U.S. patent application number 11/190356 was filed with the patent office on 2005-11-24 for methods and compositions for the treatment of chronic lymphocytic leukemia.
Invention is credited to Nardella, Francis A..
Application Number | 20050261356 11/190356 |
Document ID | / |
Family ID | 26785713 |
Filed Date | 2005-11-24 |
United States Patent
Application |
20050261356 |
Kind Code |
A1 |
Nardella, Francis A. |
November 24, 2005 |
Methods and compositions for the treatment of chronic lymphocytic
leukemia
Abstract
The level of the leukemic lymphocytes in patients suffering from
chronic lymphocytic leukemia (CLL) is reduced by the administration
of certain indole or carbazole compounds, such as the nonsteroidal
anti-inflammatory drug etodolac or related indole or carbazol
compounds.
Inventors: |
Nardella, Francis A.;
(Scottsdale, AZ) |
Correspondence
Address: |
PILLSBURY WINTHROP SHAW PITTMAN LLP
ATTENTION: DOCKETING DEPARTMENT
11682 EL CAMINO REAL, SUITE 200
SAN DIEGO
CA
92130
US
|
Family ID: |
26785713 |
Appl. No.: |
11/190356 |
Filed: |
July 26, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11190356 |
Jul 26, 2005 |
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10404943 |
Mar 31, 2003 |
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6921772 |
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10404943 |
Mar 31, 2003 |
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09720992 |
Jul 6, 2001 |
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6573292 |
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09720992 |
Jul 6, 2001 |
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PCT/US99/15501 |
Jul 8, 1999 |
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60092466 |
Jul 9, 1998 |
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60094878 |
Jul 29, 1998 |
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Current U.S.
Class: |
514/411 |
Current CPC
Class: |
A61P 35/00 20180101;
A61K 31/407 20130101; A61K 31/403 20130101; A61P 35/02
20180101 |
Class at
Publication: |
514/411 |
International
Class: |
A61K 031/407; A61K
031/403 |
Claims
1. A method for the treatment of chronic lymphocytic leukemia (CLL)
in a patient, comprising administering to said patient a
therapeutically effective amount of an indole or carbazole
derivative of the formula: 8in which R.sub.1 is selected from the
group consisting of hydrogen, lower alkyl lower alkenyl, lower
alkynyl, alkoxyloweralkyl, lower cycloalkyl phenyl, benzyl and
2-thienyl; R.sub.2 and R.sub.3 are the same or different and are
each selected from the group consisting of hydrogen and lower
alkyl; R.sub.4 and R.sub.5 are the same or different and are each
selected from the group consisting of hydrogen, lower alkyl,
--NH.sub.2, --NHCHO, --NHCONH.sub.2, .dbd.NW, oxo, --OH and
--OCH.sub.3, wherein W is hydroxy, alkoxy, aryloxy,
carboxyalkyloxy, arylamino or alkylsulfonylamino R.sub.6 is
selected from the group consisting of hydrogen, lower alkyl, lower
alkenyl, lower alkynyl, trifluoromethyl hydroxy, lower alkoxy,
trifluoroloweralkoxy, benzyloxy, araloxy, lower alkanoyloxy, acyl,
amino, nitro, cyano, alkylimido, halo, mercapto, loweralkylthio,
alkylsulfinyl, alkylsulfonyl, alkylsulfonamido and sulfamoyl;
R.sub.7 is selected from the group consisting of hydrogen, lower
alkyl and lower alkenyl; X is selected from the group consisting of
carbon, oxy and thio; Y is selected from the group consisting of
carbonyl, 9in which each of R.sub.8, R.sub.9, R.sub.10, R.sub.11,
R.sub.12 and R.sub.13 is hydrogen or lower alkyl; and Z is selected
from the group consisting of hydroxy, lower alkoxy, amino, lower
alkylamino, dio(lower)alkylamino and phenylamino, or a
pharmaceutically acceptable salt thereof.
2. The method of claim 1 wherein the indole or carbazole derivative
is etodolac.
3. The method of claim 2 wherein about 1.0 mg to 500 mg of etodolac
per kg of body weight of the patient per day is administered to the
patient.
4. The method of claim 3 wherein the etodolac is administered
orally to the patient.
5. A method according to claim 1, wherein said therapeutically
effective amount of the indole or carbazole compound is sufficient
to reduce the level of leukemic lymphocytes in said patient.
6. A method according to claim 1, wherein said indole or carbazole
compound is administered in the form of a pharmaceutical
composition.
7. A method according to claim 6, wherein said pharmaceutical
composition further comprises a pharmaceutically acceptable carrier
or diluent.
8. The use of a compound of claim 1 in the manufacture of a
medicament for the treatment of chronic lyphocytic leukemia.
Description
FIELD OF THE INVENTION
[0001] The present invention relates to the use of indole
derivatives characterized by having a 1,3,4,9-tetrahydropyrano
[3,4-b]indole, 1,3,4,9-tetrahydrothiopyrano [3,4-b]indole,
1,2,3,4-tetrahydro-4H carbazole or 2,3,4,9-tetrahydro-1H carbazole
nucleus, such as etodolac, in the treatment of chronic lymphocytic
leukemia, and B-cell and T-cell lymphomas.
BACKGROUND OF THE INVENTION
[0002] Chronic lymphocytic leukemia (CLL) is a heterogeneous group
of diseases characterized by different maturation states of the
B-cells and T-cells, which are related to the aggressiveness of the
disorder. Accordingly, CLL is commonly classified into separate
categories, including B-cell chronic lymphocytic leukemia of
classical and mixed-types, B-cell and T-cell prolymphocytic
leukemia, hairy-cell leukemia and hairy-cell variant, splenic
lymphoma with circulating villous lymphocytes, large granular
lymphocytic leukemia, adult T-ell leukemia/lymphoma syndrome and
leukemic phases of malignant lymphomas of both B-cell and T-cell
types.
[0003] B-cell chronic lymphocytic leukemia (B-CLL) is characterized
by proliferation and accumulation of B-lymphocytes that appear
morphologically mature but are biologically immature. B-CLL
typically occurs in persons over 50 years of age. This disorder
accounts for 30% of leukemias in Western countries, with 10,000 new
cases being diagnosed annually in the United States alone. The
disorder is characterized by proliferation of biologically immature
lymphocytes (lymphocytosis), which typically express low levels of
surface immunoglobulins, which upon organ infiltration cause
lymph-node enlargement and hepato-splenomegaly. In the advanced
stages of the disease, bone marrow occupation by the abnormal
lymphocytes causes bone marrow failure, resulting in anemia and
thrombocytopenia.
[0004] The B-ells in CLL have receptors for mouse erythrocytes, a
marker of immature B-cells. An increased number of T-ells has been
reported in this disorder with an increase in the number of
T-suppressor cells. Typically, an inversion of the
T-helper/suppressor ratio results, with increased suppressor
T-cells and decreased helper T-cells. The absolute number of
natural killer cells may also be increased. In addition, chromosome
analysis provides prognostic information about overall survival, in
addition to that supplied by clinical data in patients with B-cell
CLL.
[0005] It has been suggested that certain non-steroidal
anti-inflammatory drugs (NSAIDs) may exhibit chemopreventative and
anti-neoplastic properties. For example, Piazza et al., Cancer
Research 57:2452-2459 (1997), discloses that sulindac (an NSAID
that acts as a cyclooxygenase inhibitor) causes regression of and
prevents recurrence of colonic adenomas in patients with familial
adenomatous polyposis in a manner that appears to be independent of
the drug's cyclooxygenase inhibition activity. Although induction
of apoptosis was suggested the actual mechanism of action of this
NSAID in the inhibition of cell growth is poorly understood.
[0006] The compound etodolac,
1,8-diethyl-1,3,4,9-tetrahydro[3,4-b]-indole- -1-acetic acid, falls
generally in the class of NSAIDs and is a cyclooxygenase inhibitor.
Etodolac is used to treat mild-to-moderate pain, osteoarthritis,
and rheumatoid arthritis. Other related indole compounds have also
been shown to exhibit similar activity. For example, U.S. Pat. Nos.
3,843,681, 3,939,178, 3,974,179 and 4,686,213 disclose indole
derivatives based on the 1,3,4,9-tetra-hydropyrano[3,4-b]-indole-1-
-acetic acid nucleus that are stated to exhibit anti-inflammatory,
analgesic, antibacterial and/or antifingal activity. Similar
1,2,3,4-tetrahydro-4H-carbazole and 2,3,4,9-1H carbazole compounds
and their use as cyclooxygenase-2 (COX-2) inhibitors for
antiarthritic, colorectacl cancer and Alzheimer's therapy are also
disclosed in U.S. Pat. Nos., 5,776,967, 5,824,699 and
5,830,911.
SUMMARY OF THE INVENTION
[0007] It has now been surprisingly discovered that the number of
circulating leukemic lymphocytes in patients suffering from chronic
lymphocytic leukemia (CLL), such as B-cell CLL, is reduced by the
administration of certain indole compounds, such as the
nonsteroidal anti-inflammatory drug etodolac or related indole
compounds, in vivo, in vitro, and in situ.
[0008] Thus, in one aspect the present invention relates to the
discovery that etodolac or related indole compounds reduce the
level of leukemic lymphocytes in patients with CLL.
[0009] The present invention also relates to the use of etodolac,
related indole compounds and/or salts or functional derivatives
thereof, in the manufacture of a pharmaceutical composition for the
treatment of CLL or B-cell lymphomas.
[0010] In yet another aspect, the invention relates to
pharmaceutical compositions for the treatment of CLL or B-cell
lymphomas, comprising etodolac, related indole compounds and/or
salts thereof, as active ingredients, optionally together with
pharmaceutically acceptable carriers and/or excipients and/or
adjuvants.
[0011] It is contemplated that effective indole compounds of this
invention are characterized by having a pyrano [3,4-b]indole,
thiopyrano [3,4-b]indole or carbazole nucleus bearing a substituent
at position 1, said substituent incorporating an acid, ester or
amide function therein. These derivatives may be represented by
Formula I: 1
[0012] in which R.sub.1 is selected from the group consisting of
hydrogen, lower alkyl, lower alkenyl, lower alkynyl,
alkoxyloweralkyl, lower cycloalkyl, phenyl, benzyl and 2-thienyl;
R.sub.2 and R.sub.3 are the same or different and are each selected
from the group consisting of hydrogen and lower alkyl; R.sub.4 and
R.sub.5 are the same or different and are each selected from the
group consisting of hydrogen, lower alky, --NH.sub.2, --NHCHO,
--NHCONH.sub.2, .dbd.NW, oxo, --OH and --OCH.sub.3, wherein W is
hydroxy, alkoxy, aryloxy, carboxyalkyloxy, arylamino or
alkylsulfonylamino; R.sub.6 is selected from the group consisting
of hydrogen, lower alkyl, lower alkenyl, lower alkynyl,
trifluoromethyl, hydroxy, lower alkoxy, trifluorolowerlkoxy,
benzyloxy, araloxy, lower alkanoyloxy, acyl, amino, nitro, cyano,
alkylimido, halo, mercapto, loweralkylthio, alkylsulfinyl,
alkylsulfonyl, alkylsulfonamido and sulfamoyl; R.sub.7 is selected
from the group consisting of hydrogen, lower alkyl and lower
alkenyl; X is selected from the group consisting of carbon, oxy and
thio; Y is selected from the group consisting of carbonyl, 2
[0013] in which each of R.sub.8, R.sub.9, R.sub.10, R.sub.11,
R.sub.12 and R.sub.13 is hydrogen or lower alkyl; and Z is selected
from the group consisting of hydroxy, lower alkoxy, amino, lower
alkylamino, di(lower)alkylamino and phenylamino.
[0014] Also included within the scope of this invention are pyrano
[3,4-b]indole and thiopyrano [3,4-b]indole derivatives of Formula I
in which R.sub.6 represents from one to four substituents, which
may be present simultaneously, at positions 5, 6, 7 and 8 thereof.
The exact nature of such substituents does not have to be limited
necessarily by the above definitions of R.sub.6, and R.sub.6 may
also include additional substituents, for example, mercapto, lower
alkylthio, trifuoromethyl and other halo(lower)alkyls, amino and
sulfamoyl provided that any two such substituents do not interfere
with each others presence. Accordingly the indole derivatives of
this invention are represented also by general Formula Ia: 3
[0015] in which R.sub.1, R.sub.2, R.sub.3, R.sub.4, R.sub.5,
R.sub.7, X, Y and Z are as defined above and R.sub.6a, R.sub.6b,
R.sub.6c and R.sub.6d are the same or different and each is
selected from the group consisting of hydrogen, lower alkyl, lower
alkenyl, lower alkenyl, trifluoromethyl, hydroxy, lower alkoxy,
trifluoroloweralkoxy, benzyloxy, araloxy, low er alkanoyloxy, acyl,
amino, nitro, cyano, alkylimido, halo, mercapto, loweralkylthio,
alkylsulfinyl, alkylsulfonyl, alkylsulfonamido and sulfamoyl.
[0016] In yet other aspects of the invention, methods are provided
for the treatment of CLL and other lymphomas by administering to a
patient in need thereof, a lymphocyte reducing amount of a compound
of Formula I or Ia, either alone or together with a
pharmaceutically acceptable carrier.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] The foregoing aspects and many of the attendant advantages
of this invention will become more readily appreciated by reference
to the following detailed description, when taken in conjunction
with the accompanying drawings, wherein:
[0018] FIG. 1 is a graphical representation of the white blood cell
count (WBC, solid circles), lymphocyte count (LYC, solid triangles)
and neutrophil count (NC, solid squares) over time after
administration of various nonsteroidal anti-inflammatory drugs
(NSAIDs) to a patient suffering from CLL at the times shown as
solid diamonds, as described in Example 1. The administered NSAIDs
were etodolac (E, 300 mg, bid.times.3-6 days), naproxen (N, 250 mp
tid.times.4 days), diclofenac (D, 50 mg tid.times.4 days), sulindac
(S, 200 mg, bid.times.4 days), nabumetone (R, 500 mg, bid.times.6
days), oxaprozin (Q, 600 mg, bid.times.4 days), prioxican (P, 20
mg, qd.times.3 days), indomethacin (I, 25 mg tid.times.3 days),
tolmetin (T, 400 mg bid.times.3 days) and ibuprofen (M, 400 mg
tid.times.3 days). The dose and duration for administration is
shown in FIG. 1.
[0019] FIG. 2 is a graphical representation of the white blood cell
count (WBC, solid circles), lymphocyte count (LYC, solid triangles)
and neutrophil count (NC, solid squares) over time after
administration of the non-steroidal anti-inflammatory drugs
(NSAIDs) described in FIG. 1 to a patient suffering with CLL at the
times shown as inverted triangles, as shown in FIG. 1, with the
addition of the platelet count (PLTCT, solid diamonds) of the
patient.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0020] In accordance with the present invention, a method is
provided for the prophylaxix or treatment of chronic lymphocytic
leukemia (CLL) in a patient, comprising administering to said
patient a therapeutically effective amount of an indole derivative
of the formula: 4
[0021] in which R.sub.1 is selected from the group consisting of
hydrogen, lower alkyl, lower alkenyl, lower alkynyl,
alkoxyloweralkyl, lower cycloalkyl, phenyl, benzyl and 2-thienyl;
R.sub.2 and R.sub.3 are the same or different and are each selected
from the group consisting of hydrogen and lower alkyl; R.sub.4 and
R.sub.5 are the same or different and are each selected from the
group consisting of hydrogen, lower alkyl, --NH.sub.2, --NHCHO,
--NHCONH.sub.2, .dbd.NW, oxo, --OH and --OCH.sub.3, wherein W is
hydroxy, alkoxy, aryloxy, carboxyalkyloxy, arylamino or
alkylsulfonylamino; R.sub.6 is selected from the group consisting
of hydrogen, lower alkyl lower alkenyl, lower alkynyl,
trifluoromethyl, hydroxy, lower alkoxy, trifluoroloweralkoxy,
benzyloxy, araloxy, lower alkanoyloxy, acyl, amino, nitro, cyano,
alkylimido, halo, mercapto, loweralkylthio, alkylsulfinyl,
alkylsulfonyl, alkylsulfonamido and sulfamoyl; R.sub.7 is selected
from the group consisting of hydrogen, lower alkyl and lower
alkenyl; X is selected from the group consisting of carbon, oxy and
thio; Y is selected from the group consisting of carbonyl, 5
[0022] in which each of R.sub.8, R.sub.9, R.sub.10, R.sub.11,
R.sub.12 and R.sub.13 is hydrogen or lower alkyl; and Z is selected
from the group consisting of hydroxy, lower alkoxy, amino, lower
alkylamino, di(lower)alkylamino and phenylamino, or a
pharmaceutically acceptable salt thereof.
[0023] Also included within the scope of this invention are pyrano
[3,4-b]indole and thiopyrano [3,4-b]indole derivatives of Formula I
in which R.sub.6 represents from one to four substituents, which
may be present simultaneously, at positions 5, 6, 7 and 8 thereof.
The exact nature of such substituents does not have to be limited
necessarily by the above definitions of R.sub.6, and R.sub.6 may
also include additional substituents, for example, mercapto, lower
alkylthio, trifluoromethyl and other halo(lower)alkyls, amino and
sulfamoyl, provided that any two such substituents do not interfere
with each others presence. Accordingly the indole derivatives of
this invention are represented also by general Formula Ia: 6
[0024] in which R.sub.1, R.sub.2, R.sub.3, R.sub.4, R.sub.5,
R.sub.7, X,Y and Z are as defined above and R.sub.6a, R.sub.6b,
R.sub.6c and R.sub.6d are the same or different and each is
selected from the group consisting of hydrogen, lower alkyl, lower
alkenyl, lower alkynyl, trifluoromethyl, hydroxy, lower alkoxy,
trifluoroloweralkoxy, benzyloxy, araloxy, lower alkanoyloxy, acyl,
amino, nitro, cyano, alkylimido, halo, mercapto, loweralkylthio,
alkylsulfinyl, alkylsulfonyl, alkylsulfonamido and sulfamoyl, or a
pharmaceutically acceptable salt thereof.
[0025] The preparation of compounds of Formulas 1 and 1a is
disclosed in U.S. Pat. Nos. 3,843,681, 3,939,178, 3,974,179,
4,686,213, 4,748,252, 5,776,967, 5,824,699 and 5,830,911 the
disclosures of which are incorporated herein by reference.
[0026] In a presently preferred embodiment of the invention, the
indole compound of Formula I is etodolac, having the formula 7
[0027] or a pharmaceutically acceptable salt thereof. Methods for
the synthesis of etodolac are disclosed in U.S. Pat. Nos. 4,585,877
and 5,599,946, which are incorporated herein by reference. Etodolac
is commercially available under the tradename Lodine.RTM.,
Wyeth-Ayerst Laboratories Division of American Home Products
Corporation, Philadelphia, Pa., U.S.A. Also included within the
scope of this invention are the isomers of the compounds of Formula
I resulting from the asymmetric centers contained therein. The
commercially available etodolac product is a racemic mixture. U.S.
Pat. No. 5,561,151 discloses the resolution of a mixture of the
enantiomers of etodolac using conventional means, and the use of
the separated R(-) isomer as an analgesic. Thus, it is further
contemplated that the (R)- and (S)isomers of etodolac may be
separated, and used separately in the practice of the
invention.
[0028] As used herein in connection with the indole derivatives of
the invention, the term "lower alkyl" contemplates both straight
and branched chain alkyl radicals containing from one to six carbon
atoms and includes methyl, ethyl, propyl, isopropyl, butyl,
isobutyl 2-methylpentyl and the like.
[0029] As used herein, the term "lower alkenyl" contemplates both
straight and branched chain alkenyl radicals containing from two to
six carbon atoms and includes vinyl, allyl, 1-propenyl methallyl,
2-ethyl-3-butenyl and the like.
[0030] As used herein the term "lower alkynyl" contemplates both
straight and branched chain alkynyl radicals containing from two to
six carbon atoms and includes ethynyl, propargyl,
1,1-dimethylpropargyl and the like.
[0031] As used herein, the term "lower cycloalkyl" contemplates
saturated cyclic hydrocarbon radicals containing from three to six
carbon atoms and includes cyclopropyl, cyclobutyl, cyclopentyl and
the like.
[0032] As used herein, the term "lower alkoxy" contemplates both
straight and branched chain alkoxy radicals containing from one to
four carbon atoms and includes methoxy, ethoxy, isopropoxy and the
like.
[0033] As used herein, the term "lower alkanoyloxy" contemplates
both straight and branched chain alkanoyloxy radicals containing
from two to six carbon atoms and includes acetoxy, propionyloxy,
hexanoyloxy and the like.
[0034] As used herein, the term "acyl" refers to the divalent group
--C(O)--.
[0035] The term "aryl" as used herein refers to cyclic aromatic
hydrocarbon chains having twenty or fewer carbon atoms, e.g.,
phenyl, naphthyl, biphenyl and anthracenyl. One or more carbon
atoms of the aryl group may also be substituted with, e.g.: alkyl;
aryl; heterocycle; halogen; nitro; cyano; hydroxyl, alkoxyl or
aryloxyl; thio or mercapto, alkyl-, or arylthio; ammo, alkylamino,
arylamino, dialkyl-, diaryl-, or arylalkylamino; aminocarbonyl,
alkylaminocarbonyl, arylaminocarbonyl, diaalylaminocarbonyl,
diarylaminocarbonyl or arylalkylaminocarbonyl; carboxyl, or alkyl-
or aryloxycarbonyl; carboxaldehyde, or aryl- or alkylcarbonyl;
iminyl, or aryl- or alkyliminyl; sulfo; alkyl- or arylsulfonyl;
hydroximinyl, or aryl- or alkoximinyl; carbamido; or thiocarbamido.
In addition, two or more alkyl or heteroalkyl substituents of an
aryl group may be combined to form fused aryl-alkyl or
aryl-heteroalkyl ring systems (e.g., tetrahydronaphthyl).
Substituents including heterocyclic groups (e.g., heterocycleoxy,
heteroaryloxy, and heteroamalkylthio) are defined by analogy to the
above-described terms.
[0036] The terms "aralkyl" or "aralkoxy" as used herein refers to
an aryl group that is joined to a parent structure by an alkyl or
alkoxy group as described above, e.g., benzyl,
.alpha.-methylbenzyl, phenethyl, and the like.
[0037] As used herein, the term "halo" contemplates halogens and
includes fluorine, chlorine, bromine and iodine.
[0038] Where the term "lower" is used herein as part of the
description of alkylamino and dialkylamino, it contemplates one to
six carbon atoms of each alkyl group of such a radical and includes
a methylamino, n-hexylamino, dimethylamino, diethylamino and the
like.
[0039] When the present indole derivatives of this invention are
employed in accordance with the invention in warm-blooded animals,
e.g., mice, rats, or humans, they may be administered orally, alone
or in dosage forms, i.e., capsules or tablets, combined with
pharmacologically acceptable carriers or excipients, such as
starch, milk sugar and so forth. They may also be administered
orally in the form of solutions in suitable vehicles such as
vegetable oils, or they may be injected parenterally. For
parenteral administration they may be used in the form of a sterile
solution containing other solutes, for example, enough saline or
glucose to make the solution isotonic.
[0040] The dosage of the indole derivatives of this invention will
vary with the particular compound chosen and form of
administration. Furthermore, it will vary with the particular host
under treatment. The proportion of the compound is determined by
the solubility and chemical nature of the compound, chosen route of
administration and standard biological practice. Generally, the
compounds of this invention are administered at a concentration
level that affords the benefits of the invention without any
deleterious side effects. Effective concentration levels are
usually obtained within a therapeutic range of 1.0 mg to 500 mg of
an indole compound of the invention per kg of body weight of the
patient per day, with a preferred range of 10 to 100 mg/kg per
day.
[0041] The compounds of the present invention can be used in the
form of salts derived from inorganic or organic acids. These salts
include but are not limited to the following: acetate, adipate,
alginate, citrate, aspartate, benzoate, benzenesulfonate,
bisulfate, butyrate, camphorate, camphorsulfonate, digluconate,
cyclopentanepropionate, dodecylsulfate, ethanesulfonate,
glucoheptanoate, glycerophosphate, hemisulfate, heptanoate,
hexanoate, fumarate, hydrochloride, hydrobromide, hydroiodide,
2-hydroxyethanesulfonate, lactate, maleate, methanesulfonate,
nicotinate, 2-napthalenesulfonate, oxalate, pamoate, pectinate,
sulfate, 3-phenylpropionate, picrate, pivalate, propionate,
succinate, tartrate, thiocyanate, p-toluenesulfonate and
undecanoate. Also, the basic nitrogen-containing groups can be
quaternized with such agents as loweralkyl halides, such as methyl,
ethyl, propyl, and butyl chloride, bromides, and iodides; dialkyl
sulfates like dimethyl, diethyl, dibutyl, and diamyl sulfates, long
chain halides such as decyl, lauryl, myristyl and stearyl
chlorides, bromides and iodides, aralkyl halides like benzyl and
phenethyl bromides, and others. Water or oil-soluble or dispersible
products are thereby obtained.
[0042] Examples of acids which may be employed to form
pharmaceutically acceptable-acid addition salts include such
inorganic acids as hydrochloric acid, sulphuric acid and phosphoric
acid and such organic acids as oxalic acid, maleic acid, succinic
acid and citric acid. Basic addition salts can be prepared in situ
during the final isolation and purification of the compounds of
formula (I), or separately by reacting carboxylic acid moieties
with a suitable base such as the hydroxide, carbonate or
bicarbonate of a pharmaceutically acceptable metal cation or with
ammonia, or an organic primary, secondary or tertiary amine.
Pharmaceutically acceptable salts include, but are not limited to,
cations based on the alkali and alkaline earth metals, such as
sodium, lithium, potassium, calcium, magnesium, aluminum salts and
the like, as well as nontoxic ammonium, quaternary ammonium, and
amine cations, including, but not limited to ammonium,
tetramethylammonium, tetraethylammonium, methylamine,
dimethylamine, trimethylamine, triethylamine, ethylamine, and the
like. Other representative organic amines useful for the formation
of base addition salts include diethylamine, ethylenediamine,
ethanolamine, diethanolamine, piperazine and the like.
[0043] Pharmaceutical compositions comprising at least one indole
or carbazole compound of Formula I or Formula Ia, may also include
suitable solutions for administration intravenously,
subcutaneously, dermally, orally, mucosally or rectally and may be
administered by injection or orally, and contain from about 0.01 to
99 percent, preferably from about 20 to 75 percent of active
component together with the excipient. Pharmaceutical compositions
for oral administration include tablets and capsules. Compositions
which can be administered rectally include suppositories.
Pharmaceutical compositions according to the invention may be
administered via the conventional ways of administration. Preferred
ways of administration are oral, intravenous, intramuscular or
subcutaneous. The pharmaceutical compositions may also be
administered continuously, i.e., by way of infusion. The
formulation and dose will depend on the condition to be treated,
the route of administration and the condition and the body weight
of the patient to be treated. The exact dose will be determined by
the attending physician.
[0044] The pharmaceutical compositions according to the invention
are prepared in the usual manner, for example by mixing the active
ingredient with pharmaceutically and physiologically acceptable
carriers and/or stabilizers and/or excipients, as the case may be,
and are prepared in dosage form, e.g., by lyophilization in dosage
vials. As used herein, the term "pharmaceutically acceptable"
refers to a carrier medium which does not interfere with the
effectiveness of the biological activity of the active ingredients
and which is not toxic to the hosts to which it is
administered.
[0045] The composition used in these therapies can be in a variety
of forms. These include, for example, solid, semi-solid, and liquid
dosage forms, such as tablets, pills, powders, liquid solutions or
suspensions, liposomes, and injectable and infusible solutions. The
preferred form depends on the intended mode of administration and
therapeutic application. The compositions also preferably include
conventional pharmaceutically acceptable carriers and adjuvants, as
is well known to those of skill in the art. See, e.g., REMINGTON'S
PHARMACEUTICAL SCIENCES, Mack Publishing Co.: Easton, Pa., 17th Ed.
(1985). Preferably, administration will be by oral or parenteral
(including subcutaneous, intramuscular, intravenous, and
intradermal) routes. More preferably, the route of administration
will be oral. The therapeutic methods and agents of this invention
can of course be used concomitantly or in combination with other
methods and agents for treating CLL.
[0046] While it is possible to administer the active ingredient of
this invention alone, it is preferable to present a therapeutic
agent as part of a pharmaceutical formulation or composition. The
formulations of the present invention comprise at least one
compound of this invention in a therapeutically or pharmaceutically
effective dose together with one or more pharmaceutically or
therapeutically acceptable carriers and optionally other
therapeutic ingredients. Various considerations for preparing such
formulations are described, e.g., in Gilman et al. (eds.) GOODMAN
AND GILMAN'S: THE PHARMACOLOGICAL BASES OF THERAPEUTIC, 8th Ed.,
Pergamon Press (1990); and REMINGTON'S supra, each of which is
incorporated herein by reference for all purposes. Methods for
administration are discussed therein, e.g., for oral, intravenous,
intraperitoneal, intramuscular, and other forms of administration.
Typically, methods for administering pharmaceutical compositions
will be either topical, parenteral, or oral administration methods
for prophylactic and/or therapeutic treatment. Oral administration
is preferred. The pharmaceutical compositions can be administered
in a variety of unit dosage forms depending upon the method of
administration. As noted above, unit dosage forms suitable for oral
administration include powders, tablets, pills, and capsules.
[0047] One can use topical administration to deliver a compound of
the invention by percutaneous passage of the drug into the systemic
circulation of the patient. The skin sites include anatomic regions
for transdermally administering the drug, such as the forearm,
abdomen, chest, back, buttock, and mastoidal area. The compound is
administered to the skin by placing on the skin either a topical
formulation comprising the compound or a transdermal drug delivery
device that administers the compound. In either embodiment, the
delivery vehicle is designed, shaped, sized, and adapted for easy
placement and comfortable retention on the skin.
[0048] A variety of transdermal drug delivery devices can be
employed with the compounds of this invention. For example, a
simple adhesive patch comprising a backing material and an acrylate
adhesive can be prepared. The drug and any penetration enhancer can
be formulated into the adhesive casting solution. The adhesive
casting solution can be cast directly onto the backing material or
can be applied to the skin to form an adherent coating. See, e.g.,
U.S. Pat. Nos. 4,310,509; 4,560,555; and 4,542,012.
[0049] In other embodiments, the compound of the invention will be
delivered using a liquid reservoir system drug delivery device.
These systems typically comprise a backing material, a membrane, an
acrylate based adhesive, and a release liner. The membrane is
sealed to the backing to form a reservoir. The drug or compound and
any vehicles, enhancers, stabilizers, gelling agents, and the like
are then incorporated into the reservoir. See, e.g., U.S. Pat. Nos.
4,597,961; 4,485,097; 4,608,249; 4,505,891; 3,843,480; 3,948,254;
3,948,262; 3,053,255; and 3,993,073.
[0050] Matrix patches comprising a backing, a drug/penetration
enhancer max, a membrane, and an adhesive can also be employed to
deliver a compound of the invention transdermally. The matrix
material typically will comprise a polyurethane foam. The drug, any
enhancers, vehicles, stabilizers, and the like are combined with
the foam precursors. The foam is allowed to cure to produce a
tacky, elastomeric matrix which can be directly affixed to the
backing material. See, e.g., U.S. Pat. Nos. 4,542,013; 4,460,562;
4,466,953; 4,482,534; and 4,533,540.
[0051] Also included within the invention are preparations for
topical application to the skin comprising a compound of the
invention, typically in concentrations in the range from about
0.001% to 10%, together with a non-toxic, pharmaceutically
acceptable topical carrier. These topical preparations can be
prepared by combining an active ingredient according to this
invention with conventional pharmaceutical diluents and carriers
commonly used in topical dry, liquid, and cream formulations.
Ointment and creams may, for example, be formulated with an aqueous
or oily base with the addition of suitable thickening and/or
gelling agents. Such bases may include water and/or an oil, such as
liquid paraffin or a vegetable oil, such as peanut oil or castor
oil. Thickening agents that may be used according to the nature of
the base include soft paraffin, aluminum stearate, cetostearyl
alcohol, propylene glycol, polyethylene glycols, woolfat,
hydrogenated lanolin, beeswax, and the like.
[0052] Lotions may be formulated with an aqueous or oily base and
will, in general, also include one or more of the following:
stabilizing agents, emulsifying agents, dispersing agents,
suspending agents, thickening agents, coloring agents, perfumes,
and the like. Powders may be formed with the aid of any suitable
powder base, e.g., talc, lactose, starch, and the like. Drops may
be formulated with an aqueous base or non-aqueous base also
comprising one or more dispersing agents, suspending agents,
solubilizing agents, and the like. Topical administration of
compounds of the invention may also be preferred for treating
diseases such as skin cancer and fungal infections of the skin
(pathogenic fungi typically express telomerase activity).
[0053] The topical pharmaceutical compositions according to this
invention may also include one or more preservatives or
bacteriostatic agents, e.g., methyl hydroxybenzoate, propyl
hydroxybenzoate, chlorocreosol, benzalkonium chlorides, and the
like. The topical pharmaceutical compositions also can contain
other active ingredients such as antimicrobial agents, particularly
antibiotics, anesthetics, analgesics, and antipruritic agents.
[0054] The compounds of the present invention can also be delivered
through mucosal membranes. Transmucosal (i.e., sublingual, buccal,
and vaginal) drug delivery provides for an efficient entry of
active substances to systemic circulation and reduces immediate
metabolism by the liver and intestinal wall flora Transmucosal drug
dosage forms (e.g., tablet, suppository, ointment, pessary,
membrane, and powder) are typically held in contact with the
mucosal membrane and disintegrate and/or dissolve rapidly to allow
immediate systemic absorption. Note that certain such routes may be
used even where the patient is unable to ingest a treatment
composition orally. Note also that where delivery of a telomerase
inhibitor of the invention would be enhanced, one can select a
composition for delivery to a mucosal membrane, e.g., in cases of
colon cancer one can use a suppository to deliver the telomerase
inhibitor.
[0055] For delivery to the buccal or sublingual membranes,
typically an oral formulation, such as a lozenge, tablet, or
capsule, will be used. The method of manufacture of these
formulations is known in the art, including, but not limited to,
the addition of the pharmacological agent to a pre-manufactured
tablet; cold compression of an inert filler, a binder, and either a
pharmacological agent or a substance containing the agent (as
described in U.S. Pat. No. 4,806,356); and encapsulation. Another
oral formulation is one that can be applied with an adhesive, such
as the cellulose derivative hydroxypropyl cellulose, to the oral
mucosa, for example as described in U.S. Pat. No. 4,940,587. This
buccal adhesive formulation, when applied to the buccal mucosa,
allows for controlled release of the pharmacological agent into the
mouth and through the buccal mucosa.
[0056] Parenteral administration is generally characterized by
injection, either subcutaneously, intramuscularly, or
intravenously. Thus, this invention provides compositions for
intravenous administration that comprise a solution of a compound
of the invention dissolved or suspended in an acceptable carrier.
Injectables can be prepared in conventional forms, either as liquid
solutions or suspensions, solid forms suitable for solution or
suspension in liquid prior to injection, or as emulsions. Suitable
excipients are, for example, water, buffered water, saline,
dextrose, glycerol, ethanol, or the like. These compositions will
be sterilized by conventional, well known sterilization techniques,
such as sterile filtration. The resulting solutions can be packaged
for use as is or lyophilized, the lyophilized preparation being
combined with a sterile solution prior to administration. In
addition, if desired, the pharmaceutical compositions to be
administered may also contain minor amounts of non-toxic auxiliary
substances, such as wetting or emulsifying agents, pH buffering
agents and the like, such as for example, sodium acetate, sorbitan
monolaurate, triethanolamine oleate, etc. Such formulations will be
useful in treating ovarian cancers.
[0057] Another method of parenteral administration employs the
implantation of a slow-release or sustained-release system, such
that a constant level of dosage is maintained. See, e.g., U.S. Pat.
No. 3,710,795, incorporated herein by reference.
[0058] Liquid pharmaceutically administrable compositions can, for
example, be prepared by dissolving, dispersing, etc., an active
compound as defined above and optional pharmaceutical adjuvants in
an excipient, such as, for example, water, saline, aqueous
dextrose, glycerol, ethanol, olive oil, and other lipophilic
solvents, and the like, to form a solution or suspension. If
desired, the pharmaceutical composition to be administed may also
contain minor amounts of nontoxic auxiliary substances, such as
wetting or emulsifying agents, pH buffering agents, and the like,
for example, sodium acetate, sorbitan monolaurate, triethanolamine
sodium acetate, triethanolamine oleate, etc. Actual methods of
preparing such dosage forms are known and will be apparent to those
skilled in this art; for example, see REMINGTON'S PHARMACEUTICAL
SCIENCES, supra. The composition or formulation to be administered
will contain an effective amount of an active compound of the
invention.
[0059] For solid compositions, conventional nontoxic solid carriers
can be used and include, for example, pharmaceutical grades of
mannitol, lactose, starch, magnesium stearate, sodium saccharin,
talcum, cellulose, glucose, sucrose, magnesium carbonate, and the
like. For oral administration, a pharmaceutically acceptable
nontoxic composition is formed by incorporating any of the normally
employed excipients, such as those carriers previously listed, and
generally 0.1-95% of active ingredient, preferably about 20%.
[0060] The compositions containing the compounds of the invention
can be administered for prophylactic and/or therapeutic treatments.
In therapeutic applications, compositions are administered to a
patient already suffering from CLL, as described above, in an
amount sufficient to cure or at least partially arrest the symptoms
of the disease and its complications. An amount adequate to
accomplish this is defined as a "therapeutically effective amount
or dose." Amounts effective for this use will depend on the
severity of the disease and the weight and general state of the
patient.
[0061] In addition to internal (in vivo) administration, the
compounds and compositions of the invention may be applied ex vivo
to achieve therapeutic effects. In such an application, cells to be
treated, e.g., blood or bone marrow cells, are removed from a
patient and treated with a pharmaceutically effective amount of a
compound of the invention. The cells are returned to the patient
following treatment. Such a procedure can allow for exposure of
cells to concentrations of therapeutic agent for longer periods or
at higher concentrations than otherwise available.
[0062] Once improvement of the patient's conditions has occurred, a
maintenance dose is administered if necessary. Subsequently, the
dosage or the frequency of administration, or both, can be reduced,
as a function of the systems, to a level at which the improved
condition is retained. When the symptoms have been alleviated to
the desired level treatment can cease. Patients can, however,
require additional treatment upon any recurrence of the disease
symptoms.
[0063] In prophylactic applications (e.g. chemoprevention),
compositions containing the compounds of the invention are
administered to a patient susceptible to or otherwise at risk of a
CLL. Such an amount is defined to be a "prophylactically effective
amount or dose." In this use, the precise amounts again depend on
the patient's state of health and weight
EXAMPLE 1
In Vivo Administration
[0064] A patient was confirmed to have B-cell CLL by lymphocyte
typing and bone marrow studies. The patient was staged at 0 by the
Rai classification system. The patents lymphcyte phenotype, CD5+,
CD19+, CD20+, CD25+ and FMC7+. On Oct. 23, 1997, the patient's
white blood cell count was 34.3.times.E3 and the lymphocyte count
was 27.44.times.E3. On Oct. 25, 1997 through Oct. 27, 1997, the
patient was administered 300 mg of etodolac BID for neck pain. On
Oct. 28, 1997, the patient developed petechiae (bleeding from the
capillaries) on the shins. A complete blood count revealed that the
patient's platelet count was normal, but that both the white blood
cell count (13.40.times.E3) and the lymphocyte count
(6.70.times.E3) were significantly reduced, as shown in FIG. 1.
[0065] Subsequently, etodolac was administered to the patient at a
dose of 300 mg BID for the periods Nov. 5, 1997-Nov. 9, 1997, Jan.
21, 1998-Jan. 25, 1998, Feb. 26, 1998-Mar. 2, 1998 and Apr. 8,
1998-Apr. 13, 1998. The results are shown in FIGS. 1 and 2, with
the effect on platelet count also being shown in FIG. 2, and are
compared with the results of administration to the same patient
during intervening periods of the NSAIDs naproxen (N), diclofenac
(D), sulindac (S), nabumetone (R), oxaprozin (O), piroxicam (P),
indomethacin (I), tolmetin (T) and ibuprofen (M). The results from
the etodolac administration are averaged and compared with the data
for naproxin, diclofenac, sulindac, nabumetone, oxaprozin
piroxicam, indomethacin, tolmetin and ibuprofen in the following
Table 1.
1TABLE 1 WBC Lymphocyte Neutrophil Platelet Treatment Count .times.
E-3 Ct. .times. E-3 Count .times. E-3 Count .times. E-3 Baseline*
47.52 +/- 39.90 +/- 6.64 +/- 110 +/- 2.68 5.79 2.07 8.33 Etodolac*
25.27 +/- 20.68 +/- 3.58 +/- 136 +/- 3.51 3.41 0.40 16.8 p <
0.001 p < 0.001 p < 0.05 p < 0.001 Baseline 44.1 39.69
2.65 147 Naproxen 39.4 34.28 3.55 110 Baseline 42.5 35.26 5.53 101
Diclofenac 45.3 38.05 6.34 114 Baseline 45.3 38.05 6.34 114
Sulindac 45.3 34.43 9.01 119 Baseline 43.3 38.97 2.60 167
Nabumetone 41.1 35.76 5.34 134 Baseline 41.1 35.76 5.34 134
Oxaprozin 41.8 33.86 7.12 101 Baseline 41.8 33.86 7.12 101
Piroxicam 46.8 42.59 2.81 124 Baseline 46.8 42.59 2.81 124
Indomethacin 42.5 34.85 4.68 157 Baseline 42.5 34.85 4.68 157
Tolmetin 46.8 38.38 5.15 160 Baseline 47.5 38.00 7.60 105 Ibuprofen
51.3 44.63 5.13 117 *Means +/- SD of 3 experiments
[0066] As is readily apparent from the foregoing, etodolac
treatment resulted in substantial reductions of the white blood
cell count and lymphocyte count of the patient, while treatment
with the NSAIDs naproxen, diclfenac, sulindac, nabumetone,
oxaprozin, piroxicam, indomethacin, tolmetin and ibuprofen
exhibited relatively little impact on these factors. The platelet
count also increased significantly with etodolac.
[0067] To examine the possibility that a metabolite of etodolac or
a serum factor may be necessary to achieve the clinical effect, the
in vivo percentages of viable, apoptotic and late apoptotic or
necrotic cells of isolated mononuclear cells were measured by flow
cytometry using FITC annexin and propridium iodide assay. During
early apoptosis and preceding DNA fragmentation, phosphatydylserine
becomes exposed and bond by annexin V. Later in apoptosis and in
cell necrosis, cells also become permeable to propidium iodide.
FITC labeled annexin B and propidium iodide are easily detected by
flow cytometry. Mononuclear cells were isolated from the peripheral
blood of the patient by differential centrifugation on
ficoll-Hypaque at baseline and then daily for three additional days
after administration of etodolac. As the lymphocyte count dropped
after administration of etodolac, the percentage of apoptotic cells
remained the same. However, the percentage of viable cells
increased and the percentage of late apoptotic or necrotic cells
decreased. This result suggests that etodolac does not achieve the
reduction of lymphocytes by direct killing, but likely increases
the clearance of leukemic cells either into the phagocytic system
or diverts them to various tissue compartments. To examine the
possibility that etodolac might enhance the clearance of leukemic
lymphocytes by enhancing phagocytosis by macrophages, TAMRA stained
isolated mononuclear cells from the patient were incubated with
normal human adherent mononuclear cells in the presence of naproxen
or etodolac in vitro. After an overnight incubation, the adherent
cells were isolated and analyzed by flow cytometry for uptake of
TAMRA stained cells from the patient. No increase in the uptake of
the stained leukemic mononuclear cells by the normal adherent cells
could be detected for etodolac compared to naproxen. To test the
possibility that a metabolite of etodolac could be responsible for
the effect, serum from the patient was collected free of drug,
after receiving naproxen 375 mg bid for two days and after
receiving etodolac 400 mg bid for two days, and tested in the above
manner. No enhancement of phagocytosis of lymphocytes with etodolac
serum was apparent. Although not wishing to be bound by any
particular theory, these data suggest that etodolac achieves its
effect most likely by a novel mechanism of changing the
compartmentalization of B cell CLL leukemic lymphocytes.
[0068] While the preferred embodiment of the invention has been
illustrated and described, it will be appreciated that various
changes can be made therein without departing from the spirit and
scope of the invention.
* * * * *