CF3, and
  • R a i, R a 2, R a 4, and R cL - are H, and Rb is selected from halo, CH3,
  • Rb is halo, e.g., F
  • R ai is CH3.
  • Rb is F or Cl, and Rj? is F or Cl. In one embodiment, Rb is CF3. In one embodiment, Rb is
  • Rb and R ai are Cl.
  • compound (10) has the structure of compound (60) one embodiment, Ri is H. In one embodiment, Ri is a substituted or unsubstituted arylalkyl, such as benzyl or phenylethyl.
  • Ri is a substituted or unsubstituted heterocycloalkylalkyl or a substituted or unsubstituted heteroarylalkyl, such as CH2-(2-thienyl), CH2-(3-thienyl), CH2-4-methyl-2- thiazolyl, CH2-2-pyrazinyl, CH2CH2(4-N-benzyl-piperazine), CH2-(3-isoxazolidinyl), CH2-2- pyridinyl, CH2-3-pyridinyl, and CH2CH2-(4-morpholinyl).
  • the arylalkyl is substituted with C1-4alkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • the benzyl is substituted with one or more halogens.
  • the benzyl is substituted with one or more substituents selected from halo (e.g. , F), CH3, CF3, and OCH3.
  • the benzyl is substituted at the para position with a halo, CH3, CF3, or OCH3 substituent.
  • Ri is fluorophenyloxobutyl or hydroxyphenylethyl.
  • Crude products may be purified by column chromatography eluting with methylene chloride:methanol or by HPLC using acetonitrile:TFA:H2O to produce either free bases or TFA salts as final products.
  • Treatment of free bases with HO in dioxane or lyophilization of TFA salts generates products (10) as HO or TFA salts.
  • the free base may be treated with another inorganic or organic acid to form other salts, generally selected from those known to be pharmaceutically acceptable.
  • Salts of compound (10) are usually solids and examples have been crystallized from ethanol or other solvents to give high quality crystals.
  • the tricyclic structure of compound (1) has been definitively confirmed by an X-ray crystal structure and NMR.
  • Compounds described herein can be used, with or without an aminoalkyl linker (e.g., compound (33)), to identify molecules (e.g., proteins) that interact with them in a cellular context. Expression of these binding targets may be used to predict response to imipridones or analogs thereof (i.e. serve as biomarkers). These compounds can also be used to screen for structurally unrelated molecules using competition assays known in the art to identify drugs able to outcompete the target interaction with a higher affinity. In addition, these molecules may have improved drug properties or allow additional applications by altering drug properties including safety, potency, pharmacokinetics, biodistribution, or metabolism. TABLE 1 EXAMPLES OF COMPOUNDS OF FORMULA (10)
  • Measuring expression, gene mutation, or gene copy number of a dopamine receptor or other G protein-coupled receptor may be used to predict response or sensitivity to treatment methods described herein or to identify subjects likely to be responsive to treatment methods described herein, such as treatment with a compound of formula (10), a pharmaceutically acceptable salt thereof, or an analog thereof.
  • GPCR G protein-coupled receptor
  • the methods comprises (i) obtaining a biological sample from the subject; (ii) measuring expression levels of at least one dopamine receptor or GPCR in the sample; (iii) comparing the levels measured in the sample to those for a pre-determined standard; and (iv) determining whether the subject is likely to be responsive to the treatment regimen, based on the levels measured in the sample to those for the pre-determined standard.
  • the step of measuring an expression level in the sample include the steps of (i) contacting the sample with an antibody or antigenbinding fragment that specifically binds to the receptor to form a complex of the antibody or antigen-binding fragment with the receptor; and (ii) measuring the amount of the complex.
  • the subject has, or is at risk of having, cancer.
  • the cancer is a neuro-oncology disease.
  • the cancer is a neuroendocrine tumor.
  • the cancer is selected from the group consisting of meningioma, ependymoma, glioma, neuroblastoma, and diffuse intrinsic pontine glioma.
  • the subject has, or is at risk of having, a psychiatric disorder.
  • the psychiatric disorder is selected from psychosis, bipolar disorder, and major depressive disorder.
  • the subject has, or is at risk of having, an infection, such as a bacterial infection.
  • the infection is a gram-positive bacterial infection. In one embodiment, the infection is a gram-negative bacterial infection. In one embodiment, the infection is an infection of a bacteria selected from Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species. In one embodiment, the gram-positive bacterial infection is a Staphylococcus infection. For example, the Staphylococcus infection is an S. aureus infection (e.g., a methicillin-resistant S. aureus (MRSA) infection).
  • MRSA methicillin-resistant S. aureus
  • the treatment regimen comprises administering an effective amount of a therapeutic, such as a compound of formula (10), a pharmaceutically acceptable salt thereof, or an analog thereof.
  • the dopamine receptor is from the D2-like family.
  • the dopamine receptor is DRD2, DRD3, or both.
  • the dopamine receptor is DRD4.
  • the GPCR is a Class A GPCR.
  • the GPCR is GPR132.
  • the GPCR is selected from GPR132, GPR91, MTNR1A, GPR162, GPR137, BAB, LGR4, PTGIR, CXCR7, and combinations thereof.
  • the dopamine receptor is DRD5
  • the treatment regimen comprises administering an effective amount of a therapeutic, e.g., a compound of formula (10) or a pharmaceutically acceptable salt thereof, and increased DRD5 expression measured in the sample relative to the pre-determined standard indicates that the subject is or is not likely to be responsive to the treatment regimen.
  • the methods comprises (i) obtaining a biological sample from the subject; (ii) measuring expression levels of at least one dopamine receptor or GPCR in the sample; (iii) comparing the levels measured in the sample to those for a pre-determined standard; and (iv) determining a prognosis or whether the subject is responsive to the treatment regimen, based on the levels measured in the sample to those for the predetermined standard.
  • the step of measuring an expression level of a dopamine receptor or GPCR in the sample include the steps of (i) contacting the sample with an antibody or antigen-binding fragment that specifically binds to the receptor to form a complex of the antibody or antigen-binding fragment with the receptor; and (ii) measuring the amount of the complex.
  • the methods comprise (i) obtaining a biological sample from the subject; (ii) measuring gene copy number or mutations in at least one dopamine receptor in the sample; (iii) comparing the copy number measured or mutations found in the sample to those for a pre-determined standard; and (iv) determining whether the subject is responsive to the treatment regimen, based on the copy number measured or mutations found in the sample to those for the pre-determined standard.
  • the subject has, or is at risk of having, cancer.
  • the cancer is a neuro-oncology disease.
  • the cancer is a neuroendocrine tumor.
  • the cancer is selected from the group consisting of meningioma, ependymoma, glioma, neuroblastoma, and diffuse intrinsic pontine glioma.
  • the subject has, or is at risk of having, a psychiatric disorder.
  • the psychiatric disorder is selected from psychosis, bipolar disorder, and major depressive disorder.
  • the subject has, or is at risk of having, an infection, such as a bacterial infection.
  • the infection is a gram-negative bacterial infection.
  • the infection is a gram-positive bacterial infection.
  • the infection is an infection of a bacteria selected from Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species.
  • the gram-positive bacterial infection is a Staphylococcus infection.
  • the Staphylococcus infection is an S. aureus infection (e.g., a methicillin-resistant S. aureus (MRSA) infection).
  • the treatment regimen comprises administering an effective amount of a therapeutic, e.g., a compound of formula (10), a pharmaceutically acceptable salt thereof, or an analog thereof.
  • the dopamine receptor is selected from DRD2, DRD2S, DRD2L, and DRD3. In one embodiment, the dopamine receptor is from the D2-like family. In one embodiment, the it is from the DI -like family. In one embodiment, the dopamine receptor is DRD1. In one embodiment, the dopamine receptor is DRD2. In one embodiment, it is DRD3. In one embodiment, it is DRD4. In one embodiment, it is DRD5. In one embodiment, the dopamine receptor is DRD2, DRD3, or both. In one embodiment, the GPCR is a Class A GPCR. In one embodiment, it is GPR132.
  • the GPCR is selected from GPR132, GPR91, MTNR1A, GPR162, GPR137, BAB, LGR4, PTGIR, CXCR7, and combinations thereof.
  • the dopamine receptor is DRD5
  • the treatment regimen comprises administering an effective amount of a compound of formula (10) or a pharmaceutically acceptable salt thereof, and an increased DRD5 expression level measured in the sample relative to the pre-determined standard indicates that the treatment regimen is or is not effective.
  • the dopamine receptor is DRD5
  • the treatment regimen comprises administering an effective amount of a therapeutic, such as a compound of formula (10) or a pharmaceutically acceptable salt thereof, and mutation in the DRD5 gene measured in the sample indicates that the treatment regimen is or is not effective.
  • the dopamine receptor is DRD5
  • the treatment regimen comprises administering an effective amount of a therapeutic, such as a compound of formula (10) or a pharmaceutically acceptable salt thereof, and the misense mutation Q366R in the DRD5 gene measured in the sample indicates that the treatment regimen is or is not effective.
  • a therapeutic such as a compound of formula (10) or a pharmaceutically acceptable salt thereof
  • the misense mutation Q366R in the DRD5 gene measured in the sample indicates that the treatment regimen is or is not effective.
  • the methods comprises (i) obtaining a biological sample from the subject; (ii) measuring gene copy number or mutations in at least one dopamine receptor in the sample; (iii) comparing the copy number measured or mutations found in the sample to those for a pre-determined standard; and (iv) determining whether the subject is likely to be responsive to the treatment regimen, based on the copy number measured or mutations found in the sample to those for the pre-determined standard.
  • the subject has, or is at risk of having, cancer.
  • the cancer is a neuro-oncology disease.
  • the cancer is a neuroendocrine tumor.
  • the cancer is selected from the group consisting of meningioma, ependymoma, glioma, neuroblastoma, and diffuse intrinsic pontine glioma.
  • the subject has, or is at risk of having, a psychiatric disorder.
  • the psychiatric disorder is selected from psychosis, schizophrenia, bipolar disorder, and major depressive disorder.
  • the subject has, or is at risk of having, an infection, such as a bacterial infection.
  • the infection is a gram-negative bacterial infection.
  • the infection is a gram-positive bacterial infection.
  • the infection is an infection of a bacteria selected from Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species.
  • the gram-positive bacterial infection is a Staphylococcus infection.
  • the Staphylococcus infection is an S. aureus infection (e.g., a methicillin-resistant S. aureus (MRSA) infection).
  • the treatment regimen comprises administering an effective amount of a therapeutic, such as a compound of formula (10), a pharmaceutically acceptable salt thereof, or an analog thereof.
  • the dopamine receptor is from the D2-like family of dopamine receptors. In one embodiment, the dopamine receptor is DRD1. In one embodiment, the dopamine receptor is DRD2. In one embodiment, the dopamine receptor is DRD3. In one embodiment, the dopamine receptor is DRD4. In one embodiment, the dopamine receptor is DRD5. In one embodiment, the dopamine receptor is DRD2, DRD3, or both. In one embodiment, the dopamine receptor is DRD5, the treatment regimen comprises administering an effective amount of a therapeutic, such as a compound of formula (10) or a pharmaceutically acceptable salt thereof, and mutation in the DRD5 gene measured in the sample indicates that the subject is or is not likely to be responsive to the treatment regimen.
  • a therapeutic such as a compound of formula (10) or a pharmaceutically acceptable salt thereof
  • the dopamine receptor is DRD5
  • the treatment regimen comprises administering an effective amount of a therapeutic, such as a compound of formula (10) or a pharmaceutically acceptable salt thereof, and the misense mutation Q366R in the DRD5 gene measured in the sample indicates that the subject is or is not likely to be responsive to the treatment regimen.
  • measuring expression, post-translational modifications, or activity levels of or mutations in eIF2-a, ATF4, CHOP, DR5, or cleaved or total cytokeratin 18 may be used to predict response or sensitivity to a method of treatment described herein and to identify subjects likely to be responsive to a method of treatment described herein, such as treatment with a compound of formula (10), a pharmaceutically acceptable salt thereof, or an analog thereof.
  • measuring expression, post-translational modifications, or activity levels of or mutations in eIF2-a, ATF4, CHOP, DR5, or cleaved or total cytokeratin 18 can be used to assess the effectiveness of or monitor a method of treatment described herein.
  • measuring expression, post-translational modifications, or activity levels of or mutations in eIF2-a, ATF4, CHOP, DR5, or cleaved or total cytokeratin 18 can be used to screen in vivo, in vitro, or in silico for structurally unrelated anti-cancer molecules.
  • competition and other assays may be used to identify drugs able to outcompete the target interaction with a higher affinity to compare changes in those levels to the respective changes produced by a compound of formula (10) or an analog thereof.
  • Assays can also be done on living mammalian cells, which more closely approximate the effects of a particular serum drug level in the body, or on microsomal extracts prepared from cultured cell lines.
  • the subject has, or is at risk of having, cancer.
  • the treatment regimen comprises administering an effective amount of an imipridone, such as ONC201, or an analog thereof.
  • the treatment regimen comprises administering an effective amount of ONC201.
  • the treatment regimen comprises administering an effective amount of a compound of formula (10).
  • the compound of formula (10) is a compound of formula (40), e.g., a compound of formula (45).
  • a compound of formula (10) is a compound of formula (50), e.g. , a compound formula (55).
  • the compound of formula (10) is a compound of formula (80).
  • the compound of formula (10) is a compound of formula (90). In one embodiment, the compound of formula (10) is a compound of formula (60). In one embodiment, analogs of compound (1) have a structure selected from the structures of formula (25), formula (26), formula (27), formula (28), formula (29), formula (30), or formula (31).
  • Levels a pre-determined standard can be, e.g., average or median levels measured in samples from subjects.
  • the levels for a pre-determined standard can be measured under the same or substantially similar experimental conditions as in measuring a sample from a subject.
  • the levels for the pre-determined standard may be obtained from subjects who are responsive to treatment with an imipridone, such as ONC201, or an analog thereof.
  • the pre-determined standard is obtained from subjects who are responsive to treatment with the compound, and if the levels in a sample from a subject and in the standard are similar, then the subject can be classified as likely to be responsive to treatment.
  • the levels for the pre-determined standard may be obtained from subjects who are not responsive to treatment with the compound.
  • the pre-determined standard is obtained from subjects who are not responsive to treatment with the compound, and if the levels in a sample from a subject and in the pre-determined standard are different (e.g., up- or down- regulated), then the subject can be classified as likely to be responsive to treatment.
  • the levels for the pre-determined standard may be obtained from normal healthy subjects.
  • Immunoassays can be used to assay protein or methylation levels in a sample, including enzyme-linked immunosorbent assay (ELISA), enzyme-linked immunofiltration assay (ELIFA), flow cytometry, immunoblot, immunoprecipitation, immunohistochemistry, immunocytochemistry, luminescent immunoassay (LIA), fluorescent immunoassay (FIA), and radioimmunoassay.
  • ELISA enzyme-linked immunosorbent assay
  • ELIFA enzyme-linked immunofiltration assay
  • flow cytometry immunoblot, immunoprecipitation, immunohistochemistry, immunocytochemistry, luminescent immunoassay (LIA), fluorescent immunoassay (FIA), and radioimmunoassay.
  • m 6 A mRNA methylation levels can be obtained by methylated RNA immunoprecipitation (Me-RIP) ) or other quantitative biochemical assays known in the art.
  • Nucleic acid mutations can be determined by any of a number of procedures. For example, a
  • Non- limiting examples of biological samples include a bodily fluid (e.g., urine, saliva, plasma, or serum) or tissue sample (e.g., a buccal tissue sample or buccal cell).
  • tissue sample e.g., a buccal tissue sample or buccal cell.
  • the biologic sample can then be sequenced or scanned using known methods.
  • DNA arrays can be used to analyze at least a portion of the subject’s genomic sequence.
  • whole or partial genome sequence information can be used. Such sequences can be determined using standard sequencing methods including chain-termination (Sanger dideoxynucleotide), dye-terminator sequencing, and SOLIDTM sequencing (Applied Biosystems).
  • Whole genomes can be cut by restriction enzymes or sheared (mechanically) into shorter fragments for sequencing.
  • DNA sequences can also be amplified using methods such as PCR and vector-based cloning methods (e.g., Escherichia coll).
  • PCR vector-based cloning methods
  • at least a portion of a subject’s genetic material e.g., DNA, RNA, mRNA, cDNA, other nucleotide bases or derivatives of these
  • the method comprises (i) identifying whether a subject having a condition is likely to be responsive to a treatment regimen described herein; and (ii) treating with the treatment regimen a subject determined likely to be responsive to that treatment regimen.
  • the subject has, or is at risk of having, cancer.
  • the treatment regimen comprises administering an effective amount an imipridone, e.g., ONC201, or an analog thereof.
  • the treatment regimen comprises administering an effective amount of compound (1).
  • the treatment regimen comprises administering an effective amount of a compound of formula (10).
  • the compound of formula (10) is a compound of formula (40), e.g., a compound of formula (45). In one embodiment, a compound of formula (10) is a compound of formula (50), e.g. , a compound formula (55). In one embodiment, the compound of formula (10) is a compound of formula (80). In one embodiment, the compound of formula (10) is a compound of formula (90). In one embodiment, the compound of formula (10) is a compound of formula (60). In one embodiment, analogs of compound (1) have a structure selected from the structures of formula (25), formula (26), formula (27), formula (28), formula (29), formula (30), or formula (31).
  • Levels for a pre-determined standard can be, e.g., the average or median levels measured in samples from subjects.
  • the levels for a pre-determined standard can be measured under the same or substantially similar experimental conditions as in measuring a sample from a subject.
  • the levels for the pre-determined standard may be obtained from subjects who are responsive to treatment with an imipridone, such as ONC201, or an analog thereof.
  • the pre-determined standard is obtained from subjects who are responsive to treatment with the compound, and if the levels in a sample from a subject are similar to those in the standard, then the subject can be classified as likely to be responsive to treatment.
  • the levels for the pre-determined standard may be obtained from subjects who are not responsive to treatment with the compound.
  • the pre-determined standard is obtained from subjects who are not responsive to treatment with the compound, and if the levels in a sample from a subject are different (e.g., up- or down-regulated) than those in the pre-determined standard, then the subject can be classified as likely to be responsive to treatment.
  • the levels for the pre-determined standard may be obtained from normal healthy subjects. Immunoassays can be used to assay protein levels in a sample.
  • the method comprises (i) treating the subject according to a method of treatment described herein (ii) assessing as decribed herein the effectiveness of the treatment.
  • the subject has, or is at risk of having, cancer.
  • the treatment regimen comprises administering an effective amount of an imipridone, such as ONC201, or an analog thereof.
  • the treatment regimen comprises administering an effective amount of compound (1).
  • the treatment regimen comprises administering an effective amount of a compound of formula (10).
  • the compound of formula (10) is a compound of formula (40), e.g., a compound of formula (45). In one embodiment, a compound of formula (10) is a compound of formula (50), e.g., a compound formula (55). In one embodiment, the compound of formula (10) is a compound of formula (80). In one embodiment, the compound of formula (10) is a compound of formula (90). In one embodiment, the compound of formula (10) is a compound of formula (60). In one embodiment, compound (1) analogs have a structure selected from formula (25), formula (26), formula (27), formula (28), formula (29), formula (30), or formula (31).
  • Neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, Amyotrophic lateral sclerosis; Cardiovascular diseases such as coronary artery disease, cardiomyopathy, hypertensive heart disease, heart failure, pulmonary heart disease, cardiac dysrhythmias, inflammatory heart disease, endocarditis, inflammatory cardiomegaly, myocarditis, valvular heart disease, cerebrovascular disease, peripheral arterial disease, congenital heart disease, rheumatic heart disease; Diabetes; and light chain amyloidosis.
  • Cardiovascular diseases such as coronary artery disease, cardiomyopathy, hypertensive heart disease, heart failure, pulmonary heart disease, cardiac dysrhythmias, inflammatory heart disease, endocarditis, inflammatory cardiomegaly, myocarditis, valvular heart disease, cerebrovascular disease, peripheral arterial disease, congenital heart disease, rheumatic heart disease; Diabetes; and light chain amyloidosis.
  • compositions comprising compounds of formula (10): or of formula (1): and their pharmaceutically acceptable saltsln one embodiment, the salt is a pharmaceutically acceptable mono-salt of the compound. In one embodiment, the salt is a pharmaceutically acceptable di-salt of the compound.
  • the salt is a pharmaceutically acceptable mono- or multi-salt (e.g., a di-salt or tri-salt) thereof selected from hydrochloride, hydrobromide, hydrogensulphate, sulfates, phosphates, fumarates, succinates, oxalates and lactates, bisulfates, hydroxyl, tartrate, nitrate, citrate, bitartrate, carbonate, malate, maleate, fumarate sulfonate, methylsulfonate, formate, acetate, and carboxylate.
  • a pharmaceutically acceptable mono- or multi-salt e.g., a di-salt or tri-salt
  • the salt is a salt selected from the group consisting of p-toluene-sulfonate, benzenesulfonate, citrate, methanesulfonate, oxalate, succinate, tartrate, fumarate and maleate.
  • the salt is a salt selected from the group consisting of ammonium, sodium, potassium, calcium, magnesium, zinc, lithium, and/or with counter-ions such as methylamino, dimethylamino, diethylamino and triethylamino counter-ions.
  • the salt is a. di-hydrochloride salt or a dihydrobromide salt.
  • Compound (1) has the same chemical structure that would be revealed by structural analysis (e.g., NMR, X-ray diffraction) of compound NSC 350625, available from the National Cancer Institute’s Developmental Therapeutics Program Repository.
  • the pharmaceutical composition includes a di-salt (e.g., a dihydrochloride salt) of ONC201 or an analog thereof (e.g., an imipridone). Salts (e.g., di-salts or tri-salts) of an ONC201 analog can be prepared from an ONC201 analog, which can be synthesized as described herein, or using standard chemical synthetic methodology known to one of ordinary skill in the art.
  • the pharmaceutical composition includes at least one pharmaceutically acceptable carrier.
  • suitable pharmaceutically acceptable carriers include, those in Handbook of Pharmaceutical Excipients, 7 th ed., edited by Raymond C. Rowe et al., American Pharmaceutical Association, Washington, USA and Pharmaceutical Press, London; and earlier editions.
  • Exemplary pharmaceutically acceptable carriers, methods for making pharmaceutical compositions and various dosage forms, as well as administration modes are well-known in the art, for example as detailed in Pharmaceutical Dosage Forms: Tablets, edited by Larry L. Augsburger & Stephen W. Hoag., London: Informa Healthcare, 2008; and in L.V. Allen, Jr.
  • compositions are formulated for ocular administration.
  • pharmaceutical compositions are formulated for topical administration.
  • pharmaceutical compositions are formulated as drops, ointments, or liquids.
  • pharmaceutical compositions include conventional pharmaceutical carriers such as aqueous, powdery or oily bases, thickeners.
  • a pharmaceutical composition is a formulation for intravenous administration.
  • the intravenous formulation comprises a compound of formula (10) or a pharmaceutically acceptable salt thereof dissolved in a solvent.
  • the solvent comprises water.
  • the intravenous formulation includes the compound or its salt in a concentration of about 0.05, about 0.25, about 0.5, about 2.5, about 5, about 25, or about 50 mg/mL.
  • the intravenous formulation includes the compound or its salt in a concentration of from about 0.05, 0.5, or 5 mg/mL to about 1, 10, or 100 mg/mL.
  • the intravenous formulation includes from about 0.005% 0.05%, or 0.5% to about 0.1%, 1%, or 10% of the compound or its salt. In one embodiment, the intravenous formulation includes about 0.05%, 0.5%, or 5% of the compound or its salt. In one embodiment, the intravenous formulation includes a higher or a lower concentration of the compound or its salt.
  • the intravenous formulation has a pH of about 3. In one embodiment, the formulation is adjusted to pH 3 with a phosphate buffer. In one embodiment, the intravenous formulation includes dextrose or sodium chloride. In one embodiment, the intravenous formulation includes the compound or its salt in a concentration of about 5 mg/mL and pH 3 and forms a stable solution. In one embodiment, the intravenous formulation includes the compound or its salt in a concentration of about 5 mg/mL and pH ⁇ 5 and forms a stable solution. In one embodiment, the intravenous formulation includes the compound or its salt and one or more antioxidants. In one embodiment, the intravenous formulation includes a mixture of mono- and di-hydrochloride salts of the compound.
  • the intravenous formulation includes the compound or its salt as a 1 % solution in a concentration of about 10 mg/mL.
  • the intravenous formulation is a solution with a pH of about 3.3. In one embodiment, the pH is less than 4.0.
  • a suitable pharmaceutically acceptable carrier includes an aqueous carrier.
  • the aqueous carrier includes sterile water.
  • the formulation includes dextrose, sodium chloride or both.
  • the pharmaceutically acceptable carrier includes an oil.
  • an intravenous formulation comprises ONC201 or an analog thereof or a di-hydrochloride salt thereof dissolved in water at 25 mg/mL.
  • the formulation is adjusted to pH 3 with phosphate buffer.
  • the formulation includes dextrose, sodium chloride or both.
  • the formulation includes a higher or a lower concentration of the di -hydrochloride salt of ONC201 or an analog thereof.
  • the formulation includes ONC201 or an analog thereof or a di-hydrochloride salt thereof in a concentration of about 5 mg/mL. In one embodiment, the formulation of about 5 mg/mL forms a stable solution and pH 3.
  • the formulation of about 5 mg/mL has a pH ⁇ 5 and forms a stable solution.
  • the intravenous formulation includes ONC201 or an analog thereof or a dihydrochloride salt thereof and one or more antioxidants.
  • the intravenous formulation includes a mixture of mono- and di-hydrochloride salts of ONC201 or an analog thereof.
  • the intravenous formulation includes ONC201 or an analog thereof or a di-hydrochloride salt thereof as a 1 % solution in a concentration of about 10 mg/mL.
  • the intravenous formulation is a solution having a pH of about 3.3. In one embodiment, the pH is less than 4.0.
  • the intravenous formulation includes from about 0.5% to about 10% (or from about 5 mg/mL to about 100 mg/mL) of ONC201 or an analog thereof or a disalt thereof. In one embodiment, the formulation includes from about 5% (or about 50 mg/mL) of ONC201 or an analog thereof or a di-salt thereof. In one embodiment, the intravenous infusion rate may be slowed to decrease side effects of ONC201 or an analog thereof or a di-salt thereof.
  • the pharmaceutical composition comprises about 0.1-99% of an ONC201 salt or an analog thereof; and a pharmaceutically acceptable carrier, e.g., an oil or sterile water or other aqueous carrier.
  • a pharmaceutically acceptable carrier e.g., an oil or sterile water or other aqueous carrier.
  • the composition comprises a mono or di-salt of ONC201 or an analog thereof in a range of from about 5% to about 50% for oral dosage forms.
  • a pharmaceutical composition includes an antioxidant.
  • Suitable antioxidants include: ascorbic acid derivatives such as ascorbic acid, erythorbic acid, sodium ascorbate, thiol derivatives such as thioglycerol, cysteine, acetylcysteine, cystine, dithioerythreitol, dithio threitol, glutathione, tocopherols, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), sulfurous acid salts such as sodium sulfate, sodium bisulfite, acetone sodium bisulfite, sodium formaldehyde sulfoxylate, sodium metabisulfite, sodium sulfite, and sodium thiosulfate, nordihydroguaiaretic acid.
  • ascorbic acid derivatives such as ascorbic acid, erythorbic acid, sodium ascorbate
  • thiol derivatives such as thioglycerol, cysteine, acetyl
  • antioxidants used for aqueous formulations typically include: sodium sulphite, sodium metabisulphite, sodium formaldehyde sulphoxylate or ascorbic acid and combinations thereof, whereas antioxidants used in oil-based solutions, organic solvents, include BHT, BHA or propyl gallate and combinations thereof.
  • an antioxidant can be one or more of a flavanoid, an isoflavone, monothioglycerol, L-cysteine, thioglycolic acid, a-tocopherol, ascorbic acid 6-palmitate, dihydrolipoic acid, BHT, BHA, vitamin E, propyl gallate, P-carotene, and ascorbic acid.
  • Antioxidants can typically be used in about 0.1% to 1.0% by weight, more typically about 0.2%.
  • the pharmaceutical composition includes an imipridone, such as ONC201 or an analog thereof, or a pharmaceutically acceptable salt thereof and at least one other therapeutic agent.
  • the other therapeutic agent is selected from the group consisting of hormone analogs and antihormones, aromatase inhibitors, LHRH agonists and antagonists, inhibitors of growth factors, growth factor antibodies, growth factor receptor antibodies, tyrosine kinase inhibitors; antimetabolites; antitumour antibiotics; platinum derivatives; alkylation agents; antimitotic agents; tubuline inhibitors; PARP inhibitors, topoisomerase inhibitors, serine/threonine kinase inhibitors, tyrosine kinase inhibitors, protein protein interaction inhibitors, RAF inhibitors, MEK inhibitors, ERK inhibitors, IGF- 1R inhibitors, ErbB receptor inhibitors, rapamycin analogs, BTK inhibitors, CRM1 inhibitors (e.g., KPT185), P53 modulators (e
  • the other therapeutic agent comprises a hormone analog, an antihormone or both selected from tamoxifen, toremifene, raloxifene, fulvestrant, megestrol acetate, flutamide, nilutamide, bicalutamide, aminoglutethimide, cyproterone acetate, finasteride, buserelin acetate, fludrocortisone, fluoxymesterone, medroxy-progesterone, octreotide, and combinations thereof.
  • a hormone analog an antihormone or both selected from tamoxifen, toremifene, raloxifene, fulvestrant, megestrol acetate, flutamide, nilutamide, bicalutamide, aminoglutethimide, cyproterone acetate, finasteride, buserelin acetate, fludrocortisone, fluoxymesterone, medroxy-progester
  • the other therapeutic agent comprises one or more LHRH agonists are selected from goserelin acetate, luprolide acetate, triptorelin pamoate and combinations thereof and wherein the LHRH antagonists are selected from Degarelix, Cetrorelix, Abarelix, Ozarelix, Degarelix combinations thereof.
  • the other therapeutic agent comprises one or more growth factor inhibitors selected from inhibitors of: platelet derived growth factor (PDGF), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insuline- like growth factors (IGF), human epidermal growth factor (HER) and hepatocyte growth factor (HGF).
  • PDGF platelet derived growth factor
  • FGF fibroblast growth factor
  • VEGF vascular endothelial growth factor
  • EGF epidermal growth factor
  • IGF insuline- like growth factors
  • HER human epidermal growth factor
  • HGF hepatocyte growth factor
  • the other therapeutic agent comprises one or more inhibitors of the human epidermal growth factor selected from HER2, HER3, and HER4.
  • the other therapeutic agent comprises one or more tyrosine kinase inhibitors selected from cetuximab, gefitinib, imatinib, lapatinib and trastuzumab, and combinations thereof.
  • the other therapeutic agent comprises one or more aromatase inhibitors selected from anastrozole, letrozole, liarozole, vorozole, exemestane, atamestane, and combinations thereof.
  • the other therapeutic agent comprises one or more antimetabolites which are antifolates selected from methotrexate, raltitrexed, and pyrimidine analogs. In one embodiment, the other therapeutic agent comprises one or more antimetabolites which are pyrimidine analogs selected from 5 -fluorouracil, capecitabin and gemcitabin. In one embodiment, the other therapeutic agent comprises one or more antimetabolites which are purine and/or adenosine analogs selected from mercaptopurine, thioguanine, cladribine and pentostatin, cytarabine, fludarabine, and combinations thereof.
  • the other therapeutic agent comprises one or more antitumour antibiotics selected from anthracyclins, doxorubicin, daunorubicin, epirubicin and idarubicin, mitomycin-C, bleomycin, dactinomycin, plicamycin, streptozocin and combinations thereof.
  • the other therapeutic agent comprises one or more platinum derivatives selected from cisplatin, oxaliplatin, carboplatin and combinations thereof.
  • the other therapeutic agent comprises one or more alkylation agents selected from estramustin, meclorethamine, melphalan, chlorambucil, busulphan, dacarbazin, cyclophosphamide, ifosfamide, temozolomide, nitrosoureas, and combinations thereof.
  • the other therapeutic agent comprises nitrosoureas selected from carmustin, lomustin, thiotepa, and combinations thereof.
  • the other therapeutic agent comprises antimitotic agents selected from Vinca alkaloids and taxanes.
  • the other therapeutic agent comprises one or more taxanes selected from paclitaxel, docetaxel, and combinations thereof.
  • the other therapeutic agent comprises one or more Vinca alkaloids selected from vinblastine, vindesin, vinorelbin, vincristine, and combinations thereof.
  • the other therapeutic agent comprises one or more topoisomerase inhibitors which are epipodophyllotoxins.
  • the other therapeutic agent comprises one or more epipodophyllotoxins selected from etoposide and etopophos, teniposide, amsacrin, topotecan, irinotecan, mitoxantron, and combinations thereof.
  • the other therapeutic agent comprises one or more serine/threonine kinase inhibitors selected from PDK 1 inhibitors, B-Raf inhibitors, mTOR inhibitors, mTORCl inhibitors, PI3K inhibitors, dual mT0R/PI3K inhibitors, STK 33 inhibitors, AKT inhibitors, PLK 1 inhibitors, inhibitors of CDKs, Aurora kinase inhibitors, and combinations thereof.
  • the other therapeutic agent comprises one or more tyrosine kinase inhibitors which are PTK2/FAK inhibitors.
  • the other therapeutic agent comprises one or more protein protein interaction inhibitors selected from IAP, Mcl-1, MDM2/MDMX and combinations thereof.
  • the other therapeutic agent comprises one or more rapamycin analogs selected from everolimus, temsirolimus, ridaforolimus, sirolimus, and combinations thereof.
  • the other therapeutic agent comprises one or more therapeutic agents selected from amifostin, anagrelid, clodronat, filgrastin, interferon, interferon a, leucovorin, rituximab, procarbazine, levamisole, mesna, mitotane, pamidronate and porfimer, and combinations thereof.
  • the other therapeutic agent comprises one or more therapeutic agents selected from 2-chlorodesoxyadenosine, 2-fluorodesoxy-cytidine, 2-methoxyoestradiol, 2C4,3- alethine, 131-1-TM-601, 3CPA, 7-ethyl-10-hydroxycamptothecin, 16-aza-epothilone B, A 105972, A 204197, abiraterone, aldesleukin, alitretinoin, allovectin-7, altretamine, alvocidib, amonafide, anthrapyrazole, AG-2037, AP-5280, apaziquone, apomine, aranose, arglabin, arzoxifene, atamestane, atrasentan, auristatin PE, ABT- 199 (Venetoclax), ABT-263 (Navitoclax), AVLB, AZ10992, ABX-EGF, AMG
  • the other therapeutic agent comprises a steroid, including dexamethasone, prednisolone, methyl prednisolone, prednisone, hydrocortisone, triamcinolone, betamethasone, and cortivazol.
  • the other therapeutic agent comprises an anti-emetic
  • Anti-emetics include, but are not limited to, 5-HT3 receptor agonists (e.g., dolasetron, granisetron, ondansetron, tropisetron, palonosetron, and mirtazapine), dopamine agonists (e.g., domperidone, olanzapine, droperidol, haloperidol, chlorpromazine, prochlorperazine, alizapride, prochlorperazine, and metoclopramide), NK1 receptor antagonists (e.g., aprepitant and casopitant), antihistamines (such as cyclizine, diphenhydramine, dimenhydrinate, doxylamine, meclizine, promethazine, hydroxyzine), cannabinoids (e.g., cannabis, dronabinol, nabilone, and sativex), benzodiazepines (e.g., 5-
  • the other therapeutic agent comprises an anti -cancer agent, which includes a mitotic inhibitor.
  • the mitotic inhibitor includes a taxane.
  • the mitotic inhibitor includes a taxane selected from paclitaxel and docetaxel.
  • the pharmaceutical composition includes an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof; and at least one anti-cancer agent, which includes one or more of acivicin, aclarubicin, acodazole, acronine, adozelesin, aldesleukin, alitretinoin, allopurinol, altretamine, ambomycin, ametantrone, amifostine, aminoglutethimide, amsacrine, anastrozole, anthramycin, arsenic trioxide, asparaginase, asperlin, azacitidine, azetepa, azotomycin, batimastat, benzodepa, bevacizumab, bicalutamide, bisantrene, bisnafide dimesylate, bizelesin, bleomycin, brequinar, bropirimine, busulfan
  • the pharmaceutical composition includes an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof; and at least one anti-cancer agent, which includes one or more of lorlatinib (LORBRENA), pembrolizumab (KEYTRUDA), talazoparib (TALZENNA), emicizumab-kxwh injection (HEMLIBRA), cemiplimab-rwlc (LIBTAYO), dacomitinib tablets (VIZIMPRO), duvelisib (COPIKTRA), moxetumomab pasudotox-tdfk (LUMOXITI), nivolumab (OPDIVO), mogamulizumab-kpkc (Poteligeo), lusutrombopag (Mulpleta), iobenguane 1-131 (AZEDRA), ivosidenib (Tibsovo),
  • LORBRENA
  • the pharmaceutical composition includes an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof; and at least one anti-cancer agent, which includes one or more of elotuzumab (EMPLICITI) necitumumab (PORTRAZZA) ixazomib (NINLARO), cobimetinib (COTELLIC Tablets), talimogene laherparepvec (IMLYGIC), trabectedin (Yondelis Injection), irinotecan liposome injection (ONIVYDE), idarucizumab (Praxbind Injection), trifluridine/tipiracil (LONSURF), carfilzomib (Kyprolis) sonidegib (Odomzo Capsules), gefitinib (IRESSA), ramucirumab (CYRAMZA), dinutuximab (Unituxin), filgrastim-sndz (Z)
  • Suitable anti-cancer agents include those described Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 12 th Ed., edited by Laurence Brunton, Bruce Chabner, Bjorn Knollman, McGraw Hill Professional, 2010.
  • the pharmaceutical composition includes a salt (e.g., a mono-or di- salt) of an imipridone, e.g., ONC201, or an analog thereof and at least one other therapeutic agent, where the other therapeutic agent comprises an anti- angiogenic agent, for example, bevacizumab.
  • a salt e.g., a mono-or di- salt
  • the other therapeutic agent comprises an anti- angiogenic agent, for example, bevacizumab.
  • the anti-angiogenic agent is selected from aflibercept, axitinib, angiostatin, endostatin, 16kDa prolactin fragment, laminin peptides, fibronectin peptides, tissue metalloproteinase inhibitors (TIMP 1, 2, 3, 4), plasminogen activator inhibitors (PAI-1, -2), tumor necrosis factor a, (high dose, invitro), TGF-[) I , interferons (IFN-a, -
  • a pharmaceutical combination can include first and second therapeutic agents in any desired proportions provided that the synergistic or cooperative effect still occurs.
  • a synergistic pharmaceutical combination preferably the first and second therapeutic agents are in a ratio of from about 1:9 to about 9:1.
  • a synergistic combination the first and second therapeutic agents are in a ratio of from about 1:8 to about 8: 1, from about 1:7 to about 7:1, from about 1:6 to about 6:1, from about 1:5 to about 5:1, from about 1:4 to about 4:1, from about 1:3 to about 3:1, or from about 1:2 to about 2:1.
  • the synergistic combination the therapeutic agents are in a ratio of approximately 1:1.
  • the second therapeutic agent is selected from Allopurinol, Arsenic Trioxide, Azacitidine, Bortezomib, Bevacizumab, Capecitabine, Carboplatin, Celecoxib, Chlorambucil, Clofarabine, Cytarabine, dacarbazine, Daunorubicin HC1, Docetaxel, Doxorubicin HC1, Floxuridine, Gemcitabine HC1, Hydroxyurea, Ifosfamide, Imatinib Mesylate, Ixabepilone, Lenalidomide, Megestrol acetate, Methotrexate, Mitotane, Mitoxantrone HC1, Oxaliplatin, Paclitaxel, Pralatrexate, Romidepsin, Sorafenib, Streptozocin, Tamoxifen Citrate, Topotecan HC1, Tretinoin, Vandetanib, Vismodegib, Vorin
  • the second therapeutic agent comprises a small molecule multikinase inhibitor, e.g., sorafenib or regorafenib.
  • the second therapeutic agent comprises a Hedgehog Pathway Inhibitor, e.g., vismodegib.
  • the second therapeutic agent includes a drug selected from Table 2 below. Table 2: Classes Of Drugs
  • the second therapeutic agent includes drugs that target tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) receptors.
  • the second therapeutic agent includes recombinant TRAIL or an agonistic antibody that activates one or more TRAIL receptors.
  • the second therapeutic agent includes one or more antibodies or recombinant TRAIL that activate signaling by DR4, DR5 or both.
  • the second therapeutic agent includes one or more of AMG-655, LBY-135, mapatumumab, lexatumumab, Apomab, and rhApo2L/TRAIL.
  • the second therapeutic agent includes an active agent selected from Camptothecin, 5-FU, capecitabine, cisplatin, doxorubicin, irinotecan, paclitaxel, cisplatin, bortezomib, BH3I-2, rituximab, radiation, tri terpenoids, sorafenib, gemcitabine, HDAC inhibitors, carboplatin, T- 101 (a gossypol derivate), ABT-263, ABT-737, and GX-15-070 (obatoclax), vorinostat, cetuximab, panitumumab, bevacizumab, ganitumab, interferon gamma, sorafenib, XIAP antagonists, Bcl-2 antagonists, and Smac mimetics.
  • an active agent selected from Camptothecin, 5-FU, capecitabine, cisplatin, doxorubicin, irinote
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose ranging from about 40, 50, 60, or 100 mg to about 2000 mg; from about 4, 5, 6, or 10 mg to about 200 mg; or from about 0.4, 0.5, 0.6, or 1 mg to about 20 mg where the weight can be based on the compound in its free base form.
  • an imipridone such as ONC201, or an analog thereof
  • a pharmaceutically acceptable salt thereof in a dose ranging from about 40, 50, 60, or 100 mg to about 2000 mg; from about 4, 5, 6, or 10 mg to about 200 mg; or from about 0.4, 0.5, 0.6, or 1 mg to about 20 mg where the weight can be based on the compound in its free base form.
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 50 mg to about 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, or 2000 mg; from about 5 mg to about 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, and 200 mg; or from about 0.5 mg to about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20 mg.
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 40 mg to about 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, or 2000 mg; from about 4 mg to about 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 mg; or from about 0.4 mg to about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20 mg.
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 60 mg to about 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, or 2000 mg; from about 6 mg to about 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 mg; or from about 0.6 mg to about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 mg.
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 100 mg to about 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900 mg, or 2000 mg; from about 10 mg to about 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 mg; or from about 1 mg to about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 mg.
  • an imipridone such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 100 mg to about 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900 mg, or 2000 mg; from about 10
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 200 mg to about 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, or 2000 mg; from about 20 mg to about 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 mg; or from about 2 mg to about 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 mg, based on the compound in its free base form.
  • an imipridone such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 200 mg to about 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, or 2000 mg;
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 400 mg to about 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, or 2000 mg; from about 40 mg to about 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 mg; or from about 4 mg to about 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 mg based on the compound in its free base form.
  • an imipridone such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 400 mg to about 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, or 2000 mg
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof thereof in a dose level ranging from about 50 mg to about 60, 70, 80, 90, or 100 mg; from about 60 mg to about 70, 80, 90, or 100 mg; from about 70 mg to about 80, 90 or 100 mg, from about 80 mg to about 90 or 100 mg; from about 90 mg to about 100 mg; from about 5 mg to about 6, 7, 8, 9, or 10 mg; from about 6 mg to about 7, 8, 9, or 10 mg; from about 7 mg to about 8, 9 or 10 mg, from about 8 mg to about 9 or 10 mg; from about 9 mg to about 10 mg; from about 0.5 mg to about 0.6, 0.7, 0.8, 0.9, or 1 mg; from about 0.6 mg to about 0.7, 0.8, 0.9, or 1 mg; from about 0.7 mg to about 0.8, 0.9 or 1 mg; from about 0.7 mg to about 0.8, 0.9 or 1 mg, from about 0.8 mg to about 0.9 or 1 mg; or from
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose ranging from about 1 to about 40 mg/kg; about 0.1 to about 4 mg/kg; or about 0.01 to about 0.40 mg/kg.
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose level ranging from about 1, 2, 3, 4, 5, 6, 7, 8, or 9 mg/kg to about 10, 20, 30, or 40 mg/kg; from about 10, 11, 12, 13, 14, 15, 16, 17, 18, or 19 mg/kg to about 20, 30, or 40 mg/kg; from about 20, 21, 22, 23, 24, 25, 26, 27, 28, or 29 mg/kg to about 30 or 40 mg/kg; from about 30, 31, 32, 33, 34, 35, 36, 37, 38, or 39 mg/kg to about 40 mg/kg; from about 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, or 0.9 mg/kg to about 1, 2, 3, or 4 mg/kg; from about 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, or 1.9 mg/kg to about 2, 3, or 4 mg/kg; from about 2.0, 2.1, 2.2, 2.3, 2.4,
  • a pharmaceutical composition comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose ranging from about 37.5 mg/m 2 to about 1500 mg/m 2 ; from about 3.75 mg/m 2 to about 150 mg/m 2 ; or from about 0.4 mg/m 2 to about 15 mg/m 2
  • a pharmaceutical composition comprises comprises an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in a dose ranging from about 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140, 145, 150, 155, 160, 165, 170, 175, 180, 185, 190, 195, 200, 205, 210, 215, 220, 225, 230, 235, 240, 245, 250, 255,
  • compositions for use in the methods described herein can be formulated into a dosage form that can be administered to a patient.
  • the composition is in the form of an oral or parenteral dosage unit.
  • it is in the form of an oral dosage unit.
  • the oral dosage unit is fractionated into several, smaller doses, which are administered to a subject over a predetermined period of time to reduce toxicity of a therapeutic agent being administered.
  • an oral dosage unit is administered as a tablet or capsule comprising a controlled release formulation that can include a plurality of particles, granules, pellets, minitablets or tablets.
  • the composition is in the form of a parenteral dosage unit.
  • a parenteral dosage unit is selected from intravenous (IV), subcutaneous (SC), and intramuscular (M), rectal (PR) or transdermal dosage units.
  • a dosage form is selected from sterile solutions, suspensions, suppositories, tablets and capsules.
  • an oral dosage form is selected from a tablet, caplet, capsule, lozenge, syrup, liquid, suspension and elixir.
  • an oral dosage form is selected from tablets, hard shell capsules, soft gelatin capsules, beads, granules, aggregates, powders, gels, solids and semi-solids.
  • compositions for use in the methods described herein include dermatological compositions adapted for cutaneous topical administration.
  • dermatological compositions include a pharmaceutically or cosmetically acceptable medium.
  • Dermatological compositions for topical administration include ointments, lotions, creams, gels, drops, suppositories, sprays, liquids and powders.
  • conventional pharmaceutical carriers, aqueous, powder or oily bases, skin enhancers, thickeners can be needed or desirable and therefore used.
  • Suitable enhancers include ethers, e.g., diethylene glycol monoethyl ether (available as TRANSCUTOL®) and diethylene glycol monomethyl ether; surfactants, e.g., sodium laurate, sodium lauryl sulfate, cetyltrimethylammonium bromide, benzalkonium chloride, Poloxamer (231, 182, 184), Tween (20, 40, 60, 80) and lecithin; alcohols, e.g., ethanol, propanol, octanol, benzyl alcohol; polyethylene glycol and esters thereof, e.g., polyethylene glycol monolaurate; amides and other nitrogenous compounds, e.g., urea, 2-pyrrolidone, l-methyl-2-pyrrolidone, dimethylacetamide (DMA), dimethylformamide (DMF), ethanolamine, diethanolamine and triethanolamine; terpenes; alkanones; and
  • compositions and methods described herein have utility in treating many disease conditions, including cancer (e.g., colorectal, brain, and glioblastoma).
  • cancer e.g., colorectal, brain, and glioblastoma
  • the compositions and methods described herein are used to treat diseases such as ocular melanoma, desmoplastic round cell tumor, chondrosarcoma, leptomengial disease, diffuse large B-cell lymphoma, Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, Adrenocortical Carcinoma, AIDS-Related Cancers, AIDS-Related Lymphoma, Anal or Rectal Cancer, Appendix Cancer, Astrocytomas, and Atypical Teratoid/Rhabdoid Tumor.
  • diseases such as ocular melanoma, desmoplastic round cell tumor, chondrosarcoma, leptomengial disease, diffuse large B-cell lymphom
  • compositions and methods described herein are used to treat diseases such as Basal Cell Carcinoma, Basal Cell Nevus Syndrome, Gorlin-Nevus Syndrome, Bile Duct Cancer, Bladder Cancer, Bone Cancer, Osteosarcoma and Malignant Fibrous Histiocytoma, Brain Tumor, Breast Cancer, Bronchial Tumors, Burkitt Lymphoma, and Spinal Cord Tumors.
  • diseases such as Basal Cell Carcinoma, Basal Cell Nevus Syndrome, Gorlin-Nevus Syndrome, Bile Duct Cancer, Bladder Cancer, Bone Cancer, Osteosarcoma and Malignant Fibrous Histiocytoma, Brain Tumor, Breast Cancer, Bronchial Tumors, Burkitt Lymphoma, and Spinal Cord Tumors.
  • compositions and methods described herein are used to treat diseases such as Carcinoid Tumor, Carcinoma of Unknown Primary, Central Nervous System Atypical Teratoid/Rhabdoid Tumor, Leptomeningeal Disease, Central Nervous System Embryonal Tumors, Central Nervous System Lymphoma, Cervical Cancer, Chordoma, Chronic Lymphocytic Leukemia, Chronic Myelogenous Leukemia, Chronic Myeloproliferative Disorders, Colon Cancer, Colorectal Cancer, Craniopharyngioma, and Cutaneous T-Cell Lymphoma (including Sezary syndrome and mycosis fungoides (MF)).
  • diseases such as Carcinoid Tumor, Carcinoma of Unknown Primary, Central Nervous System Atypical Teratoid/Rhabdoid Tumor, Leptomeningeal Disease, Central Nervous System Embryonal Tumors, Central Nervous System Lymphoma, Cervical Cancer, Chordoma, Chronic Lymphocytic
  • compositions and methods described herein are used to treat cdiseases such as Embryonal Tumors of Central Nervous System, Endometrial Cancer, Ependymoblastoma, Ependymoma, Esophageal Cancer, Ewing Sarcoma Family of Tumors, Extracranial Germ Cell Tumor, Extragonadal Germ Cell Tumor, Extrahepatic Bile Duct Cancer, and Eye Cancer, including Intraocular Melanoma and Retinoblastoma.
  • cdiseases such as Embryonal Tumors of Central Nervous System, Endometrial Cancer, Ependymoblastoma, Ependymoma, Esophageal Cancer, Ewing Sarcoma Family of Tumors, Extracranial Germ Cell Tumor, Extragonadal Germ Cell Tumor, Extrahepatic Bile Duct Cancer, and Eye Cancer, including Intraocular Melanoma and Retinoblastoma.
  • compositions and methods described herein are used to treat diseases such as Gallbladder Cancer, Gastric (Stomach) Cancer, Gastrointestinal Carcinoid Tumor, Gastrointestinal Stromal Tumor (GIST), Germ Cell Tumor, Gestational Trophoblastic Tumor, and Glioma.
  • diseases such as Gallbladder Cancer, Gastric (Stomach) Cancer, Gastrointestinal Carcinoid Tumor, Gastrointestinal Stromal Tumor (GIST), Germ Cell Tumor, Gestational Trophoblastic Tumor, and Glioma.
  • the compositions and methods described herein are used to treat a cancer selected from the group consisting of Hairy Cell Leukemia, Head and Neck Cancer, Hepatocellular (Liver) Cancer, Histiocytosis, Hodgkin Lymphoma, and Hypopharyngeal Cancer.
  • the compositions and methods described herein are used to treat diseases such as Kaposi Sarcoma and Kidney (Renal Cell) Cancer.
  • compositions and methods described herein are used to treat diseases such as Langerhans Cell Histiocytosis, Laryngeal Cancer, Lip and Oral Cavity Cancer, Liver Cancer, Lung Cancer, including Non-Small Cell Lung Cancer, and Small Cell Lung Cancer, Non-Hodgkin Lymphoma, and Primary Central Nervous System Lymphoma.
  • diseases such as Langerhans Cell Histiocytosis, Laryngeal Cancer, Lip and Oral Cavity Cancer, Liver Cancer, Lung Cancer, including Non-Small Cell Lung Cancer, and Small Cell Lung Cancer, Non-Hodgkin Lymphoma, and Primary Central Nervous System Lymphoma.
  • compositions and methods described herein are used to treat diseases such as Waldenstrom’s macroglobulinemia (lymphoplasmacytic lymphoma), Malignant Fibrous Histiocytoma of Bone and Osteosarcoma, Medulloblastoma, Medulloepithelioma, Melanoma, Merkel Cell Carcinoma, Mesothelioma, Metastatic Squamous Neck Cancer with Occult Primary, Multiple Endocrine Neoplasia Syndrome, Mouth Cancer, Multiple Myeloma/Plasma Cell Neoplasm, Mycosis Fungoides, Myelodysplastic Syndromes, complex karyotype, blastic phase leukemia, Myelodysplastic/Myeloproliferative Neoplasms, Multiple Myeloma, and Myeloproliferative Disorders.
  • diseases such as Waldenstrom’s macroglobulinemia (lymphoplasmacytic lymphoma), Malignant Fibrous Histiocytoma of Bon
  • compositions and methods described herein are used to treat cancer.
  • the compositions and methods described herein are used to treat diseases such as Nasal Cavity and Paranasal Sinus Cancer, Nasopharyngeal Cancer, and Neuroblastoma.
  • the compositions and methods described herein are used to treat diseases such as Oral Cancer, Lip and Oral Cavity Cancer, Oropharyngeal Cancer, Osteosarcoma and Malignant Fibrous Histiocytoma of Bone, Ovarian Cancer, Ovarian Germ Cell Tumor, Ovarian Epithelial Cancer, and Ovarian Low Malignant Potential Tumor.
  • compositions and methods described herein are used to treat diseases such as Pancreatic Cancer, Papillomatosis, Paranasal Sinus and Nasal Cavity Cancer, Parathyroid Cancer, Penile Cancer, Pharyngeal Cancer, Pineal Parenchymal Tumors of Intermediate Differentiation, Pineoblastoma and Supratentorial Primitive Neuroectodermal Tumors, Pituitary Tumor, Pleuropulmonary Blastoma, Pregnancy and Breast Cancer, Primary Central Nervous System Lymphoma, and Prostate Cancer.
  • diseases such as Pancreatic Cancer, Papillomatosis, Paranasal Sinus and Nasal Cavity Cancer, Parathyroid Cancer, Penile Cancer, Pharyngeal Cancer, Pineal Parenchymal Tumors of Intermediate Differentiation, Pineoblastoma and Supratentorial Primitive Neuroectodermal Tumors, Pituitary Tumor, Pleuropulmonary Blastoma, Pregnancy and Breast Cancer, Primary Central Nervous System Lymphoma,
  • compositions and methods described herein are used to treat a cancer selected from the group consisting of Rectal Cancer, Renal Cell (Kidney) Cancer, Renal Pelvis and Ureter, Respiratory Tract Carcinoma Involving the NUT Gene on Chromosome 15, Retinoblastoma, and Rhabdomyosarcoma.
  • the compositions and methods described herein are used to treat high grade prostate cancer.
  • the compositions and methods described herein are used to treat medium grade prostate cancer.
  • the compositions and methods described herein are used to treat low grade prostate cancer.
  • the compositions and methods described herein are used to treat castration-resistant prostate cancer.
  • compositions and methods described herein are used to treat a nervous system tumor. In one embodiment, the compositions and methods described herein are used to treat a central nervous system tumor. In one embodiment, the compositions and methods described herein are used to treat a peripheral nervous system tumor. In one embodiment, the compositions and methods described herein are used to treat a paraganglioma. In one embodiment, the compositions and methods described herein are used to treat a pheochromocytoma.
  • ONC201 In in vitro models, in animal models, and in human clinical trials compound (1) (ONC201) has broad anti-cancer activity, low toxicity including few, if any, adverse effects, low genotoxicity, and high bioavailability including oral bioavailability. These features allow ONC 201 and various analogs to be particularly well suited for pediatric patients. These features also make ONC 201 and various analogs particularly well suited for chronic therapy, for high risk patients, and to ensure long-lasting responses or stable disease or to prevent disease recurrence.
  • kits for treating or preventing cancer in a subject in need thereof comprising: administering to the subject in need of such treatment a pharmaceutical composition comprising a therapeutically effective amount compound (1) or a pharmaceutically acceptable salt thereof, wherein the cancer involves a midline structure of the brain and has a histone H3 K27M mutation.
  • the cancer involves the thalamus, hypothalamus, basal ganglia, pineal gland, midbrain, cerebellum, pons, spinal cord, or medulla.
  • the cancer is not a spinal cord tumor.
  • the histone H3 K27M mutation is H3.3 K27M or H3.1 K27M.
  • the histone H3 K27M mutation is in one or more histone genes selected from H3F3A, H3F3B, HIST1H3A, HIST1H3B, HIST1H3C, HIST1H3D, HIST1H3E, HIST1H3F, HIST1H3G, HIST1H3H, HIST1H3I, or H1ST1H3J.
  • DRD2 is overexpressed
  • DRD5 is underexpressed or both in cancerous tissue.
  • the subject is a human.
  • the subject is a domesticated pet.
  • the subject is a pediatric subject.
  • a pharmaceutical composition comprising a therapeutically effective amount a compound of formula (10) or an analog thereof, or a pharmaceutically acceptable salt thereof, wherein the cancer has a histone H3 mutation.
  • the cancer is selected from the group consisting of a central nervous system tumor, a brain tumor, a peripheral nervous system tumor, a pheochromocytoma, a paraganglioma, an adrenal cortical carcinoma, an adrenal tumor, and a neuroendocrine tumor.
  • the cancer comes from glial cells and is selected from the group consisting of meningioma, ependymoma, oligodendrogliomas, astrocytoma, optic nerve glioma, pineal tumors, rhabdoid tumors, and diffuse intrinsic pontine glioma.
  • the cancer comes from neural cells and is selected from the group consisting of medulloblastoma, neuroblastoma, ganglioma, primitive neuroectodermal tumors, and schwannoma.
  • the cancer involves the thalamus, hypothalamus, basal ganglia, pineal gland, midbrain, cerebellum, pons, spinal cord, or medulla.
  • the histone H3 mutation is H3.3 K27M or H3.1 K27M.
  • the cancer has a K27M mutation in one or more histone genes selected from H3F3A, H3F3B, HIST1H3A, HIST1H3B, HIST1H3C, HIST1H3D, HIST1H3E, HIST1H3F, HIST1H3G, HIST1H3H, HIST1H3I, or HIST1H3J.
  • DRD2 is overexpressed, DRD5 is underexpressed or both in cancerous tissue.
  • the compound is ONC201.
  • the subject is a human.
  • the subject is a domesticated pet.
  • the subject is a pediatric subject.
  • kits for treating or preventing cancer in a subject in need thereof comprising: administering to the subject in need of such treatment a pharmaceutical composition comprising a therapeutically effective amount a compound of formula (10) or an analog thereof, or a pharmaceutically acceptable salt thereof, wherein the cancer involves a midline structure of the brain.
  • the cancer involves the thalamus, hypothalamus, basal ganglia, pineal gland, midbrain, cerebellum, pons, spinal cord, or medulla.
  • the cancer is not a spinal cord tumor.
  • the cancer has a histone H3 mutation, wherein the histone H3 mutation is H3.3 K27M or H3.1 K27M.
  • the cancer has a histone H3 K27M mutation in one or more histone genes selected from H3F3A, H3F3B, HIST1H3A, HIST1H3B, HIST1H3C, HIST1H3D, HIST1H3E, HIST1H3F, HIST1H3G, HIST1H3H, HIST1H3I, or HIST1H3J.
  • DRD2 is overexpressed
  • DRD5 is underexpressed or both in cancerous tissue.
  • the compound is ONC201.
  • the subject is a human.
  • the subject is a domesticated pet.
  • the subject is a pediatric subject.
  • compositions and methods described herein are used to treat a pediatric cancer (e.g., pediatric solid tumors, pediatric sarcomas, pediatric Ewing’s sarcomas, pediatric gliomas, pediatric central nervous system cancers, pediatric neuroblastoma, pediatric leukemia and pediatric lymphoma).
  • a pediatric cancer e.g., pediatric solid tumors, pediatric sarcomas, pediatric Ewing’s sarcomas, pediatric gliomas, pediatric central nervous system cancers, pediatric neuroblastoma, pediatric leukemia and pediatric lymphoma.
  • compositions and methods described herein are used to treat a proliferative skin disorder such as psoriasis.
  • a proliferative skin disorder such as psoriasis.
  • the compositions and methods described herein are used to treat a cancer selected from the group consisting of Salivary Gland Cancer, Sarcoma, Sezary Syndrome, Skin Cancer, Ocular Cancer, Skin Carcinoma, Small Intestine Cancer, Soft Tissue Sarcoma, Squamous Cell Carcinoma, Squamous Neck Cancer with Occult Primary, and Supratentorial Primitive Neuroectodermal Tumors.
  • compositions and methods described herein are used to treat a cancer selected from the group consisting of T-Cell Lymphoma, Testicular Cancer, Throat Cancer, Thymoma and Thymic Carcinoma, Thyroid Cancer, Transitional Cell Cancer of the Renal Pelvis and Ureter, and Gestational Trophoblastic Tumor.
  • the compositions and methods described herein are used to treat a cancer selected from the group consisting of Carcinoma of Unknown Primary Site, Cancer of Unknown Primary Site, Unusual Cancers of Childhood, Transitional Cell Cancer of the Renal Pelvis and Ureter, Urethral Cancer, and Uterine Sarcoma.
  • compositions and methods described herein are used to treat cancer selected from the group consisting of Vaginal Cancer and Vulvar Cancer. In one embodiment, the compositions and methods described herein are used to treat a cancer selected from the group consisting of Wilms Tumor and Women’s Cancers.
  • the compositions and methods described herein are used as a first-line therapy (sometimes called primary therapy). In one embodiment, the compositions and methods described herein are used as a second- line therapy. In one embodiment, the compositions and methods described herein are used as a third-line therapy. In one embodiment, the compositions and methods described herein are used as a salvage therapy.
  • the term “salvage therapy” means a therapeutic agent that can be taken with any regimen after a subject’s initial treatment regimen has failed or after the subject’s condition has not responded to an initial treatment. In one embodiment, the compositions and methods described herein are used as a rescue therapy. In one embodiment, the compositions are used as a rescue agent to counteract the action of an initial treatment.
  • compositions are used as rescue agent that is administered to a subject who has developed resistance to a standard or an initial treatment.
  • the compositions and methods described herein are used as a neoadjuvant therapy.
  • a neoadjuvant therapy comprises administration of one or more of the therapeutic agents described herein to a subject before a main or first line treatment.
  • a neoadjuvant therapy reduces the size or extent of the cancer being treated before a main or first line treatment is administered to the subject undergoing treament.
  • the compositions and methods described herein are used as an adjuvant therapy.
  • an adjuvant therapy comprises administration of one or more therapeutic agents described herein to a subject, wherein the one or more therapeutic agent that modify the effect of other therapeutic agents that are already administered to the subject or are concurrently administered to the subject or subsequently administered to the subject.
  • compositions and methods described herein exhibit reduced chance of drug-drug interactions.
  • an imipridone such as ONC201, or an analog thereof are eliminated from the patient’s body before it can interact with another pharmaceutically active agent.
  • compositions and methods of described herein exhibit toxicity levels that facilitates combinations with other pharamaceutical agents.
  • a subject treated according to methods and using compositions described herein can be mammalian or non-mammalian.
  • a mammalian subject includes, but is not limited to, a human; a non-human primate; a rodent such as a mouse, rat, or guinea pig; a domesticated pet such as a cat or dog; a horse, cow, pig, sheep, goat, or rabbit.
  • a non-mammalian subject includes, but is not limited to, a bird such as a duck, goose, chicken, or turkey.
  • the subject is a human.
  • subjects can be either gender and any age.
  • the composition and methods can also be used to prevent cancer.
  • the composition and methods can also be used to stimulate the immune system.
  • compositions described herein are not limited to a particular age of the subject.
  • a subject treated according to methods and using compositions described herein is over 50 years old, over 55 years old, over 60 years old, or over 65 years old.
  • a subject treated according to methods and using compositions described herein is under 50 years old, under 55 years old, under 60 years old, or under 65 years old.
  • a subject treated according to methods and using compositions described herein is a pediatric patient.
  • the pediatric patient is younger than 18 years old, younger than 17 years old, younger than 16 years old, younger than 15 years old, younger than 14 years old, is younger than 13 years old, younger than 12 years old, younger than 11 years old, younger than 10 years old, younger than 9 years old, younger than 8 years old, younger than 7 years old, younger than 6 years old, younger than 5 years old, younger than 4 years old, younger than 3 years old, younger than 2 years old, younger than 1 year old.
  • the pediatric patient is younger than 12 months old, younger than 11 months old, younger than 10 months old, younger than 9 months old, younger than 8 months old, younger than 7 months old, younger than 6 months old, is younger than 5 months old, younger than 4 months old, younger than 3 months old, younger than 2 months old, younger than 1 month old. In one embodiment, the pediatric patient younger than 4 weeks old, younger than 3 weeks old, younger than 2 weeks old, younger than 1 weeks old. In one embodiment, the pediatric patient is younger than 7 days old, younger than 6 days old, younger than 5 days old, younger than 4 days old, younger than 3 days old, younger than 2 days old, or younger than 1 day old. In one embodiment, the pediatric patient is a neonate. In one embodiment, the pediatric patient is prematurely bom.
  • the patient is less than 45 kg in weight, less than 40 kg in weight, less than 35 kg in weight, less than 30 kg in weight, less than 25 kg in weight, less than 20 kg in weight, less than 15 kg in weight, less than 14 kg in weight, less than 10 kg in weight, less than 5 kg in weight, less than 4 kg in weight, less than 3 kg in weight, less than 2 kg in weight, or less than 1 kg in weight.
  • the subject has received at least one prior therapeutic agent. In one embodiment the subject has received at least two, at least three, or at least four prior therapeutic agents.
  • the prior therapeutic agent is ibrutinib, bortezomib, carfilzomib, temozolomide, bevacizumab, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone, cytarabine, cisplatin, rituximab, 5 -fluorouracil, oxaliplatin, leucovorin, or lenalidomide.
  • the subject has been treated with radiation. In one embodiment, the subject has been treated with surgery. In one embodiment, the subject has been treated with adoptive T-cell therapy.
  • the cancer no longer responds to treatment with ibrutinib, bortezomib, carfilzomib, temozolomide, bevacizumab, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone, cytarabine, cisplatin, rituximab, 5-fluorouracil, oxaliplatin, leucovorin, lenalidomide, radiation, surgery, or a combination thereof.
  • the compositions and methods described herein have a dose response relation in cancer cells that is different from the dose response relation of the same compositions and methods in normal cells.
  • the dose response relation of ONC201 on proliferation and cell death in normal and tumor cells was determined by measuring cell viability following treatment with ONC201 at various concentrations for 72 hours.
  • the tumors tested included a human colon cancer cell line (HCT116), breast tumor cell line (MDA-MB-231), and a human primary glioblastoma cell line (U87).
  • the normal cells tested included human foreskin fibroblasts (HFF), human fetal lung fibroblast (MRC-5) cells, and a human lung fibroblast cell line (WI-38).
  • Doxorubicin was used as a positive control at 1
  • Cell viability of normal cells tested was at least about 75% at about 1-5 mg/mL of ONC201, whereas viability of tumor cells was significantly lower (e.g. , at or below 50%) at the same ONC201 concentration.
  • ONC201 concentration increased beyond about 5 mg/mL viability of tumor cells fell to below 25%, whereas viability of normal cells remained at about 75%.
  • Cell viability assays in human fetal lung fibroblast (MRC-5) cells were performed following 72 hour treatment with compound (1) (5
  • compositions and methods described herein are useful for treating cancer in a subject.
  • compositions and methods described herein are useful for treating cancer in a human subject.
  • the treatment method comprises administering to a subject in need of such treatment, a pharmaceutically effective amount of an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof and a pharmaceutically acceptable carrier.
  • the treatment method comprises administering to a subject in need of such treatment: (i) a first therapeutic agent including an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in combination with (ii) a second therapeutic agent, wherein the first and the second therapeutic agents are administered either simultaneously or sequentially.
  • the second therapeutic agent can be any suitable therapeutic agent, including a pharmaceutically active agent disclosed herein.
  • a pharmaceutically acceptable ONC201 salt includes the di-hydrochloride salt below:
  • the treatment method comprises administering a synergistic pharmaceutical combination, either simultaneously or sequentially, to a subject in need of such treatment, wherein the synergistic pharmaceutical combination comprises (i) a first therapeutic agent comprising an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof; and (ii) a second therapeutic agent.
  • the treatment method comprises administering to a subject in need of such treatment, either simultaneously or sequentially, therapeutically synergistic effective amounts of the first therapeutic agent in combination with the second therapeutic agent.
  • the treatment method comprises administering to a subject in need of such treatment, an effective amount of the first therapeutic agent in combination with an effective amount of the second therapeutic agent, wherein the combination provides a synergistic effect in the in vivo treatment of a cancer sensitive to the combination, and wherein the first and the second therapeutic agents are administered either simultaneously or sequentially.
  • the treatment method comprises administering to a subject in need of such treatment, an effective amount of the first therapeutic agent in combination with an effective amount of a second therapeutic agent, wherein the combination provides a synergistic effect in the in vivo treatment of a minimal residual disease sensitive to the combination, and wherein the first and second therapeutic agents are administered either simultaneously or sequentially.
  • the second agent is given before or prior to the first agent.
  • the treatment targets a cancer selected from the group consisting of solid tumors, liquid tumors, lymphomas, leukemias, or myelomas.
  • the treatment targets a solid tumor, wherein the solid tumor is selected from the group consisting of: Cervical Cancer, Endometrial Cancer, Extracranial Germ Cell Tumor; Extragonadal Germ Cell Tumor; Germ Cell Tumor; Gestational Trophoblastic Tumor; Ovarian Cancer, Ovarian Germ Cell Tumor, Ovarian Epithelial Cancer, and Ovarian Low Malignant Potential Tumor; Penile Cancer, Prostate Cancer; Pregnancy and Breast Cancer; high grade prostate cancer; medium grade prostate cancer; low grade prostate cancer; castration-resistant prostate cancer; Breast Cancer; Bile Duct Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Hepatocellular (Liver) Cancer; Kidney (Renal Cell) Cancer; Liver Cancer, Renal Cell (Kidney) Cancer, Renal Pelvis and Ureter; Basal Cell Carcinoma; Basal Cell Nevus Syndrome, Gorlin-Nevus Syndrome, Melanoma, Merkel Cell Carcinoma
  • the treatment targets a lymphoma selected from the group consisting of: diffuse large B-cell lymphoma, AIDS-Related Lymphoma, Cutaneous T-Cell Lymphoma, Sezary syndrome, mycosis fungoides (MF); Histiocytosis; Burkitt Lymphoma, and Central Nervous System Lymphoma; Non-Hodgkin Lymphoma, and Primary Central Nervous System Lymphoma, Hodgkin Lymphoma, Waldenstrom’s macroglobulinemia; Mycosis Fungoides; Primary Central Nervous System Lymphoma; lymphoplasmacytic lymphoma, and Primary Central Nervous System Lymphoma.
  • a lymphoma selected from the group consisting of: diffuse large B-cell lymphoma, AIDS-Related Lymphoma, Cutaneous T-Cell Lymphoma, Sezary syndrome, mycosis fungoides (MF); Histiocytosis; Burkitt Lymphoma,
  • the treatment targets a Non-Hodgkin’ s lymphoma (NHL) selected from the group consisting of: mantle cell lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, marginal zone lymphoma, small lymphocytic lymphoma, lyphoplasmacytic NHL, Waldenstrom’s macroglobulinaemia, and skin lymphomas.
  • NHL Non-Hodgkin’ s lymphoma
  • the treatment method targets a leukemia selected from the group consisting of: Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Chronic Myeloproliferative Disorders; Hairy Cell Leukemia; Acute Myeloid Leukemia (AML); Chronic Myelogenous Leukemia (CML); and Langerhans Cell Histiocytosis.
  • the treatment targets an acute leukemia selected from the group consisting of: acute lymphotyte leukemia, acute myeloid leukemia, chronic lymphoblasitc leukemia, chronic myeloid leukemia, myelodysplastic syndrome, and myeloproliferative disease.
  • the treatment targets a myeloma selected from the group consisting of: IgA myeloma; IgG myeloma; IgM myeloma; IgD myeloma; IgE myeloma; light chain myeloma; non secretory myeloma; complex karyotype, blastic phase leukemia; Multiple Myeloma/Plasma Cell Neoplasm, Multiple Myeloma, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Neoplasms, and Myeloproliferative Disorders.
  • a myeloma selected from the group consisting of: IgA myeloma; IgG myeloma; IgM myeloma; IgD myeloma; IgE myeloma; light chain myeloma; non secretory myeloma;
  • the treatment targets a peripheral nervous system tumor. In some cases, the treatment targets a paraganglioma. In some cases, it targets a pheochromocytoma. [00193] In one embodiment, treatment of cancer comprises prevention of tumor growth in a cancer subject. In one embodiment, treatment of cancer comprises prevention of formation of cancer metastases in a cancer subject. In one embodiment, treatment of cancer comprises targeted treatment of minimal residual disease in a cancer subject known to have the minimal residual disease in a cancer or a subject at risk for having minimal residual disease.
  • Disseminated tumor cells may be in their dormant state and often cannot be attacked by chemotherapy (radiotherapy). A thus treated patient seemingly is in a healed state, and refered to as “minimal residual disease.” Nevertheless, the dormant tumor cells have a potential to form metastases if they become metastasising cells due to a growth stimulus after a longer dormant state.
  • minimal residual disease denotes a small number of cancer cells that remain in a subject during or after treatment when the subject is in remission (exhibiting no symptoms or signs of the disease).
  • the methods described herein are preferably applied to a form of the diseases listed herein, including adult and childhood forms of these diseases.
  • the treatment method is useful for treating an autoimmune disease.
  • Autoimmune diseases include, but are not limited to alopecia areata, antiphospholipid, autoimmune hepatits, celiac disease, diabetes type 1, Graves’ disease, Guillain-Barre syndrome, Hashimoto’s disease, hemolytic anemia, idiopathic thrombocytopenic purpura, inflammatory bowel disease, inflammatory myopathies, multiple sclerosis, primary biliary cirrhosis, psoriasis, rheumatoid arthritis, scleroderma, Sjogren’s syndrome, systemic lupus erythematosus, and vitiligo.
  • the treatment method is useful for treating autoimmune and inflammatory disorders of the peripheral nerve system such as amyotrophic lateral sclerosis (Lou Gehrig’s disease), based on various causes such as metabolic disorders that include diabetes, B12 and folate vitamin deficiencies, chemotherapy medications and medicines used to treat HIV, poisons that cause peripheral nerve damage, cancers that develop peripheral neuropathies as well as paraneoplastic syndromes, alcohol abuse, chronic kidney disease, injuries that cause compression on nerves and other lesions, infections such as Lyme disease, Guillain Barre syndrome, connective tissue disease, rheumatoid arthritis, Sjogren’s syndrome, systemic lupus erythematosus, certain inflammatory conditions such as sarcoidosis, coeliac disease, hereditary diseases such as charcot marie tooth syndrome, Friedreich’s ataxia, and/or idiopathic where no specific cause is found but inflammatory and/or autoimmune mechanisms are the cause of onset.
  • diseases such as sarcoidosis, coeliac disease, her
  • the treatment method is useful for treating autoimmune and inflammatory disorders with ocular manifestations.
  • ocular manifestations include, but are not limited to, ocular cicatricial pemphigoid, Mooren’s corneal ulcer, various forms of uveitis, rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa, relapsing polychondritis, Wegener’s granulomatosis, scleroderma, Behcet’s disease, Reiter’s disease, inflammatory bowel disease (ulcerative colitis and Crohn’s disease) and ankylosing spondylitis, retinitis pigmentosa, macular degeneration, keratoconjunctivitis sicca, scleritis, episcleritis, keratitis, peripheral corneal ulceration, and less common entities such as choroiditis, retinal vasculitis, episcle
  • the treatment method is useful for treating acute allograft rejection in transplant patients. In one embodiment, the treatment method is useful for treating ischemic stroke. In one embodiment, the treatment method is useful for treating inflammatory diseases including arthritis, psoriasis, asthma, and colitis.
  • a therapeutic agent includes a pharmaceutically acceptable mono-salt of ONC201 or an analog thereof (e.g., a compound of formula (10)).
  • a therapeutic agent includes a pharmaceutically acceptable ONC201 di-salt or an analog thereof (e.g., a compound of formula (10)).
  • some of the analogs can be tri-salts
  • a therapeutic agent includes ONC201 or an analog thereof (e.g.
  • a pharmaceutically acceptable mono- or di-salt selected from the group consisting of hydrochloride, hydrobromide, hydrogensulphate, sulfates, phosphates, fumarates, succinates, oxalates and lactates, bisulfates, hydroxyl, tartrate, nitrate, citrate, bitartrate, carbonate, malate, maleate, fumarate sulfonate, methylsulfonate
  • a therapeutic agent includes ONC201 or an analog thereof in the form of a pharmaceutically acceptable mono- or di-salt selected from p-toluene-sulfonate, benzenesulfonate, methanesulfonate, oxalate, succinate, tartrate, citrate, fumarate and maleate.
  • a therapeutic agent includes ONC201 or an analog thereof in the form of a pharmaceutically acceptable mono- or di-salt having a counter ion selected from the group consisting of ammonium, sodium, potassium, calcium, magnesium, zinc, lithium, and/or with counter-ions such as methylamino, dimethylamino, diethylamino, triethylamino counter-ions, and combinations thereof.
  • a therapeutic agent includes a compound described herein in the form of a halide di-salt, such as a di-hydrochloride salt or a dihydrobromide salt.
  • the second therapeutic agent includes an anti -cancer agent.
  • the second therapeutic agent is selected from acivicin, aclarubicin, acodazole, acronine, adozelesin, aldesleukin, alitretinoin, allopurinol, altretamine, ambomycin, ametantrone, amifostine, aminoglutethimide, amsacrine, anastrozole, anthramycin, arsenic trioxide, asparaginase, asperlin, azacitidine, azetepa, azotomycin, batimastat, benzodepa, bevacizumab, bicalutamide, bisantrene, bisnafide dimesylate, bizelesin, bleomycin, brequinar, bropirimine, busulfan, cactinomycin, calusterone, capecitabine, caracemide,
  • the second therapeutic agent is selected, from hormone analogs and antihormones, aromatase inhibitors, LHRH agonists and antagonists, inhibitors of growth factors, growth factor antibodies, growth factor receptor antibodies, tyrosine kinase inhibitors; antimetabolites; antitumour antibiotics; platinum derivatives; alkylation agents; antimitotic agents; tubuline inhibitors; PARP inhibitors, topoisomerase inhibitors, serine/threonine kinase inhibitors, tyrosine kinase inhibitors, protein protein interaction inhibitors, MEK inhibitors, ERK inhibitors, IGF-1R inhibitors, ErbB receptor inhibitors, rapamycin analogs, amifostin, anagrelid, clodronat, filgrastin, interferon, interferon a, leucovorin, rituximab, procarbazine, levamisole, mesna, mitotane, pamidronate and por
  • the second therapeutic agent is selected from tamoxifen, toremifene, raloxifene, fulvestrant, megestrol acetate, flutamide, nilutamide, bicalutamide, aminoglutethimide, cyproterone acetate, finasteride, buserelin acetate, fludrocortisone, fluoxymesterone, medroxy-progesterone, octreotide, and combinations thereof.
  • the second therapeutic agent is selected from LHRH agonists and LHRH antagonists.
  • a LHRH agonist is selected from goserelin acetate, luprolide acetate, triptorelin pamoate and combinations thereof.
  • the second therapeutic agent includes a LHRH antagonist is selected from Degarelix, Cetrorelix, Abarelix, Ozarelix, Degarelix combinations thereof.
  • the second therapeutic agent includes an inhibitor of a growth factor.
  • the inhibitor of a growth factor is selected from inhibitors of: platelet derived growth factor (PDGF), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insuline-like growth factors (IGF), human epidermal growth factor (HER), hepatocyte growth factor (HGF), and combinations thereof.
  • PDGF platelet derived growth factor
  • FGF fibroblast growth factor
  • VEGF vascular endothelial growth factor
  • EGF epidermal growth factor
  • IGF insuline-like growth factors
  • HER human epidermal growth factor
  • HGF hepatocyte growth factor
  • the human epidermal growth factor (HER) is selected from HER2, HER3, and HER4.
  • the second therapeutic agent includes a tyrosine kinase inhibitor.
  • the tyrosine kinase inhibitor is selected from cetuximab, gefitinib, imatinib, lapatinib and trastuzumab, and combinations thereof.
  • the second therapeutic agent includes an aromatase inhibitor.
  • the aromatase inhibitor is selected from anastrozole, letrozole, liarozole, vorozole, exemestane, atamestane, and combinations thereof.
  • the second therapeutic agent includes an antimetabolite.
  • the antimetabolite comprises an antifolate.
  • the antifolate is selected from methotrexate, raltitrexed, pyrimidine analogs, and combinations thereof.
  • the antimetabolite is a pyrimidine analog.
  • the pyrimidine analog is selected from 5-fluorouracil, capecitabin, gemcitabin, and combination thereof.
  • the antimetabolite is a purine analog or an adenosine analog.
  • the purine analog or adenosine analog is selected from mercaptopurine, thioguanine, cladribine and pentostatin, cytarabine, fludarabine, and combinations thereof.
  • the second therapeutic agent includes an antitumour antibiotic.
  • the antitumor antibiotic is selected from anthracyclins, doxorubicin, daunorubicin, epirubicin and idarubicin, mitomycin-C, bleomycin, dactinomycin, plicamycin, streptozocin and combinations thereof.
  • the second therapeutic agent includes a platinum derivative.
  • the platinum derivative is selected from cisplatin, oxaliplatin, carboplatin and combinations thereof.
  • the second therapeutic agent includes an alkylation agent.
  • the alkylation agent is selected from estramustin, meclorethamine, melphalan, chlorambucil, busulphan, dacarbazin, cyclophosphamide, ifosfamide, temozolomide, nitrosoureas, and combinations thereof.
  • the second therapeutic agent includes a nitrosourea.
  • the nitrosourea is selected from carmustin, lomustin, thiotepa, and combinations thereof.
  • the second therapeutic agent includes an antimitotic agent.
  • the antimitotic agent is selected from Vinca alkaloids and taxanes.
  • the taxane is selected from paclitaxel, docetaxel, and combinations thereof.
  • the Vinca alkaloids are selected from vinblastine, vindesin, vinorelbin, vincristine, and combinations thereof.
  • the second therapeutic agent includes a topoisomerase inhibitor. In one embodiment, the topoisomerase inhibitor is an epipodophyllotoxin.
  • the topoisomerase epipodophyllotoxin is selected from etoposide, etopophos, teniposide, amsacrin, topotecan, irinotecan, mitoxantron, and combinations thereof.
  • the second therapeutic agent includes a serine/threonine kinase inhibitor.
  • the serine/threonine kinase inhibitor is selected from PDK 1 inhibitors, B-Raf inhibitors, mTOR inhibitors, mTORCl inhibitors, PI3K inhibitors, dual mT0R/PI3K inhibitors, STK 33 inhibitors, AKT inhibitors, PLK 1 inhibitors, inhibitors of CDKs, Aurora kinase inhibitors, and combinations thereof.
  • the second therapeutic agent includes a tyrosine kinase inhibitor.
  • the second therapeutic agent includes a PTK2/FAK inhibitor.
  • the second therapeutic agent includes a protein protein interaction inhibitor.
  • the protein protein interaction inhibitor is selected from IAP, Mcl-1, MDM2/MDMX and combinations thereof.
  • the second therapeutic agent includes a rapamycin analog.
  • the rapamycin analog is selected from everolimus, temsirolimus, ridaforolimus, sirolimus, and combinations thereof.
  • the second therapeutic agent is selected from amifostin, anagrelid, clodronat, filgrastin, interferon, interferon a, leucovorin, rituximab, procarbazine, levamisole, mesna, mitotane, pamidronate and porfimer, and combinations thereof.
  • the second therapeutic agent is selected from 2-chlorodesoxyadenosine, 2-fluorodesoxy-cytidine, 2-methoxyoestradiol, 2C4,3-alethine, 131-1-TM-601, 3CPA, 7-ethyl-10- hydroxycamptothecin, 16-aza-epothilone B, A 105972, A 204197, abiraterone, aldesleukin, alitretinoin, allovectin-7, altretamine, alvocidib, amonafide, anthrapyrazole, AG-2037, AP- 5280, apaziquone, apomine, aranose, arglabin, arzoxifene, atamestane, atrasentan, auristatin PE, ABT-199 (Venetoclax), ABT-263 (Navitoclax), AVLB, AZ10992, ABX-EGF, AMG- 479
  • the other therapeutic agent comprises a steroid, including dexamethasone, prednisolone, methyl prednisolone, prednisone, hydrocortisone, triamcinolone, betamethasone, and cortivazol.
  • the other therapeutic agent comprises an anti-emetic.
  • Anti-emetics include, but are not limited to, 5-HT3 receptor agonists (such as dolasetron, granisetron, ondansetron, tropisetron, palonosetron, and mirtazapine), dopamine agonists (such as domperidone, olanzapine, droperidol, haloperidol, chlorpromazine, prochlorperazine, alizapride, prochlorperazine, and metoclopramide), NK1 receptor antagonists (such as aprepitant and casopitant), antihistamines (such as cyclizine, diphenhydramine, dimenhydrinate, doxylamine, meclizine, promethazine, hydroxyzine), cannabinoids (such as cannabis, dronabinol, nabilone, and sativex), benzodiazepines (such as midazolam and lorazepam), anticholinergics (such as hyoscine), trime
  • compositions may be administered to a subject via any suitable administration route.
  • the pharmaceutical composition is administered to a subject orally, parenterally, transdermally or transmucosally.
  • the pharmaceutical composition is administered to a subject parenterally.
  • the pharmaceutical composition is administered to a subject via a parenteral administration route selected from intravenous (IV), subcutaneous (SC), and intramuscular (IM).
  • the pharmaceutical composition is administered to a subject via a route of administration selected from rectal and transdermal.
  • the pharmaceutical composition is administered to a subject in a dosage form selected from the group consisting of sterile solutions, suspensions, suppositories, tablets and capsules.
  • the pharmaceutical composition is administered to a subject in an oral dosage form selected from the group consisting of a tablet, caplet, capsule, lozenge, syrup, liquid, suspension and elixir. In one embodiment, the pharmaceutical composition is administered to a subject in an oral dosage form selected from the group consisting of tablets, hard shell capsules, soft gelatin capsules, beads, granules, aggregates, powders, gels, solids and semi-solids.
  • the pharmaceutical composition is administered to a subject as a dosage form selected from sustained release, controlled release, delayed release and response release forms.
  • the pharmaceutical composition is administered to a subject once daily. In one embodiment, the pharmaceutical composition is administered to a subject accoridng to an infrequent dosing regimen (e.g., administered once per week or less frequently). In one embodiment, the pharmaceutical composition is administered to a subject accoridng to a frequent dosing regimen (e.g., administered more than once per week). In one embodiment, the pharmaceutical composition is administered to a subject once weekly. In one embodiment, the pharmaceutical composition is administered to a subject once every four weeks. In one embodiment, the pharmaceutical composition is administered to a subject twice a week. In one embodiment, the pharmaceutical composition is administered to a subject once every two weeks. In one embodiment, the pharmaceutical composition is administered to a subject once every three weeks. In one embodiment, the pharmaceutical composition is administered to a subject in a repeated cycle of once weekly, once every two weeks, once every three weeks, once every four weeks or combinations thereof.
  • the treatment method comprises administering to a subject in need of such treatment: (i) a first therapeutic agent including a compound comprising an imipridone, such as ONC201, or an analog thereof, or a pharmaceutically acceptable salt thereof in combination with (ii) a second therapeutic agent, wherein the first therapeutic agent and the second therapeutic agent are administered either simultaneously or sequentially; and further comprises assaying the expression of an endoplasmic reticulum (ER) stress response gene in a biological sample.
  • the endoplasmic reticulum stress response gene is selected from the group that includes, but is not limited to, C/EBP-Homologous Protein (CHOP), Activating Transcription Factor 3 (ATF3) and both CHOP and ATF3.
  • the endoplasmic reticulum stress response gene is selected from the group that includes, but is not limited to, ATF3, Activating Transcription Factor 4 (ATF4) CHOP, IRE1, Binding immunoglobulin protein (BiP), Eukaryotic translation initiation factor 2A (eIF2a), X-box binding protein 1 (XBP1).
  • ATF3 Activating Transcription Factor 4
  • IRE1 Binding immunoglobulin protein
  • eIF2a Eukaryotic translation initiation factor 2A
  • XBP1 X-box binding protein 1
  • the biological sample may be tumor, peripheral blood mononuclear cells, or skin biopsy.
  • the biological sample may be obtained before, during, or after drug administration.
  • the treatment method further comprises adjusting a dose of the first therapeutic agent to achieve induction of about 50%, 75%, 100%, 125%, 150%, 175%, 200%, 225%, 250%, 275%, 300%, 325%, 350%, 375%, 400%, 425%, 450%, 475%, 500%, 525%, 550%, 575%, 600%, or greater than 600% of one or more ER stress gene.
  • the treatment method further comprises adjusting a dose of the first therapeutic agent to achieve induction of about 50% to about 100%, about 100% to about 150%, about 150% to about 200%, about 200% to about 250%, about 250% to about 300%, about 300% to about 350%, about 350% to about 400%, about 400% to about 450%, about 450% to about 500%, about 500% to about 550%, about 550% to about 600%, or greater than 600% of ER stress genes.
  • the treatment method further comprises adjusting a dose of the first therapeutic agent to achieve induction of about 50% to about 100%, about 100% to about 200%, about 200% to about 300%, about 300% to about 400%, about 400% to about 500%, about 500% to about 600%, or greater than 600% of ER stress genes.
  • the treatment method comprises administering to a subject in need of such treatment: (i) a first therapeutic agent including a compound comprising an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof in combination with (ii) a second therapeutic agent, wherein the first therapeutic agent and the second therapeutic agent are administered either simultaneously or sequentially; and further comprises assaying the expression of proteasomal activity in a biological sample.
  • a first therapeutic agent including a compound comprising an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof in combination with (ii) a second therapeutic agent, wherein the first therapeutic agent and the second therapeutic agent are administered either simultaneously or sequentially; and further comprises assaying the expression of proteasomal activity in a biological sample.
  • the proteasomal activity may be chymotrysin-like, trypsin-like, and/or caspase-like activity.
  • the biological sample may be tumor, peripheral blood mononuclear cells, or skin cells. The
  • the treatment method further comprises adjusting the dose to achieve inhibition of about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, about 95%, or about 100% of the proteasomal activity.
  • the treatment method further comprises adjusting the dose to achieve inhibition of at least 20%, at least 25%, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, or at least 95% of the proteasomal activity.
  • the treatment method further comprises adjusting the dose to achieve inhibition of about 20% to about 30%, about 30% to about 40%, about 40% to about 50%, about 50% to about 60%, about 60% to about 70%, about 70% to about 80%, about 80% to about 90%, or greater than 90% of the proteasomal activity.
  • treatment methods which comprise administering to a subject in need of such treatment a combination of a first therapeutic agent including an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof (e.g., a di-salt or tri-salt) and a second therapeutic agent, the method comprising:
  • the predetermined waiting time is chosen so as to obtain a delayed therapeutic effect of the first therapeutic agent without an increased risk of possible combined toxic effects of the first and second therapeutic agents.
  • the predetermined waiting time is determined based on the clearance rate of the compound of the first therapeutic agent or a metabolite thereof.
  • the predetermined waiting time is determined by a quantitative assessment of renal function and parameters of renal.
  • the predetermined waiting time is determined by an assay for the determination of renal function, wherein the assay is selected from the group consisting of serum level the compound of the first therapeutic agent or a metabolite thereof; clearance rate of the compound of the first therapeutic agent or a metabolite thereof; 24-hour urinary clearance of the compound of the first therapeutic agent or a metabolite thereof.
  • the predetermined waiting time substantially equals the time required for systemic clearance of the compound of the first therapeutic agent or a metabolite thereof from the subject’s body. In one embodiment, the predetermined waiting time substantially equals the time required for renal clearance of the compound of the first therapeutic agent or a metabolite thereof from the subject’s body. In one embodiment, the predetermined waiting time substantially equals the time required for hepatic clearance of the compound of the first therapeutic agent or a metabolite thereof from the subject’s body. In one embodiment, the predetermined waiting time substantially equals the time required for total clearance of the compound of the first therapeutic agent or a metabolite thereof from the subject’s body. In one embodiment, the predetermined waiting time is about 4 hours.
  • the waiting time is 1 day. In one embodiment, the waiting time is until Cmax of the compound of the first therapeutic agent has passed. In other embodiments, the waiting time is after most of the adverse events are resolved or are resolving. In one embodiment, the predetermined waiting time is about 2 days, about 3 days, about 4 days, about 5 days, about 6 days, or about 7 days. In one embodiment, the predetermined waiting time is a range of about 1-7 days, about 1-6 days, about 1-5 days, about 1-4 days, about 1-3 days, or about 1 to 2 days. In one embodiment, the waiting time is up to 3 weeks. The preceeding are considered “therapeutic time periods.”
  • timing for administration of the first therapeutic agent or drug can be after the Cmax of the second therapeutic agent (i.e. , the first administered drug) has passed.
  • administration of the first therapeutic agent can be after most or substantially all of the first drug has been eliminated from the body or the toxicity effects for the first drug are resolved or are resolving.
  • the treatment method further comprises monitoring levels of the compound of the first therapeutic agent or a metabolite thereof in the subject using pharmacokinetic profiling.
  • monitoring levels of the compound of the first therapeutic agent or a metabolite thereof in the subject using pharmacokinetic profiling comprises constructing a pharmacokinetic profile of the compound of the first therapeutic agent or a metabolite thereof for the subject using concentrations of the compound of the first therapeutic agent or a metabolite thereof in at least two samples obtained from the subject at time points suitable to construct a pharmacokinetic profile.
  • samples are collected from the subject at point-of-care or point of use by sampling or self-sampling on point-of-care devices or point of use devices or on matrices suitable for storage of the samples prior to quantitation in a laboratory.
  • each of the point-of-care devices or point of use devices is capable of quantitating the compound of the first therapeutic agent or a metabolite thereof.
  • one or more samples are collected from the subject at point-of-care or point of use by biopsy device for analysis at the point-of-care or point of use devices or for storage prior to analysis by a laboratory.
  • a biopsy is taken after a time interval of 3-8 hours following administration the first therapeutic agent to the subject.
  • a biopsy is taken after a time interval of 3-24 hours following administration of the first therapeutic agent to the subject.
  • a biopsy is taken after a time interval of 8-24 hours following administration of the first therapeutic agent thereof to the subject.
  • a biopsy is taken after a time i nterval of 2 days following administration of the first therapeutic agent to the subject. In one embodiment, a biopsy is taken after a time interval of 3 days following administration of the first therapeutic agent to the subject. In one embodiment, a biopsy is taken after a time interval of 4 days following administration of the first therapeutic agent to the subject. In one embodiment, a biopsy is taken after a time interval of 1-7 days following administration of the first therapeutic agent.
  • the pharmacokinetic profile includes pharmacokinetic parameters suitable for guiding dosing of the first therapeutic agent for the subject being treated.
  • the Cmax of the first therapeutic agent following its administration to the subject ranges from about 1000 ng/dL to 1500 ng/dL for a therapeutic time period. In one embodiment, Cmax is less than 1500 ng/dL and greater than 85 ng/dL for a therapeutic time period. In one embodiment, the Cmax of the first therapeutic following its administration to the subject ranges from about 1000 ng/mL to 1500 ng/mL for a therapeutic time period. In one embodiment, Cmax is less than 1500 ng/mL and greater than 85 ng/mL for a therapeutic time period.
  • maximum concentration of the first therapeutic agent in blood (whole blood, plasma, or serum) (“C max ”) of a subject after administeration is a Cmax of from about 1000, 1010, 1020, 1030, 1040, 1050, 1060, 1070, 1080, 1090, 1100, 1110, 1120, 1130, 1140, 1150, 1160, 1170, 1180, 1190, 1200, 1210, 1220, 1230, 1240, 1250, 1260, 1270, 1280, 1290, 1300, 1310, 1320, 1330, 1340, 1350, 1360, 1370, 1380, 1390, 1400, 1410, 1420, 1430,
  • maximum concentration of the first therapeutic agent in blood (whole blood, plasma, or serum) (“C ma x”) after its administration is a C max of from about 1000, 1010, 1020, 1030, 1040, 1050, 1060, 1070, 1080, 1090, 1100, 1110, 1120, 1130, 1140, 1150, 1160, 1170, 1180, 1190, 1200, 1210, 1220, 1230, 1240, 1250, 1260, 1270, 1280, 1290, 1300, 1310, 1320, 1330, 1340, 1350, 1360, 1370, 1380, 1390, 1400, 1410, 1420, 1430, 1440,
  • 140 140. 141, 142, 143, 144, 145, 146, 147, 148, or 149 ng/mL to about 150 ng/mL; or from about 10, 10.5, 11, 11.5, 120, 12.5, 13, 13.5, 14, or 14.5 ng/mL to about 15 ng/mL.
  • maximum concentration of the first therapeutic agent in blood (whole blood, plasma, or serum) (“Cmax”) of a subject after its administration is selected from about 1000, 1010, 1020, 1030, 1040, 1050, 1060, 1070, 1080, 1090, 1100, 1110, 1120, 1130, 1140, 1150, 1160, 1170, 1180, 1190, 1200, 1210, 1220, 1230, 1240, 1250, 1260, 1270, 1280, 1290, 1300, 1310, 1320, 1330, 1340, 1350, 1360, 1370, 1380, 1390, 1400, 1410, 1420, 1430, 1440, 1450, 1460, 1470, 1480, or 1490 ng/dL.
  • the C max of the first therapeutic agent in blood (whole blood, plasma, or serum) (“Cmax”) after its administration is selected from about 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, or 149 ng/dL.
  • the Cmax of the first therapeutic agent after its administration is selected from about 10, 10.5, 11, 11.5, 120, 12.5, 13, 13.5, 14, or 14.5 ng/dL.
  • the Cmax of the first therapeutic agent after its administration is selected from about 1000, 1010, 1020, 1030, 1040, 1050, 1060, 1070, 1080, 1090, 1100, 1110, 1120, 1130, 1140, 1150, 1160, 1170, 1180, 1190, 1200, 1210, 1220, 1230, 1240, 1250, 1260, 1270, 1280, 1290, 1300, 1310, 1320, 1330, 1340, 1350, 1360, 1370, 1380, 1390, 1400, 1410, 1420, 1430, 1440, 1450, 1460, 1470, 1480, or 1490 ng/mL.
  • the Cmax of the first therapeutic agent after its administration is selected from about 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, or 149 ng/mL.
  • the Cmax of the first therapeutic agent after its administration is selected from about 10, 10.5, 11, 11.5, 120, 12.5, 13, 13.5, 14, or 14.5 ng/mL.
  • the Cmax of the first therapeutic agent after its administration is selected from about 85, 95, 105, 115, 125, 135, 145, 155, 165, 175, 185, 195, 205, 215, 225, 235, 245, 255, 265, 275, 285, 295, 305, 315, 325, 335, 345, 355, 365, 375, 385, 395, 405,
  • the Cmax of the first therapeutic agent after its administration is selected from about 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60,
  • the C m ax of the first therapeutic agent after its administration is selected from about 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, or 14.5 ng/dL.
  • the Cmax of the first therapeutic agent after its administration is selected from about 85, 95, 105, 115, 125, 135, 145, 155, 165, 175, 185, 195, 205, 215, 225, 235, 245, 255, 265, 275, 285, 295, 305, 315, 325, 335, 345, 355, 365, 375, 385, 395, 405,
  • the Cmax of the first therapeutic after its administration is selected from about 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37,
  • the C ma x of the first therapeutic agent after its administration is selected from about 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, or 14.5 ng/mL.
  • the Cmax of the first therapeutic agent after administering it to a subject ranges from about 85 ng/dL to 1500 ng/dL; from about 8.5 ng/dL to 150 ng/dL; or from about 0.85 ng/dL to 15 ng/dL.
  • the Cmax of the first therapeutic agent in the blood (whole blood, plasma, or serum) after its administration is selected from about 85, 95, 105, 115, 125, 135, 145, 155, 165, 175, 185, 195, 205, 215, 225, 235, 245, 255, 265, 275, 285, 295, 305, 315, 325, 335, 345, 355, 365, 375, 385, 395, 405, 415, 425, 435, 445, 455, 465, 475, 485, 495, 505, 515, 525, 535, 545, 555, 565, 575, 585, 595, 605, 615, 625, 635, 645, 655, 665, 675, 685, 695, 705, 715, 725, 735, 745, 755, 765, 775, 785, 795, 805, 815, 825, 835, 845, 855, 865, 875,
  • the C max of the first therapeutic agent after its administration ranges from about 85 ng/mL to 1500 ng/mL; from about 8.5 ng/mL to 150 ng/mL; or from about 0.85 ng/mL to 15 ng/mL.
  • the Cmax of the first therapeutic after its administration is selected from about 85, 95, 105, 115, 125, 135, 145, 155, 165, 175, 185, 195, 205, 215, 225, 235, 245, 255, 265, 275, 285, 295, 305, 315, 325, 335, 345, 355, 365,
  • the total drug exposure over time measured as the area under the curve (“AUC”) of a plot of the drug’s concentration in blood (whole blood, plasma, or serum) of a subject following administration of the drug against time after administration of the drug ranges from about 150 ng hr/mL to about 8000 ng hr/mL; from about 15 ng hr/mL to about 800 ng hr/mL; or from about 1.5 ng hr/mL to about 80 ng hr/mL.
  • AUC is less than 8000 ng hr/mL and is greater than or equal to 150 ng hr/mL.
  • AUC is less than 800 ng hr/mL and is greater than or equal to 15 ng hr/mL. In one embodiment, AUC is less than 80 ng hr/mL and is greater than or equal to 1.5 ng hr/mL. [00226] In one embodiment, the total drug exposure over time is an AUC of from about 100 ng hr/mL to about 8000 ng hr/mL; from about 10 ng hr/mL to about 800 ng hr/mL; or from about 1 ng hr/mL to about 80 ng hr/mL.
  • the total drug exposure over time is an AUC of from about from about 150, 200, 400, 600, 800, 1000, 1200, 1400, 1600, 1800, 2000, 2200, 2400, 2600, 2800, 3000, 3200, 3400, 3600, 3800, 4000, 4200, 4400, 4600, 4800, 5000, 5200, 5400, 5600, 5800, 6000, 6200, 6400, 6600, 6800, 7000, 7200, 7400, 7600, or 7800 ng hr/mL to about 8000 ng hr/mL.
  • the total drug exposure over time is an AUC of from about 15, 20, 40, 60, 80, 100, 120, 140, 160, 180, 200, 220, 240, 260, 280, 300, 320, 340, 360, 380, 400, 420, 440, 460, 480, 500, 520, 540, 560, 580, 600, 620, 640, 660, 680, 700, 720, 740, 760, or 780 ng hr/mL to about 800 ng hr/mL.
  • the total drug exposure over time is an AUC of from about from about 1.5, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72, 74, 76, or 78 ng hr/mL to about 80 ng hr/mL.
  • the total drug exposure over time is an AUC of from about 100 ng hr/mL to about 8000 ng hr/mL, from about 10 ng hr/mL to about 800 ng hr/mL; or from about 1 ng hr/mL to about 80 ng hr/mL.
  • the total drug exposure over time is an AUC of from about from about 150 ng hr/mL to about 7800, 7600, 7400, 7200, 7000, 6800, 6600, 6400, 6200, 6000, 5800, 5600, 5400, 5200, 5000, 4800, 4600, 4400, 4200, 4000, 3800, 3600, 3400, 3200, 3000, 2800, 2600, 2400, 2200, 2000, 1800, 1600, 1400, 1200, 1000, 800, 600, 400, or 200 ng hr/mL.
  • the total drug exposure over time is an AUC of from about from about 15 ng hr/mL to about 780, 760, 740, 720, 700, 680, 660, 640, 620, 600, 580, 560, 540, 520, 500, 480, 460, 440, 420, 400, 380, 360, 340, 320, 300, 280, 260, 240, 220, 200, 180, 160, 140, 120, 100, 80, 60, 40, or 20 ng hr/mL.
  • the total drug exposure over time is an AUC of from about from about 1.5 ng hr/mL to about 78, 76, 74, 72, 70, 68, 66, 64, 62, 60, 58, 56, 54, 52, 50, 48, 46, 44, 42, 40, 38, 36, 34, 32, 30, 28, 26, 24, 22, 20, 18, 16, 14, 12, 10, 8, 6, 4, or 2 ng hr/mL.
  • the total drug exposure over time is an AUC of from about 100 ng hr/mL to about 200 ng hr/mL; from about 10 ng hr/mL to about 20 ng hr/mL; or from about 1 ng hr/mL to about 2 ng hr/mL.
  • the total drug exposure over time is an AUC selected from about 100, 150, 200, 400, 600, 800, 1000, 1200, 1400, 1600, 1800, 2000, 2200, 2400, 2600, 2800, 3000, 3200, 3400, 3600, 3800, 4000, 4200, 4400, 46000, 4800, 5000, 5200, 5400, 5600, 5800, 6000, 6200, 6400, 6600, 6800, 7000, 7200, 7400, 7600, 7800, and 8000 ng hr/mL.
  • total drug exposure over time is an AUC selected from about 10, 15, 20, 40, 60, 80, 100, 120, 140, 160, 180, 200, 220, 240, 260, 280, 300, 320, 340, 360, 380, 400, 420, 440, 4600, 480, 500, 520, 540, 560, 580, 600, 620, 640, 660, 680, 700, 720, 740, 760, 780, and 800 ng hr/mL.
  • total drug exposure over time is an AUC selected from about 1, 15, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 460, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72, 74, 76, 78, and 80 ng hr/mL.
  • methods of treatment, or use of a composition to treat a disease state which comprises administering to a subject in need of such treatment a combination of a first therapeutic agent and a second therapeutic agent, the method comprising:
  • the monitoring step includes constructing a pharmacokinetic profile of the compound of the first therapeutic agent or a metabolite thereof for the subject using concentrations of the compound of the first therapeutic agent or a metabolite thereof in a plurality of samples obtained from the subject at time points suitable to construct a pharmacokinetic profile.
  • at least two samples are collected at point-of-care or point of use by sampling or self-sampling on point- of-care devices or point of use devices or on matrices suitable for storage of the samples prior to quantitation of the compound or a metabolite thereof by a laboratory.
  • each point-of-care devices or point of use devices is capable of quantitating the compound or a metabolite thereof.
  • the pharmacokinetic profile includes pharmacokinetic parameters suitable for guiding dosing of the compound or a salt thereof for the subject.
  • the samples include from 2-12 samples. In one embodiment, the samples are collected over a time period of up to 8 hours, up to 24 hours, up to 48 hours, or up to 72 hours.
  • the pharmacokinetic parameters include at least one parameter selected from the group consisting of AUC, AUC1nf, Tmax, Cmax, time above threshold, steady state concentration, absorption rate, clearance rate, distribution rate, terminal T- 1/2 or parameters drawn from noncompartmental pharmacokinetic (PK) or compartmental PK analysis, including physiological model-based compartmental PK analysis.
  • the treatment method further comprises generating a report including the pharmacokinetic profile of the subject.
  • the report includes a recommendation regarding dosing based on the pharmacokinetic profile of the subject.
  • a reduction in dosage of ONC201, the analog thereof, or the pharmaceutically acceptable salt thereof is indicated to reduce risk of toxicity based on one or more pharmacokinetic parameters.
  • the reduction in dosage of the compound or salt thereof is indicated based on time above threshold, wherein the threshold is the drug concentration above which toxicity occurs, or one or more of AUC, AUC1nf, mean residence time (MRT), exponentials defining the pharmacokinetic profile, volume of distribution at steady state (Vss), volume of distribution during the terminal phase (Vz) or combination of a group of pharmacokinetic variable to adequately describe the pharmacokinetic profile.
  • a dose adjustment of the compound or salt thereof is indicated to increase efficacy based on one or more pharmacokinetic parameters.
  • an increase in dosage of the compound or salt thereof is indicated based on one or more of AUC, AUC1nf, MRT, exponentials defining the pharmacokinetic profile, steady state volume (Vss) of distribution, volume of distribution during the terminal phase (Vz) or combination of a group of pharmacokinetic variables to adequately describe the pharmacokinetic profile.
  • the dose of the compound or salt thereof is adjusted to within 5% to 25% of a desired target value.
  • each of the samples is applied to the point-of-care device or the point of use device for determining the concentration of the compound or a metabolite thereof, wherein the point-of-care device or the point of use device comprises a lateral flow strip having a construction and composition such that an application of one or more of the samples to the lateral flow strip causes a fraction of the drug in the sample to bind to with a component of the lateral flow strip such that a detectable signal proportional to the concentration of the drug in the applied sample is produced.
  • the samples are applied to matrices suitable for storage of the samples prior to quantitation by a laboratory.
  • the samples are stored as dried blood spots.
  • drug concentrations are measured by ELISA, LC MS MS, LC UV or LCMS.
  • the pharmacokinetic parameters include at least one of steady state concentration, absorption, and terminal T1/2. In one embodiment, at least one of the samples is whole blood.
  • multimodal therapeutic methods in which administration of an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof to a subject in need thereof is supplemented by other therapeutic modalities.
  • multimodal treatment comprises administering to a subject a pharmaceutical composition comprising an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof in conjunction with radiation therapy or after radiation is determined to not have been efficacious.
  • a multimodal treatment comprises administering to a subject a pharmaceutical composition comprising an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof in conjunction with radiation therapy, wherein the pharmaceutical composition comprising theimipridone, such as ONC201, the analog thereof, or pharmaceutically acceptable salt thereof and the radiation therapy are administered concurrently or sequentially in any order.
  • multimodal treatment comprises administering a pharmaceutical composition comprising an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof in conjunction with radiation therapy in a sequential arrangement.
  • multimodal treatment comprises administering a pharmaceutical composition comprising an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof concurrently with radiation therapy.
  • multimodal treatment is used to treat cancer.
  • multimodal treatment includes administering to a cancer subject a pharmaceutical composition comprising an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof and irradiating cancer cells with a radiation beam.
  • a multimodal treatment uses conformal radiotherapy (CRT) to deliver a dose volume histogram (DVH) prescribed to a cancer subject.
  • a multimodal treatment method uses intensity modulated radiation therapy (IMRT) to deliver radiation to cancer cells.
  • CTR conformal radiotherapy
  • IMRT intensity modulated radiation therapy
  • a multimodal treatment method uses techniques to compensate for tumor motion in a subject during treatment (e.g., where radiation doses must be administered to a thoracic tumor which moves as the patient breathes).
  • a multimodal treatment uses Four Dimensional Computed Tomography (4D CT) scanning techniques to adjust the delivered radiation field to compensate for tumor motion over the breathing cycle.
  • 4D CT Four Dimensional Computed Tomography
  • Any suitable type of radiation including gamma radiation which is given fractionated, IMRT (intensity modulated radiation therapy), gamma knife, proton therapy and brachytherapy can be used with multimodal treatment.
  • Radiation therapy and administering an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof can be used to treat brain tumors, e.g., glioblastoma or disease that has metastasized to the brain from lung cancer.
  • Multimodal treatment can be used to treat lung cancer, pancreatic cancer, rectal cancer, breast cancer, sarcoma, prostate cancer, gynecological malignancies, and lymphoma.
  • a gamma knife is used frequently to treat brain metastases.
  • the multimodal treatment includes use of proton therapy to treat cancer, including brain tumors, prostate cancer and any tumor proximate vital organs where it is very important to minimize toxicity to nearby normal tissue.
  • a multimodal treatment includes administering to a cancer subject, a pharmaceutical composition comprising an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof in combination with adoptive cell therapy (e.g., CAR-T (JCAR 14, 15, 16, 17, KTE-C19, or CTL019); other T Cell (AFM13); or NK (CDNO-109 or NK-92)) either simultaneously or in combination.
  • adoptive cell therapy e.g., CAR-T (JCAR 14, 15, 16, 17, KTE-C19, or CTL019
  • adoptive cell therapy e.g., CAR-T (JCAR 14, 15, 16, 17, KTE-C19, or CTL019
  • AMF13 T Cell
  • NK CDNO-109 or NK-92
  • multimodal treatment eliminates minimal residual disease without adding to toxicity resulting from treatment by an imipridone, such as ONC201, an analog thereof, or a pharmaceutically acceptable salt thereof.
  • the multimodal treatment improves prognosis and/or reduces adverse side-effects associated with a disease state or condition in a subject undergoing treatment.
  • analogs of the compounds of formula (10) and methods of making them are provided herein. Persons skilled in the art will understand that the general principles and concepts described above in conjunction with ONC201 and compounds of formula (10) and their salts, including principles and concepts related to methods and pharmaceutical compositions, apply with equal force to the following analogs and salts thereof. [00235] In one embodiment, the analogs have the structure of compound (25):
  • Ri, R2, R3, and R4 independently represent H, alkyl, cycloalkyl, cycloalkylalkyl, carboxyl, haloalkyl, alkenyl, cycloalkenyl, alkynyl, aryl, aralkyl, hydroxyalkyl, alkoxy, aryloxy, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, alkanoyl, mercapto, alkylthio, arylthio, alkylsulfinyl, arylsulfinyl, alkylsulfonyl, arylsulfonyl, heteroaryl, acyl, and heterocycle radicals.
  • Ri, R2, R3, and R4 are optionally substituted. In one embodiment, some or all hydrogens in Ri, R2, R3, and R4 are substituted by deuterium. In other embodiments, Ri, R2, R3, and R4 are independently selected from the group consisting of H, Cwalkyl, C1- 4alkylphenyl, Cwalkylphenylketone, Ci-abenzyl-piperazine, and C1-4alkylthienyl, wherein C1- 4alkyl, Cwalkylphenyl, C1-4alkylpheny Ike tone, and Cwbenzyl-piperazine are optionally substituted with Cwalkyl, hydroxyl, or halo.
  • Ri, R2, R3, and R4 are independently selected from the group consisting of H, CH3, CH2PI1, CH2-((2-Cl)-Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH2(4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2- CH 3 )-Ph), CFFCHOHPh, and (CH 2 ) 3 CO-4F-Ph.
  • analogs have the structure of compound (26):
  • Ri and R2 independently represent H, alkyl, cycloalkyl, cycloalkylalkyl, carboxyl, haloalkyl, alkenyl, cycloalkenyl, alkynyl, aryl, aralkyl, hydroxyalkyl, alkoxy, aryloxy, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, alkanoyl, mercapto, alkylthio, arylthio, alkylsulfinyl, arylsulfinyl, alkylsulfonyl, arylsulfonyl, heteroaryl, acyl, and heterocycle radicals.
  • Ri and R2 are independently selected from the group consisting of H, Cwalkyl, C1-4alkylphenyl, Cwalkylphenylketone, Cwbenzyl-piperazine, and C1-4alkylthienyl, wherein Cwalkyl, Cwalkylphenyl, C1- 4alkylphenylketone, and C1-4benzyl-piperazine are optionally substituted with C1-4alkyl, C1- 4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • Ri is selected from the group consisting of H, CH3, CH2PI1, CH2-((2-Cl)-Ph), CH2-(2-thienyl), CH2CH2PI1, CH 2 CH 2 (4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH2CHOHPI1, and (CH2)3CO-4F-Ph.
  • R2 is selected from the group consisting of H, CH3, CH 2 Ph, CH 2 -((2-Cl)-Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH 2 (4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CHOHPh, and (CH 2 ) 3 CO-4F-Ph.
  • Ri is a benzyl optionally substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH 3 , -NO 2 , -OCH 3 , -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , - CpX 2p +i, -OCX3, or -OCpX 2p+ i, where p is an integer from 2 to 20 and where X is a halogen including F, Cl, Br, or I; preferably, F, Cl, or Br; more preferably, F or Cl.
  • R 2 is a benzyl substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH3, -NO 2 , - 0CH3, -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , -CpX 2p+ i, -0CX3, or - OCpX 2p+ i, where p is an integer from 2 to 20 and where X is a halogen.
  • Ri is H.
  • Ri is a substituted or an unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • the arylalkyl is substituted with C1-4alkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • R 2 is a substituted or an unsubstituted arylalkyl, such as a benzyl or phenylethyl group.
  • the arylalkyl is substituted with Cwalkyl, C1-4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • the arylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH3, - CF3, and -OCH3.
  • R 2 is a substituted or an unsubstituted heterocycloalkylalkyl, such as a morpholinoalkyl or piperazinylalkyl group.
  • R 2 is a substituted or an unsubstituted heteroarylalkyl, such as an isoxazolidinylmethyl or pyridylmethyl group.
  • a heterocycloalkylalkyl or heteroarylalkyl is substituted with Cwalkyl, C1-4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • a heterocycloalkylalkyl or heteroarylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH3, -CF 3 , and -OCH 3 .
  • the analogs have the structure of compound (27):
  • Ri is H, alkyl, cycloalkyl, cycloalkylalkyl, carboxyl, haloalkyl, alkenyl, cycloalkenyl, alkynyl, aryl, aralkyl, hydroxyalkyl, alkoxy, aryloxy, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, alkanoyl, mercapto, alkylthio, arylthio, alkylsulfinyl, arylsulfinyl, alkylsulfonyl, arylsulfonyl, heteroaryl, acyl, and heterocycle radicals.
  • Ri is selected from the group consisting of H, C1- 4alkyl, Cualkylphenyl, C1-4alkylpheny Ike tone, C1-4benzyl-piperazine, and Chalky Ithienyl, wherein C1-4alkyl, C1-4alkylphenyl, Chalky Iphenylketone, and C1-4benzyl-piperazine are optionally substituted with Cwalkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • Ri is selected from the group consisting of H, CH3, CH2PI1, CH2-((2-Cl)- Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH 2 (4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 - ((2-CH 3 )-Ph), CH2CHOHPI1, and (CH 2 ) 3 CO-4F-Ph.
  • Ri is a benzyl optionally substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH 3 , -NO2, -OCH 3 , -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , - CpX 2p+ i, -OCX 3 , or -OCpX2p+i, where p is an integer from 2 to 20 and where X is a halogen including F, Cl, Br, or I; preferably, F, Cl, or Br; more preferably, F or Cl.
  • Ri is a H.
  • Ri is a substituted or an unsubstituted arylalkyl, such as a benzyl or phenylethyl group.
  • the arylalkyl is substituted with Cwalkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • analogs have the structure of compound (28):
  • R1 and R2 independently represent H, alkyl, cycloalkyl, cycloalkylalkyl, carboxyl, haloalkyl, alkenyl, cycloalkenyl, alkynyl, aryl, aralkyl, hydroxyalkyl, alkoxy, aryloxy, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, alkanoyl, mercapto, alkylthio, arylthio, alkylsulfinyl, arylsulfinyl, alkylsulfonyl, arylsulfonyl, heteroaryl, acyl, and heterocycle radicals.
  • Ri and R2 are independently selected from the group consisting of H, Cwalkyl, C1-4alkylphenyl, Cwalkylphenylketone, Cwbenzyl-piperazine, and C1-4alkylthienyl, wherein Cwalkyl, Cwalkylphenyl, C1- 4alkylphenylketone, and Cwbenzyl-piperazine are optionally substituted with Cwalkyl, C1- 4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • Ri is selected from the group consisting of H, CH3, CH2PI1, CH2-((2-Cl)-Ph), CH2-(2-thienyl), CH2CH2PI1, CH2- (2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CHOHPh, CH 2 CH 2 (4-N-benzyl-piperazine), and (CH2)3CO-4F-Ph.
  • R2 is selected from the group consisting of H, CH3, CH 2 Ph, CH 2 -((2-Cl)-Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH 2 (4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CHOHPh, and (CH 2 ) 3 CO-4F-Ph.
  • Ri when Ri is CfhPh, R2 is not CH2-(2-CH 3 -Ph).
  • Ri is CH2PI1 and R2 is CH2-(2-CH 3 -Ph).
  • Ri is CH2PI1 and R2 is CH2-(2,4-di F-Ph).
  • Ri is CfhPh and R2 is CH2-(4-CF3-Ph).
  • Ri is a benzyl optionally substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH 3 , -NO2, -OCH3, -CXH 2 , -CX 2 H, -CX3, -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , - CpX2 P +i, -OCX3, or -OC P X 2p+ i, where p is an integer from 2 to 20 and where X is a halogen including F, Cl, Br, or I; preferably, F, Cl, or Br; more preferably, F or Cl.
  • R2 is a benzyl substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH3, -NO2, - 0CH3, -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , -CpX 2 p + i, -OCX3, or - OC p X2p+i, where p is an integer from 2 to 20 and where X is a halogen.
  • Ri is H.
  • Ri is a substituted or an unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • an arylalkyl is substituted with Cwalkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • R2 is a substituted or an unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • an arylalkyl is substituted with Cwalkyl, C1- 4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • an arylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH3, - CF3, and -OCH3.
  • R2 is a substituted or an unsubstituted heterocycloalkylalkyl, e.g., a morpholinoalkyl or piperazinylalkyl group.
  • R2 is a substituted or an unsubstituted heteroarylalkyl, such as an isoxazolidinylmethyl or pyridylmethyl group.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with Cwalkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH3, -CF3, and -OCH3.
  • analogs have the structure of compound (29):
  • Ri and R2 independently represent H, alkyl, cycloalkyl, cycloalkylalkyl, carboxyl, haloalkyl, alkenyl, cycloalkenyl, alkynyl, aryl, aralkyl, hydroxyalkyl, alkoxy, aryloxy, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, alkanoyl, mercapto, alkylthio, arylthio, alkylsulfinyl, arylsulfinyl, alkylsulfonyl, arylsulfonyl, heteroaryl, acyl, and heterocycle radicals.
  • Ri and R2 are independently selected from the group consisting of H, Cwalkyl, C1-4alkylphenyl, Cwalkylphenylketone, Cwbenzyl-piperazine, and Cwalkylthienyl, wherein Cwalkyl, Cwalkylphenyl, C1- 4alkylphenylketone, and Cwbenzyl-piperazine are optionally substituted with Cwalkyl, C1- 4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • Ri is selected from the group consisting of H, CH3, CH2PI1, CH2-((2-Cl)-Ph), CH2-(2-thienyl), CH 2 CH 2 Ph, CH 2 CH 2 (4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH2CHOHPI1, and (CH2)3CO-4F-Ph.
  • R2 is selected from the group consisting of H, CH3, CH 2 Ph, CH 2 -((2-Cl)-Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH2(4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CHOHPh, and (CH 2 ) 3 CO-4F-Ph.
  • Ri when Ri is CH 2 Ph, R2 is not CH2-(2-CH3-Ph).
  • Ri is CH2PI1 and R 2 is CH 2 -(2-CH3-Ph).
  • Ri is CH 2 Ph and R 2 is CH 2 -(2,4-di F-Ph).
  • Ri is CH 2 Ph and R 2 is CH 2 -(4-CF3-Ph).
  • Ri is a benzyl optionally substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH 3 , -NO 2 , -OCH 3 , -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , - CpX 2p +i, -OCX3, or — OC P X 2p +i, where p is an integer from 2 to 20 and where X is a halogen including refers to F, Cl, Br, or I; preferably, F, Cl, or Br; more preferably, F or Cl.
  • R 2 is a benzyl substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH3, -NO 2 , - OCH 3 , -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , -CpX 2p+ i, -OCX 3 , or- OCpX 2p+ i, where p is an integer from 2 to 20 and where X is a halogen.
  • Ri is H.
  • Ri is a substituted or an unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • the arylalkyl is substituted with C1 ⁇ alkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • R 2 is a substituted or an unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • an arylalkyl is substituted with Cwalkyl, C1- 4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • an arylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH 3 , - CF 3 , and -OCH 3 .
  • R 2 is a substituted or an unsubstituted heterocycloalkylalkyl, e.g., a morpholinoalkyl or piperazinylalkyl group.
  • R 2 is a substituted or an unsubstituted heteroarylalkyl, such as an isoxazolidinylmethyl or pyridylmethyl group.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with C14alkyl, C1 ⁇ alkoxyl, hydroxyl, perhalogenated C1 ⁇ alkyl, or halo.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH 3 , -CF 3 , and -OCH 3 .
  • analogs have the structure of compound (30):
  • Ri and R 2 independently represent H, alkyl, cycloalkyl, cycloalkylalkyl, carboxyl, haloalkyl, alkenyl, cycloalkenyl, alkynyl, aryl, aralkyl, hydroxyalkyl, alkoxy, aryloxy, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, alkanoyl, mercapto, alkylthio, arylthio, alkylsulfinyl, arylsulfinyl, alkylsulfonyl, arylsulfonyl, heteroaryl, acyl, and heterocycle radicals.
  • Ri and R 2 are independently selected from the group consisting of H, CYalkyl, C1-4alkylphenyl, Cwalkylphenylketone, CYbenzyl-piperazine, and CYalkylthienyl, wherein Cwalkyl, (Yalkylphenyl, C1- 4alkylphenylketone, and CYbenzyl-piperazine are optionally substituted with CYalkyl, C1- 4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • Ri is selected from the group consisting of H, CH 3 , CH 2 Ph, CH 2 -((2-Cl)-Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH 2 (4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CHOHPh, and (CH 2 ) 3 CO-4F-Ph.
  • R 2 is selected from the group consisting of H, CH 3 , CH 2 Ph, CH 2 -((2-Cl)-Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH 2 (4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CHOHPh, and (CH 2 ) 3 CO-4F-Ph.
  • Ri when Ri is CH 2 Ph, R 2 is not CH 2 -(2-CH 3 -Ph).
  • Ri is CH 2 Ph and R 2 is CH 2 -(2-CH 3 -Ph).
  • Ri is CH 2 Ph and R 2 is CH 2 -(2,4-di F-Ph).
  • Ri is CH 2 Ph and R 2 is CH 2 -(4-CF 3 -Ph).
  • Ri is a benzyl optionally substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH 3 , -NO 2 , -OCH 3 , -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , - CpX 2p+ i, -OCX 3 , or -OCpX 2p+ i, where p is an integer from 2 to 20 and where X is a halogen including refers to F, Cl, Br, or I, preferably, F, Cl, or Br, more preferably, F or Cl.
  • R 2 is a benzyl substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH 3 , -NO 2 , - OCH 3 , -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , -CpX 2p+ i, -OCX 3 , or - OCpX 2p +i, where p is an integer from 2 to 20 and where X is a halogen.
  • Ri is H.
  • Ri is a substituted or an unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • the arylalkyl is substituted with C1 ⁇ alkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • R 2 is a substituted or unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • the arylalkyl is substituted with halo, hydroxyl, C1- 4alkyl, Cwalkoxyl, or perhalogenated Cwalkyl.
  • the arylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH 3 , - CF 3 , and -OCH 3 .
  • R 2 is a substituted or an unsubstituted heterocycloalkylalkyl, e.g., a morpholinoalkyl or piperazinylalkyl group.
  • R 2 is a substituted or unsubstituted heteroarylalkyl, e.g., an isoxazolidinylmethyl or pyridylmethyl group.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with C14alkyl, C1 ⁇ alkoxyl, hydroxyl, perhalogenated C1 ⁇ alkyl, or halo.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH 3 , -CF 3 , and -OCH 3 .
  • the analogs have the structure of compound (31):
  • Ri and R2 independently represent H, alkyl, cycloalkyl, cycloalkylalkyl, carboxyl, haloalkyl, alkenyl, cycloalkenyl, alkynyl, aryl, aralkyl, hydroxyalkyl, alkoxy, aryloxy, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, alkanoyl, mercapto, alkylthio, arylthio, alkylsulfinyl, arylsulfinyl, alkylsulfonyl, arylsulfonyl, heteroaryl, acyl, and heterocycle radicals.
  • Ri and R2 are independently selected from the group consisting of H, Cwalkyl, C1-4alkylphenyl, Cwalkylphenylketone, Cwbenzyl-piperazine, and Cwalkylthienyl, wherein Cwalkyl, Cwalkylphenyl, C1- 4alkylphenylketone, and C1 ⁇ benzyl-piperazine are optionally substituted with C1-4alkyl, C1- 4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • Ri is selected from the group consisting of H, CH3, CH2PI1, CH2-((2-Cl)-Ph), CH2-(2-thienyl), CH 2 CH 2 Ph, CH 2 CH 2 (4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CHOHPh, and (CH2)3CO-4F-Ph.
  • R2 is selected from the group consisting of H, CH3, CH 2 Ph, CH 2 -((2-Cl)-Ph), CH 2 -(2-thienyl), CH 2 CH 2 Ph, CH 2 CH2(4-N-benzyl-piperazine), CH 2 -(2,4-di F-Ph), CH 2 -((2-CH 3 )-Ph), CH 2 CHOHPh, and (CH 2 ) 3 CO-4F-Ph.
  • Ri when Ri is CH 2 Ph, R2 is not CH 2 -(2-CH 3 -Ph).
  • Ri is CH 2 Ph and R2 is CH 2 -(2-CH3-Ph).
  • Ri is CH 2 Ph and R 2 is CH 2 -(2,4-di F-Ph).
  • Ri is CH 2 Ph and R2 is CH 2 -(4-CF3-Ph).
  • Ri is a benzyl optionally substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH 3 , -NO2, -OCH3, -CXH 2 , -CX 2 H, -CX3, -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , - CpX2 P +i, -OCX3, or -OC p X2p+i, where p is an integer from 2 to 20 and where X is a halogen including F, Cl, Br, or I; preferably, F, Cl, or Br; more preferably, F or Cl.
  • R2 is a benzyl substituted with one or more of the following substituents alone or in combination in the ortho, meta, and/or para positions of the benzyl ring: -CH3, -NO 2 , - 0CH3, -CXH 2 , -CX 2 H, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 )3, -CpX 2p+ i, -0CX3, or - OCpX 2 p+i, where p is an integer from 2 to 20 and where X is a halogen.
  • Ri is a H.
  • Ri is a substituted or an unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • the arylalkyl is substituted with C1-4alkyl, Cwalkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • R2 is a substituted or an unsubstituted arylalkyl, e.g., a benzyl or phenylethyl group.
  • the arylalkyl is substituted with Cwalkyl, C1- 4alkoxyl, hydroxyl, perhalogenated C1-4alkyl, or halo.
  • the arylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH3, - CF3, and -OCH3.
  • R2 is a substituted or an unsubstituted heterocycloalkylalkyl, e.g., a morpholinoalkyl or piperazinylalkyl group.
  • R2 is a substituted or an unsubstituted heteroarylalkyl, e.g., an isoxazolidinylmethyl or pyridylmethyl group.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with C1-4alkyl, C1-4alkoxyl, hydroxyl, perhalogenated Cwalkyl, or halo.
  • the heterocycloalkylalkyl or heteroarylalkyl is substituted with one or more substituents selected from the group consisting of halo, -CH3, -CF3, and -OCH3.
  • Ri and R2 are independently selected from H, alkyl, cycloalkyl, cycloalkylalkyl, heterocycloalkyl, heterocycloalkylalkyl, aryl, heteroaryl, arylalkyl, heteroarylalkyl, alkoxyalkyl, alkoxycarbonyl, aralkoxy, aralkylthio, and acyl radicals.
  • Ri is CH2PI1 and R2 is CH2-(2-CH3-Ph), which is an ONC201 linear isomer -10, which lacks anti-cancer activity (Jacob et al., Angew. Chem.
  • TIC- 10 is a CXCR7 agonist.
  • CXCR7 agonists can be used for liver regeneration and to prevent or treat liver fibrosis.
  • Ri and R2 are independently selected from the group consisting of H, C1-4alkyl, C1-4alkylphenyl, Cwalkylphenylketone, Cwbenzyl-piperazine, C1-
  • Ri and/or R2 is a substituted or unsubstituted, arylalkyl or heteroarylalkyl.
  • the heteroarylalkyl is selected from Cwalkylpyrrolyl, Cwalkylfuryl, C1-4alkylpyridyl, Cwalkyl- 1,2,4-thiadiazolyl, C1-4alkylpyrimidyl, C1- 4alkylthienyl, Cwalkylisothiazolyl, C1-4alkylimidazolyl, Cwalkyltetrazolyl, C1- 4alkylpyrazinyl, Chalky Ipyrimidyl, Chalky Iquinolyl, Cwalkylisoquinolyl, C1- 4alkylthiophenyl, Chalky Ibenzothienyl, C halky!
  • Ri and/or R2 is a benzyl optionally substituted with one or more of the following substituents on the benzyl ring: X, -CH3, -NO2, -OCH3, -CN, -CXH2, - CX 2 H, C2-C4 alkyl, -CX 3 , -CH 2 (CX 3 ), -CH(CX 3 ) 2 , -C(CX 3 ) 3 , -C P X 2p+ i, -OCX3, -OC P H 2p+ i, - OC P X 2p+ i, OR m , SR m , NR m R n , NR m C(O)R n , SOR m , SO 2 R m , C(O)R m , and C(O)OR m ; R m and R n are independently selected from H or a C1-C4 alkyl
  • the resulting cold mixture was diluted with water (lOmL) and adjusted to pH 8 with 5% sodium hydroxide solution.
  • the toluene layer was separated and the aqueous layer was extracted with toluene (20 mL).
  • the combined organic layer was dried over anhydrous sodium sulfate, and concentrated under reduced pressure.
  • the compound was dried in vacuum to give methyl- 1 -tert-butoxycarbonyl- 4-oxo-3-piperidine carboxylate (5.0 g, 80%).
  • the compound obtained was carried to the next reaction without any further purification.
  • Compound ONC216 was prepared from ONC215 by treatment with TFA.
  • Compound (72) was prepared by reacting the precursor NH compound prepared in analogy to Example 5 and treating it with styrene oxide.
  • the reaction mixture from Example 8 was washed with water (500 mL) and diluted with methyl tert-butyl ether (MTBE) (800 mL).
  • the organic phase was washed with water (500 mL x 2) and transferred to a 3 L three-neck round bottom flask equipped with mechanical stirring, N2 inlet, a thermocouple, a condenser and a Dean-Stark trap.
  • MTBE methyl tert-butyl ether
  • ONC212 demonstrated efficacy in an ONC201 -resistant AML xenograft model (Fig. 11).
  • MV411 AML cells (5xl0 6 ) were subcutaneously implanted in the flanks of athymic nude.
  • ONC212 and ONC201 were administered orally (PO) as indicated.
  • Tumor volume (A and B) and body weight (C) (n 10) was measured on indicated days. * represents p ⁇ 0.05 relative to vehicle.
  • ONC212 efficacy in AML was evaluated in vitro and was upto 400 fold more potent compared to ONC201 (Table 4).
  • ONC212 was also efficacious in AML cells resistant to standard of care cytarabine (Fig. 10A).
  • Fig. 10B An 8 hr exposure of ONC212 at 250nM was sufficient to cause robust reduction in cell viability in M0LM14 and MV411 AML cells (Fig. 10C). At least 24- 48h exposure was required with ONC201 for efficacy.
  • ONC212 efficacy was determined in a leukemia xenograft model with MV411 AML cells resistant to standard-of-care cytarabine (Fig. 11).
  • ONC212 50 mg/kg significantly reduced leukemia xenograft tumor growth with oral weekly administration while ONC201 was not efficacious in this model at similar doses (Fig. 11A).
  • Fig. 11B interesting, biweekly ONC212 dosing with 25 mg/kg and weekly/biweekly dosing with 5 mg/kg was not efficacious (Fig. 11B). None of these ONC212 administration regimens were associated with body weight loss (Fig. 11C) or gross observations.
  • ONC212 25 mg/kg represents NOAEL in mouse and rat non-GLP oral single dose studies which is also the efficacious dose in mouse xenograft studies. ONC212 is approximately 10 fold more toxic compared to ONC201 (NOAEL 225 mg/kg in rat non-GLP oral single dose study).
  • ONC206 demonstrated efficacy in a Ewing’s sarcoma xenograft model.
  • MHH-ES-1 Ewing’s sarcoma cells (5xl0 6 ) were subcutaneously implanted in the flanks of athymic nude mice.
  • ONC206 showed up to 20 fold improvement compared to ONC201 in in vitro potency with no in vitro toxicity to normal cells at therapeutic doses (Table 5). With ONC206, only 2-fold increased toxicity (NOAEL 125 mg/kg) was noted overall relative to ONC201 (NOAEL 225 mg/kg) in a rat non-GLP oral single dose study. In vivo efficacy in Ewing’s sarcoma model with no toxicity (Fig. 12). ONC206 efficacy was comparable to chemotherapy methotrexate, but chemotherapy was associated with body weight loss.
  • ONC213 In vitro profiling of GPCR activity using a hetereologous reporter assay for arrestin recruitment, a hallmark of GPCR activation, indicated that ONC213 selectively targets DRD2/3 and GPR132/91. Dual targeting of DRD2/3 and GPR132/91 represents a novel strategy for anti-cancer efficacy without toxicity.
  • ONC213 is a DRD2/3 inhibitor and a GPR132/91 agonist.
  • DRD2/3 potency of ONC213 is more than ONC201 but less than ONC206.
  • GPR132 potency of ONC213 is less than ONC212.
  • ONC213 demonstrated in vitro anti-cancer potency in HCT116/RPMI8226 cancer cells similar to ONC212, but in vitro toxicity to normal cells was reduced compared to ONC212 (Fig. 13).
  • the safety profile of ONC213 confirmed in mouse MTD study with NOAEL 75 mg/kg three times that of ONC212 (25mg/kg).
  • the GPR91 agonist activity of ONC213 provides an opportunity for immunology, immune-oncology and hematopoietic applications (Nature Immunology 9:1261 (2008); J Leukoc Biol. 85(5):837 (2009)).
  • ONC237 demonstrated in vitro anti-cancer potency in HCT116/RPMI8226 cancer cells similar to ONC212, but in vitro toxicity to normal cells was reduced compared to ONC212 (Fig. 13).
  • the safety profile of ONC213 confirmed in mouse MTD study with NOAEL 75 mg/kg three times that of ONC212 (25mg/kg).
  • ONC237 selectively targets GPR132 and DRD5.
  • ONC237 is a GPR132 agonist and DRD5 antagonist and has reduced anticancer efficacy (IC50 31.2 p M) compared to ONC201.
  • This data show that combining GPR132 agonism with DRD5 (DI -like dopamine receptor) antagonism results in poor anti-cancer effects compared to ONC213 which combines GPR132 agonism and DRD2/3 antagonism.
  • ONC236 is a highly selective GPR132 agonist.
  • ONC236 has anticancer efficacy (IC50 88nM) comparable to ONC212 (lOnM) better than ONC206/ONC201, completeness of response is better than ONC201 but not ONC212 in HCT116 cells.
  • ONC234 In vitro profiling of GPCR activity using a hetereologous reporter assay for arrestin recruitment, a hallmark of GPCR activation, indicated that ONC234 is a broad spectrum and potent GPCR targeting small molecule.
  • ONC234 hits several GPCRs including antagonist activity for adrenergic, histamine, serotonin, CHRM, CCR, DRD2/5 receptors, as well as CXCR7 agonist activity.
  • ONC236 has anticancer efficacy (IC50 234nM) similar to ONC206, completeness of response same as ONC212, and better than ONC201 in HCT116 cells.
  • ONC201 was evaluated in a whole cell, functional assay of P-Arrestin G protein- coupled receptor (GPCR) activity that directly measures dopamine receptor activity by detecting the interaction of P-Arrestin with the activated GPCR that serves as a reporter.
  • GPCR P-Arrestin G protein- coupled receptor
  • DRD1, DRD2S, DRD2L, DRD3, DRD4, and DRD5 dopamine receptor
  • cell lines overexpressing reporter constructs were expanded from freezer stocks. Cells were seeded in a total volume of 20 pL into white walled, 384-well microplates and incubated at 37°C prior to testing, with antagonist followed by agonist challenge at the ECso concentration. Intermediate dilution of sample stocks was performed to generate 5x sample in assay buffer.
  • % Antagonism 100% x (1 — (mean RLU of test sample — mean RLU of vehicle control) I (mean RLU of ECso control — mean RLU of vehicle control).
  • Reference Example 12 Selective Antagonism of DRD2 by QNC201.
  • ONC201 is a first-in-class small molecule discovered in a phenotypic screen for p53 -independent inducers of tumor selective proapoptotic pathways. Oral ONC201 is being evaluated as a new therapeutic agent in five early phase clinical trials for select advanced cancers based on pronounced efficacy in aggressive and refractory tumors and excellent safety. [00294] In this Example, the prediction and validation of selective direct molecular interactions between ONC201 and specific dopamine receptor family members are reported. Experimental GPCR profiling indicated that ONC201 selectively antagonizes the D2-like, but not DI -like, dopamine receptor subfamily.
  • ONC201 selectively antagonizes both short and long isoforms of DRD2 and DRD3, with weaker potency for DRD4 and no antagonism of DRD1 or DRD5.
  • Increased secretion of prolactin is a clinical hallmark of DRD2 antagonism by several psychiatric medications that potently target this receptor.
  • ELISA measurements in peripheral blood of patients treated with ONC201 in the first-in-human trial with advanced solid tumors determined that 10/11 patients evaluated exhibited induction of prolactin (mean of 2-fold).
  • DRD2 D2-like dopamine receptor subfamily, particularly DRD2
  • DRD2 inhibition imparts antitumor efficacy, without killing normal cells, via ATF4/CHOP induction and Akt and ERK signaling inhibition that are all ONC201 attributes.
  • ONC201 dihydrochloride was obtained from Oncoceutics. Kinase inhibition assays for the kinome were performed as described (see Anastassiadis et al., Nat Biotech 29:1039 (2011)). GPCR arrestin recruitment and cAMP modulation reporter assays were performed as described (see McGuinness et al., Journal of Biomolecular Screening 14:49 (2009)). PathHunterTM (DiscoveRx) P-arrestin cells expressing one of several GPCR targets were plated onto 384-well white solid bottom assay plates (Corning 3570) at 5000 cells per well in a 20 pL volume in an appropriate cell plating reagent.
  • ONC201 is a small molecule in phase II clinical trials for select advanced cancers. It was discovered in a phenotypic screen for p53 -independent inducers of the pro-apoptotic TRAIL pathway. Although the contribution of ONC201 -induced ATF4/CHOP upregulation and inactivation of Akt/ERK signaling (Allen et al., Science translational medicine 5, 171ral 17-17 Iral 17 (2013)) to its anti-cancer activity has been characterized, its molecular binding target had remained elusive.
  • ONC201 selectively antagonizes the D2-like (DRD2/3/4), but not Dl-like (DRD1/5), dopamine receptor subfamily (Fig. 1). Antagonism of adrenoceptor alpha receptors or other GPCRs was not observed under the evaluated conditions.
  • ONC201 antagonized both short and long isoforms of DRD2 and DRD3, with weaker potency for DRD4.
  • ONC201 -mediated antagonism of arrestin recruitment to DRD2L was assessed by a Gaddum/Schild EC50 shift analysis, which determined a dissociation constant of 2.9 pM for ONC201 that is equivalent to its effective dose in many human cancer cells. Confirmatory results were obtained for cAMP modulation in response to ONC201, which is another measure of DRD2L activation. The ability of dopamine to reverse the dose-dependent antagonism of up to 100 pM ONC201 suggests direct, competitive antagonism of DRD2L. In agreement with the ONC201 specificity predicted by BANDIT, no significant interactions were identified between ONC201 and nuclear hormone receptors, the kinome, or other drug targets of FDA- approved cancer therapies.
  • ONC201 selectively antagonizes the D2-like dopamine receptor subfamily, which appears to be a promising therapeutic target in oncology, and ONC201 is the first compound to exploit this treatment paradigm in several ongoing Phase II clinical studies.
  • Reference Example 13 Preclinical data in H3 K27M adult and pediatric glioma.
  • H3 K27M refers to a specific mutation in histone H3 proteins. Due to the location of these tumors, areas of the brain involved in critical physiological functions, these tumors have historically been inoperable (especially in the brain stem where the pons is located). This means that until recently, midline gliomas such as diffuse intrinsic pontine glioma (DIPG) were diagnosed solely on a radiographic basis.
  • DIPG diffuse intrinsic pontine glioma
  • Gliomas in the midline of the brain belong to the most aggressive types of primary malignant brain cancers. The disease arises from glial cells, which are cells that form the tissue that surrounds and protects other nerve cells found within the brain and spinal cord.
  • Standard therapy for midline gliomas involves neurosurgery, when feasible, followed by fractionated external beam radiotherapy. Due to location in the brain, aggressiveness and low survival time, gliomas in the midline of the brain are considered as part of the most lethal forms of cancer.
  • H3 K27M predominantly occurs in midline gliomas and in younger patients: ⁇ 75% of thalamic brain tumors, ⁇ 54% of brainstem tumors and 55% of spinal cord tumors; 24% of pediatric gliomas and 8% of adult gliomas.
  • the H3 K27M mutation occurs in a unique spatiotemporal pattern, with midline gliomas involving the pons (i.e. DIPG) tending to occur in pediatric patients ( ⁇ 18 years of age) while midline gliomas involving the thalamus and spinal cord tending to occur in young adult patients.
  • H3 K27M mutation in midline gliomas is generally thought to confer a worse clinical prognosis.
  • This understanding was incorporated into the World Health Organization 2016 classification of central nervous system tumors that now defines diffuse midline gliomas with the H3 K27M mutation as a new distinct disease entity. This disease is defined as grade IV regardless of histopathological features due to the widely recognized dismal prognosis of brain tumors with this mutation.
  • H3 K27M Most of the prognostic literature for H3 K27M is derived from DIPG that exhibits a 70-85% prevalence of this mutation. It is clear than the presence of the H3 K27M mutation in tumors of the pons confers a much shorter overall survival relative to the minority of patients who do not have this mutation. For the smaller number of pediatric patients with gliomas outside of the pons, the literature is consistent that those with the H3 K27M mutation have a poorer prognosis. The field looks to DIPG as the most robust body of clinical experience with H3 K27M gliomas based on high prevalence of the mutation in that disease.
  • DIPG clinical trials have failed to improve outcomes and standard-of-care, a 6-week course of radiation, remains associated with a 9-11-month overall survival.
  • therapeutic clinical trials in DIPG focused on the evaluation of therapies that were proven effective in adult high-grade gliomas.
  • the recent molecular profiling and emerging preclinical models of H3 K27M midline gliomas have shown that these tumors exhibit vastly different biology and therapeutic sensitivity relative to other adult gliomas, such as glioblastoma.
  • H3 K27M-mutant gliomas occur at a lower rate in adults compared to pediatric patients.
  • the literature is relatively congruous with pediatric findings and overall seems to confirm the dismal effect of H3 K27M mutations in brain tumors for adults, especially in brainstem gliomas.
  • Overall survival of adult patients with H3 K27M midline gliomas is approximately 16 months with studies indicating that H3 K27M mutations in brainstem locations are associated with significantly shorter survival times.
  • ONC201 One of the features in the selection process that identified ONC201 as an anticancer agent was its ability to penetrate the blood-brain barrier to address tumors residing in the CNS, unlike many available therapies. Ensuing animal studies revealed that ONC201 rapidly traverses the blood-brain barrier, achieves 5-fold higher concentrations in the brain relative to plasma and induces downstream signaling (TRAIL induction) in the brain.
  • ONC201 has p53-indepenent activity against high grade glioma cell lines including those with resistance to radiotherapy. In addition to cell lines, ONC201 exerts potent anticancer activity in primary high grade glioma samples resistant to temozolomide.
  • ONC201 shrinks temozolomide-resistant high-grade glioma xenografts and prolongs the survival of mice with orthotopic xenografts as a monoagent and in combination with bevacizumab. Compelling monoagent efficacy of ONC201 has also been observed in radio- and chemo-resistant high-grade glioma cell lines and in 3D neurosphere cultures of newly diagnosed and recurrent patient samples.
  • DRD2 is overexpressed in high grade glioma.
  • expression levels of DRD2 correlated with the responsiveness of the cells to ONC201 (Fig. 3).
  • expression of DRD5 a Df-like dopamine receptor that counteracts DRD2 signaling, was significantly inversely correlated with ONC201 potency in the NCI60 and GDSC datasets (P ⁇ .05) (Fig. 3).
  • H3 and components of the PRC2 methyl transferase complex which is inhibited by the K27M mutation, were found to each mark both the DRD2 and DRD5 gene in DIPG and isogenic models. While the precise epigenetic mechanisms regulating the balance of the DRD2:DRD5 expression is an active area of investigation, H3 K27M gliomas was hypothesized to foster a chromatin landscape that leads to high DRD2 expression and suppression of DRD5 expression, which in turn may make these tumor cells more sensitive to ONC201. ONC201 was tested against a panel of patient-derived glioma tumorsphere cultures grown in serum-free neural stem cell media.
  • Patient-derived lines included five histone H3 K27M mutant DIPG (two HISTIH3B and three H3F3A mutant), two H3F3A G34 mutant pediatric glioblastoma (one G34V, one G34R), and 7 H3 wild-type (3 pediatric, 4 adult) glioblastoma cell lines.
  • ONC201 was more potently cytotoxic to histone H3 K27M mutant (median ICso ⁇ 0.6
  • DRD2 and DRD5 expression were analyzed in untreated patient glioma samples.
  • DRD5 expression in all glioma tumors tested were low, however DRD5 expression in histone H3 K27M mutant glioma tumors showed a trend towards lower expression than wild-type glioma. Therefore, DRD2 and DRD5 expression profiles of H3 K27M mutant patient gliomas appear consistent with an expression signature in preclinic al models that predicts ONC201 sensitivity.
  • Cancer stem cells have been shown to express relatively high levels of DRD2 compared to the bulk population, and ONC201 effectively depletes cancer stem cells in numerous malignancies. This effect may contribute to prolongation of survival in patients in a Phase II GBM study of ONC201 despite the fact that many patients received limited drug exposure (1 or 2 doses).
  • NK cells are known to express DRD2 and ONC201 has been reported to increase the pool of circulating and intratumoral NK cells. Even more important is activation of NK cell function documented in vivo as well as in patient samples. This significant immune-stimulatory effect likely contributes to the antitumor activity of the compound and is consistent with the response kinetics, i.e. prolonged and late responses, seen in an ongoing clinical trial.
  • the GBM tumor microenvironment has been described as profoundly immune-suppressed and several modalities that stimulate immune function have been shown to affect GBM tumor cell growth.
  • Reference Example 14 QNC201 in a 22 year old female with recurrent H3 K27M mutant glioblastoma.
  • Histone H3 K27M mutations distinguish a subgroup of midline gliomas in children and young adults with devastating prognosis for which there are no effective medical therapies.
  • the first H3 K27M glioma patient to receive ONC201 was a 22-year-old female with multifocal disease that included her thalamus who was treated as part of a Phase II recurrent glioblastoma trial in adults (NCT02525692). She had recurrent glioblastoma (unmethylated MGMT, H3.3 K27M mutant) and was treated with 625 mg of ONC201 once every three weeks. She had previously progressed following prior surgery, radiation, and temozolomide.
  • Reference Example 15 QNC201 in a 74 year old female with recurrent H3 K27M mutant glioblastoma.
  • This Example provides a case study of a 74-year-old female H3 K27M (unknown MGMT status) glioma patient who also participated in the Phase II recurrent glioblastoma trial with ONC201 referenced in the previous Example. She also had multi-focal disease and progressed following first-line surgery, radiation, and temozolomide. She also progressed following subsequent second-line therapy with CCNU. Prior to ONC201 treatment, this subject had three lesions. Her first on-treatment evaluation at 8- weeks following initiation of ONC201 therapy revealed a complete disappearance of malignant lesions (Fig. 15). She also tolerates the therapy well and remains on study after > 10 weeks.
  • Reference Example 16 QNC201 treatment in a 10 year old girl with H3 K27M mutant DIPG.
  • DIPG diffuse intrinsic pontine glioma
  • Reference Example 17 QNC201 treatment in a 3 year old girl with H3 K27M mutant DIPG.
  • DIPG diffuse intrinsic pontine glioma
  • Prior therapy included a 6 week course of radation.
  • Radiographic evaluation of her tumor revealed a stable tumor lesion (Fig. 17). She also experienced a complete resolution of her inability to use her left arm and hand that was associated with a cranial nerve palsy due to her tumor’s location. She is fully ambulatory and also tolerates the therapy well and continues on trial.
  • High grade gliomas with the H3 K27M mutation have significantly inferior clinical outcomes relative to patients who do not have the mutation.
  • all long-term survivors were H3.3 wild type.
  • ONC201 treatment confers superior progression- free survival (PFS) in H3 K27M patients.
  • Progression-free survival (PFS) with ONC201 treatment was determined for fifty patients with recurrent high grade glioma present at baseline by MRI before initiating ONC201 therapy (Fig. 18).
  • all longterm progression-free patients treated with ONC201 were H3 K27M patients.
  • Reference Example 18 Clinical Evaluation of the Imipridone QNC201 in Recurrent Glioblastoma: Predictive and Pharmacodynamic Biomarker Analyses.
  • the imipridone ONC201 is the first selective antagonist of the G protein-coupled receptor DRD2 for clinical oncology.
  • ONC201 induces p53 -independent apoptosis in newly diagnosed and recurrent glioblastoma in vitro, ex vivo, and in vivo.
  • a Phase II clinical trial was performed that enrolled an initial cohort of 17 patients with recurrent, bevacizumab-naive, IDH1/2 WT glioblastoma who received 625 mg ONC201 every three weeks.
  • One patient continues to have a durable objective response that has deepened over time, exhibiting an 92% regression by 92% after 15 months of therapy.
  • ONC201 is a well tolerated therapy with potential anti-glioblastoma activity that may be associated with a predictive biomarker signature and immune activation.
  • ONC201 is active in glioblastoma with DRD2 pathway dysregulation.
  • ONC201 an imipridone that is a selective antagonist of the G protein-coupled receptors dopamine receptor D2 (DRD2) and D3 (DRD3), has exhibited tumor shrinkage and an exceptional safety profile in a phase II recurrent glioblastoma clinical trial.
  • D2 dopamine receptor D2
  • D3 D3
  • the DRD2 pathway is a therapeutic target that is dysregulated in glioblastoma and contains biomarkers of tumor sensitivity to ONC201.
  • Reference Example 20 Differentiated pharmacology of the imipridone QNC201, the first selective DRD2/3 antagonist in clinical neuro-oncology.
  • ONC201 founding member of the imipridone class of compounds, has demonstrated evidence of tumor shrinkage along with exceptional safety in recurrent glioblastoma patients.
  • BANDIT a machine learning-based drug target identification platform - predicted that ONC201 would bind with high selectivity to the G-protein coupled receptors (GPCRs) dopamine receptor D2 (DRD2) and D3 (DRD3).
  • GPCRs G-protein coupled receptors
  • DRD2 dopamine receptor D2
  • D3 D3
  • ONC201 selectively antagonizes DRD2 and DRD3. Consistent with BANDIT and in contrast to DRD2 blocking antipsychotics, ONC201 did not antagonize other dopamine receptors or other closely related GPCRs with identified endogenous ligands. Schild analyses and radioligand competition assays revealed DRD2 affinities that were consistent with those identified for ONC201 anticancer activity. In accordance with superior selectivity, ONC201 exhibited a wider therapeutic window compared to other antipsychotics.
  • ONC201 exhibited a very slow association rate for DRD2 relative to antipsychotics, whereas the dissociation rate was similar to atypical antipsychotics that are better tolerated clinically.
  • Shotgun mutagenesis across 350 amino acids of DRD2 identified 8 residues critical for ONC201 -mediated antagonism of DRD2-induced calcium flux. Several residues were not conserved among other dopamine receptors, suggesting a potential role in conferring ONC201 selectivity.
  • ONC201 the first selective DRD2/3 antagonist in clinical neuro-oncology, may explain its unique selectivity, safety, and anti-cancer activity in clinical trials.
  • Reference Example 21 Imipridone family member QNC206 suppresses glioma stem cell maintenance.
  • Imipridones selectively target G protein-coupled receptors (GPCRs) that control critical signaling pathways in various cancer cells. Aberrant GPCR overexpression has been implicated in tumorigenesis.
  • ONC201 a first generation imipridone that directly antagonizes dopamine receptor D2 (DRD2), continues to be evaluated in clinical trials for advanced cancers.
  • D2 dopamine receptor D2
  • ONC206 an ONC201 analog that shares the same imipridone core chemical structure and selective DRD2 antagonism, potently inhibits patient- derived glioma stem cell (GSC) populations.
  • GSC patient- derived glioma stem cell
  • ONC206 Protein array of stem cell markers revealed ONC206 treatment down-regulated protein expression of oncogenic stem cell markers in the GSCs. Further, in vitro limiting dilution assay and sphere formation analysis showed that ONC206 prevented tumor sphere formation and tumor growth. These observations indicate that ONC206 exhibits promising anti-glioma activity and warrant elucidating the downstream effects of antagonizing DRD2 signaling with ONC206 in gliomas.
  • Reference Example 22 Clinical Data for Use of QNC201 in Adult H3 K27M-mutant High Grade Glioma.
  • a cohort of 15 adult patients (>18 years of age) with recurrent H3 K27M-mutanthigh grade glioma patients have been treated with ONC201 as participants in clinical trials or expanded access protocols. Demographics and clinical characteristics are described below in Table 6.
  • This cohort excludes patients who are not eligible for either current adult recurrent H3 K27M-mutant glioma trials for ONC201 (NCT03295396 and NCT02525692), i.e. excludes patients who had surgical intervention while on ONC201 or had leptomeningeal disease prior to receiving ONC201.
  • Radiographic and clinical benefits in the 4 patients with >50% regressions are summarized below, along with a brief medical history.
  • FIG. 21 Another adult with recurrent H3 K27M-mutant glioma has exhibited a 60% reduction in tumor size relative to baseline (Fig. 21), including a complete regression of the primary thalamic lesion.
  • This patient is a 38-year-old who was diagnosed with a Grade 3 anaplastic astrocytoma with the H3 K27M mutation in the left thalamus.
  • the patient began temozolomide (75mg/m 2 /day for 42 consecutive days) and radiation (60 Gy). He required accelerated fraction from 200 cGy to 250 cGy daily dose after 3,000 cGy in light of his progress disease. He completed radiation to the left thalamus.
  • this patient was on 60 mg daily hydrocortisone, plus 10 mg prednisone and would take dexamethasone for headaches up to 8 mg daily.
  • His first MRI after 6 weeks of starting ONC201 showed improved left lateral periatrial enhancement and edema, as well as a 34% overall regression. Subsequent MRIs have shown >50% regression that represents a partial response by RANG criteria.
  • the patient has reported potential clinical improvements in disease-related symptoms such as headaches, nausea, and right-sided numbness.
  • the patient continues ONC201 for > 9.1 months.
  • FIG. 22 Another adult with recurrent H3 K27M-mutant has exhibited a 53% reduction by RANO in tumor volume relative to baseline (Fig. 22), 15 weeks after beginning ONC201.
  • This patient was diagnosed with WHO Grade IV diffuse midline glioma. This patient was treated with 6,000 cGy radiation in combination with temozolomide 75 mg/m 2 for about five weeks. The patient began 625 mg ONC201 orally once every week. The patient began Avastin (every three weeks) to taper steroids. The patient continues on ONC201 for >3.5 months.
  • Example 1 ONC201 (7-benzyl-4-(2-methylbenzyl)-l,2,6,7,8,9-hexahydroimidazo- [l,2a]pyrido [3, 4e]pyrimidin-5(4H)-one, dihydrochloride) for the Treatment of Newly Diagnosed H3 K27M-mutant Diffuse Glioma Following Completion of Radiotherapy: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Study
  • ONC201 is an orally active dopamine receptor D2 (DRD2) antagonist and caseinolytic protease proteolytic subunit (ClpP) agonist being developed as a treatment for central nervous system tumors harboring H3 K27M mutations.
  • D2 dopamine receptor D2
  • ClpP caseinolytic protease proteolytic subunit
  • This example provides a randomized, double-blind, placebo-controlled, parallel- group, international, Phase 3 study in participants with newly diagnosed H3 K27M-mutant diffuse glioma to assess whether treatment with ONC201 following frontline radiotherapy will extend overall survival (OS) and progression-free survival (PFS) in this population. Eligible participants will have histologically diagnosed H3 K27M-mutant diffuse glioma and have completed standard frontline radiotherapy. Participants will be randomized at baseline in a 1:1:1 ratio to receive ONC201 at one of 2 dosing frequencies or placebo. Stratification factors include risk factors (higher, lower) and age ( ⁇ 21 years, > 21 years).
  • the higher-risk category includes enhancing tumor size > 10 cm2 , multifocal lesions (defined as more than 1 enhancing or nonenhancing tumor with intervening areas of normal brain signal), and/or a primary tumor that is located in the brainstem, based on central read of pre-radiotherapy magnetic resonance imaging (MRI).
  • Participants will receive the first dose of study intervention on Day 1 and continue twice weekly dosing (Day 1 and Day 2) throughout the treatment period.
  • Treatment and study assessments will be based on 28-day cycles. Study visits will be scheduled approximately every 4 weeks (28 days) through Cycle 12, then approximately every 8 weeks. Efficacy will be evaluated through survival status, tumor assessments, and measures of clinical outcomes (eg, changes in corticosteroid use and performance status).
  • Disease assessment via contrastenhanced MRI scans of the brain is required approximately every 8 weeks until death, initiation of subsequent anticancer therapy, or withdrawal of consent. All participants will be followed for survival until death or withdrawal of consent.
  • One clinical obj ective includes an evaluation of the efficacy of ONC201 administered following radiotherapy in participants with H3 K27M-mutant diffuse glioma. Endpoints may include: (a) Overall survival (OS) and (b) PFS using RANO-HGG criteria.
  • Additional clinical objectives and endpoints include:
  • Study Intervention Dosing Randomized, blinded, study intervention (ONC201 and/or matching placebo) will be orally administered twice weekly on 2 consecutive days per week (Day 1 and Day 2) on an empty stomach (no food within 2 hours before or for 2 hours after each dose). The first dose of study intervention (Cycle 1 Day 1) will be administered at the study center as soon as possible (within 24 hours) after randomization. An individual participant’s duration of treatment will depend on individual response, evidence of disease progression, and tolerability.
  • Participants > 52.5 kg will receive 625 mg of ONC201 (5 x 125- mg capsules) or matching placebo on dosing days; participants ⁇ 52.5 kg will receive a dose (and corresponding number of capsules) scaled by body weight and rounded to 125-mg increments. Participants who are unable to swallow capsules may dissolve the capsule contents in Gatorade or Powerade before administration. Dose modification (eg, dosing interruption and/or a 125-mg dose reduction) may be indicated if a participant experiences a Grade 3 or 4 AE that is considered related to study intervention and does not adequately resolve with medical management.
  • Dose modification eg, dosing interruption and/or a 125-mg dose reduction
  • Criteria for Evaluation Efficacy Efficacy will be evaluated through survival status, tumor assessments, and measures of clinical outcomes (eg, changes in corticosteroid use and performance status). PFS will be assessed by Response Assessment in Neuro-Oncology (RANO)-High Grade Glioma (HGG) and RANO-Low Grade Glioma (LGG) criteria using a blinded independent central review (BICR) process. PFS is defined as the time from randomization to the earlier date of progression or death. OS is defined as the time from randomization to the date of death.
  • Pharmacokinetics Plasma concentrations and PK parameters for ONC201 will be determined. The relationship between concentrations of ONC201 and select efficacy and safety endpoints will be investigated. Safety: Safety will be evaluated through the incidence of treatment-emergent AEs and clinical laboratory results. All AEs will be collected and recorded in the electronic case report form (eCRF) from the time of first dose until 30 days after the last dose of study intervention.
  • eCRF electronic case
  • R randomizalion
  • RT radiationotherapy 1
  • Participants are required to have a documented H3 K27M-mutation by testing of tumor tissue using IHC or NGS in a Clinical Laboratory Improvement Amendments (CLIA)-certified (or equivalent) laboratory.
  • Eligible participants will be randomized at baseline in a 1:1:1 ratio to one of the 3 treatment groups to receive study intervention on 2 consecutive days per week (Day 1 and Day 2): • ONC201 on both days (ONC201 twice weekly group) • ONC201 on 1 day and placebo on the alternate day (ONC201 weekly group) • Placebo on both days (placebo group)
  • Stratification factors include risk (higher, lower) and age ( ⁇ 21 years, > 21 years).
  • the higher-risk category includes enhancing tumor size > 10 cm2 , multifocal lesions (defined as more than 1 enhancing or nonenhancing tumor with intervening areas of normal brain signal), and/or a primary tumor that is located in the brainstem, based on central read of pre-radiotherapy magnetic resonance imaging (MRI). Randomization will occur 2 to 6 weeks after completion of radiotherapy and within 7 days after the baseline (post-radiotherapy) MRI. The first dose of study intervention (Cycle 1 Day 1) will be administered at the study center as soon as possible (within 24 hours) after randomization.
  • MRI magnetic resonance imaging
  • Participants > 52.5 kg will receive 625 mg of ONC201 (5 x 125-mg capsules) or matching placebo on dosing days; participants ⁇ 52.5 kg will receive a dose (and corresponding number of capsules) scaled by body weight and rounded to 125-mg increments.
  • Randomized, blinded, study intervention (ONC201 and/or matching placebo) will be orally administered twice weekly until the participant meets criteria for treatment discontinuation.
  • Treatment and study assessments will be based on 28-day cycles. An individual participant’s duration of treatment will depend on individual response, evidence of disease progression, and tolerability. Efficacy will be evaluated through survival status, tumor assessments, and measures of clinical outcomes (eg, changes in corticosteroid use and performance status).
  • PFS will be assessed by RANO-HGG and RANO-LGG criteria by BICR.
  • Disease assessment via contrast-enhanced MRI scans of the brain is required approximately every 8 weeks until death, initiation of subsequent anticancer therapy, or withdrawal of consent. All participants will be followed for survival until death or withdrawal of consent to collection of follow-up information. Two interim analyses will be conducted; the final analysis will be conducted after 327 events for OS. An IDMC will periodically review data to monitor the continuing benefit-risk of the study. Participants, investigators, the sponsor (to the extent practicable), and central imaging assessors are all blinded to the treatment arm assignment.
  • temozolomide failed to demonstrate benefits in patients with an unmethylated MGMT promoter (Hegi 2005).
  • H3 K27M-mutant gliomas typically do not have methylated MGMT promoter (Banan 2017; Meyronet 2017; Sturm 2012).
  • placebo rather than an active comparator group is used because of the increased risk of adverse effects (eg, myelosuppression with temozolomide) for participants relative to the minimal clinical benefit expected (Kamson 2021).
  • the goal of this therapy is to reduce tumor burden, improve symptoms, delay disease progression, and extend survival.
  • ONC201 has been shown to be well- tolerated in dose finding studies in patients with advanced solid tumors (Stein 2017; Stein 2019) and the maximum tolerated dose has not been determined. ONC201 has been investigated in multiple open-label clinical studies for glioma in adults and pediatric patients with the age ranging from 2 to 85 years and a minimal body weight of 10 kg. Responses have been reported in both adults and pediatric participants. This study will enroll participants without restrictions on age (if > 10 kg).
  • the primary endpoints are OS and PFS.
  • the RANG criteria will be used to assess tumor progression by BICR to minimize bias of PFS endpoints. Results from BICR will not influence treatment decisions by treating investigators.
  • 4.3. Justification for Dose This Phase 3 study will evaluate ONC201 625 mg (scaled by body weight for participants ⁇ 52.5 kg) administered once weekly or twice weekly (on 2 consecutive days each week). The single weekly dose of ONC201 at 625 mg is based on this dose achieving total peak plasma concentrations (3501 ng/mE or 9 pM) that: • Exceed in vitro H3 K27M-mutant glioma cell culture IC50 (0.75 to 3.31 pM).
  • ONC201 given twice weekly on Day 1 and Day 2 is supported by in vitro data demonstrating that prolonged exposures (> 24 hours) of ONC201 results in improved antitumor activity in vitro, see Figure 24: ONC201 Washout Experiment in U110 Glioblastoma Cells.
  • the doses proposed for the ONC201-108 study of 625 mg in adults (and the body weight adjusted equivalent pediatric dose) administered on the weekly and twice weekly schedule are believed to be efficacious doses and in line with recent FDA efforts to optimize patient doses by evaluating multiple regimens in randomized controlled clinical trials.
  • Study intervention is defined as any investigational intervention (ie, ONC201) or placebo intended to be administered to a study participant according to the study protocol.
  • the investigational drug product is a hydroxypropyl methylcellulose capsule filled with a formulation containing ONC201 dihydrochloride intended for oral administration.
  • Each capsule contains the equivalent of 125 mg of anhydrous ONC201 free base that may include the following excipients: microcrystalline cellulose, sodium starch glycolate, and/or magnesium stearate.
  • Matching placebo capsules may include the following excipients: mannitol, microcrystalline cellulose, sodium starch glycolate, and/or magnesium stearate.
  • Each bottle of study intervention will be labeled in a blinded manner and in accordance with applicable regulatory requirements and will include the following minimum information: • Drug name (blinded) and strength • Kit number • Dosing day reference (Day 1 or Day 2) • Blinded lot number • Expiry date, as applicable • Storage condition • Applicable caution statement according to in-country requirements.
  • Randomized, blinded, study intervention will be orally administered twice weekly ( ⁇ 2 days) on 2 consecutive days per week (Day 1 and Day 2).
  • the participant should take the assigned dose of study intervention from the “Day 1” bottle for the first dose of the week and take study intervention from the “Day 2” bottle for the second dose of the week.
  • Study intervention dosing is scaled by body weight and rounded to 125 mg (the strength of one capsule) (see Table: Dosing Based on Body Weight). Study intervention should be taken with a glass of water and consumed over as short a time as possible. No food should be consumed within 2 hours before or for 2 hours after each dose.
  • the dose may be increased if the weight gain is associated with a higher dose band and is not expected to decrease (as determined by the investigator; adjusting dose is not recommended if weight change is due to water-retention). Document any change in dose. [00351] If a participant’s body weight decreases to a lower dose band, the dose may remain the same if the participant is tolerating the currently assigned dose. Do not change the dose during a treatment cycle unless it is due to an AE attributed to study intervention.
  • Dose Modifications the table below includes criteria for dose modifications (ie, interruption, dose reduction, or discontinuation) due to AEs and adverse events of special interest (AEOSI). Dose modifications will be made based on AEs that occur any time during a cycle. The descriptions and grading scales in the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) will be utilized. Participants who require a dose reduction will not be eligible to re-escalate back to a higher dose upon resolution of the AE. No more than 2 dose reductions per participant are permitted. CTCA ⁇ Cs&mma Tertostoegy
  • a yarttoyw may hare so to 2 to « tototos, toe feto
  • Efficacy Assessments Efficacy will be evaluated through survival status, tumor assessments, and measures of clinical outcomes (eg, changes in corticosteroid use and performance status). PFS will be assessed by RANO criteria using a BICR process (by 2 independent radiologists and an adjudicator). Results of centrally reviewed MRIs will be used for endpoint assessments and will not impact treatment decisions. Investigator-assessed disease progression will impact treatment decisions, but will not be used for efficacy endpoints.
  • the OS endpoint for all randomized participants is defined as the time from randomization to the date of death.
  • the PFS endpoint is defined as the time from randomization to the earlier date of progression or death. Survival will be assessed at the following timepoints until death or withdrawal of consent to record survival data: • Every 4 weeks (+ 3 days) during Cycle 2 • Every 4 weeks ( ⁇ 7 days) during Cycles 3 through 12 • Every 8 weeks ( ⁇ 7 days) after Cycle 13 • Safety follow-up • Every 12 weeks (+ 2 weeks) during long-term follow-up. Virtual visits are allowed if site visits are not required for other assessments. Public sources may be searched for vital status information.
  • Tumor Assessments and Image submission MRI scans will be collected for assessing disease status. All available imaging files related to the diagnosis and ongoing monitoring of the participant’s glioma will be collected for screening, while the participant is receiving study intervention, and through the time of initiation of subsequent anticancer therapy.
  • MRI timepoints (all available scans will be collected for disease assessments): • Pre- radiotherapy/study screening: For participants who had surgical resection, this scan must be post-resection; for participants who did not have a resection, this scan may be pre- or postbiopsy. Submit this scan to the sponsor’s imaging vendor after the potential participant has started radiotherapy. In the event more than 1 scan is available during this time period, the scan that was obtained closest to the time of initiating radiotherapy will be used for assessment of inclusion and stratification. • Post-radiotherapy/baseline: to be obtained 2 to 6 weeks after completion of radiotherapy (prior to randomization). • On study: The first on-treatment MRI will be collected at C3D1 ( ⁇ 7 days).
  • MRIs will be collected approximately every 8 weeks ( ⁇ 7 days). Upon investigator determination of possible radiographic progression, a confirmatory scan is required 4 to 10 weeks later. Scan frequency is not related to any interruptions or changes in dosing of study intervention. MRIs will continue to be collected until the participant initiates a subsequent anticancer therapy.
  • the complete MRI imaging data sets must be submitted in digital imaging and communications in medicine (DICOM) format, ideally within 21 days from each MRI acquisition. Images should be de-identified, labeled with the participant’s study number, the time point of the scan (eg, post-surgery screening, postradiotherapy, C3D1), and the protocol number. Refer to the Imaging Manual for details of imaging collection and submission.
  • DICOM digital imaging and communications in medicine
  • PFS endpoints will be evaluated based on the RANO-HGG criteria (Wen 2010) and RANO-LGG criteria definitions of disease progression (Chukwueke 2019) by BICR. Results of centrally reviewed MRIs will be used for endpoint assessments and will not impact treatment decisions. In contrast, investigator assessments of disease progression will be used to determine discontinuation of study intervention or initiation of treatment beyond progression. The 2- to 6-week post-radiotherapy MRI will be used as the baseline for determining disease progression in the context of PFS endpoints, as well as investigator- assessed disease progression.
  • Criteria for investigator-assessed disease progression includes occurrence of one or more of the following radiographic or clinical criteria: • Radiographic criteria: - > 25% increase in the sum of the products of perpendicular diameters of enhancing or nonenhancing measurable lesions compared with the smallest tumor measurement obtained either at baseline (if no decrease) or best response on stable or increasing doses of corticosteroids. Note: stable doses of corticosteroids include participants not on corticosteroids. Measurable disease is defined as 2 axial perpendicular diameters each measuring at least 10 mm. Increase must not be caused by comorbid events (eg, radiotherapy, demyelination, ischemic injury, infection, seizures, postoperative changes, or other treatment effects). - New measurable lesion(s).

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Abstract

Les imipridones modulent sélectivement les récepteurs couplés aux protéines G (RCPG) de classe A, comme la sous-famille de type D2 de récepteurs dopaminergiques et sont utiles pour le traitement d'états pathologiques et de troubles nécessitant une telle modulation, comme les cancers. Plus précisément, le cancer implique une structure de ligne médiane du cerveau, un cancer ayant une mutation d'histone H3, ou les deux. De plus, l'invention concerne des méthodes permettant de déterminer si un sujet présentant ces états pathologiques est susceptible de répondre à un schéma thérapeutique, tel que l'administration d'imipridone. En outre, l'invention concerne des méthodes permettant d'évaluer l'efficacité d'un schéma thérapeutique, tel que l'administration d'imipridone, de surveiller ou de fournir un pronostic pour un sujet atteint de ces pathologies.
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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8463365B2 (en) * 2007-09-19 2013-06-11 Oncofluor, Inc. Method for imaging and treating organs and tissues
WO2019090222A1 (fr) * 2017-11-03 2019-05-09 Oncoceutics, Inc. Imipridones pour gliomes
WO2020176654A1 (fr) * 2019-02-27 2020-09-03 Madera Therapeutics, LLC Utilisation de la fonction de la protéase caséinolytique p en tant que biomarqueur de réponse médicamenteuse à des agents de type imipridone
WO2022029459A1 (fr) * 2020-08-06 2022-02-10 Eötvös Loránd Tudományegyetem Synthèse de nouveaux dérivés d'imipridone et leur évaluation concernant leur activité anticancéreuse
WO2022031952A2 (fr) * 2020-08-07 2022-02-10 City Of Hope Traitements de cancers à mutations kras

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8463365B2 (en) * 2007-09-19 2013-06-11 Oncofluor, Inc. Method for imaging and treating organs and tissues
WO2019090222A1 (fr) * 2017-11-03 2019-05-09 Oncoceutics, Inc. Imipridones pour gliomes
WO2020176654A1 (fr) * 2019-02-27 2020-09-03 Madera Therapeutics, LLC Utilisation de la fonction de la protéase caséinolytique p en tant que biomarqueur de réponse médicamenteuse à des agents de type imipridone
WO2022029459A1 (fr) * 2020-08-06 2022-02-10 Eötvös Loránd Tudományegyetem Synthèse de nouveaux dérivés d'imipridone et leur évaluation concernant leur activité anticancéreuse
WO2022031952A2 (fr) * 2020-08-07 2022-02-10 City Of Hope Traitements de cancers à mutations kras

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