Title: Methods for the treatment of nephro-disorders using aminothiol compounds
United States Patent: 6,586,476
Issued: July 1, 2003
Inventors: Stogniew; Martin (Blue Bell, PA); Alberts; David S. (Tucson, AZ); Kaplan; Edward H. (Skokie, IL)
Assignee: MedImmune Oncology, Inc. (Gaithersburg, MD)
Appl. No.: 429290
Filed: October 28, 1999
The present invention relates to new uses of S-2-(3-aminopropylamino)ethyl dihydrogen phosphorothioate, (amifostine) and other aminothiol compounds to treat and reverse toxicities caused by therapeutic agents, radiation treatment or diabetes. In particular, the invention provides a method for treating neurotoxicity and nephrotoxicity associated with the administration of chemotherapeutic agents.
DETAILED DESCRIPTION OF THE INVENTION
There are presently a number of chemotherapeutic agents that can be used against various cancers, including solid tumors and leukemias. Unfortunately, these chemotherapeutics frequently cause adverse or undesirable side effects which limit the clinician's ability to use the drug effectively. Most significantly, chemotherapeutics can cause tissue damage, organ damage and the like, which is not only painful to the patient but can also be irreversible or lethal depending upon the patient's tolerance and condition.
The inventors have quite surprisingly and unexpectedly found that the administration of amifostine, and related aminothiol compounds disclosed herein, can be used to reverse or treat the toxicities associated with the administration of various chemotherapeutics, particularly platinum coordination complexes such as cisplatin and paclitaxel. More specifically, upon clinical evidence of neuro- or nephrotoxicity commonly associated with the administration of cisplatin or paclitaxel, amifostine or related compounds can be used to rescue the patient thereby improving the overall treatment/therapy.
Based in part on this discovery, the present invention encompasses a method of treating neuro- or nephro-disorders in a human which comprises administering a therapeutically effective amount of amifostine, or a pharmaceutically acceptable salt, ester, analogue, metabolite, derivative or pro-drug thereof. The neuro- and nephro-toxicities which are treatable according to the methods of the present invention can arise from a variety of insults including, but not limited to cancer chemotherapy, radiation therapy, AIDS, chemotherapy, anti-fungal therapy, anti-bacterial therapy, and I.V. Contrast Agents. These aminothiol compounds can also be used to treat neuro- and nephro-disorders that are induced by aging and metabolic disorders, including, but not limited to diabetes. The methods of the present invention are also suitable for the treatment of neuro- and nephro-disorders induced by an unknown etiology. The methods of the invention are effective for the treatment of patients with and without cancer, as well as cancer patients undergoing or who have undergone chemotherapy. It should be recognized that the present invention also encompasses a method of treating various cancers by the combined use of a chemotherapeutic agent and one or more of the aminothiol rescue agents, such as amifostine, disclosed herein. Indeed, the use of these rescue agents allows the continued use of the chemotherapeutic agent which would have otherwise been discontinued or postponed due to toxicity.
In another embodiment, the present invention provides a method for treating toxicities associated with administration of a therapeutic agent wherein amifostine, or a related compound is administered subsequent to administration of the therapeutic agent. The administration of amifostine, and the compounds disclosed herein, after the occurrence of toxicities associated with administration of the therapeutic agent ameliorates and reverses the signs and symptoms of these toxicities. Thus, the present invention encompasses methods for treating toxicities associated with chemotherapy by administering amifostine, or salts, metabolites, functional derivatives functional analogues, esters and pro-drugs thereof after therapeutic treatment.
The present invention further provides a method for treating toxicities associated with the administration of a chemotherapeutic agent which comprises administering a therapeutically effective amount of amifostine or a metabolite, functional derivative or analogue thereof, or pharmaceutically acceptable salts thereof after the occurrence of one or more of said toxicities.
In particular, the present invention provides a method for treating neurotoxicity and nephrotoxicity associated with the administration of cisplatin or paclitaxel agent which comprises administering a therapeutically effective amount of amifostine or a salt, metabolite, ester, functional derivative, functional analogue and pro-drugs thereof, subsequent to the administration of the chemotherapeutic agent. In a preferred embodiment, the compound is administered after the disorder has appeared and been established, typically one or more days after administration of the chemotherapeutic agent.
The invention also encompasses the use of the aminothiols for the specific treatment of peripheral neuropathy, central neuropathy, autonomic neuropathy, muscle weakness, and myalgaia.
5.1. Aminothiols And Related Compounds that are Useful Within the Invention
As mentioned above, the compounds that can be used within the present invention include amifostine (WR-2721), as well as salts, hydrates, active metabolites, pro-drugs, and functional derivatives or analogues. More specifically, the invention includes all pro-drugs and metabolites of amifostine and pro-drugs of the active metabolites. Thus, compounds known to the skilled artisan to be suitable for administration to humans and known to be metabolites or otherwise converted into active thiols including metabolites such as WR-1065 and WR-33278 (disulfide) and the orally bioavailable WR-151327 and its active thiols, including metabolites such as WR-151326 and its corresponding disulfide, are encompassed within the present invention.
Similarly, described herein are aminothiols that exhibit activity similar to that of amifostine or its metabolites. Preferably, these compounds are structurally related to amifostine. Alternatively, these compounds are pro-drugs that are metabolized in vivo to a biologically active agent. These compounds are also encompassed by the present invention. Specific examples are illustrated herein.
Aminothiol compounds which can be used in the present invention are represented by the following formula (I):
R1 NH(CH2)NH(CH2)m SR.sub.2 (I)
R1 is hydrogen, C5 -C8 aryl, C2 C7 acyl or R1 NH(CH2)n NH(CH2)m S--; n and m are each an integer from 1 to 10; and preferably an integer from 2 to 6.
The methods of the present invention also encompasses the use of pharmaceutically acceptable salts and hydrates of the compounds of formula (I) above.
Preferred compounds useful in the methods of the invention are the S-.omega.(.omega.-amino-alkylamino)alkyl dihydrogen phosphorothioate analogues represented by the formula:
R--NH--(Cn H2n)--NH--(Cm H2m)--S--PO3 H2
wherein R is hydrogen or an alkyl group containing 1 to 7 carbon atoms and m and n independently have a value of from 1 to 10, preferably 2 to 6.
The chemical structure of amifostine (WR-2721) can be depicted as follows:
H2 N--(CH2)3 --NH--(CH2)2 --S--PO3 H2.
One preferred metabolite of amifostine is a dephosphorylated free thiol form known as WR-1065 (chemical nomenclature: S-2-(3-aminopropylamino) ethanethiol), which can be depicted as follows:
H2 N--(CH2)3 --NH(CH2)2 --SH.
Another preferred metabolite of amifostine is its disulfide, known as WR-33278 (chemical nomenclature: [2-[(aminopropyl)amino]ethanthiol]-N,N'-dithioidi-2,1-ethanediyl)bis-1,3-p ropanediamine), which can be depicted as follows:
H2 N--(CH2)3 --NH--(CH2)2 --S--S--(CH2)2 --NH--(CH2)3 --NH2.
A preferred analogue of amifostine is the compound designated as WR-15327 (chemical nomenclature: 1-propanethiol-3-[[3-(methylamino)propyl]amino]-dihydrogen phosphothiorate), which can be depicted as follows:
CH3 NH(CH2)3 NH(CH2)3 SPO3 H2.
Another preferred analogue of amifostine is the compound designated WR-151326, a dephosphorylated free thiol form of WR-151327 having the chemical structure: CH3 NH(CH2)3 NH(CH2)3 SH.
Other specific compounds suitable for use in the present invention include, but are not limited to:
S-1-(aminoethyl)phosphorothioic acid (WR-638);
S-[2-(3-methylaminopropyl)aminoethyl]phosphorothioate acid (WR-3689);
S-2-(4-aminobutylamino)ethyl phosphorothioic acid (WR-2822);
3-[(2-mercaptoethyl)amino]propionamide p-toluene-sulfonate (WR-2529);
S-1-(2-hydroxy-3-amino)propyl phosphorothioic acid (WR-77913);
S-2-(5-aminopentylamino)ethyl phosphorothioic acid (WR-2823);
1-[3-(3-aminopropyl)thiazolidin-2-Y1]-D-gluco-1,2,3,4,5 pentane-pentol dihydrochloride (WR-255709).
Additional aminothiols suitable for use in the present invention include, but are not limited to, S-2-(3-ethylaminopropylamino)ethyl dihydrogen phosphorothioate, S-2-(3-aminopropylamino)-2-methylpropyl dihydrogen phosphorothioate, S-2-(2-aminoethylamino)-2-ethyl dihydrogen phosphorothioate, S-2-(4-aminobutylamino)-2-ethyl dihydrogen phosphorothioate, S-2-(5-aminopentylamino)-2-ethyl dihydrogen phosphorothioate, S-2-(6-aminohexylamino)-2-ethyl dihydrogen phosphorothioate, S-2-(2-methylaminoethylamino)-2-ethyl dihydrogen phosphorothioate, S-2-(3-methylaminopropylamino)-2-ethyl dihydrogen phosphorothioate, and S-3-(3-methylaminopropylamino)-3-propyl dihydrogen phosphorothioate (WR-151327) and pharmaceutically acceptable salts thereof. Preferably, the aminothiol is amifostine, WR-1065, WR-33278, WR-151327 or WR-151326; most preferably it is amifostine.
Amifostine, and many of its salts, analogues and derivatives thereof suitable for use in the methods of the invention are commercially available, or can easily be prepared using standard techniques. The aminothiol compounds useful in the methods of the invention may be prepared by methods known in the art (see, e.g., Cortese, 1943, Organic Synthesis pp. 91-93, Coll. Vol. II, Blatt, Ed., John Wiley & Sons, Inc., New York, N.Y.; Akerfeldt, 1960, Acta Chem. Scand. 14:1980; Piper et al., 1966, Chem. Ind. (London):2010). Certain aminothiol compounds, as well as methods of synthesizing such compounds, are described in detail in U.S. Pat. No. 3,892,824 to Piper et al., U.S. Pat. Nos. 5,424,472 and 5,591,731, both to Kennedy et al., and WO 96/25045, each of which is incorporated herein by reference in its entirety.
The aminothiol compounds useful in the methods of the invention may be in the form of free acids, free bases, or pharmaceutically acceptable addition salts thereof. Such salts can be readily prepared by treating an aminothiol compound with an appropriate acid and/or base. Such acids include, by way of example and not limitation, inorganic acids such as hydrohalic acids (hydrochloric, hydrobromic, hydrofluoric, etc.), sulfuric acid, nitric acid, phosphoric acid, etc. and organic acids such as acetic acid, propanoic acid, 2-hydroxyacetic acid, 2-hydroxypropanoic acid, 2-oxopropanoic acid, propandioic acid, butandioic acid, etc. Conversely, the salt can be converted into the free base form by treatment with alkali.
The aminothiol compounds useful in the methods of the invention, as well as the pharmaceutically acceptable addition salts thereof, may be in a hydrated, solvated or anhydrous form. Methods of preparing such forms will be apparent to those of skill in the art of organic chemistry.
As used herein the term "aminothiol" means a compound represented by formula (I) set forth in Section 5.1 above, or any other compound disclosed therein.
The term "rescue agent" as used herein is intended to mean a compound capable of ameliorating, treating, reversing, reducing or arresting the signs and symptoms and pathology associated with the administration of chemotherapeutic agents radiation and pathology of associated diseases.
As used herein the term "disorder" means an illness, a sickness or a disease manifested by an interruption, cessation, derangement or abnormality of body functions, systems or organs.
As used herein, the term "toxicity" means a disorder characterized by a recognized etiologic agent or agents, an identifiable group of signs and symptoms, including adverse effects, unwanted effects, undesired effects, or abnormal signs or symptoms or consistent anatomical alterations.
The preferred subjects of the present invention are mammals, including humans. The subjects include cancer patients that are undergoing or have undergone chemotherapy, radiation treatment or both; AIDS patients and diabetics.
The term "treating" as used herein is intended to mean the administering to a subject the rescue agent of the present invention, preferably amifostine or a functional analogue or derivative thereof, for purposes which may include amelioration of symptoms of, or reversal of toxicities associated with chemotherapy.
As used herein the term "reversing" means that the progress of the disease, disorder or toxicity is inhibited and its symptoms are reversed or improved.
5.3. Toxicities/Disorders to be Treated
The methods of the present invention comprise administration of a pharmaceutical composition which contains an effective amount of an aminothiol of the invention in an acceptable carrier to a subject during or preferably after the subject has received therapy. The aminothiol is preferably amifostine, alone or in combination with one or more other drugs useful in the treatment of toxicities associated with therapy. Also included within the scope of the invention is the administration of compositions comprising a mixture of two or more of the aminothiol compounds of the present invention described above.
The methods of the present invention are suitable for treating toxicities associated with a wide variety of therapeutic agents. In addition, the methods of the invention are suitable for treatment of a variety of neuro- and nephro-disorders resulting from a variety of insults.
5.3.1 Chemically- and Radiation-Induced Toxicities
In one embodiment, the methods of the invention are used to treat toxicities associated with administration of chemotherapeutic agents which include, but are not limited to, cisplatin, carboplatin, paclitaxel, vinblastine, vincristine and methotrexate. In another embodiment, the methods of the invention are used to treat toxicities associated with radiation therapy (x-ray, nuclear and particularly gamma radiation).
The methods of the invention may be used to treat toxicities associated with the administration of the following chemotherapeutic agents: taxanes such as paclitaxel and docetaxel; alkylating agents, which include: nitrogen mustards such as mechlorethamine, cyclophosphamide, ifosamide, melphalan (phenalphenine mustard) and chlorambucil; ethylenimines and methylmelamines such as altretamine, diaziquone (AZQ) and thiotepa; alkyl sulfonates such as busulfan; nitrosoureas such as carmustine (BCNU), lomustine (CCNU), semustine (methyl-CCNU) and streptozocin (streptozotocin); and triazenes such as dacarbazine (DTIC; dimethyltriazenoimidazolecarboxamide); antimetabolites, which include folic acid analogs such as methotrexate, trimetrexate and other dihydrofolates; pyrimidine analogs such as fluorouracil (5-fluorouracil; 5-FU), floxuridine (fluorodeoxyuridine; FUdR) and cytarabine (cytosine arabinoside); purine analogs and related inhibitors such as mercaptopurine (6-mercaptopurine; 6-MP), thioguanine (6-thioguanine; TG) and pentostatin (2'-deoxycoformycin); natural products, which include vinca alkaloids such as vinblastine, vincristine, navelbine and vincristine; epipodophylotoxins such as etoposide and teniposide; antibiotics such as dactinomycin (actinomycin D), daunorubincin (daunomycin; rubidomycin); doxorubicin, bleomycin, plicamycin (mithramycin) and mitomycin (mitomycin C); enzymes such as L-asparaginase; and biological response modifiers such as interferon-alfa and other interferons; platinum coordination complexes such as cisplatin (cis-DDP) and carboplatin; anthracenediones such as mitoxantrone; substituted ureas such as hydroxyurea; methylhydrazide derivatives such as procarbazine (N-methylhydrazine, MIH), and adrenocortical suppressants such as mitotane (o,p'-DDD) and aminoglutethimide; hormones and antagonists which include adrenocorticosteroids such as prednisone; progestins such as hydroxyprogesterone caproate, medroxy progesterone acetate and megestrol acetate; estrogens such as diethylstilbestrol and ethinyl estradiol; antiestrogens such as tamoxifen; androgens such as testosterone propionate and fluoxymetsterone; antiandrogens such as flutamide; and gonadotropin-releasing hormone analogs such as leuprolide; camptothecins such as irinotecan, topotecan; gemciatdins such as gemcitabine; estramustine phosphate, VM-26 (vumon) and all-trans retinoic acid (ATRA). These agents are normally used in the treatment of head and neck, ovarian, breast, colon, lung, prostate, testicular and cervical cancers, as well as certain lymphomas, leukemias, and cancers of the CNS.
The toxicities associated with the administration of these agents or radiation therapy include, but are not limited to nephrotoxicity, neurotoxicity, ototoxicity, myelosuppression, cardiotoxicity, alopecia, infertility and local inflammation from extravasation into the skin, xerostomia and mucositis.
The methods of the present invention are also suitable for treating comparable toxicities associated with anti-virals such as ddI (didanosine), ddC (zalcitabine), d4T (stavadine), 3TC (lamivudine), AZT (zidovudine, 3'azido-3'-deoxythymidine) and the like, anti-bacterials such as aminoglycosides, and anti-fungals, such as amphotericin B.
5.3.2 Nephro-disorders to be Treated
The following nephro-disorders, which are also referred to herein as renal diseases, may be treated according to the methods of the present invention: Various types of glornerulonephritis, including diffuse forms of glornerulonephritis such as acute poststreptococcal, acute nonstreptococcal, rapidly progressive, chronic progressive, and end-stage chronic; focal forms of glomerulonephritis, such as those with systematic bacterial infection, of probable immunologic origin, i.e., IgA focal glomerulonephritis, and hereditary forms; nephrotic syndromes such as minimal change disease, lipoid nephrosis, or nil disease, focal segmental glomerular sclerosis, congenital nephrotic syndrome, membranoproliferative glomerulonephritis, idiopathic membranous nephropathy (membranous glomerulonephritis), systemic lupus erythematosus, systemic infection or hypersensitivity reactions, circulatory disturbances and renal vein thrombosis, amyloidosis, and toxemia of pregnancy; renal diseases of vascular origin such as hypertensive vascular disease, benign nephrosclerosis, malignant nephrosclerosis, diabetic nephropathy, renal infarction, polyarteritis nodosa and Wegener's granulomatosis; thrombotic renal diseases such as disseminated intravascular coagulation, bilateral renal cortical necrosis, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura; scleroderma; radiation nephritis; tubular diseases such as acute tubular necrosis, including toxic nephropathy and ischemic tubular necrosis, osmotic nephrosis, hypokalemic nephropathy, chronic interstitial and tubular diseases such as interstitial nephritis, pyelonephritis, tuberculous pyelonephritis, urinary tract obstructive disease, renal papillary necrosis, analgesic abuse nephropathy, multiple myeloma nephropathy, gout nephropathy, hypercalemic nephropathy and renal calcinosis, and renal lithiasis; congenital malformations and anomalies such as agenesis and hypoplasia, fusion, ectopia, and reduplication, dysplasia and polycystic dysplasia, congenital obstructive microcystic disease, simple cysts, infantile polycystic disease, adult polycystic disease, and medullary cystic disease; renal neoplasms such as benign tumors, which include adrenocortical nodules, hamartomas, mesenchymal tumors, and cortical tubular adenomas; and malignant tumors, such as adenocarcinoma, Wilms'tumor, leukemic infiltration, and transitional cell carcinoma.
5.3.3 Metabolic Disorders to be Treated
The present invention provides methods for the treatment of a wide variety of metabolic disorders. One such metabolic disorder is diabetes. The methods of the present invention are also suitable for, the treatment of disorders relating to basal metabolism, i.e., heat production of an individual at the lowest level of cell chemistry in the waking state, or the minimal amount of cell activity associated with the continuous organic functions of respiration, circulation and secretion; carbohydrate metabolism, i.e., the changes that carbohydrates undergo in the tissues, including oxidation, breakdown, and synthesis; electrolyte metabolism, i.e., the changes which the various essential minerals, sodium, potassium, calcium magnesium, etc. undergo in the fluids and tissues of the body; fat metabolism, i.e., the chemical changes, oxidation, decomposition, and synthesis, that fats undergo in the tissues; protein metabolism, i.e., the chemical changes, decompositions, and synthesis that protein undergoes in the tissues; and respiratory metabolism, i.e., the exchange of respiratory gases in the lungs and the oxidation of foodstuffs in the tissues with the production of carbon dioxide and water.
5.3.4 Disorders Associated with Diabetes
Diabetes patients often suffer from numerous debilitating disorders. One such disorder, peripheral neuropathy, is particularly likely to occur in the older diabetic patient, with approximately 30% to 50% of the patients showing minor reflex changes and evanescent pains in the extremities. The basic pathologic change in the peripheral nerves is a segmental demyelination. The autonomic nervous system may also be involved in diabetic patients, with resultant development of severe diarrhea and abdominal pain. Greatly elevated levels of sorbitol and fructose have been demonstrated in peripheral nerves of animals with experimentally induced diabetes. The accumulation of sorbitol and fructose is apparently attributable to a partial shunting of the metabolism of glucose through the aldose reductase pathway. It is unknown whether this abnormal metabolism of glucose with the formation of sorbitol is responsible for the decreased nerve conduction and segmental demyelination in diabetic subjects. In experimental diabetes, degenerative changes have been found in autonomic nerve fibers of the intestinal tract of rats and were associated with the development of megacolon in these animals. Control of the diabetes by islet transplantation resulted in either prevent or disappearance of the degenerative lesions in the autonomic nerves.
Kidney disease is common in diabetes and renal failure is one of the major causes of death. The dominant form of diabetic nephropathy is microvascular disease affecting the renal glomerulus. Early in diabetes, the kidney increases in size and the associated glomerular hypertrophy leads to an increased glomerular filtration rate with hyperfiltration and microalbuminuria in up to 50% of patients with new onset insulin dependent diabetes mellitus. Later in the disease, diffuse thickening of the glomerular basement membrane is noted along with increased mesangial volume and progressive impairment of renal function which in turn leads to further expansion of the mesangium and eventual glomerular occlusion.
Clinically, in some cases mild proteinuria can remain constant for many years, while in other cases it progresses to reduction in glomerular filtration and renal function with all the classical features of nephrotic syndrome. Once azotemia (increased serum creatinine and BUN) develops, progression to renal failure and uremia is inevitable within a few months to two to three years. Once renal failure develops, the only alternatives are dialysis or transplantation.
The treatment of the above disorders is included within the scope of the present invention.
5.4 Effective Dosages
Pharmaceutical compositions suitable for use with the present invention include compositions wherein the active ingredient is contained in a therapeutically effective amount, i.e., an amount effective to achieve its intended purpose. Of course, the actual amount of active ingredient will depend on, among other things, the particular disorder being treated. Determination of an effective amount is well within the capabilities of those skilled in the art.
For any compound described herein the therapeutically effective amount can be initially estimated from cell culture assays. For example, a dose can be formulated in animal models to achieve a circulating concentration range of compound, and/or an active metabolite thereof, that includes an effective concentration as determined in cell culture. Such information can be used to more accurately determine useful doses in humans. See, e.g., Washburn et al., 1976, "Prediction of the Effective Radioprotective Dose of WR-2721 in Humans Through an Interspecies Tissue Distribution Study" Radiat. Res. 66:100-5.
Therapeutically effective amounts for use in humans can also be estimated from animal models. For example, a dose for humans can be formulated to achieve a circulating concentration found to be effective in animals.
A therapeutically effective dose can also be estimated from current clinical experience and data, including human pharmacokinetic data. While not intending to be bound by any particular theory, it is believed that efficacy is related to a subject's total exposure to an applied dose of administered drug, and/or an active metabolite thereof, as determined by measuring the area under the blood concentration-time curve (AUC). Thus, a dose administered according to the methods of the invention that has an AUC of administered compound (and/or an active metabolite thereof) within about 50% of the AUC of a dose-known to be effective for the indication being treated is expected to be effective. A dose that has an AUC of administered compound (and/or an active metabolite thereof) within about 70%, 8.0% or even 90% or more of the AUC of a known effective dose is preferred. Adjusting the dose to achieve maximal efficacy in humans based on the methods described above, particularly on the blood concentration and duration of administered compound and/or its active metabolites is well within the capabilities of the ordinarily skilled artisan.
Usual patient doses for administration of amifostine and/or its active metabolite WR-1065 usually range from about 50 mg/day to 6000 mg/day, commonly from about 100 mg/day to 4000 mg/day, and typically from about 200 mg/day to 3500 mg/day. Stated in terms of patient body weight, usual dosages range from about 0.6 to 100 mg/kg/day, commonly from about 1.1 to 66 mg/kg/day, and typically from about 2.2 to 58 mg/kg/day. Stated in terms of patient body surface areas, usual dosages range from about 23 to 4000 mg/m2 /day, commonly from about 45 to 2666 mg/m2 /day, and typically from about 90 to 2333 mg/m2 /day.
For other modes of administration, dosage amount and interval can be adjusted individually to provide effective plasma and/or tissue levels of the administered compound, and/or an active metabolite thereof, according to the pharmacokinetic profiles described herein, as previously described.
The actual amount of composition administered will, of course, be dependent on the subject being treated, the subject's weight, the severity of the affliction, the mode of administration and the judgement of the prescribing physician.
Dosages are in the range of between about 10-1000 mg/m2 administered parenterally. Preferred doses for intravenous administration are between about 100-750 mg per m2 of body surface area, more preferably between about 200-750 mg/m2. Preferred doses for oral administration are between about 20-2000 mg per m2 of body surface area, more preferably between about 500-1500 mg/m2 body surface area.
5.5 Formulations and Dosage Administration
The aminothiol compounds described herein, or pharmaceutically acceptable addition salts or hydrates thereof, can be delivered to a patient according to the invention using a wide variety of routes or modes of administration. Suitable routes of administration include but are not limited to, inhalation, or parenteral routes, including intravenous (infusion or bolus injection), intramuscular, intraperitoneal, intrathecal, subcutaneous, intranasal, transmucosal, buccal, sublingual, vaginal, rectal, intestinal, local intradermal or transdermal routes. Alternatively, or concurrently, administration may be by the oral route. Intravenous administration is particularly desirable.
The aminothiol compounds described herein, or pharmaceutically acceptable salts and/or hydrates thereof, or mixtures thereof, may be administered alone, or in combination with other aminothiol compounds of the invention, and/or in combination with one or more therapeutic agents, including cancer chemotherapeutic agents, intended to also treat the toxicity or disorder suffered by the subject being treated. Examples of such additional drugs include but are not limited to vitamins, in particular the B complex.
Medicaments are considered to be provided "in combination" with one another if they are provided to the subject concurrently, sequentially or if the time between the administration of each medicament is such as to permit an overlap of biological activity.
The aminothiol compounds of the present invention may be administered by any means that achieve their intended purpose. Amounts and regimens for the administration of the aminothiol rescue agents can be determined readily by those with ordinary skill in the clinical art of treating neuro- and nephro-disorders, toxicities or cancer.
It is understood that the dosage of the aminothiol compound will be dependent upon the age, sex, health, and weight of the recipient, kind of concurrent treatment, if any, frequency of treatment, and the nature of the effect desired. An effective amount of the active compound of the present invention is any amount which would serve to treat or reverse symptoms of the neuro- or nephro-disorder or the neurotoxicity or nephrotoxicity caused by administration of a chemotherapeutic agent in vivo. The ranges of effective doses provided herein are not intended to limit the invention and represent preferred dose ranges. However, the most preferred dosage will be tailored to the individual subject, as is understood and determinable by one of ordinary skill in the art without undue experimentation.
For any mode of administration, the actual amount of compound delivered, as well as the dosing schedule necessary to achieve the advantageous effects described herein, will also depend, in part, on such factors as the bioavailability of the compound (and/or an active metabolite thereof), the disorder being treated, the desired therapeutic dose, and other factors that will be apparent to.those of skill in the art. The actual amount delivered and dosing schedule can be readily determined by those of skill without undue experimentation by monitoring the blood plasma levels of administered compound and/or an active metabolite thereof, and adjusting the dosage or dosing schedule as necessary to achieve the desired therapeutic effect. Additionally the dosage or dosing schedule can be adjusted as necessary to achieve the desired therapeutic effect by monitoring the signs and symptoms of the disorder.
The active compoundis) may be administered alone or in the form of a pharmaceutical composition, wherein the active compound(s) is in admixture with one or more pharmaceutically acceptable carriers, excipients or diluents. Pharmaceutical compositions for use in accordance with the present invention may be formulated in conventional manner using one or more physiologically acceptable carriers comprising excipients and auxiliaries which facilitate processing of the active compounds into preparations which can be used pharmaceutically. Proper formulation is dependent upon the route of administration chosen.
The present methods also include providing a liquid based dosage form of the active compound suitable for administration to a subject in need thereof. The liquid base may be any liquid capable of transporting the active ingredient into the body without disrupting the activity of the compound or harming the patient. A preferred base is an isotonic solution, which may also contain conventional additives such as sugars. These solutions are useful for both oral and intravenous administration.
For injection, the agents of the invention may be formulated in aqueous solutions, preferably in physiologically compatible buffers such as Hanks's solution, Ringer's solution, or physiological saline. For transmucosal administration, penetrants appropriate to the barrier to be permeated are used in the formulation. Such penetrants are generally known in the art.
Suitable injectable solutions include intravenous subcutaneous and intramuscular injectable solutions. The active compound may also be administered in the form of an infusion solution or as a nasal inhalation or spray.
For intravenous administration, the active compound is preferably administered by drip infusion in an aqueous solution. The active ingredient may be administered in single or divided doses.
Suitable formulations for parenteral administration include aqueous solutions of the active compounds in water-soluble form, for example, water-soluble salts. In addition, suspensions of the active compounds as appropriate oily injection suspensions may be administered. Suitable lipophilic solvents or vehicles include fatty oils, for example, sesame oil, or synthetic fatty acid esters, for example, ethyl oleate or triglycerides. Aqueous injection suspensions that may contain substances which increase the viscosity of the suspension include, for example, sodium carboxymethyl cellulose, sorbitol, and/or dextran. Optionally, the suspension may also contain stabilizers.
For oral administration, the active ingredient, preferably amifostine or a functional derivative or analogue thereof such as WR-151327, may be a preparation in any dosage form capable of oral administration. Such dosage forms include tablets, hard,or soft gelatin capsules, caplets, dragees, pills, tablets including coated tablets, and solutions including elixirs, suspensions, gels, slurries or syrups, and the like. Pharmaceutical preparations for oral use can be obtained solid excipient, optionally grinding a resulting mixture, and processing the mixture of granules, after adding suitable auxiliaries, if desired, to obtain tablets or dragee cores.
The active compound of the present invention may be administered rectally in the form of suppositories or enemas.
In general, the preparation in which the active compound of the present invention is administered contains from about 0.1 to about 100 percent, preferably from about 25-85 percent, of active compound(s), together with a carrier or excipient. Suitable pharmaceutically acceptable carriers comprise excipients and auxiliaries which facilitate processing of the active compounds into preparations which can be used pharmaceutically. Suitable excipients are, in particular, fillers such as sugars, such as lactose, sucrose, mannitol, or sorbitol; cellulose preparations and/or calcium phosphates, such as tricalcium phosphate or calcium hydrogen phosphate; as well as binders such as starch paste made using, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethylcellulose, sodium carboxymethyl cellulose, and/or polyvinylpyrrolidone. If desired, disintegrating agents may also be added, such as the above-mentioned starches as well as carboxymethyl starch, cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt thereof, such as sodium alginate. Auxiliaries which can be used in the compositions according to the present invention include flow-regulating agents and lubricants such as silica, talc, stearic acid or salts thereof, and/or polyethylene glycol.
Dragee cores are provided with suitable coatings. For this purpose, concentrated sugar solutions may be used, which may optionally contain gum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, and/or titanium dioxide, lacquer solutions, and suitable organic solvents or solvent mixtures. Dyestuffs or pigments may be added to the tablets or dragee coatings for identification or to characterize different combinations of active compound doses.
Pharmaceutical preparations which can be used orally include push-fit capsules made of gelatin, as well as soft, sealed capsules made of gelatin and a plasticizer, such as glycerol or sorbitol. The push-fit capsules can contain the active ingredients in admixture with filler such as lactose, binders such as starches, and/or lubricants such as talc or magnesium stearate and, optionally, stabilizers. In soft capsules, the active compounds may be dissolved or suspended in suitable liquids, such as fatty oils, liquid paraffin, or liquid polyethylene glycols. In addition, stabilizers may be added. All formulations for oral administration should be in dosages suitable for such administration.
For buccal administration,the compositions may take the form of tablets or lozenges formulated in conventional manner.
For administration by inhalation, the compounds for use according to the present invention are conveniently delivered in the form of an aerosol spray presentation from pressurized packs or a nebulizer, with the use of a suitable propellant, e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas. In the case of a pressurized aerosol the dosage unit may be determined by providing a valve to deliver a metered amount. Capsules and cartridges of e.g. gelatin for use in an inhaler or insufflator may be formulated containing a powder mix of the compound and a suitable powder base such as lactose or starch.
The compounds may be formulated for parenteral administration by injection, e.g., by bolus injection or continuous infusion. Formulations for injection may be presented in unit dosage form, e.g., in ampoules or in multi-dose containers, with an added preservative. The compositions may take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
Pharmaceutical formulations for parenteral administration include aqueous solutions of the active compounds in water-soluble form. Additionally, suspensions of the active compounds may be prepared as appropriate oily injection suspensions. Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acid esters, such as ethyl oleate or triglycerides, or liposomes. Aqueous injection suspensions may contain substances which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol, or dextran. Optionally, the suspension may also contain suitable stabilizers or agents which increase the solubility of the compounds to allow for the preparation of highly concentrated solutions.
Alternatively, the active ingredient may be in powder form for constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use.
The compounds may also .be formulated in rectal compositions such as suppositories or retention enemas, e.g., containing conventional suppository bases such as cocoa butter or other glycerides.
In addition to the formulations described previously, the compounds may also be formulated as a depot preparation. Such long acting formulations may be administered by implantation, subcutaneous or intramuscular injection. Thus, for example, the compounds may be formulated with suitable polymeric or hydrophobic materials (for example as an emulsion in an acceptable oil) or ion exchange resins, or as sparingly soluble derivatives, for example, as a sparingly soluble salt.
The pharmaceutical compositions also may comprise suitable solid or gel phase carriers or excipients. Examples of such carriers or excipients include but are not limited to calcium carbonate, calcium phosphate, various sugars, starches, cellulose derivatives, gelatin, and polymers such as polyethylene glycols.
It will be understood that the aminothiol rescue agents of the invention may be administered in accordance with the methods of the invention at any time during or after administration of the chemotherapeutic agent, preferably after administration. For example, the rescue agent may be administered one hour after, or more preferably, four or more hours after administration of the chemotherapeutic agent. Most preferably, the rescue agent is administered days, or even weeks after chemotherapy. The rescue agent may be administered after toxicities associated with administration of chemotherapy are observed. Preferably, the rescue agent is administered after chemotherapeutically-induced toxicities are observed or demonstrated.
Indications of toxicity in a patient who has received chemotherapy are well known to those of ordinary skill in the art of treating cancer patients. For example, indications or "markers" of neurotoxicity caused by chemotherapy include, but are not limited to clinical signs and symptoms, nerve conduction studies, and vibrometer measurements. Markers of nephrotoxicity caused by chemotherapy include, but are not limited to increased levels of serum creatinine above 1.5 mg/Dl, BUN greater than 20, abnormal electrolytes, for example decrease in serum, magnesium, bicarbonate or elevations in serum potassium. Preferably, the aminothiol compounds of the invention are administered after one or more of such toxicity markers are observed following chemotherapeutic treatment.
It will be understood that the aminothiol compounds of the invention may be administered according to the methods of the invention after any one or more cycles of administration of a chemotherapeutic drug. For example, the rescue agent may be administered after one cycle of administration of a chemotherapeutic agent, but prior to the next cycle of administration of chemotherapeutic agent.
Claim 1 of 19 Claims
What is claimed is:
1. A method for treating a nephro-disorders in a human which comprises administering a therapeutically effective amount of one or more aminothiol compounds, or a pharmaceutically acceptable salt thereof, to a human in need of such treatment after the occurrence of said nephro-disorders.