Note: Descriptions are shown in the official language in which they were submitted.
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USE OF BETA-LAPACHONE FOR TREATING HEMATOLOGIC TUMORS
CROSS REFERENCE TO RELATED APPLICATIONS
This application claims the benefit under 35 U.S.C. ~ 119(e) of U.S.
Application
No. 60/545,914, filed February 20, 2004.
BACKGROUND OF THE INVENTION
Hematologic cancers, including lymphomas and leukemias, are a leading cause of
cancer
mortality in the United States ("Cancer Facts and Figures 2003," American
Cancer Society).
For example, non-Hodgkin's lymphoma is the sixth leading cause of cancer
mortality in the U.S.
and is particularly insidious because symptoms are nonspecific and are
frequently attributed to
the effects of infectious etiologies. Non-Hodgkin's lymphoma can be cured in
only about one
third of the patients. ("Neoplasms of the Hematopoitic System: Non-Hodgkin's
Lymphomas,"
in Cancer Medicine, 5th Edition, Bast et al. eds., B.C. Decker Inc., Hamilton,
Ontario). In
addition, various leukemias are estimated to have resulted in about 22,000
deaths in 2003
("Cancer Facts and Figures 2003," American Cancer Society).
Surgery and radiotherapy may be curative if a cancer is found early, but
current drug
therapies for metastatic disease are mostly palliative and seldom offer a long-
term cure. Even
with the new chemotherapies entering the market, improvement in patient
survival is measured
in months rather than in years, and the need continues for new drugs effective
both in
combination with existing agents as first line therapy and as second and third
line therapies in
treatment of resistant tumors.
Cancer cells are by definition heterogeneous. For example, within a single
tissue or cell
type, multiple mutational 'mechanisms' may lead to the development of cancer.
As such,
heterogeneity frequently exists between cancer cells taken from tumors of the
same tissue and
same type that have originated in different individuals. Frequently-observed
mutational
'mechanisms' associated with some cancers may differ between one tissue type
and another (e.g.,
frequently-observed mutational 'mechanisms' leading to colon cancer may differ
from
frequently-observed 'mechanisms' leading to leukemias). It is therefore often
difficult to predict
whether a particular cancer will respond to a particular chemotherapeutic
agent. (Cancer
Medicine, 5th Edition, Bast et al. eds., B.C. Decker Inc., Hamilton, Ontario).
(3-lapachone is an agent with a reported anti-cancer activity in a limited
number of
cancers. For example, there is reported a method and composition for the
treatment of tumors,
which comprises the administration of an effective amount of [3-lapachone, in
combination with
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a taxane derivative (W000/61142). Additionally, U.S. Pat. No. 6,245,07
discloses the use of
(3-lapachone, amongst other (3-lapachone derivatives, for use in treatment of
human prostate
disease. As a single agent, (3-lapachone has also been reported to decrease
the number of
tumors, reduce tumor size, or increase survival time, or a combination of
these, in
xenotransplant mouse models of human ovarian cancer (Li, C.J. et al., (1999)
Pr~oc. Natl. Acad.
Sci. USA, 96(23): 13369-13374), human prostate cancer (Li, C.J. et al., (1999)
Proc. Natl. Acad.
Sci. USA, 96(23): 13369-13374), human breast cancer (Li, C.J. et al., (2000)
AACR Proc., p. 9),
and human multiple myeloma (WO 03/011224).
While [3-lapachone, alone or in combination with other agents, has been
reported to
reduce tumor size in a limited number of tumor models it has not been reported
to be an
effective agent for the treatment of certain human hematologic cancers.
SUMMARY OF THE INVENTION
The present invention provides a method of treating a cancer selected from the
group
consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell neoplasm,
comprising
administering to a subject in need thereof a therapeutically effective amount
of (3-lapachone, or a
pharmaceutically acceptable salt thereof, in combination with a
pharmaceutically acceptable
Garner, where the cancer selected from the group consisting of lymphoma,
leukemia, myeloid
neoplasms, and mast cell neoplasm is treated.
The present invention also provides a method of treating lymphoma comprising
administering to a subject in need thereof a therapeutically effective amount
of [3-lapachone, or
pharmaceutically acceptable salt thereof, in combination with a
pharmaceutically acceptable
Garner, where the lymphoma is treated.
The present invention also provides a method of treating leukemia comprising
administering to a subject in need thereof a therapeutically effective amount
of (3-lapachone, or
pharmaceutically acceptable salt thereof, in combination with a
pharmaceutically acceptable
Garner, where the leukemia is treated.
The present invention also provides a method of treating myeloid neoplasms
comprising
administering to a subject in need thereof a therapeutically effective amount
of (3-lapachone, or
pharmaceutically acceptable salt thereof, in combination with a
pharmaceutically acceptable
carrier, where the myeloid neoplasms are treated.
The present invention also provides a method for inducing cell death in a
cancer selected
from the group consisting of lymphoma, leukemia, myeloid neoplasms, and mast
cell neoplasm,
comprising contacting the cancer selected from the group consisting of
lymphoma, leukemia,
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myeloid neoplasms, and mast cell neoplasm with an effective amount of (3-
lapachone, or a
pharmaceutically acceptable salt thereof, where the contacting induces the
cell death in the a
cancer selected from the group consisting of lymphoma, leukemia, myeloid
neoplasms, and mast
cell neoplasm.
The present invention also provides a method of treating a cancer selected
from the
group consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell
neoplasm,
comprising administering to a subject in need thereof a therapeutically
effective amount of ~3-
lapachone, or a pharmaceutically acceptable salt, prodrug, metabolite, analog
or derivative
thereof, in combination with a pharmaceutically acceptable carrier, where the
cancer selected
from the group consisting of lymphoma, leukemia, myeloid neoplasms, and mast
cell neoplasm
is treated.
The present invention also provides a method of treating lymphoma comprising
administering to a subject in need thereof a therapeutically effective amount
of (3-lapachone, or a
pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative
thereof, in
combination with a pharmaceutically acceptable carrier, where the lymphoma is
treated.
The present invention also provides a method of treating leukemia comprising
administering to a subject in need thereof a therapeutically effective amount
of (3-lapachone, or a
pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative
thereof, in
combination with a pharmaceutically acceptable carrier, where the leukemia is
treated.
The present invention also provides a method of treating myeloid neoplasms
comprising
administering to a subject in need thereof a therapeutically effective amount
of (3-lapachone, or a
pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative
thereof, in
combination with a pharmaceutically acceptable carrier, where the myeloid
neoplasms are
treated.
The present invention also provides a method for inducing cell death in a
cancer selected
from the group consisting of lymphoma, leukemia, myeloid neoplasms, and mast
cell neoplasm,
comprising contacting the cancer selected from the group consisting of
lymphoma, leukemia,
myeloid neoplasms, and mast cell neoplasm with an effective amount of (3-
lapachone, or a
pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative
thereof, where the
contacting induces the cell death in the a cancer selected from the group
consisting of
lymphoma, leukemia, myeloid neoplasms, and mast cell neoplasm.
The present invention also provides a method of treating a cancer selected
from the
group consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell
neoplasm,
comprising administering to a subject in need thereof a therapeutically
effective amount of a) (3-
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lapachone, or a pharmaceutically acceptable salt thereof, in combination with
a pharmaceutically
acceptable carrier, and b) gemcitabine, or a pharmaceutically acceptable salt
thereof, in
combination with a pharmaceutically acceptable carrier, where the cancer
selected from the
group consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell
neoplasm is treated.
The present invention also provides a method for inducing cell death in a
cancer selected
from the group consisting of lymphoma, leukemia, myeloid neoplasms, and mast
cell neoplasm,
comprising contacting the lung cancer cell with an effective amount of a) (3-
lapachone, or a
pharmaceutically acceptable salt thereof, and b) gemcitabine, or a
pharmaceutically acceptable
salt thereof, where the contacting induces the cell death in the cancer
selected from the group
consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell neoplasm.
The present invention also provides a method of treating a cancer selected
from the
group consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell
neoplasm,
comprising achninistering to a subject in need thereof a therapeutically
effective amount of a) (3-
lapachone, or a pharmaceutically acceptable salt, prodrug, metabolite, analog
or derivative
thereof, in combination with a pharmaceutically acceptable carrier, and b)
gemcitabine, or a
pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative
thereof, in
combination with a pharmaceutically acceptable carrier, where the cancer
selected from the
group consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell
neoplasm is treated.
The present invention also provides a method for inducing cell death in a
cancer selected
from the group consisting of lymphoma, leukemia, myeloid neoplasms, and mast
cell neoplasm
comprising contacting the lung cancer cell with an effective amount of a) (3-
lapachone, or a
pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative
thereof, and b)
gemcitabine, or a pharmaceutically acceptable salt, prodrug, metabolite,
analog or. derivative
thereof, where the contacting induces the cell death in the cancer selected
from the group
consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell neoplasm.
The present invention provides a method of treating a hematologic cancer
selected from
the group consisting of a lymphoma (including Hodgkin's lymphoma, non-
Hodgkin's
lymphoma, childhood lymphomas, and lymphomas of lymphocytic and cutaneous
origin),
leukemia (including childhood leukemia, hairy-cell leukemia, acute lymphocytic
leukemia, acute
myelocytic leukemia, chronic lymphocytic leukemia, chronic myelocytic
leukemia, and mast
cell leukemia), myeloid neoplasms, and mast cell neoplasms (collectively "a
hematologic cancer
of the present invention"), comprising administering to a subject in need
thereof a
therapeutically effective amount of (3-lapachone or pharmaceutically
acceptable salts thereof, or
a metabolite thereof, in combination with a pharmaceutically acceptable
Garner, where the [3-
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lapachone or pharmaceutically acceptable salts thereof, or a metabolite
thereof, treats the cancer
selected from the group consisting of a hematologic cancer of the present
invention.
The present invention also provides a method of treating a cancer selected
from the
group consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of (3-lapachone or
pharmaceutically
acceptable salt thereof, or a metabolite thereof, in combination with a
pharmaceutically
acceptable Garner, and activating one or more cell cycle checkpoints in cells
of a hematologic
cancer of the present invention, where the (3-lapachone or pharmaceutically
acceptable salts
thereof, or a metabolite thereof, treats the cancer selected from the group
consisting of a
hematologic cancer of the present invention.
The present invention further provides a method of treating a cancer selected
from the
group consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of [3-lapachone or
pharmaceutically
acceptable salt thereof, or a metabolite thereof, in combination with a
pharmaceutically
acceptable carrier, and activating one or more cell cycle checkpoint pathways
in one or more
cells of a cancer selected from the group consisting of a hematologic cancer
of the present
invention, where the (3-lapachone or pharmaceutically acceptable salts
thereof, or a metabolite
thereof, treats the cancer selected from the group consisting of a hematologic
cancer of the
present invention
The present invention also provides a method of treating a cancer selected
from the
group consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of [3-lapachone or
pharmaceutically
acceptable salt thereof, or a metabolite thereof, in combination with a
pharmaceutically
acceptable carrier, and activating one or more cell cycle checkpoint
regulators in one or more
cells of a cancer selected from the group consisting of a hematologic cancer
of the present
invention, where the (3-lapachone or pharmaceutically acceptable salts
thereof, or a metabolite
thereof, treats the cancer selected from the group consisting of a hematologic
cancer of the
present invention.
The present invention further provides a method of treating a cancer selected
from the
group consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of (3-lapachone or
pharmaceutically
acceptable salt thereof, or a metabolite thereof, in combination with a
pharmaceutically
acceptable carrier, and activating cell death selectively in one or more cells
of a cancer selected
from the group consisting of a hematologic cancer of the present invention,
where the (3-
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lapachone or pharmaceutically acceptable salts thereof, or a metabolite
thereof, treats the cancer
selected from the group consisting of a hematologic cancer of the present
invention.
The present invention also provides a method of treating or preventing a cell
proliferative
disorder selected from the group consisting of lymphoma, leukemia, myeloid
neoplasms, mast
cell neoplasm, myelodysplasia, benign monoclonal gammopathy, lymphomatoid
granulomatosis, lymphomatoid papulosis, polycythemia vera, chronic myelocytic
leukemia,
agnogenic myeloid metaplasia, and essential thrombocythemia (collectively, "a
hematologic cell
proliferative disorder of the present invention"), comprising administering to
a subj ect in need
thereof a therapeutically effective amount of (3-lapachone or pharmaceutically
acceptable salt
thereof, or a metabolite thereof, in combination with a pharmaceutically
acceptable Garner,
where the (3-lapachone or pharmaceutically acceptable salts thereof, or a
metabolite thereof,
treats or prevents the cell proliferative disorder selected from the group
consisting of a
hematologic cell proliferative disorder of the present invention.
The present invention provides a method of treating a cancer selected from the
group
consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of a derivative or
analog of (3-
lapachone or pharmaceutically acceptable salt thereof, or a metabolite
thereof, in combination
with a pharmaceutically acceptable carrier, where the derivative or analog of
(3-lapachone or
pharmaceutically acceptable salts thereof, or a metabolite thereof, treats the
cancer selected from
the group consisting of a hematologic cancer of the present invention.
The present invention also provides a method of treating a cancer selected
from the
group consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of a derivative or
analog of ~3-
lapachone or pharmaceutically acceptable salt thereof, or a metabolite
thereof, in combination
with a pharmaceutically acceptable Garner, and activating one or more cell
cycle checkpoints in
one or more cells of a cancer selected from the group consisting of a
hematologic cancer of the
present invention, where the derivative or analog of (3-lapachone or
pharmaceutically acceptable
salts thereof, or a metabolite thereof, treats the cancer selected from the
group consisting of a
hematologic cancer of the present invention.
The present invention further provides a method of treating a cancer selected
from the
group consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of a derivative or
analog (3-lapachone
or pharmaceutically acceptable salt thereof, or a metabolite thereof, in
combination with a
pharmaceutically acceptable Garner, and activating one or more cell cycle
checkpoint pathways
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in one or more cells of a cancer selected from the group consisting of a
hematologic cancer of
the present invention, where the [3-lapachone or pharmaceutically acceptable
salts thereof, or a
metabolite thereof, treats the cancer selected from the group consisting of a
hematologic cancer
of the present invention.
The present invention also provides a method of treating a cancer selected
from the
group consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of a derivative or
analog of ~3-
lapachone or pharmaceutically acceptable salt thereof, or a metabolite
thereof, iri combination
with a pharmaceutically acceptable carrier, and activating one or more cell
cycle checkpoint
regulators in one or more cells of a cancer selected from the group consisting
of a hematologic
cancer of the present invention, where the derivative or analog of [3-
lapachone or
pharmaceutically acceptable salts thereof, or a metabolite thereof, treats the
cancer selected from
the group consisting of a hematologic cancer of the present invention.
The present invention further provides a method of treating a cancer selected
from the
group consisting of a hematologic cancer of the present invention, comprising
administering to a
subject in need thereof a therapeutically effective amount of a derivative or
analog of (3-
lapachone or pharmaceutically acceptable salt thereof, or a metabolite
thereof, in combination
with a pharmaceutically acceptable Garner, and activating cell death
selectively in one or more
cells of a cancer selected from the group consisting of a hematologic cancer
of the present
invention, where the derivative or analog of (3-lapachone or pharmaceutically
acceptable salts
thereof, or a metabolite thereof, treats the cancer selected from the group
consisting of a
hematologic cancer of the present invention.
The present invention also provides a method of treating or preventing a cell
proliferative
disorder selected from the group consisting of a hematologic cell
proliferative disorder of the
present invention, comprising administering to a subject in need thereof a
therapeutically
effective amount of a derivative or analog of (3-lapachone or pharmaceutically
acceptable salt
thereof, or a metabolite thereof, in combination with a pharmaceutically
acceptable Garner,
where the derivative or analog of (3-lapachone or pharmaceutically acceptable
salts thereof, or a
metabolite thereof, treats or prevents the cell proliferative disorder
selected from the group
consisting of a hematologic cell proliferative disorder of the present
invention.
The present invention also provides a method of treating or preventing a
hematologic cell
proliferative disorder of the present invention, comprising administering to a
subject in need
thereof a therapeutically effective amount of (3-lapachone or pharmaceutically
acceptable salts
thereof, or a metabolite thereof, in combination with a pharmaceutically
acceptable carrier, and
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activating one or more cell cycle checkpoints in a hematologic cell, where the
~i-lapachone or
pharmaceutically acceptable salts thereof, or a metabolite thereof, treats or
prevents a
hematologic cell proliferative disorder of the present invention.
The present invention also provides a method of treating or preventing a
hematologic cell
proliferative disorder of the present invention, comprising administering to a
subj ect in need
thereof a therapeutically effective amount of (3-lapachone or pharmaceutically
acceptable salts
thereof, or a metabolite thereof, in combination with a pharmaceutically
acceptable carrier, and
activating one or more cell cycle checkpoint pathways in a hematologic cell,
where the [3-
lapachone or pharmaceutically acceptable salts thereof, or a metabolite
thereof, treats or prevents
a hematologic cell proliferative disorder of the present invention.
The present invention also provides a method of treating or preventing a
hematologic cell
proliferative disorder of the present invention, comprising administering to a
subj ect in need
thereof a therapeutically effective amount of (3-lapachone or pharmaceutically
acceptable salts
thereof, or a metabolite thereof, in combination with a pharmaceutically
acceptable carrier, and
activating one or more cell cycle checkpoint regulators in a hematologic cell,
where the (3-
lapachone or pharmaceutically acceptable salts thereof, or a metabolite
thereof, treats or prevents
a hematologic cell proliferative disorder of the present invention.
The present invention also provides a method of treating or preventing a
hematologic cell
proliferative disorder of the present invention, comprising administering to a
subject in need
thereof a therapeutically effective amount of (3-lapachone or pharmaceutically
acceptable salts
thereof, or a metabolite thereof, in combination with a pharmaceutically
acceptable carrier, and
activating cell death selectively in hematologic cell, where the [3-lapachone
or pharmaceutically
acceptable salts thereof, or a metabolite thereof, treats or prevents a
hematologic cell
proliferative disorder of the present invention.
BRIEF DESCRIPTION OF THE FIGURES
Figure 1 sets forth a schematic of the proposed points of action of (3-
Lapachone and
Taxol on the cell cycle.
Figure 2 sets forth an effect of ~i-Lapachone on survival of human cancer cell
lines in the
NCI60 assay in vitro.
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DETAILED DESCRIPTION OF THE INVENTION
The present invention provides a method of treating a cancer selected from the
group
consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell neoplasm
comprising
administering to a subject in need thereof a therapeutically effective amount
of (3-lapachone, or a
pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative
thereof, in
combination with a pharmaceutically acceptable Garner, where the a cancer
selected from the
group consisting of lymphoma, leukemia, myeloid neoplasms, and mast cell
neoplasm is treated.
The present invention also provides a method of treating or preventing a cell
proliferative
disorder of the hematologic system, comprising administering to a subj ect in
need thereof a
therapeutically effective amount of [3-lapachone, or a pharmaceutically
acceptable salt, prodrug,
metabolite, malog or derivative thereof, in combination with a
pharmaceutically acceptable
carrier, where the cell proliferative disorder of the hematologic system is
treated or prevented.
The invention also provides the use of (3-lapachone for the preparation of a
medicament useful
for the treatment of a cancer selected from the group consisting of lymphoma,
leukemia,
myeloid neoplasms, and mast cell neoplasm. The invention also provides the use
of (3-lapachone
for the preparation of a medicament useful for the treatment or prevention of
a cell proliferative
disorder of the hematologic system. The invention also provides the use of an
analog or
derivative of (3-lapachone for the preparation of a medicament useful for the
treatment of
hematologic cancer. The invention also provides the use of an analog or
derivative of (3-
lapachone for the preparation of a medicament useful for the treatment or
prevention of a cell
proliferative disorder of the hematologic system. .
While not limited by theory, the present invention includes and is based in
part on an
understanding of, and methods for, the activation of cell cycle checkpoints by
modulators of cell
cycle checkpoint activation (e.g., (3-lapachone, or a pharmaceutically
acceptable salt, prodrug,
metabolite, analog or derivative thereof). The activation of cell cycle
checkpoints in general is
referred to as Activated Checkpoint TherapyTM, or ACTTM. Briefly, many cancer
cells are
defective in their cell cycle checkpoint functions secondary to mutations in
one of their
molecular modulators, e.g., p53. It is in part, for this reason, that cancer
cells have accumulated
genetic errors during the carcinogenic process. Therapeutic agents that
activate cell cycle
checkpoint functions can selectively promote cell death in cancer cells, since
cell death appears
to be induced at least in part by the conflict between the uncontrolled-
proliferation drive in
cancer cells and the checkpoint delays induced artificially. ACTTM takes
advantage of the
tendency of cell death to occur at checkpoints during the cell proliferation
cycle by activating
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one or more checkpoints, thereby producing conflicting signals regarding cell
cycle progression
versus arrest. If more than one checkpoint is activated, cancer cells with
uncontrolled
proliferation signals and genetic abnormalities are blocked at multiple
checkpoints, creating
"collisions" that promote synergistic cell death.
ACTTM offers selectivity against cancer cells as compared to normal cells and
is
therefore safer than less selective therapies. First, the ACTTM method
activates but does not
disrupt cell cycle checkpoints. Second, normal cells with well-controlled
proliferation signals
can be delayed at checkpoints in a regulated fashion, resulting in no cell
death-prone collisions.
Third, normal cells with intact Gl checkpoint control are expected to arrest
in Gl. Cancer cells,
on the other hand, are expected to be delayed in S-, G2-, and M-phases, since
most cancer cells
harbor G1 checkpoint defects, making cancer cells more sensitive to drugs
imposing S and M
phase checkpoints. ~3-lapachone is a Gl and S phase compound, and contacting a
cell with [3-
lapachone results in activation of a Gl or S cell cycle checkpoint. Figure 1
sets forth a schematic
of the proposed points of action of (3-lapachone and Taxol on the cell cycle.
The term "modulator of cell cycle checkpoint activation," as used herein,
refers to a
compound capable of altering checkpoint activation in cells (in preferred
embodiments,
activating one or more cell cycle checkpoints), preferably by activating
checkpoint-mediated
DNA repair mechanisms, or by reinstating checkpoint activity that has been
lost due to a
malfunction or mutation in the cellular pathways that regulate cell cycle
activity. As is known in
the art, major cell cycle checkpoints occur at Gl/S phase and at the GZ/Mphase
transitions. In a
model, four major cell cycle checkpoints monitor the integrity of genetic
material. DNA
synthesis begins only past the restriction point (R point), where the cell
determines if preparation
during Gl has been satisfactory for cell cycle continuation. The second
checkpoint occurs
during replication initiation in S phase. The third and fourth checkpoints
take place in G2 phase
and M phase, respectively. Modulation of cell cycle checkpoint activation is
further discussed
in, e.g., C.J. Li et al. Proc. Natl. Acad. Sci. USA (1999), 96(23), 13369-
13374, and Y. Li et al.
Pr°oc. Natl. Acad. Sci. USA (2003), 100(5), 2674-2678, and PCT
Publication WO 00/61142
(Pardee et al.). Preferred modulators of cell cycle checkpoint activation for
use in the present
invention induce checkpoint activation (i. e., activate one or more cell cycle
checkpoints,
preferably at Gl/S phase), preferably without causing substantial DNA damage.
In addition,
certain preferred modulators of cell cycle checkpoint activation are capable
of increasing the
level or activity of E2F (more preferably E2F1) in a cell. Methods for
screening for modulators
of cell cycle checkpoint activation, including compounds capable of elevating
E2F activity or
levels in a cell, include those that are disclosed in PCT Patent Application
No. PCT/LTS03/22631
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to Li et al. In certain embodiments, preferred modulators of cell cycle
checkpoint activation are
capable of increasing the level or activity of E2F in a cell by an amount
sufficient to cause cell
death (e.g., apoptosis) if the cell is a cancerous cell. More preferred
modulators of cell cycle
checkpoint activation are capable of raising the level or activity of E2F1 in
a cell by an amount
sufficient to cause cell death (e.g., apoptosis) if the cell is a cancerous
cell. In one aspect, a
modulator of cell cycle checkpoint activation is not (3-lapachone.
Again not limited by theory, cellular response to DNA damage is regulated by
the
ATM/ATR signal transduction pathway, in which ATM and ATR are protein kinases
of the
phosphatidyl-inositol-3 kinase family (PI3K). In response to DNA damage, ATM
and ATR
phosphorylate Chk2 and Chk1 respectively, which in turn activate a variety of
substrates
involved in arresting cells at the Gl/S phase of the cell cycle, as well as
inducing and activating
proteins involved in DNA repair. Chk2 has been shown to activate proteins
involved in DNA
repair including the tumor suppressor BRCAl, thereby enhancing DNA repair
capacity
following DNA damage. Chk2 has also been shown to stabilize p53 both by
directly
phosphorylating p53, and by inhibiting Mdm2, a ubiquitin ligase that targets
p53 for
degradation. Under such conditions, increased levels of p53 lead to Gl/S
arrest, DNA repair,
and apoptosis in cells with irreparable DNA damage. Again not limited by
theory, it is believed
that Chk2 is an important cell cycle regulator, which, depending on the
conditions, can induce
cell cycle arrest and DNA repair, or initiate cell death (e.g., apoptosis) if
DNA damage is too
severe. In certain embodiments, preferred modulators of cell cycle checkpoint
activation are
capable of increasing the level or activity of Chk2 in a cell by an amount
sufficient to cause cell
death (e.g., apoptosis) if the cell is a cancerous cell.
Again not limited by theory, EZF1 is one of related proteins in the E2F family
of nuclear
transcription factors, which family is critically important in regulation of
the cell cycle. E2F1 is
required for cellular proliferation by promoting passage through the Gl/S
checkpoint. During
proliferation of normal cells, transcriptionally active E2F1 is liberated from
an inactive E2F1/Rb
complex following phosphorylation of Rb. E2F1 levels rise, promoting
progression through G1.
As the cell moves toward the end of S phase, E2F1 levels must decline for
progress to continue.
Sustained elevation of E2F1 at this point in the cell cycle causes activation
of the S phase
checkpoint, and subsequent cell death (e.g., by apoptosis). Thus, depending on
the phase of the
cell cycle and dynamics of E2F1 elevation, this regulatory protein may either
promote cellular
proliferation, induce cell cycle delay, DNA repair or cell death. During the
G1 phase of the cell
cycle, phosphorylation of Rb results in dissociation of Rb-E2F1 complexes,
liberating active
E2F1, which then stimulates entry into S phase by promoting transcription of
key cell cycle
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effectors. During S-phase, E2F1 must be degraded for progress to continue. In
the presence of
DNA damage, however, E2F1 levels increase rather than decrease, causing cell
cycle delay,
DNA repair, and, if damage is severe, cell death. As used herein, "E2F" is the
E2F transcription
factor family (including but not limited to E2F-1, E2F-2, E2F-3).
As used herein, "a cell cycle checkpoint pathway" refers to a biochemical
pathway that is
involved in modulation of a cell cycle checkpoint. A cell cycle checkpoint
pathway may have
stimulatory or inhibitory effects, or both, on one or more functions
comprising a cell cycle
checkpoint. A cell cycle checkpoint pathway is comprised of at least two
compositions of
matter, preferably proteins, both of which contribute to modulation of a cell
cycle checkpoint. A
cell cycle checkpoint pathway may be activated through an activation of one or
more members
of the cell cycle checkpoint pathway. Preferably, a cell cycle checkpoint
pathway is a
biochemical signaling pathway.
As used herein, "cell cycle checkpoint regulator" refers to a composition of
matter that
can function, at least in part, in modulation of a cell cycle checkpoint. A
cell cycle checkpoint
regulator may have stimulatory or inhibitory effects, or both, on one or more
functions
comprising a cell cycle checkpoint. In one aspect, a cell cycle checkpoint
regulator is a protein.
In another aspect, a cell cycle checkpoint regulator is a not a protein. In
one aspect, a cell cycle
checkpoint regulator is selected from the group consisting of ATM, ATR, Chkl,
Chk2, E2F1,
BRCAl, Rb, p53, p21, Mdm2, Cdc2, Cdc25, and 14-4-3[sigma].
I. Compositions
As used herein, the phrase "[3-lapachone" refers to 3,4-dihydro-2,2-dimethyl-
2H-
naphtho[1,2-b]pyran-5,6-dione and derivatives and analogs thereof, and has the
chemical
structure:
O
Formula I
Preferred derivatives and analogs are discussed below.
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(3-Lapachone (3,4-dihydro-2, 2-dimethyl-2H-naphtho [1,2-b] pyran-5, 6-dione),
a simple
non-water soluble orthonapthoquinone, was first isolated in 1882 by Paterno
from the heartwood
of the lapacho tree (See Hooker, SC, (1936) I. Ana. Chem. Soc. 58:1181-1190;
Goncalves de '
Lima, O, et al., (1962) Rev. Inst. Antibiot. Univ. Recife. 4:3-17). The
structure of [3-Lapachone
was established by Hooker in 1896 and it was first synthesized by Fieser in
1927 (Hooker, SC,
(1936) I. Ana. Chem. Soc. 58:1181-1190). [3-Lapachone can, for example, be
obtained by simple
sulfuric acid treatment of the naturally occurring lapachol, which is readily
isolated from
Tabebuia avellenedae growing mainly in Brazil, or is easily synthesized from
seeds of lomatia
growing in Australia (Li, CJ, et al., (1993) J. Biol. Chem. 268:22463-33464).
Methods for
formulating (3-Lapachone or its derivatives or analogs can be accomplished as
described in U.S.
Patent No. 6,458,974 and U.S. Publication No. US-2003-0091639-A1.
As used herein, derivatives or analogs of (3-Lapachone include, for example,
3,4-dihydro-
2,2-dimethyl-3-(3-methyl-2-butenyl)-2H-naphtho[1,2-b]pyran-5,6-dione, 3,4-
dihydro-2,2-
dimethyl-2H-naphtho[1,2-b]thiopyran-5,6-dione and 3,4-dihydro-4,4-dimethyl-2H-
naphtho[1,2-
b]thiopyran-5,6-dione. Other derivatives or analogs of (3-lapachone are
described in PCT
International Application PCT/US93/07878 (W094/04145), and U.S. Pat. No.
6,245,807. PCT
International Application PCT/US00/10169 (WO 00/61142), discloses (3-
lapachone, which may
have a variety of substituents at the 3- position as well as in place of the
methyl groups attached
at the 2-position. U.S. Patent Nos. 5,763,625, 5,824,700, and 5,969,163,
disclose analogs and
derivatives with a variety of substituents at the 2-, 3- and 4-positions.
Furthermore, a number of
journals report [3-lapachone analogs and derivatives with substituents at one
or more of the
following positions: 2-, 3-, 8- and/or 9-positions, (See, Sabba et al., (1984)
JMed Chem 27:990-
994 (substituents at the 2-, 8- and 9- positions); (Portela and Stoppani,
(1996) Biochern Pharm
51:275-283 (substituents at the 2- and 9- positions); Goncalves et al., (1998)
Molecular' and
Biochemical Parasitology 1:167-176 (substituents at the 2- and 3- positions)).
Other derivatives
or analogs of [3-lapachone have sulfur-containing hetero-rings in the "a" and
"(3" positions of
lapachone (Kurokawa S, (1970) Bulletin. of Tlae Chemical Society ofJapan
43:1454-1459;
Tapia, R.A et al., (2000) Heterocycles 53(3):585-598; Tapia, RA et al., (1997)
Tetrahedron
Lettet~s 38(1):153-154; Chuang, CP et al., (1996) Heterocycles 40(10):2215-
2221; Suginome H
et al., (1993) Journal of the Chemical Society, Chemical Communications 9:807-
809; Tonholo J
et al., (1988) Journal of the Brazilian Cherraical Society 9(2):163-169; and
Krapcho AP et al.,
(1990) Journal ofMedicinal Chemistry 33(9):2651-2655).
Further, derivatives or analogs of (3-lapachone include reduced (3-lapachone
(e.g.,
Formula la, in which R' and R" are both hydrogen) and derivatives of reduced
(3-lapachone
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(see,e.g., Formula la, in which R' and R" are each independently hydrogen, Cl-
C6 alkyl, C1-C6
alkylcarbonyl, or a pharmaceutically acceptable salt).
)R
Formula Ia
While (3-lapachone is the preferred Gl/S-phase compound for use in the
composition in
accordance with the present invention, the invention is not limited in this
respect, and (3-
lapachone derivatives or analogs, such as lapachol, and pharmaceutical
compositions and
formulations thereof are part of the present invention. Such (3-lapachone
analogs include those
recited in PCT International Application PCT/IJS93/07878 (WO 94/04145), which
discloses
compounds of the formula:
Formula II
where R and Rl are each independently hydrogen, substituted and unsubstituted
aryl, substituted
and unsubstituted alkenyl, substituted and unsubstituted alkyl and substituted
or unsubstituted
alkoxy. The alkyl groups preferably have from 1 to about 15 carbon atoms, more
preferably
from 1 to about 10 carbon atoms, still,more preferably from 1 to about 6
carbon atoms. The
term alkyl unless otherwise modified refers to both cyclic and noncyclic
groups, although of
course cyclic groups will comprise at least three carbon ring members.
Straight or branched
chain noncyclic alkyl groups are generally more preferred than cyclic groups.
Straight chain
alkyl groups are generally more preferred than branched. The alkenyl groups
preferably have
from 2 to about 15 carbon atoms, more preferably from 2 to about 10 carbon
atoms, still more
preferably from 2 to 6 carbon atoms. Especially preferred alkenyl groups have
3 carbon atoms
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(i. e., 1-propenyl or 2-propenyl), with the allyl moiety being particularly
preferred. Phenyl and
napthyl are generally preferred aryl groups. Alkoxy groups include those
alkoxy groups having
one or more oxygen linkage and preferably have from 1 to 15 carbon atoms, more
preferably
from 1 to about 6 carbon atoms. The substituted R and Rl groups may be
substituted at one or
more available positions by one or more suitable groups such as, for example,
alkyl groups such
as alkyl groups having from 1 to 10 carbon atoms or from 1 to 6 carbon atoms,
alkenyl groups
such as alkenyl groups having from 2 to 10 carbon atoms or 2 to 6 carbon
atoms, aryl groups
having from six to ten carbon atoms, halogen such as fluoro, chloro and bromo,
and N, O and S,
including heteroalkyl, e.g., heteroalkyl having one or more hetero atom
linkages (and thus
including alkoxy, aminoalkyl and thioalkyl) and from 1 to 10 carbon atoms or
from 1 to 6
carbon atoms.
Other (3-lapachone analogs contemplated in accordance with the present
invention
include those described in U.S. Patent No. 6,245,807, which discloses (3-
lapachone analogs and
derivatives having the structure:
O
R
Formula III
where R and Rl are each independently selected from hydrogen, hydroxy,
sulfliydryl, halogen,
substituted alkyl, unsubstituted alkyl, substituted alkenyl, unsubstituted
alkenyl, substituted aryl,
unsubstituted aryl, substituted alkoxy, unsubstituted alkoxy, and salts
thereof, where the dotted
double bond between the ring carbons represents an optional ring double bond.
Additional (3-lapachone analogs and derivatives are recited in PCT
International
Application PCT/LTS00/10169 (WO00/61142), which disclose compounds of the
structure:
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O
Formula IV
where R5 and R6 may be independently selected from hydroxy, C1-C~ alkyl, C1-C6
alkenyl, C1-
C6 alkoxy, C1-C6 alkoxycaxbonyl, --(CH2)ri phenyl; and R7 is hydrogen,
hydroxyl, C1-C6 alkyl,
C1-C6 alkenyl, C1-C6 alkoxy, C1-C6 alkoxycarbonyl, --(CH2)"-amino, --(CH2)"-
aryl, --(CH2)n-
heteroaryl, --(CH2)"-heterocycle, or --(CH2)"-phenyl, wherein n is an integer
from 0 to 10.
Other (3-lapachone analogs and derivatives are disclosed in U.S. Pat. No.
5,763,625, U.S.
Pat. No. 5,824,700, and U.S. Pat. No. 5,969,163, as well is in scientific
journal articles, such as
Sabba et al., JMed Chem 27:990-994 (1984), wluch discloses (3-lapachone with
substitutions at
one or more of the following positions: 2-, 8- and/or 9- positions. See also
Portela et al.,
BioclZem PlZaf°m 51:275-283 (1996) (substituents at the 2- and 9-
positions); Maruyama et al.,
Cherrl Lett 847-850 (1977); Sun et al., Tetrahedron Lett 39:8221-8224 (1998);
Goncalves et al.,
Molecular and Biochemical Parasitology 1:167-176 (1998) (substituents at the 2-
and 3-
positions); Gupta et al., IfZdian Jours2al of Chemistry 16B: 35-37 (1978);
Gupta et al., Cuf°r Sci
46:337 (1977) (substituents at the 3- and 4- positions); DiChenna et al., JMed
Chem 44: 2486-
2489 (2001) (monoarylamino derivatives).
More preferably, analogs and derivatives contemplated by the present
application are
intended to encompass compounds having the general formula V and VI:
O O
R1
R R
7
Formula V Formula VI
where the dotted double bond between the ring carbons represents an optional
ring double bond
and where R and Rt are each independently selected from hydrogen, hydroxy,
sulfhydryl,
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halogen, substituted alkyl, unsubstituted alkyl, substituted alkenyl,
unsubstituted alkenyl,
substituted aryl, unsubstituted aryl, substituted alkoxy, unsubstituted
alkoxy, and salts thereof.
The alkyl groups preferably have from 1 to about 15 carbon atoms, more
preferably from 1 to
about 10 carbon atoms, still more preferably from 1 to about 6 carbon atoms.
The term alkyl
refers to both cyclic and noncyclic groups. Straight or branched chain
noncyclic alkyl groups
are generally more preferred than cyclic groups. Straight chain alkyl groups
are generally more
preferred than branched. The alkenyl groups preferably have from 2 to about 15
carbon atoms,
more preferably from 2 to about 10 carbon atoms, still more preferably from 2
to 6 carbon
atoms. Especially preferred alkenyl groups have 3 carbon atoms (i.e., 1-
propenyl or 2-
propenyl), with the allyl moiety being particularly preferred. Phenyl and
napthyl are generally
preferred aryl groups. Alkoxy groups include those alkoxy groups having one or
more oxygen
linkage and preferably have from 1 to 15 carbon atoms, more preferably from 1
to about 6
carbon atoms. The substituted R and Rl groups may be substituted at one or
more available
positions by one or more suitable groups such as, for example, alkyl groups
having from 1 to 10
carbon atoms or from 1 to 6 carbon atoms, alkenyl groups having from 2 to 10
carbon atoms or
2 to 6 carbon atoms, aryl groups having from six to ten carbon atoms, halogen
such as fluoro,
chloro and bromo, and N, O and S, including heteroalkyl, e.g., heteroalkyl
having one or more
hetero atom linkages (and thus including alkoxy, aminoalkyl and thioalkyl) and
from 1 to 10
carbon atoms or from 1 to 6 carbon atoms; and where RS and R6 may be
independently selected
from hydroxy, C1-C~ alkyl, Ci-C6 alkenyl, C1-C6 alkoxy, C1-C6 alkoxycarbonyl, -
-(CH2)"-aryl, --
(CH2)ri heteroaryl, --(CH2)"-heterocycle, or --(CH2)"-phenyl; and R7 is
hydrogen, hydroxyl, C1-
C6 alkyl, C1-C6 alkenyl, C1-C6 alkoxy, C1-C6 alkoxycarbonyl, --(CH2)ri amino, -
-(CH2)"-aryl, --
(CHz)"-heteroaryl, --(CH2)"-heterocycle, or --(CHZ)ri phenyl, wherein n is an
integer from 0 to
10.
Preferred analogs and derivatives also contemplated by the invention include
compounds
of the following general formula VII:
Formula VII
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where Rl is (CH2)n R2, where n is an integer from 0-10 and R2 is hydrogen, an
alkyl, an aryl, a
heteroaromatic, a heterocyclic, an aliphatic, an alkoxy, an allyloxy, a
hydroxyl, an amine, a thiol,
an amide, or a halogen.
Analogs and derivatives also contemplated by the invention include 4-acetoxy-
/3-
lapachone, 4-acetoxy-3-bromo-[3-lapachone, 4-keto-(3-lapachone, 7-hydroxy-(3-
lapachone, 7-
methoxy-(3-lapachone, 8-hydroxy-(3-lapachone, 8-methoxy-(3-lapachone, 8-chloro-
(3-lapachone,
9-chloro-(3-lapachone, 8-methyl-(3-lapachone and 8,9-dimethoxy-/3-lapachone.
Preferred analogs and derivatives also contemplated by the invention include
compounds
of the following general formula VIII:
O
t1
Z2
Formula VIII
where Rl-R4 are each, independently, selected from the group consisting of H,
C1-C6 alkyl, C1-
CG allcenyl, C1-C~ alkoxy, C1-C6 alkoxycarbonyl, --(CHZ)ri aryl, --(CH2)"-
heteroaryl, --(CHZ)n
heterocycle, or --(CH2)"-phenyl; or Rl and RZ combined are a single
substituent selected from
the above group, and R3 and R4 combined are a single substituent selected from
the above
groups, in which case ---- is a double bond.
Preferred analogs and derivatives also contemplated by this invention include
dunnione
and 2-ethyl-6-hydroxynaphtho[2,3-b]-furan-4,5-dione.
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Preferred analogs and derivatives also contemplated by the invention include
compounds
of the following general formula IX:
Formula IX
where Rl is selected from H, CH3, OCH3 and NOZ.
Additional preferred ~3-lapachone analogs useful in the methods and kits of
the invention
are represented by Formula X (see also the co-owned PCT patent application
entitled "NOVEL
LAPACHONE COMPOUNDS AND METHODS OF USE THEREOF", PCT/IJS2003/037219,
filed November 18, 2003, and claiming priority to U.S. provisional application
no. 60/427,283,
filed November 18, 2002):
R$
R
Formula X
or pharmaceutically acceptable salts thereof, or a regioisomeric mixture
thereof, wherein
R1-R6 are each, independently, selected from the group consisting of H, OH,
substituted and
unsubstituted Cl-C6 alkyl, substituted and unsubstituted C1-C6 alkenyl,
substituted and
unsubstituted C1-C6 alkoxy, substituted and unsubstituted C1-C~
alkoxycarbonyl, substituted and
unsubstituted C1-C~ acyl, -(CH2)"-amino, -(CH2)"-aryl, -(CHZ)"-heterocycle,
and -(CHZ)"-phenyl;
or one of Rl or R2 and one of R3 or R4; or one of R3 or R4 and one of RS or R6
form a fused
ring, wherein the ring has 4-8 ring members; R7-R10 are each, independently,
hydrogen,
hydroxyl, halogen, substituted or unsubstituted alkyl, substituted or
unsubstituted alkoxy, nitro,
cyano or amide; and n is an integer from 0 to 10.
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In a preferred embodiment, Rl and R2 are alkyl, R3-R6 are, independently, H,
OH,
halogen, alkyl, alkoxy, substituted or unsubstituted acyl, substituted alkenyl
or substituted alkyl
carbonyl, and R7-R10 are hydrogen. In another preferred embodiment, Rl and R2
are each
methyl and R3-R10 are each hydrogen. In another preferred embodiment, Rl-R4
are each
hydrogen, RS and R6 are each methyl and R7-R10 are each hydrogen.
Additional preferred (3-lapachone analogs useful in the methods and kits of
the invention
are represented by Formula XI (see also the co-owned PCT patent application
entitled "NOVEL
LAPACHONE COMPOUNDS AND METHODS OF USE THEREOF", PCT/US2003/037219,
filed November 18, 2003):
R4
Formula XI
or pharmaceutically acceptable salts thereof, or a regioisomeric mixture
thereof, wherein
Rl-R4 are each, independently, selected from the group consisting of H, OH,
substituted and
unsubstituted CI-C6 alkyl, substituted and unsubstituted C1-C6 alkenyl,
substituted and
unsubstituted C1-C6 alkoxy, substituted and unsubstituted C1-C6
alkoxycarbonyl, substituted and
unsubstituted C1-C~ acyl, -(CH2)"-amino, -(CH2)n-aryl, -(CHZ)n heterocycle,
and -(CHZ)n phenyl;
or one of Rl or R2 and one of R3 or R4 form a fused ring, wherein the ring has
4-8 ring
members; RS-R8 are each, independently, hydrogen, hydroxyl, halogen,
substituted or
unsubstituted alkyl, substituted or unsubstituted alkoxy, nitro, cyano or
amide; and n is an
integer from 0 to 10. In certain embodiments of Formula XI, Rl, R2, R3, R4,
R5, R6, R7 and
R8 are not each simultaneously H.
All stereoisomers of the compounds of the instant invention are contemplated,
either in
admixture or in pure or substantially pure form. The definition of the
compounds according to
the invention embraces all possible stereoisomers (e.g., the R and S
configurations for each
asymmetric center) and their mixtures. It very particularly embraces the
racemic forms and the
isolated optical isomers having a specified activity. The racemic forms can be
resolved by
physical methods, such as, for example, fractional crystallization, separation
or crystallization of
diastereomeric derivatives or separation by chiral column chromatography. The
individual
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optical isomers can be obtained from the racemates by conventional methods,
such as, for
example, salt formation with an optically active acid followed by
crystallization. Furthermore,
all geometric isomers, such as E- and Z-configurations at a double bond, are
within the scope of
the invention unless otherwise stated. Certain compounds of this invention may
exist in
tautomeric forms. All such tautomeric forms of the compounds are considered to
be within the
scope of this invention unless otherwise stated. The present invention also
includes one or more
regioisomeric mixtures of an analog or derivative of (3-Lapachone.
As used herein, the term "salt" is a pharmaceutically acceptable salt and can
include acid
addition salts including hydrochlorides, hydrobromides, phosphates, sulphates,
hydrogen
sulphates, alkylsulphonates, arylsulphonates, acetates, benzoates, citrates,
maleates, fumarates,
succinates, lactates, and tartrates; alkali metal cations such as Na, K, Li,
alkali earth metal salts
such as Mg or Ca, or organic amine salts.
As used herein, the term "metabolite" means a product of metabolism of (3-
lapachone, or
a pharmaceutically acceptable salt, analog or derivative thereof, that
exhibits a similar activity in
vivo to (3-lapachone.
As used herein, the term "prodrug" means a compound of the present invention
covalently linked to one or more pro-moieties, such as an amino acid moiety or
other water
solubilizing moiety. A compound of the present invention may be released from
the pro-moiety
via hydrolytic, oxidative, and/or enzymatic release mechanisms. In an
embodiment, a prodrug
composition of the present invention exhibits the added benefit of increased
aqueous solubility,
improved stability, and improved pharmacokinetic profiles. The pro-moiety may
be selected to
obtain desired prodrug characteristics. For example, the pro-moiety, e.g., an
amino acid moiety
or other water solubilizing moiety may be selected based on solubility,
stability, bioavailability,
and/or in vivo delivery or uptake.
II. Methods of Treatment
As used herein, a "subject" can be any mammal, e.g., a human, a primate,
mouse, rat,
dog, cat, cow, horse, pig, sheep, goat, camel. In a preferred aspect, the
subject is a human.
As used herein, a "subj ect in need thereof' is a subj ect having a cell
proliferative
disorder of the hematologic system, or a subject having an increased risk of
developing a cell
proliferative disorder of the hematologic system relative to the population at
large. In one
aspect, a subj ect in need thereof has a precancerous condition of the
hematologic system. In a
preferred aspect, a subject in need thereof has hematologic cancer. In an
aspect, the subject may
be suffering from a known (i.e., diagnosed) condition characterized by cell
hyperproliferation
(e.g., cancer) of the hematologic system.
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As used herein, an "immune cell" is any cell that functions in an immune
response or is a
direct precursor to a cell that functions in an immune response, including but
not limited to
hematopoietic cells, lymphoid cells, myeloid cells, lymphocyte precursors, B
cell precursors, T
cell precursors, lymphocytes, B cells, T cells, plasma cells, monocytes,
macrophages,
neutrophils, eosinophils, basophils, natural killer cells (i.e., NK cells),
mast cells, and dendritic
cells. As used herein, a "white blood cell" (i.e., a leukocyte) is a blood
cells that lacks
. hemoglobin, and includes but is not limited to lymphocytes, B cells, T
cells, monocytes,
macrophages, natural killer cells, neutrophils, eosinophils, and basophils. As
used herein, a
"lymphocyte" is type of white blood cell that is continuously made in the bone
marrow, may be
present in blood, lymph nodes, spleen, thymus, gut wall and bone marrow, and
includes but is
not limited to B lymphocytes and T lymphocytes. As used herein, a "monocyte"
is a large white
blood cell that is capable of phagocytosis and which, when it enters tissue,
develops into a
macrophage. As used herein a "neutrophil" is a white blood cell that is
capable of phagocytosis
and is distinguished by a lobed nucleus and granular cytoplasm. As used
herein, a "natural killer
cell" is a subset of bone marrow-derived lymphocytes, distinct from B or T
cells, that function in
innate immune responses through lytic mechanisms and by secreting IFN-y.
As used herein, the term "cell proliferative disorder" refers to conditions in
which
unregulated or abnormal growth, or both, of cells can lead to the development
of an unwanted
condition or disease, which may or may not be cancerous. In one aspect, a cell
proliferative
disorder includes, for example, hematologic cancer and precancerous conditions
of the
hematologic system. A "cell proliferative disorder of the hematologic system"
is a cell
proliferative disorder involving cells of the hematologic system. In one
aspect, a cell
proliferative disorder includes a pre-cancer or precancerous condition of the
hematologic
system. In one aspect, a cell proliferative disorder of the hematologic system
includes a non-
cancerous cell proliferative disorder of the hematologic system. In another
aspect, a cell
proliferative disorder includes hematologic cancer, including metastatic
lesions in other tissues
or organs distant from the tumor site. In one aspect, a "precancer cell" or
"precancerous cell" is
a cell manifesting a cell proliferative disorder that is a precancer or a
precancerous condition. In
another aspect, a "cancer cell" or "cancerous cell" is a cell manifesting a
cell proliferative
disorder that is a cancer. Any reproducible means of measurement may be used
to identify
cancer cells or precancerous cells. In a preferred aspect, cancer cells or
precancerous cells are
identified by histological typing or grading of a tissue sample (e.g., a
biopsy sample). In another
aspect, cancer cells or precancerous cells are identified through the use of
appropriate molecular
markers.
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In one aspect, cell proliferative disorders of the hematologic system include
all forms of
cell proliferative disorders affecting hematologic cells, e.g., benign and
premalignant
hematologic conditions of the hematologic system, as well as cancers of the
hematologic system.
In one aspect, cell proliferative disorders of the hematologic system include
hematologic cancer
and precancerous conditions of the hematologic system. In one aspect, cell
proliferative
disorders of the hematologic system include hyperplasia, metaplasia, and
dysplasia of the
hematologic system. In one aspect, cell proliferative disorders of the
hematologic system include
sporadic and hereditary cell proliferative disorders of the hematologic
system. In one aspect,
cell proliferative disorders of the hematologic system include benign tumors
of the hematologic
system. In an aspect, a cell proliferative disorder of the hematologic system
that is to be treated
includes a cell proliferative disorder of immune cells. In another aspect, a
cell proliferative
disorder of the hematologic system includes a cell proliferative disorder of
white blood cells. In
another aspect, a cell proliferative disorder of the hematologic system
includes a cell
proliferative disorder of lymphocytes, monocytes, macrophages, natural killer
cells, neutrophils,
eosinophils, or basophils. In another aspect, a cell proliferative disorder of
the hematologic
system includes a cell proliferative disorder of T cells or B cells. In
another aspect, a cell
proliferative disorder of the hematologic system includes a cell proliferative
disorder of
myeloblasts or monoblasts. In another aspect, a cell proliferative disorder of
the hematologic
system includes a cell proliferative disorder of mononuclear cells (e.g.,
lymphocytes and
monocytes) or granulocytes (e.g., neutrophils, eosinophils, and basophils). In
one aspect, a cell
proliferative disorder of the hematologic system includes a cell proliferative
disorder of plasma
cells (e.g., multiple myeloma). In another aspect, a cell proliferative
disorder of the hematologic
system does not include a cell proliferative disorder of plasma cells (e.g.,
multiple myeloma).
In an aspect, a cell proliferative disorder of the hematologic system that is
to be treated
includes lymphoma (including, for example, Hodgkin's lymphoma, non-Hodgkin's
lymphoma,
childhood lymphomas, and lymphomas of lymphocytic and cutaneous origin),
leukemia
(including, for example, childhood leukemia, hairy-cell leukemia, acute
lymphocytic leukemia,
acute myelocytic leukemia, chronic lymphocytic leukemia, chronic myelocytic
leukemia, and
mast cell leukemia), myeloid neoplasms, and mast cell neoplasm. In another
aspect, a cell
proliferative disorder of the hematologic system that is to be treated
includes myelodysplasia,
benign monoclonal gammopathy, lymphomatoid granulomatosis, lymphomatoid
papulosis,
polycythemia vera, chronic myelocytic leukemia, agnogenic myeloid metaplasia,
and essential
thrombocythemia. In another aspect, a cell proliferative disorder of the
hematologic system that
is to be treated is a myelodyplastic syndrome (e.g., refractory anemia,
refractory anemia with
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ringed sideroblasts, refractory cytopenia with multilineage dysplasia,
refractory cytopenia with
multilineage dysplasia and ringed sideroblasts, refractory anemia with excess
blasts-1 (RAEB-
1), refractory anemia with excess blasts-2 (R.AEB-2), myelodysplastic syndrome
unclassified
(MDS-L~, and MDS associated with isolated del(Sq)). Other exemplary cell
proliferative
disorder of the hematologic system are known to those of ordinary skill in the
art.
In a preferred aspect, the cell proliferative disorder of the hematologic
system is selected
from the group consisting of a hematologic cancer of the present invention or
a hematologic cell
proliferative disorder of the present invention. In a preferred aspect,
compositions of the present
invention may be used to treat a hematologic cancer of the present invention
or a hematologic
cell proliferative disorder of the present invention.
In one aspect, a hematologic cancer that is to be treated includes lymphoma
(including,
for example, Hodgkin's lymphoma, non-Hodgkin's lymphoma, childhood lymphomas,
and
lymphomas of lymphocytic and cutaneous origin), leukemia (including, for
example, childhood
leukemia, hairy-cell leukemia, acute lyrnphocytic leukemia, acute myelocytic
leukemia, chronic
lymphocytic leukemia, chronic myelocytic leukemia, and mast cell leukemia),
myeloid
neoplasms and mast cell neoplasms. Cancers to be treated may include but are
not limited to
sarcoma, carcinoma, and adenocarcinoma. In an aspect, a hematologic cancer
that is to be
treated includes a cancer of immune cells. In another aspect, a hematologic
cancer includes a
cancer of white blood cells. In another aspect, a hematologic cancer includes
a cancer of
lymphocytes, monocytes, macrophages, natural killer cells, neutrophils,
eosinophils, or
basophils. In another aspect, a hematologic cancer includes a cancer of T
cells or B cells. In .
another aspect, a hematologic cancer includes a cancer of myeloblasts or
monoblasts. In another
aspect, a hematologic cancer includes a cancer of mononuclear cells (e.g.,
lymphocytes and
monocytes) or granulocytes (e.g., neutrophils, eosinophils, and basophils). In
another aspect, a
hematologic cancer to be treated is selected from the group consisting of
lymphoma, leukemia,
myeloid neoplasms, and mast cell neoplasm. Tn one aspect, a hematologic cancer
to be treated
includes a cancer of plasma cells (e.g., multiple myeloma). In another aspect,
a hematologic
cancer to be treated does not include a cancer of plasma cells (e.g., multiple
myeloma).
In one aspect, a hematologic cancer that is to be treated is a leukemia. As
used herein, the
term "leulcernia" does not encompass multiple myeloma. In one aspect, a
leukemia to be treated
includes acute leukemias and chronic leukemias. In an aspect, a leukemia to be
treated includes
lymphocytic leukemias derived from lymphocytes. In another aspect, a leukemia
to be treated
includes myeloid leukemias (e.g., myeloid neoplasms). In another aspect, a
leukemia to be
treated includes childhood leukemia, hairy-cell leukemia, acute lymphocytic
leukemia (ALL),
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acute myelocytic leukemia (AML), acute promyelocytic leukemia, chronic
lymphocytic
leukemia (CLL), chronic myelocytic leukemia (CML), mast cell leukemia,
prolylnphocytic
leukemia and T-cell chronic lymphocytic leukemia.
In one aspect, a hematologic cancer that is to be treated is myeloid
neoplasms. As used
herein, the term "myeloid neoplasms" does not encompass multiple myeloma. As
used herein,
the term "myeloid neoplasms" refers to cancers of cells of the myeloid
lineage, e.g., myeloid
(myelocytic or myelogenous) leukemias derived from granulocytes (e.g.,
neutrophils,
eosinophils, and basophils) or monocytes; for example, chronic myelocytic
leukemia, acute
myelocytic leukemia, chronic neutrophilic leukemia, chronic eosinophilic
leukemia, and
myelodyplastic syndromes.
In one aspect, a hematologic cancer that is to be treated is a lymphoma. As
used herein,
the term "lymphoma" does not encompass multiple myeloma. In one aspect, a a
hematologic
cancer that is to be treated is a B cell lymphoma or a T cell lymphoma. In one
aspect, a
hematologic cancer that is to be treated is non-Hodgkin's lymphoma, Hodgkin's
disease (e.g.,
Hodgkin's lymphoma), childhood lymphomas, or lymphomas of lymphocytic and
cutaneous
origin. In another aspect, a hematologic cancer that is to be treated is a
diffuse large B-cell
lymphoma (DLBCL); follicular lymphoma; small lymphocytic lymphoma (SLL);
mantle cell
lymphoma; extranodal marginal zone B cell lymphoma; mucosa-associated lyphoid
tissue
(MALT) lymphoma; nodal marginal zone B cell lymphoma; splenic marginal zone B
cell
lymphoma; primary mediastinal B cell lymphoma; Burkitt's lymphoma;
lymphoplamocytic
lymphoma (Waldenstrom macroglobulinemia); primary central nervous system (CNS)
lymphoma. In one aspect, a hematologic cancer that is to be treated is a
peripheral T-cell
lymphoma, such as cutaneous T cell lymphoma, angioimmunoblastic T-cell
lymphoma,
extranodal natural killer/T cell lymphoma, enteropathy type T cell lymphoma,
subcutaneous
panniculitis-like T cell lymphoma, anaplastic large cell lymphoma, anaplastic
large T/null-cell
lymphoma, or null cell lymphoma. In another aspect, a hematologic cancer that
is to be treated
is precursor T-lymphoblastic lymphoma/leukemia. In an aspect, a hematologic
cancer that is to
be treated is granulocytic sarcoma.
In one aspect, a hematologic cancer that is to be treated is a mast cell
neoplasm. As used
herein, the term "mast cell neoplasm" does not encompass multiple myeloma. As
used herein,
the term "mast cell neoplasm" refers to cancers of mast cells (e.g., mast cell
leukemia, malignant
mastocytosis).
In one aspect, a hematologic cancer that is to be treated has arisen in a
subject equal to or
older than 30 years old, or a subject younger than 30 years old. In one
aspect, a hematologic
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cancer that is to be treated has arisen in a subject equal to or older than 50
years old, or a subject
younger than 50 years old. In one aspect, a hematologic cancer that is to be
treated has arisen in
a subject equal to or older than 70 years old, or a subject younger than 70
years old. In one
aspect, a hematologic cancer that is to be treated has been typed to identify
a familial or
spontaneous mutation in p53, Rb, CDKN2A (P16INK4A), FHIT, ATM myc, ras, bcr,
abl, or
bax. In another aspect, a hematologic cancer that is to be treated is
associated with the
Philadelphia chromosome translocation [t(9;22)] to form a bcr-abl gene fusion.
In one aspect, a
hematologic cancer that is to be treated is associated with a chromosomal
translocation selected
from the group consisting of t(9;22), t(10;11), t(11;19), t(5;12), t(3;11),
t(15;17), t(11;17), and
t(5;17). In another aspect, a hematologic cancer that is to be treated is
associated with an
increased level of a marker selected from the group consisting of beta-2-
microglobulin, Zap-70
and CD3~.
In one aspect, a hematologic cancer that is to be treated includes a localized
tumor of the
hematologic system. In one aspect, a hematologic cancer that is to be treated
includes a tumor of
the hematologic system that is associated with a negative regional lymph node
biopsy. In one
aspect, a hematologic cancer that is to be treated includes a tumor of the
hematologic system that
is associated with a positive regional lymph node biopsy. In another aspect, a
hematologic
cancer that is to be treated includes a tumor of the hematologic system that
has been typed as
having nodal negative status (e.g., node-negative) or nodal positive status
(e.g., node-positive).
In another aspect, a hematologic cancer that is to be treated includes a tumor
of the hematologic
system that has metastasized to other locations in the body. In one aspect, a
hematologic cancer
that is to be treated is classified as having metastasized to a location
selected from the group
consisting of lymph nodes, liver, lungs, bone marrow, brain, spinal cord, and
spleen. In one
aspect, a a hematologic cancer that is to be treated is classified as occurnng
in a patient with a
high white blood cell count (e.g., above 15,000), or a low blood lymphocyte
count (e.g., below
600). W another aspect a hematologic cancer that is to be treated is
classified according to a
characteristic selected from the group consisting of metastatic, limited
stage, extensive stage,
unresectable, resectable, localized, regional, local-regional, locally
advanced, distant,
multicentric, bilateral, ipsilateral, contralateral, newly diagnosed,
recurrent, and inoperable.
In one aspect, a hematologic cancer that is to be treated has been staged as
Stage 0, I, II,
III, or IV. In one aspect, a hematologic cancer that is to be treated has been
staged according to
the Rai classification system as Rai Stage 0, Rai Stage I, Rai Stage II, Rai
Stage III, or Rai Stage
IV. In one aspect, a hematologic cancer that is to be treated has been staged
according to the
Binet classification system as Binet Stage A, Binet Stage B, or Binet Stage C.
In one aspect, a
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hematologic cancer that is to be treated has been staged as Stage I, IB, IE,
II, IIB, IIE, III, IIIB,
IIIE, IIIS, IIISE, IV or IVB. In one aspect, In one aspect, a hematologic
cancer that is to be
treated has been staged as chronic phase, accelerated phase, or blast phase.
In one aspect, a
hematologic cancer that is to be treated has been staged according to the
American Joint
Committee on Cancer (AJCC) TNM classification system, where the tumor (T) has
been
assigned a stage of Tis, Tl, T2, T3,T4; and where the regional lymph nodes (N)
have been
assigned a stage of NX, N0, Nl, N2, N2a, N2b, N3, N3a, N3b, or N3c; and where
distant
metastasis (M) has been assigned a stage of MX, M0, or M1. In another aspect,
a hematologic
cancer that is to be treated has been staged according to an American Joint
Committee on Cancer
(AJCC) classification as Stage 0, I, IA, IB, II, IIA, IIB, III, IIIA, IIIB,
IIIC and IV hematologic
cancer. In another aspect, a hematologic cancer that is to be treated has been
assigned a grade
according to an AJCC classification as Grade GX (e.g., grade cannot be
assessed), Grade l,
Grade 2, Grade 3 or Grade 4.
In one aspect, a hematologic cancer that is to be treated includes a tumor
that has been
determined to be less than or equal to about 2 centimeters in diameter. In
another aspect, a
hematologic cancer that is to be treated includes a tumor that has been
determined to be from
about 2 to about 5 centimeters in diameter. hl another aspect, a hematologic
cancer that is to be
treated includes a tumor that has been determined to be greater than or equal
to about 2
centimeters in diameter. hl another aspect, a hematologic cancer that is to be
treated includes a
tumor that has been determined to be greater than 5 centimeters in diameter.
In another aspect, a
hematologic cancer that is to be treated is classified by microscopic
appearance as well
differentiated, moderately differentiated, poorly differentiated, or
undifferentiated. In another
aspect, a hematologic cancer that is to be treated is classified by
microscopic appearance with
respect to mitosis count (e.g., amount of cell division) or nuclear
pleiomorphism (e.g., change in
cells). In another aspect, a hematologic cancer that is to be treated is
classified by microscopic
appearance as being associated with areas of necrosis (e.g., areas of dying or
degenerating cells).
In one aspect, a hematologic cancer that is to be treated is classified as
having an abnormal
karyotype, having an abnormal number of chromosomes, or having one or more
chromosomes
that are abnormal in appearance. In one aspect, a hematologic cancer that is
to be treated is
classified as being aneuploid, triploid, tetraploid, or as having an altered
ploidy. In one aspect, a
hematologic cancer that is to be treated is classified as having a chromosomal
translocation, or a
deletion or duplication of an entire chromosome, or a region of deletion,
duplication or
amplification of a portion of a chromosome.
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In one aspect, a hematologic cancer that is to be treated has been typed as
having less
than 5% blast cells. In another aspect, a hematologic cancer that is to be
treated has been typed
as having more than 5%, 10%, 20%, 30% or 40% blast cells. In another aspect, a
hematologic
cancer that is to be treated has been typed as having more than 5%, 10%, 20%,
30% or 40%
blast cells and promyelocytes.
In one aspect, a hematologic cancer that is to be treated is evaluated by DNA
cytometry,
flow cytometry, or image cytometry. In one aspect, a hematologic cancer that
is to be treated has
been typed as having 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% of cells
in the
synthesis stage of cell division (e.g., in S phase of cell division). In one
aspect, a hematologic
cancer that is to be treated has been typed as having a low S-phase fraction
or a high S-phase
fraction.
As used herein, a "normal cell" is a cell that cannot be classified as part of
a "cell
proliferative disorder." In one aspect, a normal cell lacks unregulated or
abnormal growth, or
both, that can lead to the development of an unwanted condition or disease.
Preferably, a
normal cell possesses normally functioning cell cycle checkpoint control
mechanisms.
As used herein, "contacting a cell" refers to a condition in which a compound
or other
composition of matter is in direct contact with a cell, or is close enough to
induce a desired
biological effect in a cell.
As used herein, "monotherapy" refers to administration of a single active or
therapeutic
compound to a subj ect in need thereof. Preferably, monotherapy will involve
administration of
a therapeutically effective amount of an active compound. For example, (3-
lapachone
monotherapy for cancer comprises administration of a therapeutically effective
amount of (3-
lapachone, or a pharmaceutically acceptable salt, prodrug, metabolite, analog
or derivative
thereof, to a subject in need of treatment of cancer. Monotherapy may be
contrasted with
combination therapy, in which a combination of multiple active compounds is
administered,
preferably with each component of the combination present in a therapeutically
effective
amount. In one aspect, (3-lapachone montherapy is more effective than
combination therapy in
inducing a desired biological effect.
In one aspect, combination therapy includes (3-lapachone with taxol; (3-
lapachone with
docetaxel; [3-lapachone with vincristin; (3-lapachone with vinblastin; ~3-
lapachone with
nocodazole; [3-lapachone with teniposide; [3-lapachone with etoposide; (3-
lapachone with
adriamycin; (3-lapachone with epothilone; (3-lapachone with navelbine; (3-
lapachone with
camptothecin; (3-lapachone with daunorubicin; (3-lapachone with dactinomycin;
(3-lapachone
with mitoxantrone; (3-lapachone with amsacrine; (3-lapachone with epirubicin;
or (3-lapachone
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with idarubicin. In a preferred aspect, combination therapy includes (3-
lapachone with
gemcitabine. In another aspect, combination therapy includes reduced (3-
lapachone with taxol;
reduced (3-lapachone with docetaxel; reduced (3-lapachone with vincristin;
reduced (3-lapachone
with vinblastin; reduced (3-lapachone with nocodazole; reduced [3-lapachone
with teniposide;
reduced (3-lapachone with etoposide; reduced (3-lapachone with adriamycin;
reduced (3-
lapachone with epothilone; reduced [3-lapachone with navelbine; reduced (3-
lapachone with
camptothecin; reduced (3-lapachone with daunorubicin; reduced (3-lapachone
with dactinomycin;
reduced (3-lapachone with mitoxantrone; reduced (3-lapachone with amsacrine;
reduced (3-
lapachone with epirubicin; or reduced (3-lapachone with idarubicin. In a
preferred aspect,
combination therapy includes reduced [3-lapachone with gemcitabine.
As used herein, "treating" describes the management and care of a patient for
the
purpose of combating a disease, condition, or disorder and includes the
administration of a
compound of the present invention to prevent the onset of the symptoms or
complications,
alleviating the symptoms or complications, or eliminating the disease,
condition or disorder.
In one aspect, treating a hematologic cancer of the present invention results
in a decrease
in number of cancerous cells. Preferably, after treatment, number of cancerous
cells is reduced
by 5% or greater relative to number prior to treatment; more preferably,
number of cancerous
cells is reduced by 10% or greater; more preferably, reduced by 20% or
greater; more
preferably, reduced by 30% or greater; more preferably, reduced by 40% or
greater; even more
preferably, reduced by 50% or greater; and most preferably, reduced by greater
than 75%.
Number of cancerous cells may be measured by any reproducible means of
measurement. In a
preferred aspect, number of cancerous cells may be measured by counting
cancerous cells at a
specified magnification. In a preferred aspect, the specified magnification is
2x, 3x, 4x, Sx, 10x,
or 50x. In another aspect, number of cancerous cells is measured by
fluorescence activated cell
sorting (FACS). In another aspect, number of cancerous cells is measured by
immunofluorescence microscopy.
In another aspect, treating a hematologic cancer of the present invention
results in a
reduction in size of a tumor. A reduction in size of a tumor may also be
referred to as "tumor
regression." Preferably, after treatment, tumor size is reduced by 5% or
greater relative to its
size prior to treatment; more preferably, tumor size is reduced by 10% or
greater; more
preferably, reduced by 20% or greater; more preferably, reduced by 30% or
greater; more
preferably, reduced by 40% or greater; even more preferably, reduced by 50% or
greater; and
most preferably, reduced by greater than 75% or greater. Size of a tumor may
be measured by
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any reproducible means of measurement. In a preferred aspect, size of a tumor
may be
measured as a diameter of the tumor.
In another aspect, treating a hematologic cancer of the present invention
results in a
reduction in tumor volume. Preferably, after treatment, tumor volume is
reduced by 5% or
greater relative to its size prior to treatment; more preferably, tumor volume
is reduced by 10%
or greater; more preferably, reduced by 20% or greater; more preferably,
reduced by 30% or
greater; more preferably, reduced by 40% or greater; even more preferably,
reduced by 50% or
greater; and most preferably, reduced by greater than 75% or greater. Tumor
volume may be
measured by any reproducible means of measurement.
In another aspect, treating a hematologic cancer of the present invention
results in a
decrease in number of tumors. Preferably, after treatment, tumor number is
reduced by 5% or
greater relative to number prior to treatment; more preferably, tumor number
is reduced by 10%
or greater; more preferably, reduced by 20% or greater; more preferably,
reduced by 30% or
greater; more preferably, reduced by 40% or greater; even more preferably,
reduced by 50% or
greater; and most preferably, reduced by greater than 75%. Number of tumors
may be
measured by any reproducible means of measurement. In a preferred aspect,
number of tumors
may be measured by counting tumors visible to the naked eye or at a specified
magnification. In
a preferred aspect, the specified magnification is 2x, 3x, 4x, Sx, 10x, or
50x.
In another aspect, treating a hematologic cancer of the present invention
results in a
decrease in number of metastatic lesions in other tissues or organs distant
from the primary
tumor site. Preferably, after treatment, the number of metastatic lesions is
reduced by 5% or
greater relative to number prior to treatment; more preferably, the number of
metastatic lesions
is reduced by 10% or greater; more preferably, reduced by 20% or greater; more
preferably,
reduced by 30% or greater; more preferably, reduced by 40% or greater; even
more preferably,
reduced by 50% or greater; and most preferably, reduced by greater than 75%.
The number of
metastatic lesions may be measured by any reproducible means of measurement.
In a preferred
aspect, the number of metastatic lesions may be measured by counting
metastatic lesions visible
to the naked eye or at a specified magnification. In a preferred aspect, the
specified
magnification is 2x, 3x, 4x, Sx, 10x, or 50x.
In another aspect, treating a hematologic cancer of the present invention
results in an
increase in average survival time of a population of treated subjects in
comparison to a
population receiving Garner alone. Preferably, the average survival time is
increased by more
than 30 days; more preferably, by more than 60 days; more preferably, by more
than 90 days;
and most preferably, by more than 120 days. An increase in average survival
time of a
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population may be measured by any reproducible means. In a preferred aspect,
an increase in
average survival time of a population may be measured, for example, by
calculating for a
population the average length of survival following initiation of treatment
with an active
compound. In an another preferred aspect, an increase in average survival time
of a population
may also be measured, for example, by calculating for a population the average
length of
survival following completion of a first round of treatment with an active
compound.
In another aspect, treating a hematologic cancer of the present invention
results in an
increase in average survival time of a population of treated subjects in
comparison to a
population of untreated subjects. Preferably, the average survival time is
increased by more than
30 days; more preferably, by more than 60 days; more preferably, by more than
90 days; and
most preferably, by more than 120 days. An increase in average survival time
of a population
may be measured by any reproducible means. In a preferred aspect, an increase
in average
survival time of a population may be measured, for example, by calculating for
a population the
average length of survival following initiation of treatment with an active
compound. In an
another preferred aspect, an increase in average survival time of a population
may also be
measured, for example, by calculating for a population the average length of
survival following
completion of a first round of treatment with an active compound.
In another aspect, treating a hematologic cancer of the present invention
results in
increase in average survival time of a population of treated subj ects in
comparison to a
population receiving monotherapy with a drug that is not ~3-lapachone, or a
pharmaceutically
acceptable salt, metabolite, analog or derivative thereof. Preferably, the
average survival time is
increased by more than 30 days; more preferably, by more than 60 days; more
preferably, by
more than 90 days; and most preferably, by more than 120 days. An increase in
average survival
time of a population may be measured by any reproducible means. In a preferred
aspect, an
increase in average survival time of a population may be measured, for
example, by calculating
for a population the average length of survival following initiation of
treatment with an active
compound. In an another preferred aspect, an increase in average survival time
of a population
may also be measured, for example, by calculating for a population the average
length of
survival following completion of a first round of treatment with an active
compound.
In another aspect, treating a hematologic cancer of the present invention
results in a
decrease in the mortality rate of a population of treated subj ects in
comparison to a population
receiving carrier alone. In another aspect, treating hematologic cancer
results in a decrease in
the mortality rate of a population of treated subjects in comparison to an
untreated population.
In a further aspect, treating hematologic cancer results a decrease in the
mortality rate of a
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population of treated subjects in comparison to a population receiving
monotherapy with a drug
that is not (3-lapachone, or a pharmaceutically acceptable salt, metabolite,
analog or derivative
thereof. Preferably, the mortality rate is decreased by more than 2%; more
preferably, by more
than 5%; more preferably, by more than 10%; and most preferably, by more than
25%. In a
preferred aspect, a decrease in the mortality rate of a population of treated
subjects may be
measured by any reproducible means. In another preferred aspect, a decrease in
the mortality
rate of a population may be measured, for example, by calculating for a
population the average
number of disease-related deaths per unit time following initiation of
treatment with an active
compound. In another preferred aspect, a decrease in the mortality rate of a
population may also
be measured, for example, by calculating for a population the average number
of disease-related
deaths per unit time following completion of a first round of treatment with
an active compound.
In another aspect, treating a hematologic cancer of the present invention
results in a
decrease in tumor growth rate. Preferably, after treatment, tumor growth rate
is reduced by at
least 5% relative to number prior to treatment; more preferably, tumor growth
rate is reduced by
at least 10%; more preferably, reduced by at least 20%; more preferably,
reduced by at least
30%; more preferably, reduced by at least 40%; more preferably, reduced by at
least 50%; even
more preferably, reduced by at least 50%; and most preferably, reduced by at
least 75%. Tumor
growth rate may be measured by any reproducible means of measurement. In a
preferred aspect,
tumor growth rate is measured according to a change in tumor diameter per unit
time.
In another aspect, treating a hematologic cancer of the present invention
results in a
decrease in tumor regrowth. Preferably, after treatment, tumor regrowth is
less than 5%; more
preferably, tumor regrowth is less than 10%; more preferably, less than 20%;
more preferably,
less than 30%; more preferably, less than 40%; more preferably, less than 50%;
even more
preferably, less than 50%; and most preferably, less than 75%. Tumor regrowth
may be
measured by any reproducible means of measurement. In a preferred aspect,
tumor regrowth is
measured, for example, by measuring an increase in the diameter of a tumor
after a prior tumor
shrinkage that followed treatment. In another preferred aspect, a decrease in
tumor regrowth is
indicated by failure of tumors to reoccur after treatment has stopped.
In another aspect, treating or preventing a cell proliferative disorder of the
present
invention results in a reduction in the rate of cellular proliferation.
Preferably, after treatment,
the rate of cellular proliferation is reduced by at least 5%; more preferably,
by at least 10%;
more preferably, by at least 20%; more preferably, by at least 30%; more
preferably, by at least
40%; more preferably, by at least 50%; even more preferably, by at least SO%;
and most
preferably, by at least 75%. The rate of cellular proliferation may be
measured by any
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reproducible means of measurement. In a preferred aspect, the rate of cellular
proliferation is
measured, for example, by measuring the number of dividing cells in a tissue
sample per unit
time.
In another aspect, treating or preventing a cell proliferative disorder of the
present
invention results in a reduction in the proportion of proliferating cells.
Preferably, after
treatment, the proportion of proliferating cells is reduced by at least 5%;
more preferably, by at
least 10%; more preferably, by at least 20%; more preferably, by at least 30%;
more preferably,
by at least 40%; more preferably, by at least 50%; even more preferably, by at
least 50%; and
most preferably, by at least 75%. The proportion of proliferating cells may be
measured by any
reproducible means of measurement. In a preferred aspect, the proportion of
proliferating cells
is measured, for example, by quantifying the number of dividing cells relative
to the number of
nondividing cells in a tissue sample. In another preferred aspect, the
proportion of proliferating
cells is equivalent to the mitotic index.
In another aspect, treating or preventing a cell proliferative disorder of the
present
invention results in a decrease in size of an area or zone of cellular
proliferation. Preferably,
after treatment, size of an area or zone of cellular proliferation is reduced
by at least 5% relative
to its size prior to treatment; more preferably, reduced by at least 10%; more
preferably, reduced
by at least 20%; more preferably, reduced by at least 30%; more preferably,
reduced by at least
40%; more preferably, reduced by at least 50%; even more preferably, reduced
by at least 50%;
and most preferably, reduced by at least 75%. Size of an area or zone of
cellular proliferation
may be measured by any reproducible means of measurement. In a preferred
aspect, size of an
area or zone of cellular proliferation may be measured as a diameter or width
of an area or zone
of cellular proliferation.
In another aspect, treating or preventing a cell proliferative disorder of the
present
invention results in a decrease in the number or proportion of cells having an
abnormal
appearance or morphology. Preferably, after treatment, the number of cells
having an abnormal
morphology is reduced by at least 5% relative to its size prior to treatment;
more preferably,
reduced by at least 10%; more preferably, reduced by at least 20%.; more
preferably, reduced by
at least 30%; more preferably, reduced by at least 40%; more preferably,
reduced by at least
50%; even more preferably, reduced by at least 50%; and most preferably,
reduced by at least
75%. An abnormal cellular appearance or morphology may be measured by any
reproducible
means of measurement. In one aspect, an abnormal cellular morphology is
measured by
microscopy, e.g., using an inverted tissue culture microscope. In one aspect,
an abnormal
cellular morphology takes the form of nuclear pleiomorphism.
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As used herein, the term "selectively" means tending to occur at a higher
frequency in
one population than in another population. In one aspect, the compared
populations are cell
populations. In a preferred aspect, ~i-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, acts selectively on a cancer or
precancer cell but not on
a normal cell. In another preferred aspect, a compound of the present
invention, or a
pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative
thereof, acts
selectively to modulate one molecular target (e.g., E2F-1) but does not
significantly modulate
another molecular target (e.g., Protein Kinase C). In another preferred
aspect, the invention
provides a method for selectively inhibiting the activity of an enzyme, such
as a kinase.
Preferably, an event occurs selectively in population A relative to population
B if it occurs
greater than two times more frequently in population A as compared to
population B. More
preferably, an event occurs selectively if it occurs greater than five times
more frequently in
population A. More preferably, an event occurs selectively if it occurs
greater than ten times
more frequently in population A; more preferably, greater than fifty times;
even more
preferably, greater than 100 times; and most preferably, greater than 1000
times more frequently
in population A as compared to population B. For example, cell death would be
said to occur
selectively in cancer cells if it occurred greater than twice as frequently in
cancer cells as
compared to normal cells.
In a preferred aspect, a compound of the present invention or a
pharmaceutically
acceptable salt, prodrug, metabolite, analog or derivative thereof, modulates
the activity of a
molecular target (e.g., E2F-1). In one aspect, modulating refers to
stimulating or inhibiting an
activity of a molecular target. Preferably, a compound of the present
invention modulates the
activity of a molecular target if it stimulates or inhibits the activity of
the molecular target by at
least 10% relative to the activity of the molecular target under the same
conditions but lacking
only the presence of said compound. More preferably, a compound of the present
invention
modulates the activity of a molecular target if it stimulates or inhibits the
activity of the
molecular target by at least 25%, at least 50%, 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
the molecular target
under the same conditions but lacking only the presence of said compound. The
activity of a
molecular target may be measured by any reproducible means. The activity of a
molecular
target may be measured in vitro or in vivo. For example, the activity of a
molecular target may
be measured in vitro by an enzymatic activity assay or a DNA binding assay, or
the activity of a
molecular target may be measured in vivo by assaying for expression of a
reporter gene.
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In one aspect, a compound of the present invention, or a pharmaceutically
acceptable
salt, prodrug, metabolite, analog or derivative thereof, does not
significantly modulate the
activity of a molecular target if the addition of the compound stimulates or
inhibits the activity
of the molecular target by less than 10% relative to the activity of the
molecular target under the
same conditions but lacking only the presence of said compound.
As used herein, the term "isozyme selective" means preferential inhibition or
stimulation
of a first isoform of an enzyme in comparison to a second isoform of an enzyme
(e.g.,
preferential inhibition or stimulation of a kinase isozyrne alpha in
comparison to a kinase
isozyme beta). Preferably, a compound of the present invention demonstrates a
minimum of a
four fold differential, preferably a ten fold differential, more preferably a
flftyy fold differential,
in the dosage required to achieve a biological effect. Preferably, a compound
of the present
invention demonstrates this differential across the range of inhibition, and
the differential is
exemplified at the ICSO, i.e., a 50% inhibition, for a molecular target of
interest.
W a preferred embodiment, administering (3-lapachone, or a pharmaceutically
acceptable
salt, prodrug, metabolite, analog or derivative thereof, to a cell or a
subject in need thereof
results in modulation (i.e., stimulation or inhibition) of an activity of a
member of the E2F
family of transcription factors (e.g., E2F-l, E2F-2, or E2F-3). As used
herein, an activity of a
member of the E2F family of transcription factors refers to any biological
function or activity
that is carried out by an E2F family member. For example, a function of E2F-1
includes binding
of E2F-1 to its cognate DNA sequences. Other functions of E2F-1 include
migrating to the cell
nucleus and activating transcription.
In one aspect, treating hematologic cancer or a cell proliferative disorder
results in cell
death, and preferably, cell death results in a decrease of at least 10% in
number of cells in a
population. More preferably, cell death means a decrease of at least 20%; more
preferably, a
decrease of at least 30%; more preferably, a decrease of at least 40%; more
preferably, a
decrease of at least 50%; most preferably, a decrease of at least 75%. Number
of cells in a
population may be measured by any reproducible means. In one aspect, number of
cells in a
population is measured by fluorescence activated cell sorting (FACS). In
another aspect,
number of cells in a population is measured by immunofluorescence microscopy.
In another
aspect, number of cells in a population is measured by light microscopy. In
another aspect,
methods of measuring cell death are as shown in Li et al., (2003) Proc Natl
Acad Sci U S A.
100(5): 2674-~. In a preferred aspect, cell death results from apoptosis.
In a preferred aspect, an effective amount of (3-lapachone, or a
pharmaceutically
acceptable salt, metabolite, analog or derivative thereof is not significantly
cytotoxic to normal
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cells. A therapeutically effective amount of a compound is not significantly
cytotoxic to normal
cells if administration of the compound at a therapeutically effective amount
does not induce
. apoptosis in greater than 10% of normal cells. A therapeutically effective
amount of a
compound does not significantly affect the viability of normal cells if
administration of the
compound at a therapeutically effective amount does not induce cell death in
greater than 10%
of normal cells.
In one aspect, activating refers to placing one or more compositions of matter
(e.g.,
protein or nucleic acid) in a state suitable for carrying out a desired
biological function. In one
aspect, a composition of matter capable of being activated also has an
unactivated state. In one
aspect, an activated composition of matter may have an inhibitory or
stimulatory biological
function, or both.
In one aspect, elevation refers to an increase in a desired biological
activity of a
composition of matter (e.g., a protein or a nucleic acid). In one aspect,
elevation may occur
through an increase in concentration of a composition of matter.
In one aspect, stimulation of unscheduled expression of a checkpoint molecule
by (3-
lapachone, or a pharmaceutically acceptable salt, metabolite, analog or
derivative thereof,
triggers cell death in cells with defective checkpoints, a hallmark of cancer
and pre-cancer cells.
In one aspect, contacting a cell with (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, stimulates unscheduled expression of
the checkpoint
molecule E2F.
In one aspect, contacting a cell with (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, results in activation of an E2F
checkpoint pathway.
Preferably, administering to a subject in need thereof (i-lapachone, or a
pharmaceutically
acceptable salt, metabolite, analog or derivative thereof, results in
activation of an E2F
checkpoint pathway. In a preferred aspect, E2F pathway activity is increased
by more than
10%; more than 25%; more than 50%; more than 2-fold; more than 5-fold; and
most preferably,
by more than 10-fold. In another preferred aspect, E2F activity is increased
by more than 10%;
more than 25%; more than 50%; more than 2-fold; more than 5-fold; and most
preferably, by
more than 10-fold. Methods of measuring induction of E2F activity and
elevation of E2F levels
are as shown in Li et al., (2003) Proc Natl Acad Sci USA. 100(5): 2674-~.
In one aspect, contacting a cell with ~3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, results in elevation of an E2F
transcription factor.
Preferably, administering to a subject in need thereof (3-lapachone, or a
pharmaceutically
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acceptable salt, metabolite, analog or derivative thereof, results in
elevation of an E2F
transcription factor.
In one aspect, contacting a cell with (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, results in elevation of an E2F
transcription factor
selectively in hematologic cancer cells but not in normal cells. Preferably,
administering to a
subject in need thereof (3-lapachone, or a pharmaceutically acceptable salt,
metabolite, analog or
derivative thereof, results in elevation of an E2F transcription factor
selectively in hematologic
cancer cells but not in normal cells.
In one aspect, contacting a cell with (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, stimulates unscheduled activation of
an E2F
transcription factor. Preferably, administering to a subject in need thereof
(3-lapachone, or a
pharmaceutically acceptable salt, metabolite, analog or derivative thereof,
stimulates
unscheduled activation of an E2F transcription factor.
In one aspect, contacting a cell with (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, stimulates unscheduled activation of
an E2F
transcription factor selectively in hematologic cancer cells but not in normal
cells. Preferably,
administering to a subject in need thereof (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, stimulates unscheduled activation of
an E2F
transcription factor selectively in hematologic cancer cells but not in normal
cells.
In normal cells with their intact regulatory mechanisms, imposed expression of
a
checkpoint molecule (e.g., as induced by contacting a cell with (i-lapachone,
or a
pharmaceutically acceptable salt, metabolite, analog or derivative thereof )
results in an
expression pattern that is not reported to be of substantial consequence. In
contrast, cancer and
pre-cancer cells have defective mechanisms, which result in unchecked or
persistent expression,
or both, of unscheduled checkpoint molecules, e.g., E2F, leading to selective
cell death in cancer
and pre-cancer cells. The present invention includes and provides for the
unchecked or
persistent expression, or both, of unscheduled checkpoint molecules by the
administration of (3-
lapachone, or a pharmaceutically acceptable salt, metabolite, analog or
derivative thereof.
In one aspect, contacting a cell with (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, results in activation of one or more
cell cycle
checkpoints. Preferably, administering to a subject in need thereof (3-
lapachone, or a
pharmaceutically acceptable salt, metabolite, analog or derivative thereof,
results in activation of
one or more cell cycle checkpoints.
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In one aspect, contacting a cell with ~i-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, results in activation of one or more
cell cycle
checkpoint pathways. Preferably, administering to a subject in need thereof /3-
lapachone, or a
pharmaceutically acceptable salt, metabolite, analog or derivative thereof,
results in activation of
one or more cell cycle checkpoint pathways.
In one aspect, contacting a cell with (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, results in activation of one or more
cell cycle
checkpoint regulators. Preferably, administering to a subject in need thereof
(3-lapachone, or a
pharmaceutically acceptable salt, metabolite, analog or derivative thereof,
results in activation of
one or more cell cycle checkpoint regulators.
In one aspect, contacting a cell with (3-lapachone, or a pharmaceutically
acceptable salt,
metabolite, analog or derivative thereof, induces or activates cell death
selectively in
hematologic cancer cells. Preferably, administering to a subject in need
thereof [3-lapachone, or
a pharmaceutically acceptable salt, metabolite, analog or derivative thereof,
induces or activates
cell death selectively in hematologic cancer cells. In another aspect,
contacting a cell with (3-
lapachone, or a pharmaceutically acceptable salt, metabolite, analog or
derivative thereof,
induces cell death selectively in one or more cells affected by a cell
proliferative disorder of the
hematologic system. Preferably, administering to a subject in need thereof (3-
lapachone, or a
pharmaceutically acceptable salt, metabolite, analog or derivative thereof,
induces cell death
selectively in one or more cells affected by a cell proliferative disorder of
the hematologic
system.
In a preferred aspect, the present invention relates to a method of treating
or preventing
cancer by administering (3-lapachone, or a pharmaceutically acceptable salt,
metabolite, analog
or derivative thereof to a subject in need thereof, where administration of
the (3-lapachone, or a
pharmaceutically acceptable salt, metabolite, analog or derivative thereof
results in one or more
of the following: accumulation of cells in G1 and/or S phase of the cell
cycle, cytotoxicity via
cell death in cancer cells but not in normal cells, antitumor activity in
animals with a therapeutic
index of at least 2, and acitvation of a cell cycle checkpoint (e.g.,
activation or elevation of a
member of the E2F family of transcription factors). As used herein,
"therapeutic index" is the
maximum tolerated dose divided by the efficacious dose.
In additional aspects, (3-lapachone, or a pharmaceutically acceptable salt,
metabolite,
analog or derivative thereof, can be administered in combination with a
chemotherapeutic agent.
Exemplary chemotheraputics with activity against cell proliferative disorders,
such as
hematologic cancer, are known to those of ordinary skill in the art, and may
be found in
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reference texts such as the Physician's Desk Reference, 59th Edition, Thomson
PDR (2005). For
example, the chemotherapeutic agent can be a taxane, an aromatase inhibitor,
an anthracycline, a
microtubule targeting drug, a topoisomerase poison drug, a targeted monoclonal
or polyconal
antibody, an inhibitor of a molecular target or enzyme (e.g., a kinase
inhibitor), or a cytidine
analogue drug. In preferred aspects, the chemotherapeutic agent can be, but is
not restricted to,
tamoxifen, raloxifene, anastrozole, exemestane, letrozole, HERCEPTIN~
(trastuzumab),
GLEEVEC~ (imatanib), TAXOL~ (paclitaxel), IRESSA~° (gefitinib),
TARCEVATM (erlotinib),
cyclophosphamide, lovastatin, minosine, araC, 5-fluorouracil (5-F~,
methotrexate (MTX),
TAXOTERE~ (docetaxel), ZOLADEX~ (goserelin), AVASTINTM (bevacizuxnab),
vincristin,
vinblastin, nocodazole, teniposide, etoposide, epothilone, navelbine,
camptothecin,
daunonibicin, dactinomycin, mitoxantrone, amsacrine, doxorubicin (adriamycin),
epirubicin or
idarubicin. -or agents listed in www.cancer.org/docroot/cdg/cdg_O.asp. In
another aspect, the
chemotherapeutic agent can be a cytokine such as G-CSF (granulocyte colony
stimulating
factor). In another aspect, ~3-lapachone, or a pharmaceutically acceptable
salt, metabolite, analog
or derivative thereof may be administered in combination with radiation
therapy. In yet another
aspect, (3-lapachone, or a pharmaceutically acceptable salt, metabolite,
analog or derivative
thereof may be administered in combination with standard chemotherapy
combinations such as,
but not restricted to, CMF (cyclophosphamide, methotrexate and 5-
fluorouracil), CAF
(cyclophosphamide, adriamycin and 5-fluorouracil), AC (adriamycin and
cyclophosphamide),
FEC (5-fluorouracil, epirubicin, and cyclophosphamide), ACT or ATC
(adriamycin,
cyclophosphamide, and paclitaxel), or CMFP (cyclophosphamide, methotrexate, 5-
fluorouracil
and prednisone).
In a preferred aspect, a cell proliferative disorder of the hematologic
system, such as
hematologic cancer, is treated by administering to a patient in need thereof a
therapeutically
effective amount of (3-lapachone, or a pharmaceutically acceptable salt,
metabolite, analog or
derivative thereof, in combination with a therapeutically effective amount of
gemcitabine.
GEMZAR~ (gemcitabine HCl) is 2'-deoxy-2',2'-difluorocytidine monohydrochloride
((3-
isomer), a nucleoside analog that exhibits antitumor activity. Gemcitabine may
be used in
monotherapy, or in combination with other agents (e.g., cisplatin,
carboplatin, TAXOL~
(paclitaxel)), to treat various cancers, including pancreatic cancer, breast
cancer, non-small cell
hematologic cancer, ovarian cancer, and bladder cancer. Gemcitabine exhibits
cell phase
specificity, primarily killing cells undergoing DNA synthesis (S-phase) and
also blocking the
progression of cells through the Gl/S boundary. Without being limited by
theory, it is believed
that after a gemcitabine nucleotide is incorporated into DNA, only one
additional nucleotide
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may be added to the growing DNA strands. Again not limited by theory, it is
believed that DNA
polymerase epsilon is unable to remove the gemcitabine nucleotide and repair
the growing DNA
strand (e.g., masked chain termination). In CEM T lymphoblastoid cells,
gemcitabine induces
internucleosomal DNA fragmentation, one of the characteristics of programmed
cell death (e.g.,
apoptosis).
As used herein, "leukopenia" is a condition in which the number of white blood
cells
circulating in the blood is reduced, e.g., a condition in which the white
blood cell count (WBC)
is below the normal range. In one aspect, in an adult human subject, a normal
white blood cell
count is between about 5,000 and 11,000 cu per microliter of whole blood. In
one aspect, in an
adult human subject, leukopenia exists when the white blood cell~count is
below about 5,000 cu
per microliter. In another aspect, in an adult human subject, mild leukopenia
exists when the
white blood cell count is between about 3,000 and 5,000 cu per microliter,
moderate leukopenia
exists when the white blood cell count is between about 1,500 and 3,000 cu per
microliter, and
severe leukopenia exists when the white blood cell count is less than about
1,500 cu per
microliter. White blood cell count may be measured by any reproducible means.
In one aspect,
a white blood cell count is measured by a medical diagnostic instrument
capable of performing
an automated white blood count.
As used herein, "neutropenia" is a condition in which the number of
neutrophils
circulating in the blood is reduced. In one aspect, in an adult human subject,
a normal neutrophil
count is between about 1,000 and 1,500 cells per cc3 of whole blood. In one
aspect, in an adult
human subject, neutropenia exists when the neutrophil count is below about
1,000 cells per cc3.
In another aspect, in an adult human subject, mild neutropenia exists when the
neutrophil count
is between about 500 and 1,000 cells per cc3, moderate neutropenia exists when
the neutrophil
count is between about 200 and500 cells per cc3, and severe neutropenia exists
when the
neutrophil count is less than about 200 cells per cc3. Neutropenia may be
assessed by any
reproducible means. In one aspect, neutropenia is assessed by performing a
white blood count
and differential. In one aspect, a differential is performed by counting one
hundred white blood
cells and identifying them by shape and appearance of nucleus, color and
granularity as either
neutrophils, bands, lymphocytes, monocytes, eosinophils, basophils, or
atypical or immature
cells. In one aspect, a white blood cell count is measured by a medical
diagnostic instrument
capable of performing an automated white blood count. In one aspect, a
differential is
performed manually using a light microscope. In another aspect, a differential
is performed
automatically by a medical diagnostic instrument.
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As used herein, "monocytopenia" is a condition in which the number of
monocytes
circulating in the blood is reduced. In one aspect, in an adult human subject,
a normal monocyte
count is between about 40 and 180 cells per cc3 of whole blood. In one aspect,
in an adult
human subject, monocytopenia exists when the monocyte count is below about 35
cells per cc3.
In another aspect, monocytopenia exists when the percentage of monocytes is
less than about
2% using the differential assay method. Monocytopenia may be assessed by any
reproducible
means. In one aspect, monocytopenia is assessed by performing a white blood
count and
differential. In one aspect, a differential is performed by counting one
hundred white blood cells
and identifying them by shape and appearance of nucleus, color and granularity
as either
neutrophils, bands, lymphocytes, monocytes, eosinophils, basophils, or
atypical or immature
cells. In one aspect, a white blood cell count is measured by a medical
diagnostic instrument
capable of performing an automated white blood count. In one aspect, a
differential is
performed manually using a light microscope. In another aspect, a differential
is performed
automatically by a medical diagnostic instrument.
As used herein, "lymphocytopenia" is a condition in which the number of
lymphocytes
circulating in the blood is reduced. W one aspect, in an adult human subject,
a normal
lymphocyte count is between about 400 and 1,200 cells per cc3 of whole blood.
In one aspect, in
an adult human subject, lymphocytopenia exists when the lymphocyte count is
below about 350
cells per cc3. lil another aspect, lylnphocytopenia exists when the percentage
of lymphocytes is
less than about 20% using the differential assay method. Lymphocytopenia may
be assessed by
any reproducible means. In one aspect, lymphocytopenia is assessed by
performing a white
blood count and differential. In one aspect, a differential is performed by
counting one hundred
white blood cells and identifying them by shape and appearance of nucleus,
color and
granularity as either neutrophils, bands, lymphocytes, monocytes, eosinophils,
basophils, or
atypical or immature cells. In one aspect, a white blood cell count is
measured by a medical
diagnostic instrument capable of performing an automated white blood count. In
one aspect, a
differential is performed manually using a light microscope. In another
aspect, a differential is
performed automatically by a medical diagnostic instrument.
W one aspect, an altered profile of immune cells may be assessed by performing
a white
blood count and differential. In one aspect, in an adult human subject, a
normal profile of
immune cells includes a total white cell count of between about 5,000 and
11,000 cu per
microliter of whole blood; a neutrophil count of between about 1,000 and 1,500
cells per cc3 of
whole blood; neutrophils 50-60%; lymphocytes 20-40%; monocytes 2-6%;
eosinophils 1-4%;
and basophils 0.5-1%. In one aspect, an altered profile of immune cells is a
profile that differs
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from a normal profile in one of the stated parameters, or two, three, four,
five, six or seven of the
stated parameters. In one aspect, a white blood cell count is measured by a
medical diagnostic
instrument capable of performing an automated white blood count. In one
aspect, a differential
is performed manually using a light microscope. In another aspect, a
differential is performed
automatically by a medical diagnostic instrument.
One skilled in the art may refer to general reference texts for detailed
descriptions of
known techniques discussed herein or equivalent techniques. These texts
include Ausubel et al.,
Current Protocols in Molecular Biology, John Wiley and Sons, Inc. (2005);
Sambrook et al.,
Molecular' Cloning, A Laboratory Manual (3d ed.), Cold Spring Harbor Press,
Cold Spring
Harbor, New York (2000); Coligan et al., Current Protocols in Immunology, John
Wiley &
Sons, N.Y.; Enna et al., Current Ps°otocols in Plaarmacology, John
Wiley & Sons, N.Y.; Fingl et
al., The Plaa~macological Basis of Tlaenapeutics (1975), Remingtofa's
Pharmaceutical Sciences,
Mack Publishing Co., Easton, PA, 18th edition (1990). These texts can, of
course, also be
referred to in making or using an aspect of the invention.
A compound of the present invention, or a pharmaceutically acceptable salt,
prodrug,
metabolite, analog or derivative thereof, can be incorporated into
pharmaceutical compositions
suitable for administration. Such compositions typically comprise the compound
(i.e., including
the active compound), and a pharmaceutically acceptable excipient or earner.
As used herein,
"pharmaceutically acceptable excipient" or "pharmaceutically acceptable
earner" is intended to
include any and all solvents, dispersion media, coatings, antibacterial and
antifungal agents,
isotonic and absorption delaying agents, and the like, compatible with
pharmaceutical
administration. Suitable earners are described in the most recent edition of
Remington's
Pharmaceutical Sciences, a standard reference text in the field. Preferred
examples of such
carriers or diluents include, but are not limited to, water, saline, ringer's
solutions, dextrose
solution, and 5% human serum albumin. Pharmaceutically acceptable carriers
include solid
earners such as lactose, terra alba, sucrose, talc, gelatin, agar, pectin,
acacia, magnesium
stearate, stearic acid and the like. Exemplary liquid earners include syrup,
peanut oil, olive oil,
water and the like. Similarly, the carrier or diluent may include time-delay
material known in the
art, such as glyceryl monostearate or glyceryl distearate, alone or with a
wax, ethylcellulose,
hydroxypropylmethylcellulose, methylinethacrylate or the like. Other fillers,
excipients,
flavorants, and other additives such as are known in the art may also be
included in a
pharmaceutical composition according to this invention. Liposomes and non-
aqueous vehicles
such as fixed oils may also be used. The use of such media and agents for
pharmaceutically
active substances is well known in the art. Except insofar as any conventional
media or agent is
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incompatible with the active compound, use thereof in the compositions is
contemplated.
Supplementary active compounds can also be incorporated into the compositions.
The pharmaceutical compositions of this invention which are provided as part
of the
combination therapies may exist in the dosage form as a solid, semi-solid, or
liquid such as, e.g.,
suspensions, aerosols or the like. Preferably the compositions are
administered in unit dosage
forms suitable for single administration of precise dosage amounts. The
compositions may also
include, depending on the formulation desired, pharmaceutically-acceptable,
nontoxic carriers or
diluents, which are defined as vehicles commonly used to formulate
pharmaceutical
compositions for animal or human administration. The diluent is selected so as
not to affect the
biological activity of the combination. Examples of such diluents are
distilled water,
physiological saline, Ringer's solution, dextrose solution, and Hank's
solution. A preferred
carrier for the solubilization of (3-lapachone is hydroxypropyl beta
cyclodextrin, a water
solubilizing Garner molecule. Other water-solubilizing agents for combining
with (3-lapachone
and/or an S-phase compound, such as Poloxamer, Povidone K17, Povidone K12,
Tween 80,
ethanol, Cremophor/ethanol, polyethylene glycol 400, propylene glycol and
Trappsol, are
contemplated. Furthermore, the invention is not limited to water-solubilizing
agents, and oil-
based solubilizing agents such as lipiodol and peanut oil, may also be used.
In addition, the pharmaceutical composition or formulation may also include
other
carriers, adjuvants, or nontoxic, nontherapeutic, nonimmunogenic stabilizers
and the like.
Effective amounts of such diluent or Garner will be those amounts which are
effective to obtain a
pharmaceutically acceptable formulation in terns of solubility of components,
or biological
activity, and the like. Liposome formulations, are also contemplated by the
present invention,
and have been described. See, e.g. U.S. Pat. No. 5,424,073.
For the purposes of the present invention, the Gl/S phase drugs or compounds,
or
derivatives or analogs thereof, and the S phase drugs or compounds, or
derivatives or analogs
thereof, described herein include their pharmacologically acceptable salts,
preferably sodium;
analogs containing halogen substitutions, preferably chlorine or fluorine;
analogs containing
ammonium or substituted ammonium salts, preferably secondary or tertiary
ammonium salts;
analogs containing alkyl, alkenyl, aryl or their alkyl, alkenyl, aryl, halo,
alkoxy, alkenyloxy
substituted derivatives, preferably methyl, methoxy, ethoxy, or phenylacetate;
and natural
analogs such as naphthyl acetate. Further, the G1/S phase compounds or
derivatives or analogs
thereof, and the S phase compounds or derivatives or analogs thereof,
described herein may be
conjugated to a water-soluble polymer or may be derivatized with water-soluble
chelating agents
or radionuclides. Examples of water soluble polymers are, but not limited to:
polyglutamic acid
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polymer, copolymers with polycaprolactone, polyglycolic acid, polyactic acid,
polyacrylic acid,
poly (2-hydroxyethyl 1-glutamine), carboxymethyl dextran, hyaluronic acid,
human serum
albumin, polyalginic acid or a combination thereof. Examples of water-soluble
chelating agents
are, but not limited to: D1PA (diethylenetriaminepentaacetic acid), EDTA,
DTTP, DOTA or
their water-soluble salts, etc. Examples of radionuclides include, but not
limited to: 111In, 9oY,
166H0' 68Ga, g9»'Tc, and the like.
Due to the water insolubility of (3-lapachone, pharmaceutical carriers or
solubilizing
agents may be used to provide sufficient quantities of (3-lapachone for use in
the treatment
methods of the present invention. See, e.g., U.S. Patent Publication
20030091639 to Jiang et al.,
and U.S. Patent Publication 20040001871 to Bootlnnan et al. This publication
describes the use
of complexing agents such as cyclodextrins, including hydroxypropyl beta-
cyclodextrin
(HPBCD), to permit the solubilization of (3-lapachone at levels sufficient for
administration. See
also U.S. Patent Publication 20040001871 to Boothman et al. In an embodiment,
the Gl/S
phase drug, or an analog or derivative thereof, is administered with a
pharmaceutically
acceptable water solubilizing carrier molecule selected from the group
consisting of Poloxamer,
Povidone K17, Povidone K12, Tween 80, ethanol, Cremophor/ethanol, polyethylene
glycol
(PEG) 400, propylene glycol, Trappsol, alpha-cyclodextrin or derivatives or
analogs thereof,
beta-cyclodextrin or derivatives or analogs thereof, and gamma-cyclodextrin or
derivatives or
analogs thereof.
In one aspect, a compound of the present invention, or a pharmaceutically
acceptable
salt, prodrug, metabolite, analog or derivative thereof, is administered in a
suitable dosage form
prepared by combining a therapeutically effective amount (e.g., an efficacious
level sufficient to
achieve the desired therapeutic effect through inhibition of tumor growth,
killing of tumor cells,
treatment or prevention of cell proliferative disorders, etc.) of a compound
of the present
invention, or a pharmaceutically acceptable salt, prodrug, metabolite, analog
or derivative
thereof, (as an active ingredient) with standard pharmaceutical carriers or
diluents according to
conventional procedures (i. e., by producing a pharmaceutical composition of
the invention).
These procedures may involve mixing, granulating, and compressing or
dissolving the
ingredients as appropriate to attain the desired preparation.
A pharmaceutical composition of the invention is formulated to be compatible
with its
intended route of administration. Examples of routes of administration include
parenteral, e.g.,
intravenous, intradermal, subcutaneous, oral (e.g., inhalation), transdermal
(topical), and
transmucosal administration. Although intravenous administration is preferred
as discussed
above, the invention is not intended to be limited in this respect, and the
compounds can be
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administered by any means known in the art. Such modes include oral, rectal,
nasal, topical
(including buccal and sublingual) or parenteral (including subcutaneous,
intramuscular,
intravenous and intradermal) administration. For ease of administration and
comfort to the
patient, oral adaninistration is generally preferred. However, oral
administration may require the
administration of a higher dose than intravenous administration. The skilled
artisan can
determine which form of administration is best in a particular case, balancing
dose needed
versus the number of times per month administration is necessary. Solutions or
suspensions
used for parenteral, intradermal, or subcutaneous application can include the
following
components: a sterile diluent such as water for injection, saline solution,
fixed oils, polyethylene
glycols, glycerine, propylene glycol or other synthetic solvents;
antibacterial agents such as
benzyl alcohol or methyl parabens; antioxidants such as ascorbic acid or
sodium bisulfate;
chelating agents such as ethylenediaminetetraacetic acid; buffers such as
acetates, citrates or
phosphates, and agents for the adjustment of tonicity such as sodium chloride
or dextrose. The
pH can be adjusted with acids or bases, such as hydrochloric acid or sodium
hydroxide. The
parenteral preparation can be enclosed in ampoules, disposable syringes or
multiple dose vials
made of glass or plastic.
Solutions or suspensions used for parenteral, intradermal, or subcutaneous
application
can include the following components: a sterile diluent such as water for
injection, saline
solution, fixed oils, polyethylene glycols, glycerine, propylene glycol or
other synthetic solvents;
antibacterial agents such as benzyl alcohol or methyl parabens; antioxidants
such as ascorbic
acid or sodium bisulfate; chelating agents such as ethylenediaxninetetraacetic
acid; buffers such
as acetates, citrates or phosphates, and agents for the adjustment of tonicity
such as sodium
chloride or dextrose. The pH can be adjusted with acids or bases, such as
hydrochloric acid or
sodium hydroxide. The parenteral preparation can be enclosed in ampoules,
disposable syringes
or multiple dose vials made of glass or plastic.
A compound or pharmaceutical composition of the invention can be administered
to a
subject in many of the well-known methods currently used for chemotherapeutic
treatment. For
example, for treatment of cancers, a compound of the invention may be injected
directly into
tumors, injected into the blood stream or body cavities or taken orally or
applied through the
skin with patches. The dose chosen should be sufficient to constitute
effective treatment but not
so high as to cause unacceptable side effects. The state of the disease
condition (e.g., cancer,
precancer, and the like) and the health of the patient should preferably be
closely monitored
during and for a reasonable period after treatment.
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The term "therapeutically effective amount," as used herein, refers to an
amount of a
pharmaceutical agent to treat, ameliorate, or prevent an identified disease or
condition, or to
exhibit a detectable therapeutic or inhibitory effect. The effect can be
detected by any assay
method known in the art. The precise effective amount for a subject will
depend upon the
subject's body weight, size, and health; the nature and extent of the
condition; and the
therapeutic or combination of therapeutics selected for administration.
Therapeutically effective
amounts for a given situation can be determined by routine experimentation
that is within the
skill and judgment of the clincian. In a preferred aspect, the disease or
condition to be treated is
cancer. In another aspect, the disease or condition to be treated is a cell
proliferative disorder.
For any compound, the therapeutically effective amount can be estimated
initially either
in cell culture assays, e.g., of neoplastic cells, or in animal models,
usually rats, mice, rabbits,
dogs, or pigs. The animal model may also be used to determine the appropriate
concentration
range and route of administration. Such information can then be used to
determine useful doses
and routes for administration in humans. Therapeutic/prophylactic efficacy and
toxicity may be
determined by standard pharmaceutical procedures in cell cultures or
experimental animals, e.g.,
EDso (the dose therapeutically effective in 50% of the population) and LDSO
(the dose lethal to
50% of the population). The dose ratio between therapeutic and toxic effects
is the therapeutic
index, and it can be expressed as the ratio, EDSO/LDSO. Pharmaceutical
compositions that exhibit
large therapeutic indices are preferred. The dosage may vary within this range
depending upon
the dosage form employed, sensitivity of the patient, and the route of
administration.
Dosage and administration are adjusted to provide sufficient levels of the
active agents)
or to maintain the desired effect. Factors which may be taken into account
include the severity
of the disease state, general health of the subject, age, weight, and gender
of the subject, diet,
time and frequency of administration, drug combination(s), reaction
sensitivities, and
tolerance/response to therapy. Long-acting pharmaceutical compositions may be
administered
every 3 to 4 days, every week, or once every two weeks depending on half life
and clearance
rate of the particular formulation.
The pharmaceutical compositions containing active compounds of the present
invention
may be manufactured in a manner that is generally known, e.g., by means of
conventional
mixing, dissolving, granulating, dragee-making, levigating, emulsifying,
encapsulating,
entrapping, or lyophilizing processes. Pharmaceutical compositions may be
formulated in a
conventional manner using one or more pharmaceutically acceptable carriers
comprising
excipients and/or auxiliaries that facilitate processing of the active
compounds into preparations
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that can be used pharmaceutically. Of course, the appropriate formulation is
dependent upon the
route of administration chosen.
Pharmaceutical compositions suitable for injectable use include sterile
aqueous solutions
(where water soluble) or dispersions and sterile powders for the
extemporaneous preparation of
sterile injectable solutions or dispersion. For intravenous administration,
suitable carriers
include physiological saline, bacteriostatic water, Cremophor ELTM (BASF,
Parsippany, N.J.) or
phosphate buffered saline (PBS). In all cases, the composition must be sterile
and should be
fluid to the extent that easy syringeability exists. It must be stable under
the conditions of
manufacture and storage and must be preserved against the contaminating action
of
microorganisms such as bacteria and fungi. The Garner can be a solvent or
dispersion medium
containing, for example, water, ethanol, polyol (for example, glycerol,
propylene glycol, and
liquid polyethylene glycol, and the like), and suitable mixtures thereof. The
proper fluidity can
be maintained, for example, by the use of a coating such as lecithin, by the
maintenance of the
required particle size in the case of dispersion and by the use of
surfactants. Prevention of the
action of microorganisms can be achieved by various antibacterial and
antifungal agents, for
example, parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, and the
like. In many
cases, it will be preferable to include isotonic agents, for example, sugars,
polyalcohols such as
manitol, sorbitol, sodium chloride in the composition. Prolonged absorption of
the injectable
compositions can be brought about by including in the composition an agent
which delays
absorption, for example, aluminum monostearate and gelatin.
Sterile injectable solutions can be prepared by incorporating the active
compound in the
required amount in an appropriate solvent with one or a combination of
ingredients enumerated
above, as required, followed by filtered sterilization. Generally, dispersions
are prepared by
incorporating the active compound into a sterile vehicle that contains a basic
dispersion medium
and the required other ingredients from those enumerated above. In the case of
sterile powders
for the preparation of sterile injectable solutions, methods of preparation
are vacuum drying and
freeze-drying that yields a powder of the active ingredient plus any
additional desired ingredient
from a previously sterile-filtered solution thereof.
Oral compositions generally include an inert diluent or an edible
pharmaceutically
acceptable Garner. They can be enclosed in gelatin capsules or compressed into
tablets. For the
purpose of oral therapeutic administration, the active compound can be
incorporated with
excipients and used in the form of tablets, troches, or capsules. Oral
compositions can also be
prepared using a fluid carrier for use as a mouthwash, wherein the compound in
the fluid Garner
is applied orally and swished and expectorated or swallowed. Pharmaceutically
compatible
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binding agents, and/or adjuvant materials can be included as part of the
composition. The
tablets, pills, capsules, troches and the like can contain any of the
following ingredients, or
compounds of a similar nature: a binder such as microcrystalline cellulose,
gum tragacanth or
gelatin; an excipient such as starch or lactose, a disintegrating agent such
as alginic acid,
Primogel, or corn starch; a lubricant such as magnesium stearate or Sterotes;
a glidant such as
colloidal silicon dioxide; a sweetening agent such as sucrose or saccharin; or
a flavoring agent
such as peppermint, methyl salicylate, or orange flavoring.
For administration by inhalation, the compounds are delivered in the form of
an aerosol
spray from pressured container or dispenser, which contains a suitable
propellant, e.g., a gas
such as carbon dioxide, or a nebulizer.
Systemic administration can also be by transmucosal or transdermal means. For
transmucosal or transdermal administration, penetrants appropriate to the
barrier to be permeated
are used in the formulation. Such penetrants are generally known in the art,
and include, for
example, for transmucosal administration, detergents, bile salts, and fusidic
acid derivatives.
Transmucosal administration can be accomplished through the use of nasal
sprays or
suppositories. For transdermal administration, the active compounds are
formulated into
ointments, salves, gels, or creams as generally known in the art.
In one aspect, the active compounds are prepared with pharmaceutically
acceptable
carriers that will protect the compound against rapid elimination from the
body, such as a
controlled release formulation, including implants and microencapsulated
delivery systems.
Biodegradable, biocompatible polymers can be used, such as ethylene vinyl
acetate,
polyanhydrides, polyglycolic acid, collagen, polyorthoesters, and polylactic
acid. Methods for
preparation of such formulations will be apparent to those skilled in the art.
The materials can
also be obtained commercially from Alza Corporation and Nova Pharmaceuticals,
Inc.
Liposomal suspensions (including liposomes targeted to infected cells with
monoclonal
antibodies to viral antigens) can also be used as pharmaceutically acceptable
Garners. These can
be prepared according to methods known to those skilled in the art, for
example, as described in
U.S. Pat. No. 4,522,811.
It is especially advantageous to formulate oral or parenteral compositions in
dosage unit
form for ease of administration and uniformity of dosage. Dosage unit form as
used herein
refers to physically discrete units suited as unitary dosages for the subject
to be treated; each unit
containing a predetermined quantity of active compound calculated to produce
the desired
therapeutic effect in association with the required pharmaceutical carrier.
The specification for
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the dosage unit forms of the invention are dictated by and directly dependent
on the unique
characteristics of the active compound and the particular therapeutic effect
to be achieved.
In therapeutic applications, the dosages of the pharmaceutical compositions
used in
accordance with the invention vary depending on the agent, the age, weight,
and clinical
condition of the recipient patient, and the experience and judgment of the
clinician or
practitioner administering the therapy, among other factors affecting the
selected dosage.
Generally, the dose should be sufficient to result in slowing, and preferably
regressing, the
growth of the tumors and also preferably causing complete regression of the
cancer. Dosages
can range from about 0.01 mg/kg per day to about 3000 mg/kg per day. In
preferred aspects,
dosages can range from about 1 mg/kg per day to about 1000 mg/kg per day. In
an aspect, the
dose will be in the range of about 0.1 mg/day to about 70 g/day; about 0.1
mg/day to about 25
g/day; about 0.1 mg/day to about 10 g/day; about 0.1 mg to about 3g/day; or
about 0.1 mg'to
about 1 g/day, in single, divided, or continuous doses (which dose may be
adjusted for the
patient's weight in kg, body surface area in m2, and age in years). An
effective amount of a
pharmaceutical agent is that which provides an objectively identifiable
improvement as noted by
the clinician or other qualified observer. For example, regression of a tumor
in a patient may be
measured with reference to the diameter of a tumor. Decrease in the diameter
of a tumor
indicates regression. Regression is also indicated by failure of tumors to
reoccur after treatment
has stopped. As used herein, the term "dosage effective manner" refers to
amount of an active
compound to produce the desired biological effect in a subject or cell.
A compound of the present invention may be administered in combination with an
S
phase compound, such as an gemcitabine, in any manner found appropriate by a
clinician in
generally accepted efficacious dose ranges, such as those described in the
Physician's Desk
Reference, 59th Edition, Thomson PDR (2005)("PDR"). In general, gemcitabine is
administered
intravenously at dosages from about 10 mg/m2 to about 10,000 mg/ma, preferably
from about
100 mg/m2to about 2000 mg/m2, and most preferably about 500 to about 1500
mg/mz. In an
embodiment, gemcitabine is administered intravenously at a dosage from
approximately 100
mg/m2 to about 2000 mg/ma. In an embodiment, gemcitabine is administered
intravenously at a
dosage of approximately 1000 mg/ma. Dosage can be repeated, e.g., once weekly,
preferably for
about 1 to 6 weeks. It is preferred that dosages be administered over a time
period of about 30
minutes to about 6 hours, and typically over a period of about 3 hours.
The S phase drug, such as an gemcitabine, will be administered in a similar
regimen with
a Gl/S phase drug, such as (3-lapachone or an analog or derivative thereof,
although the amounts
will preferably be reduced from that normally administered. It is preferred,
for example, that the
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gemcitabine be administered at the same time or after the (3-lapachone has
administered to the
patient. When the gemcitabine is administered after the (3-lapachone, the
gemcitabine is
advantageously administered about 24 hours after the (3-lapachone has been
administered.
The combination therapy agents described herein may be administered singly and
sequentially, or in a cocktail or combination containing both agents or one of
the agents with
other therapeutic agents, including but not limited to, immunosuppressive
agents, potentiators
and side-effect relieving agents. As aforesaid, the therapeutic combination,
if administered
sequentially, may be more effective when the Gl/S phase drug component (e.g.,
(3-lapachone) is
administered prior to the S phase drug, e.g., gemcitabine. For example, a dose
of the Gl/S phase
drug component (e.g., (3-lapachone) is administered at least one hour (more
preferably at least 2
hours, 4 hours, 8 hours, 12 hours, or 24 hours) prior to administration of a
dose of the S phase
drug, e.g., gemcitabine. In another embodiment, a dose of the G1/S phase drug
component (e.g.,
(3-lapachone) is administered at least one hour (more preferably at least 2
hours, 4 hours, 8
hours, 12 hours, or 24 hours) following administration of a dose of the S
phase drug, e.g.,
gemcitabine. The therapeutic agents will preferably be administered
intravenously or otherwise
systemically by injection intramuscularly, subcutaneously, intrathecally or
intraperitoneally. In
an embodiment, the S phase drug is administered simultaneously with or
following
administration of the Gl/S phase drug. In another embodiment, the S phase drug
is administered
following administration of the Gl/S phase drug. In another embodiment, the S
drug is
administered within 24 hours after the G1/S phase drug is administered.
The other component of the combination therapy for combination with the S
phase drug
or compound is the G1/S phase drug, which is preferably (i-lapachone or an
analog or derivative
thereof.
(3-lapachone has been shown to have a variety of pharmacological effects. (3-
lapachone
has been shown to be a DNA repair inhibitor which sensitizes cells to DNA
damaging agents
(Boorstein, R.J., et al., (1984) Biocherra. Biophys. Res. Conarraun., 118:828-
834; Boothman, D.A.,
et al., (1989) J. Cancer Res., 49:605-612). (3-lapachone is generally well-
tolerated in dogs, rats,
and mice.
The present invention provides a method of treating cancer or a precancerous
condition
or preventing cancer in a subject, the method comprising administering to the
subject a
therapeutically effective amount of a pharmaceutical composition comprising (3-
lapachone, or a
derivative or analog thereof, or pharmaceutically acceptable salt thereof, or
a metabolite thereof,
and a pharmaceutically acceptable carrier such that the composition maintains
a plasma
concentration of about 0.15 ~.M to about 50 ~,M and treats the cancer or
precancerous condition
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or prevents the cancer. In one aspect, the plasma concentration can be about
0.1 ~M to about
100 ~M, about 0.125 ~.M to about 75 ~,M; about 0.15 ~,M to about 50 ~.M; about
0.175 p,M to
about 30 ~,M; and about 0.2 ~,M to about 20 ~,M. In another aspect, the
pharmaceutical
composition can maintain a suitable plasma concentration for at least a month,
at least a week, at
least 24 hours, at least 12 hrs, at least 6 hrs, at least 1 hour. In a further
aspect, a suitable plasma
concentration of the pharmaceutical composition can be maintained
indefinitely. In yet another
aspect, the subject can be exposed to the pharmaceutical composition in a AUC
(area under the
curve) range of about 0.5 ~,M-hr to about 100 ~M-hr, about 0.5 ~.M-hr to about
50 ~.M-hr, about
1 ~M-hr to about 25 ~,M-hr, about 1 ~,M-hr to about 10 ~,M-hr; about 1.25 ~,M-
hr to about 6.75
~,M-hr, about 1.5 ~M-hr to about 6.5 ~,M-hr. The pharmaceutical composition
can be
administered at a dosage from about 2 mg/ma to 5000 mg/m2 per day, more
preferably from
about 20 mg/m2 to 2000 mg/m2 per day, more preferably from about 20 mg/m2 to
500 mg/m2 per
day, most preferably from about 30 to 300 mg/m2 per day. Preferably, 2 mg/m2
to 5000 mg/m2
per day is the administered dosage for a human. In another aspect, the
pharmaceutical
composition can be administered at a dosage from about 10 to 1,000,000 ~,g per
kilogram body
weight of recipient per day; preferably about 100 to 500,000 ~,g per kilogram
body weight of
recipient per day, more preferably from about 1000 to 250,000 ~.g per kilogram
body weight of
recipient per day, most preferably from about 10,000 to 150,000 ~,g per
kilogram body weight of
recipient per day. One of ordinary skill in the art can determine the
appropriate dosage amount
in mg/m2 per day or ~,g per kilogram body weight of recipient per day
depending on subject to
which the pharmaceutical composition is to be administered.
As with the use of other chemotherapeutic drugs, the individual patient will
be monitored
in a manner deemed appropriate by the treating physician. Dosages can also be
reduced if
severe neutropenia or severe peripheral neuropathy occurs, or if a grade 2 or
higher level of
mucositis is observed, using the Common Toxicity Criteria of the National
Cancer Institute.
In administering a G1/S phase compound such as (3-lapachone, the normal dose
of such
compound individually is utilized as set forth above. However, when
combination therapies are
used, it is preferable to use a lower dosage -- preferably 75% or less of the
individual amount,
more preferably 50% or less, still more preferably 40% or less. The term
"effective amount," as
used herein, refers to an amount effective to treat the disease condition in
combination with any
other active agent in a combination regimen according to the invention.
In therapeutic applications, the dosages of the agents used in accordance with
the
invention vary depending on the agent, the age, weight, and clinical condition
of the recipient
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patient, and the experience and judgment of the clinician or practitioner
administering the
therapy, among other factors affecting the selected dosage. Generally, the
dose should be
sufficient to result in slowing, and preferably regressing, the growth of the
tumors and also
preferably causing complete regression of the cancer. An effective amount of a
pharmaceutical
agent is that which provides an obj ectively identifiable improvement as noted
by the clinician or
other qualified observer. Regression of a tumor in a patient is typically
measured with reference
to the diameter of a tumor. Decrease in the diameter of a tumor indicates
regression. Regression
is also indicated by failure of tumors to reoccur after treatment has stopped.
In preferred
embodiments, a decrease in tumor size or burden of at least 20%, more
preferably 50%, 80%,
90%, 95% or 99% is preferred.
The pharmaceutical compositions can be included in a container, pack, or
dispenser
together with instructions for administration.
EXAMPLES
Example 1
Proliferating human leukemia or lymphoma cells are seeded at 1000 per well in
six-well
plates and incubated 48 hours. (3-lapachone is added to dishes in less than 5
~1 of concentrated
solution (corresponding to a final DMSO concentration of less that 0.1%). (3-
lapachone is
dissolved at a concentration of 20 mM in DMSO and diluted in complete media.
Control plates
receive the same volume of DMSO alone. After 1-4 hours exposure, cells are
rinsed and drug-
free medium may be added. Cultures are left undisturbed for 10-20 days to
allow for colony
formation and then may be fixed and stained with modified Wright-Giemsa stain
(Sigma).
Colonies of greater than 30 cells are scored as survivors. Cells are
maintained at 37 °C in 5%
C02 in complete humidity.
Alternatively, cell death of human leukemia or lymphoma cells cultured in the
absence or
presence of (3-Lapachone (e.g., at 2, 4, 8, and 20 ~M) for one to 24 hours is
measured by MTT
assay. Briefly, the MTT assay is performed by plating in a 96-well plate at
10,000 cells per
well, culturing for 48 hours in complete growth medium, treating with (3-
Lapachone for one to
24 hours, and cultured with drug-free medium for 24 hours. MTT solution is
added to the
culture medium, and after 2 hours, optical density may be read with an ELISA
reader.
Alternatively, cell death of human leukemia or lymphoma cells cultured in the
absence or
presence of 13-Lapachone is measured by fluorescence activated cell sorting
(FACS) analysis.
Alternatively, cell death of human leukemia or lymphoma cells cultured in the
absence or
presence of (i-Lapachone is measured by methods described in Li et al., (2003)
Proc Natl Acad
Sci USA. 100(5): 2674-8.
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Example 2
(3-lapachone is tested in the NCI in vitro screen of 60 cancer cell lines,
which allows
comparison with other anti-tumor agents under standardized conditions. The NCI
assays are
performed under standardized conditions not designed to mimic the conditions
of dosing and use
the sulforhodamine B assay as the endpoint. (i-lapachone is broadly active
against many cell
types, with LCSO (1og10 molar concentration causing 50% lethality) between -
4.5 and -5.3, and
mean of -5.07 across all cells. The NCI set of 60 lines includes at least four
leukemia cell lines,
CCRF-CEM (acute lymphoblastic leukemia); HL-60 (acute myeloid leukemia); K562
(chronic
myelogenous leukemia); MOLT-4 (acute lymphoblastic leukemia); and one lymphoma
cell line
SR (lymphoid lymphoma). The NCI set of 60 lines also includes cell line RPMI-
8226 (multiple
myeloma). When compared to many FDA approved chemotherapeutic agents for
common
cancer types with publicly available data, no approved drug exceeds the mean
of (3-lapachone
across all cells and only mitoxantrone equals it. See, e.g., Figure 2.
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