U.S. patent application number 16/549043 was filed with the patent office on 2019-12-19 for compositions and methods for treating myelofibrosis.
The applicant listed for this patent is Impact Biomedicines, Inc.. Invention is credited to Janice Cacace, Arvind Jayan.
Application Number | 20190381041 16/549043 |
Document ID | / |
Family ID | 46024747 |
Filed Date | 2019-12-19 |
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United States Patent
Application |
20190381041 |
Kind Code |
A1 |
Jayan; Arvind ; et
al. |
December 19, 2019 |
COMPOSITIONS AND METHODS FOR TREATING MYELOFIBROSIS
Abstract
Provided herein are compositions and methods for treating
myelofibrosis in a subject. The methods comprise administering to
the subject an effective amount of compound which is which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutical salt
thereof or a hydrate thereof.
Inventors: |
Jayan; Arvind; (La Jolla,
CA) ; Cacace; Janice; (Miami, FL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Impact Biomedicines, Inc. |
Summit |
NJ |
US |
|
|
Family ID: |
46024747 |
Appl. No.: |
16/549043 |
Filed: |
August 23, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13888096 |
May 6, 2013 |
10391094 |
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16549043 |
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PCT/US2011/059643 |
Nov 7, 2011 |
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13888096 |
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61410924 |
Nov 7, 2010 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61P 19/08 20180101;
A61P 35/00 20180101; A61P 7/00 20180101; A61K 9/4866 20130101; A61K
31/506 20130101; A61K 9/48 20130101 |
International
Class: |
A61K 31/506 20060101
A61K031/506; A61K 9/48 20060101 A61K009/48 |
Claims
1-69. (canceled)
70. A unit dosage form for ingestion to the stomach, the unit
dosage form comprising: (i) a compound: ##STR00006## or a
pharmaceutically acceptable salt or hydrate thereof; (ii) a
microcrystalline cellulose, wherein the weight ratio of the
compound to the microcrystalline cellulose is about 1:1.5 to about
1:9; and (iii) about 0.5% to about 5% w/w of sodium stearyl
fumarate.
71. The unit dosage form of claim 70, wherein the weight ratio of
the compound to the microcrystalline cellulose is about 1:1.5 to
about 1:2.
72. The unit dosage form of claim 70, wherein the microcrystalline
cellulose is silicified microcrystalline cellulose.
73. The unit dosage form of claim 70, wherein the unit dosage form
comprises about 0.5% to about 2% w/w of sodium stearyl
fumarate.
74. The unit dosage form of claim 73, wherein the unit dosage form
comprises about 1% w/w of sodium stearyl fumarate.
75. The unit dosage form of claim 70, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00007## and the
weight ratio of ##STR00008## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
76. The unit dosage form of claim 71, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00009## and the
weight ratio of ##STR00010## to the microcrystalline cellulose is
about 1:1.5 to about 1:2.
77. The unit dosage form of claim 72, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00011## and the
weight ratio of ##STR00012## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
78. The unit dosage form of claim 73, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00013## and the
weight ratio of ##STR00014## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
79. The unit dosage form of claim 74, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00015## and the
weight ratio of ##STR00016## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
80. A unit dosage form for ingestion to the stomach, the unit
dosage form comprising: (i) a compound: ##STR00017## or a
pharmaceutically acceptable salt or hydrate thereof; (ii) a
microcrystalline cellulose, wherein the weight ratio of the
compound to the microcrystalline cellulose is 1:1.5 to 1:9; and
(iii) one or more lubricants.
81. The unit dosage form of claim 80, wherein the one or more
lubricants comprises sodium stearyl fumarate.
82. The unit dosage form of claim 80, wherein the weight ratio of
the compound to the microcrystalline cellulose is 1:1.5 to 1:2.
83. The unit dosage form of claim 80, wherein the microcrystalline
cellulose is silicified microcrystalline cellulose.
84. The unit dosage form of claim 80, wherein the unit dosage form
comprises about 0.5% to about 5% w/w of the one or more
lubricants.
85. The unit dosage form of claim 84, wherein the unit dosage form
comprises about 0.5% to about 2% w/w of the one or more
lubricants.
86. The unit dosage form of claim 85, wherein the unit dosage form
comprises about 1% w/w of the one or more lubricants.
87. The unit dosage form of claim 80, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00018## and the
weight ratio of ##STR00019## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
88. The unit dosage form of claim 81, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00020## and the
weight ratio of ##STR00021## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
89. The unit dosage form of claim 82, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00022## and the
weight ratio of ##STR00023## to the microcrystalline cellulose is
about 1:1.5 to about 1:2.
90. The unit dosage form of claim 83, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00024## and the
weight ratio of ##STR00025## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
91. The unit dosage form of claim 84, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00026## and the
weight ratio of ##STR00027## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
92. The unit dosage form of claim 85, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00028## and the
weight ratio of ##STR00029## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
93. The unit dosage form of claim 86, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00030## and the
weight ratio of ##STR00031## to the microcrystalline cellulose is
about 1:1.5 to about 1:9.
94. A unit dosage form for ingestion to the stomach, the unit
dosage form comprising: (i) a compound: ##STR00032## or a
pharmaceutically acceptable salt or hydrate thereof; (ii) one or
more fillers and/or diluents; and (iii) about 0.5% to about 5% w/w
of sodium stearyl fumarate.
95. The unit dosage form of claim 94, wherein the one or more
fillers and/or diluents comprises a microcrystalline cellulose.
96. The unit dosage form of claim 95, wherein the microcrystalline
cellulose is silicified microcrystalline cellulose.
97. The unit dosage form of claim 94, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00033##
98. The unit dosage form of claim 95, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00034##
99. The unit dosage form of claim 96, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00035##
100. A unit dosage form for ingestion to the stomach, the unit
dosage form comprising: (i) a compound: ##STR00036## or a
pharmaceutically acceptable salt or hydrate thereof; (ii) one or
more fillers and/or diluents, wherein the ratio of the weight of
the compound to the total weight of the one or more fillers and/or
diluents is about 1:1.5 to about 1:9; and (iii) about 0.5% to about
5% w/w of a lubricant.
101. The unit dosage form of claim 100, wherein the compound is in
the form of a dihydrochloride monohydrate: ##STR00037## and the
ratio of the weight of ##STR00038## to the total weight of the one
or more fillers and/or diluents is about 1:1.5 to about 1:9.
102. The unit dosage form of claim 100, wherein the ratio of the
weight of the compound to the total weight of the one or more
fillers and/or diluents is about 1:1.5 to about 1:2.
103. The unit dosage form of claim 100, wherein the unit dosage
form comprises about 0.5% to about 2% w/w of the lubricant.
104. The unit dosage form of claim 103, wherein the unit dosage
form comprises about 1% w/w of the lubricant.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the priority benefit of U.S.
provisional application Ser. No. 61/410,924, filed Nov. 7, 2010,
which is incorporated herein by reference in its entirety.
TECHNICAL FIELD
[0002] Provided herein are compositions and methods for treating
myelofibrosis. The compositions and methods provided herein relate
to treatment of myelofibrosis with compounds that inhibit JAK2 or a
pharmaceutically acceptable salt thereof or a hydrate thereof.
BACKGROUND
[0003] Myelofibrosis ("MF") is a rare disease mainly affecting
people of older age. MF is a BCR-A BLI-negative myeloproliferative
neoplasm ("MPN") that presents de novo (primary) or may be preceded
by polycythemia vera ("PV") or essential thrombocythemia ("ET").
Clinical features include progressive anemia, marked splenomegaly,
constitutional symptoms (e.g. fatigue, night sweats, bone pain,
pruritus, and cough) and weight loss (Tefferi A, N Engl J Med
342:1255-1265, 2000). Median survival ranges from less than 2 years
to over 15 years based on currently identified prognostic factors
(Cervantes F et al., Blood 113:2895-2901, 2009; Hussein K et al.
Blood 115:496-499, 2010; Patnaik M M et al., Eur J Haematol
84:105-108, 2010). Mutations involving JAK2 (James C et al., Nature
434:1144-1148, 2005; Scott L M et al., N Engl J Med 356:459-468,
2007), MPL (Pikman Y el al., PLoS Med 3:e270, 2006), TET2
(Delhommeau F et al., N Engl J Med 360:2289-2301, 2009), ASXL1
(Carbuccia N et al., Leukemia 23:2183-2186, 2009), IDH1/IDH2 (Green
A et al., N Engl J Med 362:369-370, 2010; Tefferi A et al.,
Leukemia 24:1302-1309, 2010), CBL (Grand F H et al., Blood
113:6182-6192, 2009), IKZFI (Jager R et al., Leukemia 24:1290-1298,
2010), LINK (Oh S T et al., Blood 116:988-992, 2010), or EZH2
(Ernst T et al., Nat Genet 42:722-726) have been described in
patients with MPN, including those with MF. Some mutations occur at
high frequency in MF (e.g. JAK2 mutations in .about.50% patients),
and either directly (e.g. JAK2 or MPL mutations) or indirectly
(e.g. LNK or CBL mutations) induce JAK-STAT hyperactivation.
[0004] The currently available treatments are not effective in
reversing the process of MF, be it primary or secondary disease.
The only potential for cure of the disease to date is bone marrow
transplantation. However, most patients are not suitable bone
marrow transplant candidates because of the older median age at
diagnosis, in which transplant-related morbidity and mortality
tends to be high. Thus management options of MF are currently
inadequate to meet the needs of all patients. The main options for
active intervention include cyto-reductive therapy, e.g. with
hydroxyurea, treatment of anemia with androgens, erythropoietin and
splenectomy. These options have not been shown to improve survival
and are largely seen as palliative (Cervantes F., Myclofibrosis:
Biology and treatment options, European Journal of Haematology,
2007, 79 (suppl.68) 13-17). Therefore, there is a need to provide
additional therapy options for MF patients.
SUMMARY OF THE INVENTION
[0005] Provided herein are capsules suitable for oral
administration. In some embodiments, the capsule comprises an
admixture of (i) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]-
amino}pyrimidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) a
microcrystalline cellulose, and (iii) sodium stearyl fumarate,
wherein the admixture is contained in the capsule.
[0006] In some embodiments, the capsule contains about 10 mg to
about 680 mg of the compound, wherein the specified weight is the
free base moiety weight of the compound. In some embodiments, the
capsule contains about 10 mg to about 500 mg of the compound. In
some embodiments, the capsule contains about any of 10 mg, 40 mg,
100 mg, 200 mg, 300 mg, 400 mg, 500 mg, or 600 mg of the compound.
In some embodiments, the weight ratio of the compound to
microcrystalline cellulose in the capsule is between about 1:1.5 to
1:15, wherein the weight for the compound in the weight ratio is
the free base moiety weight of the compound. In some embodiments,
the weight ratio of the compound to sodium stearyl fumarate in the
capsule is between about 5:1 to about 50:1, and wherein the weight
for the compound in the weight ratio is the free base moiety weight
of the compound. In some embodiments, the microcrystalline
cellulose is silicified microcrystalline cellulose. In some
embodiments, the silicified microcrystalline cellulose is a
combination of 98% microcrystalline cellulose and 2% colloidal
silicon dioxide.
[0007] Also provided herein are unit dosage forms comprising an
admixture of (i) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) a
microcrystalline cellulose, and (iii) sodium stearyl fumarate. In
some embodiments, the unit dosage forms are for treatment of
myelofibrosis such as treatment of myelofibrosis according to a
method described herein.
[0008] In some embodiments, the unit dosage form comprises an
admixture of (i) about 10 mg to about 680 mg (or about 10 mg to
about 500 mg) of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the specified
weight is the free base moiety weight of the compound, (ii) a
microcrystalline cellulose, and (iii) sodium stearyl fumarate. In
some embodiments, the unit dosage form is in the form of a capsule,
and the admixture is contained in the capsule. In some embodiments,
the compound in the admixture is about 10 mg to about 500 mg,
wherein the specified weight is the free base moiety weight of the
compound. In some embodiments, the admixture comprises (i) about 10
mg (or about any of 40 mg, 100 mg, 200 mg, 300 mg. 400 mg, or 500
mg) of the compound, (ii) a microcrystalline cellulose, and (iii)
sodium stearyl fumarate, wherein the specified weight is the free
base moiety weight of the compound. In some embodiments, the
compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
In some embodiments, the weight ratio of the compound to
microcrystalline cellulose in the capsule is between about 1:1.5 to
1:15, wherein the weight for the compound in the weight ratio is
the free base moiety weight of the compound. In some embodiments,
the weight ratio of the compound to sodium stearyl fumarate in the
capsule is between about 5:1 to about 50:1, and wherein the weight
for the compound in the weight ratio is the free base moiety weight
of the compound. In some embodiments, the microcrystalline
cellulose is silicified microcrystalline cellulose. In some
embodiments, the silicified microcrystalline cellulose is a
combination of 98% microcrystalline cellulose and 2% colloidal
silicon dioxide.
[0009] In some embodiments, sodium stearyl fumarate is about 1% w/w
of capsule fill weight. In some embodiments, the weight ratio of
the compound to microcrystalline cellulose such as silicified
microcrystalline cellulose is about 40:60 to about 10:90 (e.g.,
about 40:60 or about 1:1.5, or about 10:90 or about 1:9).
[0010] In some embodiments, the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
In some embodiments, the unit dosage form or capsule contains an
admixture of about 12 mg of
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate,
about 122 mg of silicified microcrystalline cellulose, and about 1
mg of sodium stearyl fumarate. In some embodiments, the unit dosage
form or capsule contains an admixture of about 47 mg of
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate,
about 448 mg of silicilfed microcrystalline cellulose, and about 5
mg of sodium stearyl fumarate. In some embodiments, the unit dosage
form or capsule contains an admixture of about 117 mg of
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
In some embodiments, the unit dosage form or capsule contains an
admixture of about 235 mg of
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate,
about 357 mg of silicified microcrystalline cellulose, and about
6.00 mg of sodium stearyl fumarate. In some embodiments, the
capsule is a hard gelatin capsule.
[0011] Also provided herein are methods of preparing a capsule drug
product comprising a) blending a lubricant with a compound that is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof to generate granules
and b) mixing the granules of a) with an excipient. In some
embodiments, the lubricant is sodium stearyl fumarate. In some
embodiments, the excipient is microcrystalline cellulose such as
silicified microcrystalline cellulose. In some embodiments, sodium
stearyl fumarate is about 1% w/w of capsule fill weight. In some
embodiments, the weight ratio of the compound to silicified
microcrystalline cellulose is about 1:1.5 to about 1:9. In some
embodiments, the weight ratio of the compound to silicified
microcrystalline cellulose is about 1:1.5. In some embodiments, the
weight ratio of the compound to silicified microcrystalline
cellulose is about 1:9. In some embodiments, the capsule is a hard
gelatin capsule.
[0012] Also provided herein are methods of treating myelofibrosis
in a subject, comprising orally administering a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, and wherein the
compound is in an admixture of (i) the compound, (ii) an excipient
(e.g., a microcrystalline cellulose), and (iii) a lubricant (e.g.,
sodium stearyl fumarate). Any of the unit dosage forms or capsules
described herein may be used. In some embodiments, there is
provided a method of treating myelofibrosis in a subject comprising
orally administering a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, and wherein the
compound is in a capsule containing an admixture of (i) the
compound, (ii) a microcrystalline cellulose (e.g., silicified
microcrystalline cellulose), and (iii) sodium stearyl fumarate.
[0013] Also provided herein are methods of treating myelofibrosis
in a subject, comprising administering to the subject an effective
amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
is negative for the valine 617 to phenylalanine mutation of human
Janus Kinase 2 (JAK2) or negative for the mutation corresponding to
the valine 617 to phenylalanine mutation of human JAK2.
[0014] Also provided herein are methods of treating myelofibrosis
in a subject, comprising administering to the subject an effective
amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
has previously received another myelofibrosis therapy. In some
embodiments, the previous therapy is a treatment with a JAK2
inhibitor which is not
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the previous therapy comprises administration of INCB018424
(ruxolitinib). In some embodiments, the subject is unresponsive to
the previous therapy. In some embodiments, the previous therapy is
a treatment with
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the previous therapy has been discontinued upon indication of
elevated levels of amylase, lipase, aspartate aminotransferase
("AST"), alanine aminotransferase ("ALT"), and/or creatinine. In
some embodiments, the previous therapy has been discontinued upon
indication of a hematologic condition selected from the group
consisting of anemia, thrombocytopenia, and neutropenia.
[0015] Also provided herein are methods of ameliorating bone marrow
cellularity or bone marrow fibrosis associated with myelofibrosis
in a subject, comprising administering to the subject an effective
amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof.
[0016] Also provided herein are methods of improving pruritus
associated with myelofibrosis in a subject, comprising
administering to the subject an effective amount of a compound
which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof.
[0017] Also provided herein are methods of monitoring treatment of
myelofibrosis in a subject, comprising (a) administering to a
subject an effective amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof; (b) monitoring a
non-hematologic parameter selected from the group consisting of
amylase level, lipase level, aspartate aminotransferase (AST)
level, alanine aminotransferase (ALT) level, and creatinine level
in the subject; and (c) determining if the subject should continue
or discontinue with the treatment. Also provided herein are methods
of monitoring treatment of myelofibrosis to a subject, comprising
administering to the subject an effective amount of a compound
which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]-
amino}pyrimidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, and discontinuing the
treatment upon indication of elevated levels of one or more enzymes
or molecules selected from the group consisting of amylase, lipase,
aspartate aminotransferase (AST), alanine aminotransferase (ALT),
and creatinine in the serum of the subject without prior dose
reduction. In some embodiments, the one or more of the elevated
levels are Grade 4 events.
[0018] Also provided herein are methods of monitoring a treatment
of myelofibrosis to a subject, comprising (a) administering to the
subject an effective amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof; (b) monitoring a
hematologic parameter selected from the group consisting of anemia,
thrombocytopenia, and neutropenia in the serum of the subject; and
(c) determining if the subject should continue or discontinue with
the treatment. Also provided herein are methods of monitoring
treatment of myelofibrosis to a subject, comprising administering
to the subject an effective amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]-
amino}pyrimidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, and discontinuing the
treatment upon indication of one or more hematologic conditions
selected from the group consisting of anemia, thrombocytopenia, and
neutropenia without prior dose reduction. In some embodiments, the
one or more hematologic conditions are grade 4 events.
[0019] In some embodiments of the methods of monitoring treatment
provided herein, the methods further comprise administering to the
subject an effective amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof after the subject has
been discontinued with the treatment for at least 2 weeks. In some
embodiments, the subject has been discontinued with the treatment
for at least 3 weeks. In some embodiments, the subject has been
discontinued with the treatment for at least 4 weeks. In some
embodiments, the treatment has been discontinued without prior dose
reduction.
[0020] In some embodiments, the compound is administered to the
human subject at a dose of about 240 mg per day to about 680 mg per
day, and wherein the specified weight is the free base moiety
weight of the compound. In some embodiments, the compound is
administered at a dose of about 300 mg per day to about 500 mg per
day (e.g., about 300 mg per day to about 400 mg per day, or about
400 mg per day to about 500 mg per day), and wherein the specified
weight is the free base moiety weight of the compound. In some
embodiments, the compound is administered at a dose of about any of
240 mg per day, 250 mg per day, 300 mg per day, 350 mg per day, 400
mg per day, 450 mg per day, 500 mg per day, 550 mg per day, 600 mg
per day, 650 mg per day, or 680 mg per day, and wherein the
specified weight is the free base moiety weight of the compound. In
some embodiments, the compound is administered daily and/or orally.
In some embodiments, the compound is administered over a period of
at least 1 cycle, at least 2 cycles, at least 3 cycles, at least 4
cycles, at least 5 cycles, or at least 6 cycles (e.g., at least 7
cycles, at least 8 cycles, at least 9 cycles, at least 10 cycles,
at least 11 cycles, at least 12 cycles, at least 15 cycles, at
least 18 cycles, or at least 24 cycles) of a 28-day treatment
cycle. In some embodiments, the compound is in a capsule and
administered orally. In some embodiments, the compound is in a unit
dosage form. Any of the capsules or unit dosage forms described
herein may be administered. In some embodiments of the methods
provided herein, the compound is in an admixture of (i) a compound
which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}-
pyrimidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) a
microcrystalline cellulose, and (iii) sodium stearyl fumarate. In
some embodiments, the weight ratio of the compound to
microcrystalline cellulose in the admixture is between about 1:1.5
to 1:15, and wherein the weight for the compound is the free base
moiety weight of the compound. In some embodiments, the weight
ratio of the compound to sodium stearyl fumarate in the admixture
is between about 5:1 to about 50:1, and wherein the weight for the
compound is the free base moiety weight of the compound. In some
embodiments, the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
In some embodiments, the microcrystalline cellulose is silicified
microcrystalline cellulose. In some embodiments, the subject is a
human.
[0021] In some embodiments of the compositions and methods provided
herein, the subject has primary myelofibrosis. In some embodiments
of the compositions and methods provided herein, the subject has
post polycythemia vera myelofibrosis. In some embodiments of the
compositions and methods provided herein, the subject has post
essential thrombocythemia myelofibrosis. In some embodiments, the
subject has high risk myelofibrosis. In some embodiments, the
subject has intermediate risk myelofibrosis (such as intermediate
risk level 2). In some embodiments of the compositions and methods
provided herein, the subject is positive for the valine 617 to
phenylalanine mutation of human Janus Kinase 2 (JAK2) or positive
for the mutation corresponding to the valine 617 to phenylalanine
mutation of human JAK2. In some embodiments of the compositions and
methods provided herein, the subject is negative for the valine 617
to phenylalanine mutation of human Janus Kinase 2 (JAK2) or
negative for the mutation corresponding to the valine 617 to
phenylalanine mutation of human JAK2. In some embodiments of the
compositions and methods provided herein, the subject has palpable
splenomegaly. In some embodiments, the subject with myelofibrosis
has spleen of at least 5 cm below costal margin as measured by
palpation. In some embodiments of the compositions and methods
provided herein, the subject is transfusion dependent. In some
embodiments of the compositions and methods provided herein, the
subject is not transfusion dependent.
[0022] In some embodiments of the methods provided herein, upon
administration of the compound to a human subject, the Cmax of the
compound is achieved within about 2 to about 4 hours post-dose. In
some embodiments, upon administration of the compound to a human
subject, the elimination half life of the compound is about 16 to
about 34 hours. In some embodiments, the mean AUC of the compound
increases more than proportionally with increasing doses ranging
from about 30 mg to about 800 mg per day. In some embodiments, the
accumulation of the compound is about 1.25 to about 4.0 fold at
steady state when the compound is dosed once daily. In some
embodiments, the compound is in an admixture of (i) a compound
which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) microcrystalline
cellulose, and (iii) sodium stearyl fumarate. In some embodiments,
the weight ratio of the compound to microcrystalline cellulose in
the admixture is between about 1:1.5 to 1:15, and wherein the
weight for the compound is the free base moiety weight of the
compound. In some embodiments, the weight ratio of the compound to
sodium stearyl fumarate in the admixture is between about 5:1 to
about 50:1, and wherein the weight for the compound is the free
base moiety weight of the compound. In some embodiments, the
compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
In some embodiments, the microcrystalline cellulose is silicified
microcrystalline cellulose.
[0023] Also provided herein are articles of manufacture or kits
comprising (a) any one of the capsules provided herein, and (b) a
package insert or a label indicating that the capsule is useful for
treating myelofibrosis in a subject. Also provided herein are
articles of manufacture or kits comprising (a) any one of the unit
dosage forms provided herein, and (b) a package insert or a label
indicating that the capsule is useful for treating myelofibrosis in
a subject. In some embodiments, there is provided an article of
manufacture or kit comprising (a) an admixture of (i) a compound
which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) microcrystalline
cellulose, and (iii) sodium stearyl fumarate, and (b) a package
insert or a label indicating that the admixture is useful for
treating myelofibrosis in a subject.
[0024] Also provided herein are articles of manufacture or kits
comprising (a) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutical salt
thereof or a hydrate thereof, and (b) a package insert or a label
indicating that the compound can be used for treating myelofibrosis
in a subject, wherein the subject is negative for the valine 617 to
phenylalanine mutation of human Janus Kinase 2 (JAK2) or negative
for the mutation corresponding to the valine 617 to phenylalanine
mutation of human JAK2.
[0025] Also provided herein are articles of manufacture or kits
comprising (a) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutical salt
thereof or a hydrate thereof, and (b) a package insert or a label
indicating that the compound can be used for treating myelofibrosis
in a subject, wherein the subject has previously received another
myelofibrosis therapy. In some embodiments, the previous therapy is
a treatment with a JAK2 inhibitor which is not
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof.
[0026] Also provided herein are articles of manufacture or kits
comprising (a) a compound which is
N-ter-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyri-
midin-4-yl)amino]benzenesulfonamide or a pharmaceutical salt
thereof or a hydrate thereof, and (b) a package insert or a label
indicating that the compound can be used for ameliorating bone
marrow cellularity and/or bone marrow fibrosis.
[0027] Also provided herein are articles of manufacture or kits
comprising (a) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutical salt
thereof or a hydrate thereof, and (b) a package insert or a label
indicating that the compound can be used for improving pruritus
associated with myelofibrosis.
[0028] Also provided herein are articles of manufacture or kits
comprising a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutical salt
thereof or a hydrate thereof, and a package insert or a label
indicating that the compound can be used for treating myelofibrosis
in a subject, and that subject should discontinue the treatment
upon indication of elevated levels of one or more enzymes or
molecules selected from the group consisting of: amylase, lipase,
aspartate aminotransferase (AST), alanine aminotransferase (ALT),
and creatinine in the serum of the subject, and/or upon indication
of one or more hematologic condition selected from the group
consisting of anemia, thrombocytopenia, and neutropenia. In some
embodiments, the package insert or the label further indicates that
the compound can be discontinued without prior dose reduction. In
some embodiments, the one or more of the elevated levels of the
enzymes or molecules are Grade 4 events. In some embodiments, the
one or more of the hematologic conditions are Grade 4 events.
[0029] In some embodiments, the package insert or the label is in a
position which is visible to prospective purchasers. In some
embodiments, the compound is in a unit dosage form or capsule
form.
[0030] In some embodiments, the package insert or the label
indicates that, upon administration of the admixture to a human
subject, the Cmax of the compound is achieved within about 2 to
about 4 hours post-dose. In some embodiments, the package insert or
the label indicates that, upon administration of the compound to a
human subject, the elimination half life of the compound is about
16 to about 34 hours. In some embodiments, the package insert or
the label indicates that the mean AUC of the compound increases
more than proportionally with increasing doses ranging from about
30 mg to about 800 mg per day. In some embodiments, the package
insert or the label indicates that the accumulation of the compound
is about 1.25 to about 4.0 fold at steady state when the compound
is dosed once daily. In some embodiments, the compound is in an
admixture of (i) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) a
microcrystalline cellulose, and (iii) sodium stearyl fumarate. In
some embodiments, the weight ratio of the compound to
microcrystalline cellulose in the admixture is between about 1:1.5
to 1:15, and wherein the weight for the compound is the free base
moiety weight of the compound. In some embodiments, the weight
ratio of the compound to sodium stearyl fumarate in the admixture
is between about 5:1 to about 50:1, and wherein the weight for the
compound is the free base moiety weight of the compound. In some
embodiments, the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
In some embodiments, the microcrystalline cellulose is silicified
microcrystalline cellulose.
[0031] In some embodiments, there is provided use of a compound in
the manufacture of a medicament for treating myelofibrosis in a
subject, wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the compound is in an admixture of (i) the compound, (ii) an
excipient (e.g., microcrystalline cellulose such as silicified
microcrystalline cellulose), and (iii) a lubricant (e.g., sodium
stearyl fumarate). In some embodiments, the compound is
administered orally. In some embodiments, the use is according to a
method described herein.
[0032] In some embodiments, there is provided use of a compound in
the manufacture of a medicament for treating myelofibrosis in a
subject, wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
is negative for the valine 617 to phenylalanine mutation of human
Janus Kinase 2 (JAK2) or negative for the mutation corresponding to
the valine 617 to phenylalanine mutation of human JAK2. In some
embodiments, there is provided use of a compound in the manufacture
of a medicament for treating myelofibrosis in a subject, wherein
the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
has previously received another myelofibrosis therapy. In some
embodiments, the previous therapy comprises a JAK2 inhibitor which
is not
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzensulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the use is according to a method described herein.
[0033] In some embodiments, there is provided a compound for
treating myelofibrosis in a subject, wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the compound is in an admixture of (i) the compound, (ii) an
excipient (e.g., microcrystalline cellulose such as silicified
microcrystalline cellulose), and (iii) a lubricant (e.g., sodium
stearyl fumarate). In some embodiments, the compound is
administered orally. In some embodiments, the treatment is
according to a method described herein.
[0034] In some embodiments, there is provided a compound for
treating myelofibrosis in a subject, wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
is negative for the valine 617 to phenylalanine mutation of human
Janus Kinase 2 (JAK2) or negative for the mutation corresponding to
the valine 617 to phenylalanine mutation of human JAK2. In some
embodiments, there is provided a compound for treating
myelofibrosis in a subject, wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
has previously received another myelofibrosis therapy. In some
embodiments, the previous therapy comprises a JAK2 inhibitor which
is not
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the treatment is according to a method described herein.
[0035] It is to be understood that one, some, or all of the
properties of the various embodiments described herein may be
combined to form other embodiments of the compositions and methods
provided herein. These and other aspects of the compositions and
methods provided herein will become apparent to one of skill in the
art.
BRIEF DESCRIPTION OF THE FIGURES
[0036] FIG. 1 shows decrease in palpable spleen size by cycle for
patients treated with TG101348 680 mg/day (starting dose) (N=37).
Doses for cycle 1 were 520-800 mg/day and doses for cycles 2-6 were
360-680 mg/day. For cycle 6 .gtoreq.50% subjects, there was 22-47%
increase in 3 subjects with drug held for .about.2-3 weeks
immediately prior to measurement.
[0037] FIG. 2 shows WBC count in subjects treated with TG101348.
The baseline WBC count was >1.times.10.sup.9/L. The doses at
follow-up ranged from 360 to 680 mg/day. Last follow-up visit
ranged from 8 to 24 weeks (median 24 weeks). "ULN" means upper
limit of normal.
[0038] FIG. 3 shows platelet count in subjects treated with
TG101348. The baseline platelet count >450.times.10.sup.9/L. The
doses at follow-up ranged from 360 to 680 mg/day. Last follow-up
visit ranged from 12 to 24 weeks (median 24 weeks). "ULN" means
upper limit of normal.
[0039] FIG. 4 shows the percentages of subjects with worsened,
unchanged, improved or resolved constitutional symptoms (fatigue,
early satiety, cough, night sweats, and pruritus) in subjects
treated with TG101348. Last visit ranged from 4 to 24 weeks (median
20 weeks). The data here reflected changes from symptoms present at
baseline. 18 subjects reported new onset of .gtoreq.1 symptom
during the study; of these, symptoms for 12 subjects were resolved
by last follow-up visit. Severity was rated by subjects on a scale
of 1-10: 0=absent; 1-3=mild; 4-7=moderate; 8-10=severe.
Improved=downgrade to absent or to mild or moderate from more
severe rating at baseline.
[0040] FIG. 5 shows the cytokine levels (IL-6. IL-8, IL-2 and
TNF-.alpha.) in subjects treated with TG101348. The values shown
are median values.
[0041] FIG. 6 shows the change in V617F allele burden from baseline
as a proportion of baseline in subjects with baseline >20%
(N=22) treated with TG101348. The figure shows the subset of
JAK2V617F positive subjects in the overall population (N=48). The
doses at follow-up were 360 to 680 mg/day. Last follow-up visit
ranged from 20 to 72 weeks (median 24 weeks).
[0042] FIG. 7 shows the bone marrow cellularity at baseline (60%
cellularity) and after 18 cycles of TG101348 treatment (5-10%
cellularity) in a 76-year-old male subject with V617F negative PMF.
The starting dose was 30 mg/day and the dose at follow-up was 520
mg/day.
[0043] FIG. 8 shows the bone marrow fibrosis at baseline (3+) and
after 18 cycles of TG101348 treatment (0) in a 56-year-old male
subject with V617F negative PMF. The starting dose was 240 mg/day
and the dose at follow-up was 440 mg/day.
[0044] FIG. 9 shows various measurements of a subject with JAK2
V617F-positive PMF treated with TG101348 (starting dose at 680
mg/day).
[0045] FIGS. 10A-10G show distribution of TG1101348 doses at the
end of each cycle for subjects who initiated dosing at 30 mg/day,
60 mg/day, 120 mg/day, 240 mg/day, 360 mg/day, 520 mg/day, and 800
mg/day, respectively, (n=25).
[0046] FIG. 11 shows distribution of TO 101348 doses at the end of
each cycle for subjects who initiated dosing at 680 mg/day
(n=34).
[0047] FIG. 12A shows plot of mean plasma TG101348 concentrations
versus time on a semi-log scale (Cycle 1, Day 1). FIG. 12B shows
plot of mean plasma TG101348 concentrations versus time on a
semi-log scale (Cycle 1, Day 28).
[0048] FIG. 13 shows splenomegaly response to TG101348 therapy.
This figure shows decrease in palpable spleen size from baseline by
cycle for subjects in the maximum tolerated dose cohort (n=37). The
proportion of subjects with >50% and 100% decrease in palpable
splenomegaly is shown. For subjects who completed 6 cycles of
treatment, 90% had a >25% reduction in palpable spleen size, 66%
had a >50% reduction, and in 31% the spleen became non
palpable.
[0049] FIGS. 14A-14C show effects of TG101348 on symptoms of
myelofibrosis. (A): Proportion of subjects in maximum tolerated
dose cohort with complete resolution of early satiety by cycle from
a baseline symptom score of "mild" (score=1-3), "moderate"
(score=4-7), or "severe" (score=8-10). Twenty-seven (79%) and 19
(56%) patients were evaluable for improvement in early satiety at
the end of 1 and 6 cycles, respectively. After 2 cycles of
treatment, 56% reported complete resolution of this symptom with
durable benefit. (H): Proportion of subjects in maximum tolerated
dose cohort with complete resolution of fatigue by cycle from a
baseline symptom score of "mild" (score=1-3), or improvement in or
complete resolution of fatigue from a baseline score of "moderate"
(score=4-7) or "severe" (score=8-10). Twenty-four (71%) and 16
(47%) patients were evaluable for improvement in fatigue at the end
of 1 and 6 cycles, respectively. After 6 cycles, 63% reported
improvement and 25% had complete resolution of this symptom. (C):
Proportion of subjects in maximum tolerated dose cohort with
complete resolution of night sweats by cycle from a baseline
symptom score of "mild" (score=1-3), "moderate" (score=4-7), or
"severe" (score=8-10). Fourteen (40%) and 9 (26%) patients were
evaluable for improvement in night sweats at the end of 1 and 6
cycles, respectively. After 1 cycle, 64% of subjects had complete
resolution of this symptom; after 6 cycles, this proportion had
increased to 89%.
[0050] FIG. 15 shows response of leukocytosis to TG101348 therapy.
Changes in white blood cell (WBC) count after 6 cycles for subjects
who entered the study with leukocytosis (WBC count
>11.times.10.sup.9/L). Following 6 cycles, 16 subjects across
doses (57%) and 13 subjects in the MTD cohort (72%) achieved a
normal WBC count, with durable benefit.
[0051] FIGS. 16A-16D show effect of TG101348 therapy on JAK2V617F
allele burden. Box plot representation of JAK2V617F allele burden
data for all mutation-positive subjects (n=51; figures A and B) and
for the subgroup with baseline allele burden >20% (n=23; FIGS.
16C and 16D). The y-axis represents the JAK2V617F allele burden
from 1.0 (100%) to 0.0 (0%). The change in JAK2V617F allele burden
per cycle of treatment (up to end of cycle 12; i.e. C13D1) as
compared to pre-study baseline is shown for the 2 groups (FIGS. 16A
and 16C); the change at the end of cycle 6 (i.e. C7D1) and cycle 12
is shown in FIGS. 16B and 16D. A significant decrease in JAK2V617F
allele burden as compared to pre-study baseline was observed at the
end of cycle 6 for the mutation-positive group (FIG. 16B; p=-0.04)
and the subgroup with baseline allele burden >20% (FIG. 16D;
p=0.002); a similar significant decrease was seen at the end of
cycle 12 for the former (FIG. 16B; p=0.01) and latter (FIG. 16D;
p-0.002) groups. The Wilcoxon matched-pair signed-rank test was
used to compare the median JAK2V617F allele burden for the
comparisons.
[0052] FIG. 17 shows absolute changes in pro-inflammatory cytokine
levels from baseline at cycle 6: IL-6 (A), TNF-.alpha. (B), IL-8
(C), and IL-2 (D). Absolute differences in IL-6 (-4719 pg/mL) and
IL-2 (-1827 pg/mL) are omitted from FIGS. 17A and 17D,
respectively, for 1 subject (101-039) because they skewed
presentation of data for other subjects.
[0053] FIG. 18 shows a plot of mean plasma TG101348 concentrations
versus time on a linear plot after once daily oral doses (Cycle 1:
Day 28).
DETAILED DESCRIPTION
I. Definitions
[0054] As used herein, "treatment" or "treating" is an approach for
obtaining beneficial or desired results including clinical results.
Beneficial or desired clinical results can include, but are not
limited to, one or more of the following: decreasing symptoms
resulting from the disease, increasing the quality of life of those
suffering from the disease, decreasing the dose of other
medications required to treat the disease, delaying the progression
of the disease, and/or prolonging survival of individuals. In some
embodiments, for the treatment of myelofibrosis, beneficial
clinical results include one or more of reduction of splenomegaly,
improvement in constitutional symptoms (such as early satiety,
fatigue, night sweats, cough, and pruritus), reduction of
leukocytosis, reduction of thrombocytosis, decrease of JAK2V617F
allele burden, reduction of bone marrow fibrosis, and/or reduction
of bone marrow cellularity.
[0055] As used herein, "delaying development of a disease" means to
defer, hinder, slow, retard, stabilize, and/or postpone development
of the disease (such as myelofibrosis) or symptoms of the disease,
and can include "progression free survival". This delay can be of
varying lengths of time, depending on the history of the disease
and/or individual being treated. As is evident to one skilled in
the art, a sufficient or significant delay can, in effect,
encompass prevention, in that the individual does not develop the
disease.
[0056] As used herein, an "effective dosage" or "effective amount"
of drug, compound, or pharmaceutical composition is an amount
sufficient to effect beneficial or desired results. For
prophylactic use, beneficial or desired results can include, for
example, one or more results such as eliminating or reducing the
risk, lessening the severity, or delaying the onset of the disease,
including biochemical, histological and/or behavioral symptoms of
the disease, its complications and intermediate pathological
phenotypes presenting during development of the disease. For
therapeutic use, beneficial or desired results can include,
include, for example one or more clinical results such as
decreasing one or more symptoms and pathological conditions
resulting from or associated with the disease, increasing the
quality of life of those suffering from the disease, decreasing the
dose of other medications required to treat the disease, enhancing
effect of another medication such as via targeting, delaying the
progression of the disease, and/or prolonging survival. In the case
of myelofibrosis, an effective amount of a drug may have the effect
in reducing one or more of splenomegaly, improving constitutional
symptoms (such as early satiety, fatigue, night sweats, cough, and
pruritus), reducing leukocytosis, reducing thrombocytosis,
decreasing JAK2V617F allele burden, reducing bone marrow fibrosis,
and/or reducing bone marrow cellularity. An effective dosage can be
administered in one or more administrations. An effective dosage of
drug, compound, or pharmaceutical composition can be, for example,
an amount sufficient to accomplish prophylactic or therapeutic
treatment either directly or indirectly. As is understood in the
clinical context, an effective dosage of a drug, compound, or
pharmaceutical composition may or may not be achieved in
conjunction with another drug, compound, or pharmaceutical
composition. Thus, an "effective dosage" may be considered in the
context of administering one or more therapeutic agents, and a
single agent may be considered to be given in an effective amount
if, in conjunction with one or more other agents, a desirable
result may be or is achieved.
[0057] As used herein, "ameliorating" bone marrow cellularity or
bone marrow fibrosis refers to reducing the level of bone marrow
cellularity or bone marrow fibrosis in a subject compared to the
level of bone marrow cellularity or bone marrow fibrosis prior to
commencing treatment with the compound provided herein. The
reduction of bone marrow cellularity or bone marrow fibrosis can be
at least by 5, 10, 20, 30, 40, 50, 60, 70, 80, or 90%.
[0058] As used herein, "in conjunction with" refers to
administration of one treatment modality in addition to another
treatment modality. As such, "in conjunction with" can refer to
administration of one treatment modality before, during or after
administration of the other treatment modality to the
individual.
[0059] As used herein, a "patient" or a "subject" refers to a
mammal including a human, a dog, a horse, a cow or a cat, etc.
[0060] The term "pharmaceutically acceptable" refers to the fact
that the carrier, diluent or excipient must be compatible with the
other ingredients of the formulation and can be administered to a
subject.
[0061] As used herein, "pharmaceutically acceptable salts" refer to
derivatives of the disclosed compounds wherein the parent compound
is modified by making acid or base salts thereof.
[0062] As used herein and in the appended claims, the singular
forms "a," "an," and "the" include plural reference unless the
context clearly indicates otherwise.
[0063] Reference to "about" a value or parameter herein includes
(and describes) embodiments that are directed to that value or
parameter per se. For example, description referring to "about X"
includes description of "X."
[0064] It is understood that aspects and variations of the
compositions and methods provided herein can include "consisting"
and/or "consisting essentially of" aspects and variations.
II. Compounds and Pharmaceutical Compositions
[0065] Provided herein is a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. Also provided herein
are pharmaceutical compositions comprising
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzensulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, and a
pharmaceutically acceptable excipient or carrier. The compound and
the pharmaceutical compositions described herein can be used for
treating or delaying development of myelofibrosis in a subject.
N-tert-Butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide has the following chemical
structure:
##STR00001##
[0066] The compound provided herein may be formulated into
therapeutic compositions as natural or salt forms. Pharmaceutically
acceptable non-toxic salts include the base addition salts (formed
with free carboxyl or other anionic groups) which may be derived
from inorganic bases such as, for example, sodium hydroxide,
potassium hydroxide, ammonium hydroxide, calcium hydroxide, or
ferric hydroxide, and such organic bases as isopropylamine,
trimethylamine, 2-ethylamino-ethanol, histidine, procaine, and the
like. Such salts may also be formed as acid addition salts with any
free cationic groups and will generally be formed with inorganic
acids such as, for example, hydrochloric acid, sulfuric acid, or
phosphoric acid, or organic acids such as acetic acid, citric acid,
p-toluenesulfonic acid, methanesulfonic acid, oxalic acid, tartaric
acid, mandelic acid, and the like.
[0067] Salts of the compounds provided herein can include amine
salts formed by the protonation of an amino group with inorganic
acids such as hydrochloric acid, hydrohromic acid, hydroiodic acid,
sulfuric acid, phosphoric acid, and the like. Salts of the
compounds provided herein can also include amine salts formed by
the protonation of an amino group with suitable organic acids, such
as p-toluenesulfonic acid, acetic acid, methanesulfonic acid and
the like. Additional excipients which are contemplated for use in
the practice of the compositions and methods provided herein are
those available to those of ordinary skills in the art, for
example, those found in the United States Pharmacopeia Vol. XXII
and National Formulary Vol. XVII, U.S. Pharmacopeia Convention,
Inc., Rockville, Md. (1989), the relevant contents of which are
incorporated herein by reference.
[0068] In addition, the compounds provided herein can include
polymorphs. The compound described herein may be in alternative
forms. For example, the compound described herein may include a
hydrate form. As used herein, "hydrate" refers to a compound
provided herein which is associated with water in the molecular
form, i.e., in which the H--OH bond is not split, and may be
represented, for example, by the formula R.H.sub.2O, where R is a
compound provided herein. A given compound may form more than one
hydrate including, for example, monohydrates (R.H.sub.2O) or
polyhydrates (R.nH.sub.2O wherein n is an integer greater than 1)
including, for example, dihydrates (R.2H.sub.2O), trihydrates
(R.3H.sub.2O), and the like, or fractional hydrates, such as, for
example, R.n/2H.sub.2O, R.n/3H.sub.2O, R.n/4H.sub.2O and the like
wherein n is an integer.
[0069] The compounds described herein may also include acid salt
hydrate forms. As used herein, "acid salt hydrate" refers to a
complex that may be formed through association of a compound having
one or more base moieties with at least one compound having one or
more acid moieties or through association of a compound having one
or more acid moieties with at least one compound having one or more
base moieties, said complex being further associated with water
molecules so as to form a hydrate, wherein said hydrate is as
previously defined and R represents the complex herein described
above.
[0070] In some embodiments, the compound is
N-tert-butyl-3-[(5-methyl-2-{([4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}py-
rimidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate
and has the following chemical structure:
##STR00002##
[0071] The pharmaceutical compositions for the administration of
the compound described herein, either alone or in combination with
other therapeutic agents, may conveniently be presented in dosage
unit form and may be prepared by any of the methods well known in
the art of pharmacy and methods described in Examples 4, 5 and 6.
Such methods can include bringing the active ingredient into
association with the carrier which constitutes one or more
accessory ingredients. In general, the pharmaceutical compositions
are prepared by uniformly and intimately bringing the active
ingredient into association with a liquid carrier or a finely
divided solid carrier or both, and then, if necessary, shaping the
product into the desired formulation. In the pharmaceutical
composition the active object compound is included in an amount
sufficient to produce the desired effect upon the process or
condition of diseases. The pharmaceutical compositions containing
the active ingredient may be in a form suitable for oral use, for
example, as hard or soft capsules. The suitable capsule shell may
be hard gelatin or hydroxypropylmethyl cellulose ("HPMC").
[0072] Provided herein are formulations comprising (i) a compound
which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) one or more
excipients, and (iii) one or more lubricants. The formulations may
be in capsule form and administered orally. The formulations may be
in unit dosage form. In some embodiments, the excipient is lactose
(such as Fast-Flo), mannitol (such as Parteck M200),
microcrystalline cellulose ("MCC") (such as Avicel PII102), MCC
(such as ProSolv 90 IID). In some embodiments, the lubricant is
magnesium stearate, sodium stearyl fumarate (such as Pruv), or
sodium laurel fumarate. In some embodiments, the microcrystalline
cellulose is silicified microcrystalline cellulose. In some
embodiments, the capsule is hard gelatin capsule.
[0073] In some embodiments, there is provided a capsule suitable
for oral administration comprising an admixture of (i) a compound
which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) an excipient
(e.g., microcrystalline cellulose such as silicified
microcrystalline cellulose), and (iii) a lubricant (e.g., sodium
stearyl fumarate), wherein the admixture is contained in the
capsule. Methods known in the art and described herein may be used
for making the capsules. See, e.g., Example 3. Microcrystalline
cellulose may be used as a filler and/or diluent in the capsules
provided herein. Sodium stearyl fumarate may be used as a lubricant
in the capsules provided herein. In some embodiments, the
microcrystalline cellulose is silicified microcrystalline
cellulose. For example, silicified microcrystalline cellulose may
be composed of microcrystalline cellulose and colloidal silicon
dioxide particles. In some embodiments, the silicified
microcrystalline cellulose is a combination of 98% microcrystalline
cellulose and 2% colloidal silicon dioxide.
[0074] In some embodiments, the capsule contains about 10 mg to
about 680 mg of the compound, wherein the specified weight is the
free base moiety weight of the compound. In some embodiments, the
capsule contains about 10 mg to about 650 mg (or about 10 mg to
about 550 mg or about 10 mg to about 500 mg), wherein the specified
weight is the free base moiety weight of the compound. In some
embodiments, the capsule contains about 100 mg to about 600 mg (or
about 200 mg to about 550 mg or about 300 mg to about 500 mg),
wherein the specified weight is the free base moiety weight of the
compound. In some embodiments, the capsule contains about 10 mg,
about 20 mg, about 40 mg, about 100 mg, about 150 mg, about 200 mg,
about 250 mg, about 300 mg, about 350 mg, about 400 mg, about 450
mg, about 500 mg, about 550 mg, about 600 mg, or about 650 mg of
the compound, wherein the specified weight is the free base moiety
weight of the compound. In some embodiments, the capsule is a hard
gelatin capsule. In some embodiments, the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride
monohydrate.
[0075] In some embodiments, the weight ratio of the compound to
excipient (e.g., microcrystalline cellulose such as silicified
microcrystalline cellulose) in the capsule is between about 1:1.5
to about 1:15 (e.g., between about 1:5 to about 1:10, between about
1:5 to about 1:12, or between about 1:10 to about 1:15), wherein
the weight of the compound is the free base moiety weight of the
compound. In some embodiments, the weight ratio of the compound to
lubricant (e.g., sodium stearyl fumarate) in the capsule is between
about 5:1 to about 50:1 (e.g., between about 5:1 to about 10:1,
between about 5:1 to about 25:1, between about 5:1 to about 40:1,
between about 7:1 to about 34:1, or between about 8:1 to about
34:1), wherein the weight of the compound is the free base moiety
weight of the compound.
[0076] In some embodiments, the capsule contains about 5% to about
50% (e.g., about 5% to about 10% or about 5% to about 35%) compound
of the total fill weight of the capsule, wherein the weight of the
compound is the free base moiety weight of the compound. In some
embodiments, the capsule contains about 40% to about 95% (e.g.,
about 50% to about 90% or about 60% to about 90%) excipient (e.g.,
microcrystalline cellulose such as silicified microcrystalline
cellulose) of the total fill weight of the capsule. In some
embodiments, the capsule contains about 0.2% to about 5% (e.g.,
about 0.2% to about 2% or about 0.5% to about 1.5%, or about 0.5%,
about 1%, or about 1.5%) lubricant (e.g., sodium stearyl fumarate)
of the total fill weight of the capsule.
[0077] Also provided herein are unit dosage forms comprising an
admixture of (i) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) an excipient
(such as microcrystalline cellulose), and (iii) a lubricant (such
as sodium stearyl fumarate). Any one of the capsules described
herein may be used in a unit dosage form. In some embodiments, the
unit dosage form is for treating myelofibrosis. In some
embodiments, the treatment is according to a method described
herein.
[0078] In some embodiments, the unit dosage form comprises an
admixture of (i) about 10 mg to about 680 mg (or about 10 mg to
about 500 mg) of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the specified
weight is the free base moiety weight of the compound, (ii) a
microcrystalline cellulose, and (iii) sodium stearyl fumarate. In
some embodiments, the compound in the admixture is about 10 mg to
about 500 mg, wherein the specified weight is the free base moiety
weight of the compound.
[0079] In some embodiments, the unit dosage form is in the form of
a capsule, and the admixture is contained in the capsule. In some
embodiments, the unit dosage form comprises about 10 mg, about 20
mg, about 40 mg, about 100 mg, about 150 mg, about 200 mg, about
250 mg, about 300 mg, about 350 mg, about 400 mg, about 450 mg,
about 500 mg, about 550 mg, about 600 mg, or about 650 mg of the
compound, wherein the specified weight is the free base moiety
weight of the compound. In some embodiments, the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
In some embodiments, the admixture comprises (i) about 10 mg (or
about any of 40 mg, 100 mg, 200 mg, 300 mg, 400 mg, or 500 mg) of
the compound, (ii) a microcrystalline cellulose, and (iii) sodium
stearyl fumarate, wherein the specified weight is the free base
moiety weight of the compound. In some embodiments, the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride
monohydrate.
[0080] In some embodiments, the weight ratio of the compound to
excipient (e.g., microcrystalline cellulose such as silicified
microcrystalline cellulose) in the unit dosage form is between
about 1:1.5 to about 1:15 (e.g., between about 1:5 to about 1:10,
between about 1:5 to about 1:12, or between about 1:10 to about
1:15), wherein the weight of the compound is the free base moiety
weight of the compound. In some embodiments, the weight ratio of
the compound to lubricant (e.g., sodium stearyl fumarate) in the
unit dosage form is between about 5:1 to about 50:1 (e.g., between
about 5:1 to about 10:1, between about 5:1 to about 25:1, between
about 5:1 to about 40:1, between about 7:1 to about 34:1, or
between about 8:1 to about 34:1), wherein the weight of the
compound is the free base moiety weight of the compound. In some
embodiments, the microcrystalline cellulose is silicified
microcrystalline cellulose. In some embodiments, the silicified
microcrystalline cellulose is a combination of 98% microcrystalline
cellulose and 2% colloidal silicon dioxide.
[0081] In some embodiments, the lubricant (e.g., sodium stearyl
fumarate) is about 0.1% to about 10%, about 0.5% to about 5%, about
0.5% to about 3%, about 0.5% to about 2%, about 0.75% to about 1.5%
of the capsule fill weight. In some embodiments, the lubricant
(e.g., sodium stearyl fumarate) is at least about any one of 0.1%,
0.25%, 0.5%, 0.75%, 1%, 1.25%, 1.5%, 1.75%. 2%, 2.5%, 3%, 3.5%, 4%,
4.5%, or 5% of the capsule fill weight. In some embodiments, the
lubricant (e.g., sodium stearyl fumarate) is about any one of 0.1%,
0.25%, 0.5%, 0.75%, 1%, 1.25%, 1.5%, 1.75%, 2%, 2.5%, 3%, 3.5%, 4%,
4.5%, or 5% of the capsule fill weight.
[0082] In some embodiments, the weight ratio of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof to an excipient (e.g.,
microcrystalline cellulose such as silicified microcrystalline
cellulose) in a capsule or unit dosage form is about 40:60 to about
10:90. In some embodiments, the weight ratio of the compound to an
excipient (e.g., microcrystalline cellulose such as silicified
microcrystalline cellulose) in a capsule ot unit dosage form is
about any one of 95:5, 90:10, 85:15, 80:20, 75:25, 70:30, 65:35,
60:40, 55:45, 50:50, 45:55, 40:60, 35:65, 30:70, 25:75, 20:80,
15:85, 10:90, or 5:95. In some embodiments, the weight ratio of the
compound to an excipient (e.g., microcrystalline such as silicified
microcrystalline cellulose) is about 1:1.5 to about 1:9.5, such as
about any of 1:1.5, 1:2, 1:2.5, 1:3, 1:3.5, 1:4, 1:4.5, 1:5, 1:5.5,
1:6, 1:6.5, 1:7, 1:7.5, 1:8, 1:8.5, 1:9, or 1:9.5. In some
embodiments, the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}-
pyrimidin-4-yl)amino]benzenesulfonamide dihydrochloride
monohydrate.
[0083] In some embodiments, the capsule contains about 5% to about
50% (e.g., about 5% to about 10% or about 5% to about 35%) compound
of the total weight of the admixture, wherein the weight of the
compound is the free base moiety weight of the compound. In some
embodiments, the capsule contains about 40% to about 95% (e.g.,
about 50% to about 90% or about 60% to about 90%) microcrystalline
cellulose (such as silicified microcrystalline cellulose) of the
total weight of the admixture. In some embodiments, the capsule
contains about 0.2% to about 5% (e.g., about 0.2% to about 2% or
about 0.5% to about 1.5%, or about 0.5%, about 1%, or about 1.5%)
sodium stearyl fumarate of the total weight of the admixture.
[0084] In some embodiments, the capsule or unit dosage form
contains an admixture of about 12 mg of
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate,
about 122 mg of silicified microcrystalline cellulose, and about 1
mg of sodium stearyl fumarate. In some embodiments, the capsule or
unit dosage form contains an admixture of about 47 mg of
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate,
about 448 mg of silicified microcrystalline cellulose, and about 5
mg of sodium stearyl fumarate. In some embodiments, the capsule or
unit dosage form contains an admixture of about 117 mg of
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
In some embodiments, the capsule or unit dosage form contains an
admixture of about 235 mg of
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate,
about 357 mg of silicified microcrystalline cellulose, and about
6.00 mg of sodium stearyl fumarate.
[0085] Also provided herein are oral solution formulations
comprising a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof.
[0086] In some embodiments, the oral solution formulation further
comprises methylcellulose. In some embodiments, the oral solution
formulation further comprises methylcellulose and Tween 80. In some
embodiments, the oral solution formulation comprises the compound
at about 1 mg/ml to about 25 mg/ml, about 2 mg/ml to about 20
mg/ml, about 3 mg/ml to about 15 mg/ml, about 5 mg/ml to about 10
mg/ml. In some embodiments, the oral solution formulation comprises
the compound at about any one of 2 mg/ml, 3 mg/ml, 4 mg/ml, 5
mg/ml, 6 mg/ml, 6.25 mg/ml, 6.5 mg/ml, 7 mg/ml, 8 mg/ml, 9 mg/ml,
10 mg/ml, or 12.5 mg/ml, or 15 mg/ml. In some embodiments, the oral
solution formulation comprises about 0.1% to about 5%, 0.2% to
about 3%, about 0.25% to about 2%, about 0.25% to about 1%, or
about 0.5% by weight of methylcellulose. In some embodiments, the
oral solution formulation comprises about 0.01% to about 0.5%,
0.02% to about 0.3%, about 0.025% to about 0.2%, about 0.025% to
about 0.1%, or about 0.05% by weight of Tween 80.
[0087] In some embodiments, the capsule does not comprise an
absorption enhancer. In some embodiments, the capsule comprises an
absorption enhancer (e.g., Vitamin E TPGS, Gelucire 44/14. Pluronic
F127, or glyceryl monostearate).
[0088] A capsule or unit dosage form provided may comprise one or
more of the following properties: (1) upon administration to a
subject such as human subject, the Cmax of the compound is achieved
within about 2 to about 4 hours post-dose; (2) upon administration
to a human subject, the elimination half life of the compound is
about 16 to about 34 hours; (3) the mean AUC of the compound
increases more than proportionally with increasing doses ranging
from about 30 mg to about 800 mg per day; (4) the accumulation of
the compound is about 1.25 to about 4.0 fold at steady state when
the compound is dosed once daily.
[0089] Also provided are methods of preparing a capsule drug
product comprising a) blending a lubricant with a compound that is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof to generate granules
and b) mixing the granules of a) with an excipient. In some
embodiments, the lubricant is sodium stearyl fumarate. In some
embodiments, the excipient is microcrystalline cellulose such as
silicified microcrystalline cellulose. Such method may be used to
prepare a capsule or unit dosage form described herein. The weight
(such as weight ratio or weight percentage) and components
regarding the compound, excipient, and/or lubricant may be
according to any described herein.
III. Methods of Treatment and Prevention of Myelofibrosis
[0090] Provided herein are methods for treating, delaying
development, and/or preventing myelofibrosis in a subject
comprising administering to the subject an effective amount of a
compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof (e.g.,
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate).
In some embodiments, the subject has myelofibrosis. In some
embodiments, the subject is at risk of developing myelofibrosis. In
some embodiments, the subject is a human subject. Any one of the
formulations described herein such as capsule or unit dosage forms
described herein may be used to treat a subject with myelofibrosis.
In some embodiments, the compound is in an admixture of (i) a
compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) an excipient
(such as microcrystalline cellulose), and (iii) a lubricant (such
as sodium stearyl fumarate).
[0091] Myclofibrosis that may be treated by the compounds described
herein includes primary myelofibrosis (MF) and secondary
myelofibrosis (e.g., myelofibrosis arising from antecedent
polycythemia vera (post-PV MF) or essential thrombocythemia
(post-ET MF)). Myelofibrosis that may be treated by the compounds
described herein also includes myelofibrosis of high risk,
intermediate risk such as intermediate risk level 2. Methods for
diagnosing various types of myelofibrosis are known in the art.
See, e.g., Cervantes et al., Blood 2009. In some embodiments, the
subject with myelofibrosis has spleen of at least 5 cm below costal
margin as measured by palpation.
[0092] In some embodiments, the subject has a point mutation from
valine 617 to phenylalanine in the Janus kinase 2 (JAK2 kinase)
(JAK2V617F) if the subject is a human, or a point mutation
corresponding to the valine 617 to phenylalanine in the Janus
kinase 2 (JAK2 kinase) if the subject is not a human. In some
embodiments, the subject is negative for the valine 617 to
phenylalanine mutation of JAK2 if the subject is a human, or
negative for a mutation corresponding to the valine 617 to
phenylalanine in the Janus kinase 2 (JAK2 kinase) if the subject is
not a human. Whether a subject is positive or negative for
JAK2V617F can be determined by a polymerase chain reaction ("PCR")
analysis using genomic DNA from bone marrow cells or blood cells
(e.g., whole blood leukocytes). The PCR analysis can be an
allele-specific PCR (e.g., allele-specific quantitative PCR) or PCR
sequencing. See Kittur J et al., Cancer 2007, 109(11):2279-84 and
McLornan D et al., Ulster Med J. 2006, 75(2):112-9, each of which
is expressly incorporated herein by reference.
[0093] In some embodiments, the subject treated with the methods
described herein has previously received another myelofibrosis
therapy or treatment. In some embodiments, the subject is a
non-responder to the other myelofibrosis therapy or has a relapse
after receiving the other myelofibrosis therapy. The previous
therapy may be a JAK2 inhibitor (e.g. INCB018424 (also known as
ruxolitinib, available from Incyte), CEP-701 (lestaurtinib,
available from Cephalon), or XL019 (available from Exelixis)) (See
Verstovsek S., Hematology Am Soc Hematol Educ Program. 2009:636-42)
or a non-JAK2 inhibitor (such as hydroxyurea). In some embodiments,
the subject has received ruxolitinib treatment for primary
myelofibrosis, post-polycythemia vera myelofibrosis (Post-PV MF),
post-essential thrombocythemia myelofibrosis (Post-ET MF),
polycythemia vera, or essential thrombocythemia for at least 14
days and discontinued the treatment for at least 30 days. In some
embodiments, the previous therapy is a treatment with a compound
described herein and the previous therapy has been discontinued
upon indication of one or more elevated levels of amylase, lipase,
aspartate aminotransferase (AST), alanine aminotransferase (ALT),
and/or creatinine in the serum from the subject, and/or upon
indication of a hematologic condition selected from the group
consisting of anemia, thrombocytopenia, and neutropenia. In some
embodiments, the dose of the compound in the second treatment is
the same or lower than the dose in the previous therapy.
[0094] The subject may be treated orally and/or daily. The subject
(such as a human) may be treated by administering at a dose of
about 240 mg per day to about 680 mg per day (or about 300 mg per
day to about 500 mg per day), wherein the specified weight is the
free base moiety weight of the compound. In some embodiment, the
compound is administered at a dose of about any of 240 mg/day, 250
mg/day, 300 mg/day. 350 my/day, 400 mg/day, 450 mg/day, 500 mg/day,
550 mg/day, 600 mg/day, 650 mg/day, or 680 mg/day. The compound may
be in a capsule and/or a unit dosage form described herein. In some
embodiments, the compound administered is in an admixture with a
microcrystalline cellulose and sodium stearyl fumarate, and the
admixture is in a capsule. In some embodiments, the compound is
administered orally.
[0095] Also provided herein are methods for ameliorating one or
more symptoms associated with myelofibrosis. For example, the
treatment using the compound described herein is effective in
reducing spleen size, ameliorating constitutional symptoms (such as
early satiety, fatigue, night sweats, cough, and pruritus),
reducing leukocytosis, reducing thrombocytosis, decreasing
JAK2V617F allele burden, reducing bone marrow fibrosis, improving
pruritus, improving cachexia, and/or reducing bone marrow
cellularity. The reduction, decrease, amelioration, or improvement
can be at least by 5, 10, 20, 30, 40, 50, 60, 70, 80, or 90%
compared to the level prior to commencing treatment with the
compound provided herein. In some embodiment, the spleen becomes
non-palpable in the subject after treatment. In some embodiments,
the subject has complete resolution of leukocytosis and/or
thrombocytosis after treatment. In some embodiments, the subject
has complete resolution of pruritus after treatment.
[0096] In some embodiments, the compound is administered to the
subject daily for at least 1 cycle, at least 2 cycles, at least 3
cycles, at least 4 cycles, at least 5 cycles, or at least 6 cycles
of a 28-day cycle. In some embodiments, the compound is
administered to the subject daily for at least 6 cycles of a 28-day
cycle, at least 8 cycles of a 28-day cycle, at least 10 cycles of a
28-day cycle, at least 12 cycles of a 28-day cycle, at least 15
cycles of a 28-day cycle, at least 18 cycles of a 28-day cycle, or
at least 24 cycles of a 28-day cycle. In some embodiments, the
compound is administered to the subject daily for at least one
month, at least two month, at least three month, at least four
month, at least five month, at least six month, at least eight
month, or at least one year. In some embodiments, the compound is
administered once a day.
[0097] In some embodiments, upon administration of a compound which
is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof to a subject such as
human subject, the Cmax of the compound is achieved within about 1
to about 5 hours, about 1.5 to about 4.5 hours, about 2 to about 4
hours, or about 2.5 to about 3.5 hours post-dose. In some
embodiments, upon administration of the compound to a human
subject, the elimination half life of the compound is about 12 to
about 40 hours, about 16 to about 34 hours, or about 20 to about 30
hours. In some embodiments, the mean AUC of the compound increases
more than proportionally with increasing doses ranging from about
30 mg to about 800 mg per day. In some embodiments, the
accumulation of the compound is about 1.1 to about 5 fold, about
1.25 to about 4.0 fold, about 1.5 to about 3.5 fold, about 2 to
about 3 fold at steady state when the compound is dosed once
daily.
[0098] In some embodiments, the method comprises instructing the
subject to ingest the effective amount of the compound on an empty
stomach. In some embodiments, the methods further comprise
instructing the subject to avoid ingesting agents that are at least
moderate inducers or inhibitors of CYP3A4. In some embodiments, the
subject does not receive concomitant treatment with or use of drugs
to herbal agents known to be at least moderate inhibitors or
inducers of CYP3A4. Based on in vitro evaluations,
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide is metabolized by human
CYP3A4. Agents that may increase
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide plasma concentrations (i.e.,
CYP3A4 inhibitors) or decrease
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide plasma concentrations (i.e.,
CYP3A4 inducers), including herbal agents and foods (e.g.
grapefruit/grapefruit juice), should be avoided in subjects being
treated as described herein. In addition, in vitro data have
indicated that
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide inhibits CYP3A4 in a
time-dependent fashion. Agents that are sensitive substrates for
metabolism by CYP3A4 should be used with caution as
coadmninistration with
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide may result in higher plasma
concentrations of the coadministered agent. A list of clinically
relevant substrates of CYP3A4 include alfentanil, Cyclosporine,
Diergotamine, ethinyl estradiol, ergotamine, fentanyl, pimozide,
quinidine, sirolimus, tacrolimus, clarithromycin erythromycin,
telithromycin, alprazolam, diazepam, midazolamn, triazolam,
indinavir, ritonavir, saquinavir, prokinetic, cisapride,
astemizole, chlorpheniramine, amlodipine, diltiazem, felodipine,
nifedipine, verapamil, atorvastatin, cerivastatin, lovastatin,
simvastatin, aripiprazole, gleevec, halopericol, sildenafil,
tamoxifcn, taxanes, trazodonc, and Vincristinc. A list of
clinically relevant inducers of CYP3A4 include carbamazepine,
phenobarbital, phenytoin, pioglitazone, rifabutin, rifampin, St.
John's wort, and troglitazone. A list of clinically relevant
inhibitors of CYP3A4 include indinavir, nelfinavir, ritonavir,
clarithromycin, itraconazole, ketoconazole, nefazodone,
erythromycin, grapefruit juice, verapamil, diltiazem, cimetidine,
amniodarone, fluvoxamine, mibefradil, and Troleandomycin. See
reference Flockhart et al.,
http://nedicine.iupui.edu/clinpharnn/ddis/clinicaltable.aspx.,
2009.
[0099] Also provided herein are methods of monitoring treatment of
myelofibrosis to a subject, comprising (a) administering to the
subject an effective amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof; (b) monitoring a
hematologic parameter and/or a non-hematologic parameter in the
subject; and (c) determining if the subject should continue or
discontinue with the treatment. In some embodiments, the
hematologic parameter is selected from the group consisting of
anemia, thrombocytopenia, and neutropenia. In some embodiments, the
non-hematologic parameter is an enzyme or molecule in the blood or
serum wherein an elevated level of the enzyme or molecule is
indicative of tissue or organ damage. In some embodiments, the
serum enzyme or molecule can be, for example, amylase, lipase,
aspartate aminotransferase (AST), alanine aminotransferase (ALT),
creatinine, alkaline phosphatase, and calcium. Methods of
monitoring these parameters are known in the art and are described
herein. See Examples 1-3. In some embodiments, the method further
comprises administering to the subject an effective amount of the
compound described herein after the subject has been discontinued
with the treatment for at least 2 week, at least 3 weeks, or at
least 4 weeks. In some embodiments, the previous treatment has been
discontinued without prior dose reduction.
[0100] Also provided herein are methods of monitoring treatment of
myelofibrosis to a subject, comprising administering to the subject
an effective amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, and discontinuing the
treatment upon indication of elevated levels of one or more enzymes
or molecules selected from the group consisting of amylase, lipase,
aspartate aminotransferase (AST), alanine aminotransferase (ALT),
and creatinine and/or decreased level of calcium in the blood or
serum of the subject without prior dose reduction. Also provided
herein are methods of monitoring treatment of myelofibrosis to a
subject, comprising administering to the subject an effective
amount of a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzensulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, and discontinuing the
treatment upon indication of one or more hematologic conditions
selected from the group consisting of anemia, thrombocytopenia, and
neutropenia without prior dose reduction. In some embodiments, the
treatment is discontinued when one or more of the parameters
(including hematologic and non-hematologic parameters) are grade 3
or 4 events.
[0101] Grade 3 or 4 adverse events for hematologic and
non-hematologic parameters are known in the art and shown in the
Table below. See, e.g. C Common Terminology Criteria for Adverse
Events (CTCAE), Version 4.0, Published: May 28, 2009 (v4.03: Jun.
14, 2010).
TABLE-US-00001 RESPONSE (hematologic and non- hematologic)
Definition Grade 3 Grade 4 Hyperlipasemia A finding based on
>2.0-5.0 .times. ULN* >5.0 .times. ULN laboratory test
results that indicate an increase in the level of lipase in a
biological specimen. Serum amylase A finding based on >2.0-5.0
.times. ULN >5.0 .times. ULN laboratory test results that
indicate an increase in the levels of amylase in a serum specimen.
Alanine A finding based on >5.0-20.0 .times. ULN >20.0
.times. ULN aminotransferase laboratory test results that increased
indicate an increase in the level of alanine aminotransferase (ALT
or SGPT) in the blood specimen. Aspartate A finding based on
>5.0-20.0 .times. ULN >20.0 .times. ULN aminotransferase
laboratory test results that increased indicate an increase in the
level of aspartate aminotransferase (AST or SGOT) in a blood
specimen. Blood creatinine A finding based on >3.0 baseline;
>3.0 6.0 .times. ULN >6.0 .times. increased laboratory test
results that ULN indicate increased levels of creatinine in a
biological specimen. Blood alkaline A finding based on >5.0-20.0
.times. ULN >20.0 .times. ULN phosphatase increased laboratory
test results that indicate an increase in the level of alkaline
phosphatase in a blood specimen. Hypocalcemia A disorder
characterized Corrected serum Corrected serum by laboratory test
results calcium of calcium of that indicate a low <7.0-6.0
mg/dL; <6.0 mg/dL; <1.5 mmol/L; concentration of calcium
<1.75-1.5 mmol/L; Ionized calcium (corrected for albumin) in
Ionized <0.8 mmol/L; the blood. calcium <0.9-0.8 mmol/L;
life-threatening hospitalization consequences indicated Anemia A
disorder characterized Hgb <8.0 g/dL; <4.9 mmol/L;
Life-threatening by a reduction in the <80 g/L; transfusion
consequences; amount of hemoglobin in indicated urgent intervention
100 ml of blood. Signs indicated and symptoms of anemia may include
pallor of the skin and mucous membranes, shortness of breath,
palpitations of the heart, soft systolic murmurs, lethargy, and
fatigability. Thrombocytopenia a platelet count below the 25,000 to
<50,000/.mu.L below 25,000/.mu.L normal range for the population
([+ or -] 2 standard deviations). In most laboratories, a normal
platelet count is between 150,000 to 450,000/.mu.L Neutropenia A
finding based on <1000-500/mm3; <1.0-0.5 .times. <500/mm3;
<0.5 .times. laboratory test results that 10.sup.9/L 10.sup.9/L
indicate a decrease in number of neutrophils in a blood specimen. *
"ULN" refers to upper limit of normal.
IV. Articles of Manufactures and Kits
[0102] Also provided herein are articles of manufacture or kits
containing a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the article of manufacture or the kit further includes instructions
for using the compounds described herein in the methods provided
herein. In some embodiments, the article of manufacture or the kit
further comprises a label or a package insert providing the
instructions. In some embodiments, the compound is in a capsule
and/or a unit dosage form described herein.
[0103] In some embodiments, the article of manufacture or kit may
further comprise a container. Suitable containers include, for
example, bottles, vials (e.g., dual chamber vials), syringes (such
as single or dual chamber syringes) and test tubes. The container
may be formed from a variety of materials such as glass or plastic,
and the container may hold the compound, for example in the
formulation to be administered. The article of manufacture or the
kit may further comprise a label or a package insert, which is on
or associated with the container, may indicate directions for
reconstitution and/or use of the compound. In some embodiments, the
package insert or the label is in a position which is visible to
prospective purchasers.
[0104] The label or package insert may further indicate that the
compound is useful or intended for treating or preventing
myelofibrosis in a subject. In some embodiments, the package insert
or the label indicates that the compound can be used for
ameliorating bone marrow cellularity and/or bone marrow fibrosis.
In some embodiments, the package insert or the label indicates that
the compound can be used for treating myelofibrosis in a subject,
wherein the subject is negative for the valine 617 to phenylalanine
mutation of human JAK2 (JAK2V617F) or negative for the mutation
corresponding to the valine 617 to phenylalanine mutation of human
JAK2. In some embodiments, the package insert or the label
indicates that the compound can be used for treating myelofibrosis
in a subject, and that subject should discontinue the treatment
upon indication of elevated levels of one or more of amnylase,
lipase, aspartate aminotransferase (AST), alanine aminotransferase
(ALT), creatinine, and/or alkaline phosphatase and/or decreased
level of calcium in the serum of the subject, and/or upon
indication of one or more of anemia, thrombocytopenia, and/or
neutropenia. In some embodiments, the package insert or the label
further indicates that the compound can be discontinued without
prior dose reduction.
[0105] In some embodiments, there is provided a kit or article of
manufacture comprising (a) an admixture of (i) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, (ii) excipient (e.g.,
microcrystalline cellulose such as silicified microcrystalline
cellulose), and (iii) lubricant (e.g., sodium stearyl fumarate),
and (b) a package insert or a label indicating that the admixture
is useful for treating myelofibrosis in a subject. In some
embodiments, there is provided a kit or article of manufacture
comprising (a) a compound which is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutical salt
thereof or a hydrate thereof, and (b) a package insert or a label
indicating that the compound can be used for treating myelofibrosis
in a subject, wherein the subject has previously received another
myelofibrosis therapy with a JAK2 inhibitor which is not
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof.
[0106] In some embodiments, the package insert or a label indicates
that, upon administration of the compound to a human subject, the
Cmax of the compound is achieved within about 1 to about 5 hours,
about 1.5 to about 4.5 hours, about 2 to about 4 hours, or about
2.5 to about 3.5 hours post-dose. In some embodiments, the package
insert or a label indicates that, upon administration of the
compound to a human subject, the elimination half life of the
compound is about 12 to about 40 hours, about 16 to about 34 hours,
or about 20 to about 30 hours. In some embodiments, the mean AUC of
the compound increases more than proportionally with increasing
doses ranging from about 30 mg to about 800 mg per day. In some
embodiments, the accumulation of the compound is about 1.1 to about
5 fold, about 1.25 to about 4.0 fold, about 1.5 to about 3.5 fold,
about 2 to about 3 fold at steady state when the compound is dosed
once daily.
[0107] In some embodiments, the package insert or the label
instructs the subject to ingest the effective amount of the
compound on an empty stomach. In some embodiments, the package
insert or the label instructs the subject to avoid ingesting agents
that are at least moderate inducers or inhibitors of CYP3A4. In
some embodiments, the inducer or inhibitor of CYP3A4 is any one of
the inducers or inhibitors of CYP3A4 described herein.
[0108] Also provided are uses of a compound in the manufacture of a
medicament for treating myelofibrosis in a subject, wherein the
compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}-
pyrimidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the use is according to a method described herein. In some
embodiments, the compound is in an admixture of (i) the compound,
(ii) an excipient (e.g., microcrystalline cellulose such as
silicified microcrystalline cellulose), and (iii) a lubricant
(e.g., sodium stearyl fumarate). In some embodiments, the compound
is administered orally. In some embodiments, the use is according
to a method described herein. In some embodiments, there is
provided use of a compound in the manufacture of a medicament for
treating myelofibrosis in a subject, wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}-
pyrimidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
is negative for the valine 617 to phenylalanine mutation of human
Janus Kinase 2 (JAK2) or negative for the mutation corresponding to
the valine 617 to phenylalanine mutation of human JAK2. In some
embodiments, there is provided use of a compound in the manufacture
of a medicament for treating myelofibrosis in a subject, wherein
the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
has previously received another myelofibrosis therapy. In some
embodiments, the previous therapy comprises a JAK2 inhibitor which
is not
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof.
[0109] Also provided is a compound for treating myelofibrosis in a
subject, wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof. In some embodiments,
the treatment is according to a method described herein. In some
embodiments, the compound is in an admixture of (i) the compound,
(ii) an excipient (e.g., microcrystalline cellulose such as
silicified microcrystalline cellulose), and (iii) a lubricant
(e.g., sodium stearyl fumarate). In some embodiments, the compound
is administered orally. In some embodiments, the treatment is
according to a method described herein. In some embodiments, there
is provided a compound for treating myelofibrosis in a subject,
wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
is negative for the valine 617 to phenylalanine mutation of human
Janus Kinase 2 (JAK2) or negative for the mutation corresponding to
the valine 617 to phenylalanine mutation of human JAK2. In some
embodiments, there is provided a compound for treating
myelofibrosis in a subject, wherein the compound is
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof, wherein the subject
has previously received another myelofibrosis therapy. In some
embodiments, the previous therapy comprises a JAK2 inhibitor which
is not
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide or a pharmaceutically
acceptable salt thereof or a hydrate thereof.
[0110] The following are examples of the methods and compositions
provided herein. It is understood that various other embodiments
may be practiced, given the general description provided above.
EXAMPLES
Example 1 Evaluation of TG101348 in Myelofibrosis
[0111] As used herein, "TG101348" refers to
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide dihydrochloride monohydrate.
The subjects in this study were administered with capsule form of
TG101348 as described in Example 5. TG101348 was evaluated in a
Phase I study for the treatment of myelofibrosis. This study was
ongoing at the time the data were collected.
[0112] Background:
[0113] TG101348 is a potent, orally bioavailable, JAK2-selective
small molecule inhibitor, that was evaluated in a Phase I study for
the treatment of myelofibrosis. The dose-limiting toxicity was
asymptomatic grade 3 or 4 amylasemia/lipasemia that was reversible,
and the maximum tolerated dose ("MTD") was 680 mg. The most
frequent non-hematological toxicities were mild nausea, vomiting,
and/or diarrhea that were easily controlled or resolved
spontaneously. Grade 3/4 neutropenia and thrombocytopenia were
observed in 14% and 25% of patients, respectively. TG101348 had
activity in reducing spleen size, leukocyte count, and JAK2V617F
("VF") allele burden. This example describes the results with a
focus on the data from the dose confirmation cohort who initiated
treatment at a dose of 680 mg/day.
[0114] Results:
[0115] Fifty nine patients (median age=66 years; range 43-86) were
treated--28 in the dose escalation phase, and 31 in the dose
confirmation phase. Overall, 44 patients had PMF, 12 post-PV MF,
and 3 post-ET MF; 86% were VF-positive. Median palpable spleen size
was 18 cm and 22 patients were red blood cell ("RBC")
transfusion-requiring at study enrollment. After a median follow-up
of 12 weeks (range <1-76), 18 (31%) patients discontinued
treatment due to toxicity (n=7; thromnbocytopenia=3,
neutropenia=1), comorbidities (n=5), withdrawal of consent (n=4),
or non-compliance/lack of response (1 each). The remaining 41
patients were at the following dose levels when the data in this
example were collected: 680 mg (n=14), 520-600 mg (n=16), 360-440
mg (n=10), and 240 mg (n=1). The cumulative drug exposure to the
time when the data in this example were collected was 362
patient-months; exposure at or above MTD (680 mg) was 154
patient-months. Forty patients (68%) started treatment at
.gtoreq.680 mg.
[0116] Toxicity:
[0117] TG101348 was well tolerated. Of the patients who started at
.gtoreq.680 mg, Gr3/4 neutropenia was observed in 15/0% and Gr3/4
thrombocytopenia in 20/10%. Twenty four (60%) patients did not
require RBC transfusions at baseline (median hemoglobin ("Hgb")=9.6
g/dL; range 7.4-13.1); of these, 42% and 8% of patients developed
Grade 3 ("Gr3") and Grade 4 ("Gr4") anemia, respectively. The
majority of patients who started at .gtoreq.680 mg developed mild
nausea (1 Gr3), vomiting (1 Gr3), and/or diarrhea (3 Gr3) that were
self-limited or easily controlled. Other non-hematological
toxicities included Grade 1/2 ("Gr1/2") transaminitis (38%). Gr1/2
serum creatinine elevation (38%), and asymptomatic hyperlipasemia
(33%).
[0118] Efficacy:
[0119] Thirty three patients who started at .gtoreq.680 mg
completed at least 3 cycles of treatment: at 3 months, reduction in
palpable spleen size (baseline median=18 cms; range 6-32) was at
least 50% in 22 (67%) patients; the spleen became non-palpable in 9
(27%) patients. All 21 patients with leukocytosis at baseline (WBC
range 11 to 203.times.10.sup.9/L) who started at 2680 mg
experienced a marked reduction in their WBC count (range 4 to 90);
70% had a normal WBC count at their last follow-up visit. Overall,
48 of the 51 VF-positive patients completed at least 1 cycle and
were evaluable for response in VF allele burden; at last available
follow-up, the median decrease in granulocyte mutant allele burden
was 48%; 21 (44%) patients had a 250% reduction, and in the group
who started treatment at >680 mg, 48% have had a 250% reduction.
Of those evaluable, there was clinically significant benefit or
resolution of constitutional symptoms, including early satiety,
fatigue, cough, pruritus, and night sweats.
[0120] Conclusions:
[0121] TG101348 was well tolerated in patients with myelofibrosis.
Spleen and leukocyte responses were frequent, observed early, and
produced substantial clinical benefit for patients. These responses
were associated with significant decrease in VF allele burden and
pointed to activity of TG101348 against the malignant clone in
myelofibrosis.
Example 2 Evaluation of TG101348 in Myelofibrosis
[0122] The subjects in this study were administered with capsule
form of TG101348. TG101348 was evaluated in a Phase I study for the
treatment of myelofibrosis. This study is also described in Example
1. This example describes data available at the time of data
collection.
[0123] This study was an open-label, multicenter, and
dose-escalation study with expanded cohort dose confirmation at
MTD. The primary objective of this study was to determine
safety/tolerability, DI T, MTD, and pharmacokinetics of TG101348 in
subjects with MF. The secondary objective of this study was to
evaluate preliminary clinical and pharmacodynamic activity.
[0124] The key eligibility criteria for subjects included:
Myelofibrosis (PMF or post-PV/ET MF); High-risk or
intermediate-risk with symptomatic splenomegaly/unresponsive to
available therapy; ECOG performance status .ltoreq.2; ANC
.gtoreq.1.times.10.sup.9/L; Platelet count
.gtoreq.250.times.10.sup.9/L; Serum creatinine .ltoreq.2 mg/dL;
Total bilirubin .ltoreq.2 mg/dL; AST/ALT .ltoreq.3.times. upper
limit of normal.
[0125] The subject disposition for this study is included in Table
1.
TABLE-US-00002 TABLE 1 Subject Disposition MTD* Overall Enrolled 40
59 Included in safety analysis 40 59 Included in drug activity
analysis 37 55 Discontinued 11 (28%) 15 (25%) Reasons for
discontinuation Adverse event 5 6 Subject withdrew consent 4 6
Investigator discretion 2 3 Median (range) treatment 24 weeks 24
weeks duration (1-24 weeks) (0.3-84 weeks)** *Includes all subjects
who initiated treatment at 680 or 800 mg/day. **Includes continued
treatment in extension study.
[0126] The demographic and baseline characteristics for the
subjects are included in Table 2.
TABLE-US-00003 TABLE 2 Demographic and Baseline Characteristics MTD
Overall (n = 40) (N = 59) Age (median; years) 65 (43-85) 64 (43-85)
Male 22 (55%) 34 (58%) JAK-2.sup.V617F positive 35 (88%) 51 (86%)
PMF 31 (78%) 44 (75%) Post-PV MF 6 (15%) 12 (20%) Post-ET MF 3 (8%)
3 (5%) High risk 20 (50%) 26 (44%) Palpable splenomegaly 39 (98%)
58 (98%) Transfusion dependent 16 (40%) 22 (37%)
[0127] This study was a dose-escalation study with expanded cohort
dose confirmation at MTD. Below describes the data with a focus on
the dose confirmation cohort who initiated treatment at a dose of
680 mg/day.
[0128] The decrease in palpable spleen size by cycle for subjects
treated with TG101348 680 mg/day (starting dose) (N=37) is shown in
FIG. 1. The baseline spleen size was: median=18 cm; range=6-32 cm.
49% of subjects achieved clinical improvement based on reduction of
palpable splenomegaly (IWG response) (56% of subjects by 12 weeks;
100% of subjects by 20 weeks). There was no relapse or disease
progression at the time of data collection.
[0129] The effect of TG101348 on leukocytosis is shown in FIG. 2.
The baseline WBC count was >11.times.10.sup.9/L. 73% of subjects
had normal WBC counts at their follow-up visit. The effect of
TG101348 on thrombocytosis is shown in FIG. 3 (baseline platelet
count >450.times.10.sup.9/L). TG101348 was able to reduce
platelet counts. The effects of TG101348 on constitutional symptoms
(baseline versus last visit) are shown in FIG. 4. TG101348 was able
to improve the MF-associated constitutional symptoms. TG101348 had
no significant changes on cytokine levels (see FIG. 5, all values
shown are medians). FIG. 6 shows the effect of TG101348 on V617F
allele burden in subjects with baseline >20% (N=22). FIG. 6
shows that TG101348 was able to decrease JAK2 V617F allele burden
in 59% of the subjects with baseline >20%.
[0130] FIG. 7 shows the effects of TG1101348 on bone marrow
cellularity in a 76-year-old male with V617F negative PMF. The
starting dose was 30 mg/day and the dose at follow-up was 520
mg/day. FIG. 7 shows that TG101348 was able to reduce bone marrow
cellularity in this subject from 60% bone marrow cellularity at
baseline to 5-10% bone marrow cellularity after 18 cycles. FIG. 8
shows the effect of TG1101348 on bone marrow fibrosis in a
56-year-old male with V617F negative PMF. The starting dose was 240
mg/day and the dose at follow-up was 440 mg/day. FIG. 8 shows that
TG101348 was able to reduce bone marrow fibrosis in this subject
from 3+ at baseline to 0 after 18 cycles.
[0131] The treatment-emergent grade 3 & 4 hematologic
toxicities in MTD Subjects (N=40) is shown in Table 3. The
treatment-emergent non-hematologic adverse events (reported for at
least 5 subjects) in MTD Subjects (N=40) is shown in Table 4.
TABLE-US-00004 TABLE 3 Treatment-Emergent Grade 3 & 4
Hematologic Toxicities in MTD Subjects (N = 40) Anemia Neutropenia
Thrombocytopenia (N = 24)* (N = 40) (N = 40) New Transfusion Grade
3 Grade 4 Grade 3 Grade 4 Requirement on Study.dagger-dbl. 6 (15%)
0 8 (20%) 5 (13%) 16 (67%) *Subjects who were not transfusion
dependent at baseline. .dagger-dbl.Transfusion on at least 2
occasions for hemoglobin ("Hb") <10 g/dL.
TABLE-US-00005 TABLE 4 Treatment-Emergent Non-Hematologic Adverse
Events in MTD Subjects (N = 40) Event Grade 1 Grade 2 Grade 3 Grade
4 Gastrointestinal disorders Diarrhea 21 (53%) 4 (10%) 5 (13%) 0
Nausea 20 (50%) 6 (15%) 2 (5%) 0 Vomiting 20 (50%) 7 (18%) 1 (3%) 0
Constipation 6 (15%) 1 (3%) 0 0 Abdominal pain 5 (13%) 0 0 0 Other
Anorexia 7 (18%) 0 1 (3%) 0 Edema peripheral 7 (18%) 1 (3%) 0 0
Fatigue 2 (5%) 3 (8%) 1 (3%) 0 Contusion 5 (13%) 0 0 0 Headache 4
(10%) 1 (3%) 0 0 Proteinuria 2 (5%) 3 (8%) 0 0
[0132] The grade .gtoreq.2 treatment-emergent non-hematologic
laboratory findings in MTD subjects (N=40) is shown in Table 5.
TABLE-US-00006 TABLE 5 Grade .gtoreq. 2 Treatment-Emergent
Non-Hematologic Laboratory Findings in MTD Subjects (N = 40)
Finding Grade 2 Grade 3 Grade 4 Creatinine increased 11 (28%) 0 0
Hypocalcemia 8 (20%) 3 (8%) 0 AST increased 5 (13%) 1 (3%) 0 ALT
increased 8 (20%) 2 (5%) 0 Hyperkalemia 3 (8%) 2 (5%) 1 (3%)
Hyperlipasemia 4 (10%) 3 (8%) 2 (5%) Hyperamylasemia 0 1 (3%) 1
(3%)
Laboratory findings were transient and reversible, and resolved
spontaneously or following dose interruption and/or reduction.
[0133] FIG. 9 shows various measurements in a subject with
JAK2V617F-positive PMF that started at TG101348 680 mg/day.
TG101348 was able to reduce the palpable spleen size from 9 cm to 0
cm and led to complete resolution of pruritus in this subject.
[0134] Conclusions:
[0135] TG101348 was generally well tolerated, with manageable,
grade 1 gastrointestinal effects, especially at higher doses. The
data indicated no long-term toxicities. The expected on-target
myelosuppressive effect appeared to be mostly limited to
erythropoiesis, which may be attenuated at lower, but still
effective, doses. TG101348 had remarkable activity in MF-associated
splenomegaly: .about.two-thirds achieved >50% reduction in
palpable splenomegaly; .about.30% had complete response. TG101348
had significant anti-myeloproliferation activity with virtually all
treated subjects experiencing complete resolution of leukocytosis
and thrombocytosis. TG101348 had remarkable activity against
MF-associated constitutional symptoms, pruritus and cachexia.
TG101348 induced a significant decrease in JAK2V617F allele burden
in a substantial proportion of treated subjects. TG101348 had
minimal effect on serum levels of proinflammatory cytokines; this
was consistent with the absence of immediate adverse
cytokine-rebound phenomenon upon study drug discontinuation.
Without wishing to be bound by any theory, the activity of TG01348
appeared to be a direct consequence of its JAK2 inhibitory activity
and not an indirect effect from non-specific anti-cytokine
activity. Furthermore, the preliminary observations showed
reduction in BM cellularity and reticulinfibrosis with extended
treatment.
Example 3 Evaluation of TG101348 in Myelofibrosis
[0136] The subjects in this study were administered with capsule
form of TG101348.
[0137] Study Design:
[0138] The study constituted a Phase 1, dose-escalation trial
(M-TG101348-001). This study is also described in Examples 1 and 2.
Study eligible patients were >18 years of age with high- or
intermediate-risk primary myelofibrosis (PMF), post-PV MF, or
post-ET MF (Tefferi A et al., Leukemia 22:14-22, 2008). Additional
eligibility criteria and participating centers are listed in Table
6. All patients provided written informed consent. The primary
endpoints were determination of safety and tolerability,
dose-limiting toxicity ("DLT"), maximum tolerated dose ("MTD") and
pharmacokinetic ("PK") behavior of TG101348. The secondary endpoint
was assessment of therapeutic activity.
TABLE-US-00007 TABLE 6 Detailed enrollment criteria for
MF-TG101348-001 Inclusion Criteria Exclusion Criteria 1. Diagnosis
of MF (PMF, post-PV MF, or 1. Any chemotherapy, immunomodulatory
post-ET MF) according to the revised WHO drug therapy,
immunosuppressive therapy, criteria.* corticosteroids > 10
mg/day prednisone or equivalent, or growth factor treatment within
14 days (28 days in the case of darbepoetin) prior to initiation of
TG101348. 2. High-risk MF (defined by Mayo PSS), or 2. Major
surgery or radiation therapy within Mayo PSS intermediate-risk MF**
28 days prior to initiation of TG101348. accompanied by symptomatic
splenomegaly and/or unresponsive to available therapy. 3. At least
18 years of age. 3. Concomitant treatment with agents known to
inhibit or induce CYP3A4, unless approved by the sponsor. 4. Body
weight .gtoreq. 50 kg. 4. Known hypersensitivity to any ingredients
in the study drug formulation. 5. ECOG performance status .ltoreq.
2. 5. Active infection requiring antibiotics. 6. Within 4 days
prior to initiation of 6. Uncontrolled CHF (NYHA Classification 3
TG101348: or 4), angina, MI, CVA, coronary/peripheral ANC .gtoreq.
1 .times. 10.sup.9/L artery bypass graft surgery, TIA, or pulmonary
Platelet count .gtoreq. 50 .times. 10.sup.9/L embolism within 3
months prior to initiation of Serum creatinine .ltoreq. 2.0 mg/dL
study drug. Total bilirubin .ltoreq. 2.0 mg/dL AST or ALT .ltoreq.
3 times the ULN (unless clinically compatible with hepatic EMH) 7.
Life expectancy .gtoreq. 12 weeks. 7. Cardiac dysrhythmias
requiring ongoing treatment, bundle branch block on ECG or QRS
duration > 120 ms, or prolongation of the QTc (Fridericia)
interval to > 450 ms for males or > 470 ms for females. 8.
Negative serum pregnancy test result for 8. Pregnant or lactating
females. women of childbearing potential. 9. Absence of active
malignancy other than 9. Women of childbearing potential, unless
MF, with the exception of adequately treated surgically sterile for
at least 3 months (i.e., basal cell carcinoma and squamous cell
hysterectomy), postmenopausal for at least 12 carcinoma of the
skin. months (FSH > 30 U/mL), unless they agree to use
effective, dual contraceptive methods (i.e., oral, injectable, or
barrier method with male partner using a condom) while on study
drug. 10. Provide written informed consent to 10. Men who partner
with a woman of participate. childbearing potential, unless they
agree to use effective, dual contraceptive methods (i.e., a condom,
with female partner using oral, injectable, or barrier method)
while on study drug. 11. Willing to comply with scheduled visits,
11. Known HIV- or AIDS-related illness. treatment plans, laboratory
assessments, and 12. Clinically active hepatitis B or C. other
study-related procedures. 13. Any severe, acute or chronic medical,
neurological, or psychiatric condition or laboratory abnormality
that may increase the risk associated with study participation or
study drug administration, may interfere with the informed consent
process and/or with compliance with the requirements of the study,
or may interfere with the interpretation of study results and, in
the investigator's opinion, would make the patient inappropriate
for entry into this study. Abbreviations: AIDS = acquired
immunodeficiency syndrome; ALT = alanine aminotransferase; ANC =
absolute neutrophil count; AST = aspartate aminotransferase; CHF =
congestive heart failure; CVA = cerebrovascular accident; ECG =
electrocardiogram; ECOG = Eastern Cooperative Oncology Group; EMH =
extramedullary hematopoiesis; FSH = follicle stimulating hormone;
HIV = human immunodeficiency virus; MF = myelofibrosis; MI =
myocardial infarction; NYHA = New York Heart Association; PSS =
prognostic scoring system; TIA = transient ischemic attack; WBC =
white blood cell. *Tefferi and Vardiman. Leukemia. 2008 Jan; 22(1):
14-22 **High-risk disease requires two and intermediate-risk
disease requires one of the following prognostic factors:
hemoglobin < 10 g/dL, WBC count <4 or> 30 .times.
10.sup.9/L, platelet count < 100 .times. 10.sup.9/L, absolute
monocyte count .gtoreq. 1 .times. 10.sup.9/L.
[0139] Patients were assigned to one of 8 dose cohorts, ranging
from 30 to 800 mg per day, using standard 3+3 cohort design.
TG101348 was administered orally once daily, with a treatment plan
for continuous daily therapy for 24 weeks (6.times.28-day cycles).
Intra-subject dose escalation was permitted after completion of at
least 3 cycles of treatment at the starting dose. Once DLT was
identified, a dose-confirmation cohort initiated treatment at the
MTD. Treatment beyond 6 cycles was allowed on an extension study
(MF-TG101348-002; NCT00724334) if deemed beneficial to the patient
and if well tolerated.
[0140] Assessment of Toxicity and Response:
[0141] Safety assessments were performed weekly during cycle 1,
every other week during cycles 2 and 3, and every 4 weeks
thereafter. Toxicity was graded in accordance with the National
Cancer Institute Common Terminology Criteria for Adverse Events
(NCI-CTCAE) version 3.0.
[0142] Responses were measured every 4 weeks per International
Working Group for MPN Research and Treatment (IWG-MRT) criteria
(Tefferi A et al., Blood 108:1497-1503, 2006). Assessment of bone
marrow histology was performed at baseline and every 24 weeks of
therapy. Changes in JAK2V617F allele burden in the granulocyte
fraction of peripheral blood were measured as previously described
(Kittur J et al., Cancer 109:2279-2284, 2007); the assessments were
at baseline and every 4 weeks during the first 6 cycles, and every
6.sup.th cycle of therapy in the extension study.
[0143] Pharmacokinetics:
[0144] The concentration-time curves of TG101348 in plasma were
evaluated by a non-compartmental analysis (with the use of
WinNonlin.RTM. software, version 5.2).
[0145] Cytokine Assessment:
[0146] Samples for cytokine measurement were collected at baseline
and every 4 weeks thereafter. Cytokine levels were measured using
multiplexed sandwich ELISAs (Millipore, St. Charles, Mo.).
Results
[0147] Enrollment of Patients:
[0148] A total of 59 subjects were enrolled; 28 in the
dose-escalation phase and 31 in the dose-confirmation phase (Table
7). Forty-four subjects had PMF, 12 post-PV MF, and 3 post-ET MF;
86% were JAK2V617F-positive. The median duration of disease was 3.4
years (range 0.06 to 25.8). At study enrollment, the median
palpable spleen size was 18 cm below the left costal margin (83%
had a palpable spleen size >10 cm), median hemoglobin level was
9.2 g/dL. (range 6.6 to 15.2) and 21 (36%) subjects were red cell
transfusion-dependent by IWG-MRT criteria.
TABLE-US-00008 TABLE 7 Demographic and Baseline Subject
Characteristics TG101348 Starting Dose (mg/day) MTD All 30 60 120
240 360 520 680 800 Cohort Doses Characteristic n = 4 n = 3 n = 3 n
= 3 n = 3 n = 3 n = 34 n = 6 n = 40 n = 59 Age - years 63.5 64.0
63.0 68.0 66.0 57.0 63.5 69.0 65.1 (10.47).dagger. .sup. 64.5
(9.70).dagger. .sup. Range 55-76 56-66 53-71 55-79 61-71 50-66
43-83 50-85 43-85 43-85 Gender Male 2 3 1 2 2 2 18 4 22 (55.0%) 34
(57.6%) Female 2 0 2 1 1 1 16 2 18 (45.0%) 25 (42.4%) Race White 3
2 3 3 3 2 29 6 35 (87.5%) 51 (86.4%) Black, African 0 0 0 0 0 0 1 0
1 (2.5%) 1 (1.7%) American Asian 1 1 0 0 0 0 3 0 3 (7.5%) 5 (8.5%)
Other 0 0 0 0 0 1 1 0 1 (2.5%) 2 (3.4%) Diagnosis PMF 3 2 1 3 2 2
27 4 31 (77.5%) 44 (74.6%) Post-PV MF 1 1 2 0 1 1 6 0 6 (15.0%) 12
(20.3% ) Post-ET MF 0 0 0 0 0 0 1 2 3 (7.5%) 3 (5.1%) Risk Category
(Mayo PSS) High 0 0 1 2 0 3 14 6 20 (50.0%) 26 (44.1%) Not high* 4
3 2 1 3 0 20 0 20 (50.0%) 33 (55.9%) JAK2.sup.V617F 3 3 3 2 3 2 29
6 35 (87.5%) 51 (86.4%) Positive Transfusion 1 1 0 1 0 2 13 3 16
(40.0%) 21 (35.6%) Dependent Spleen Size > 3 3 3 2 3 2 28 5 33
(82.5%) 49 (83.1%) 10 cm Abbreviations: ET, essential
thrombocythemia; JAK, Janus kinase; MF, myelofibrosis; PMF, primary
myelofibrosis; PV, polycythemia vera; PSS, prognostic scoring
system. *Equivalent to symptomatic/treatment refractory
intermediate-risk disease. .dagger.Mean (standard deviation)
[0149] In the dose-escalation phase, the starting dose of TG101348
was 30 mg/day and subsequent dose levels were 60, 120, 240, 360,
520, 680 and 800 mg/day (Table 7). At 800 mg/day, 2 of 6 patients
experienced DLT; consequently, the MTD was declared at 680 mg/day.
In the dose-confirmation phase, all patients started treatment at
the MID. The "MTD cohort" (n=40; Table 7) included patients who
received 680 mg/day as their starting dose (dose-escalation cohort,
n=3; dose-confirmation cohort, n=31) and those whose drug dose was
decreased from 800 mg/day (n=6) to 680 mg/day after MTD was
declared.
[0150] The median (range) exposure to TG101348 for the overall
(n=59) and MTD (n=40) cohorts was 155 (2-172) and 147 (8-171) days,
respectively. TG101348 doses at the end of each cycle per dose
cohort are illustrated in FIGS. 10 and 11. In the MTD cohort, 28
subjects (70%) required dose-reduction during the first 6 cycles;
the primary reasons were: cytopenia(s) (20%), gastrointestinal
adverse events (12.5%), amylase/lipase elevation (10%), ALT
elevation (7.5%), investigator discretion (7.5%), or other adverse
events (12.5%). The median cycle at dose-reduction for the MTD
cohort was cycle 3 (range 1-7); the median (range) dose at the end
of cycle 3 was 680 mg/day (360-680 mg/day); and 520 mg/day (360-680
mg/day) at the end of cycle 6.
[0151] Forty three (73%) subjects, including 28 (70%) from the MTD
cohort, continued treatment on the extension study; at entry into
the extension study, 31 (72%) subjects were receiving <680
mg/day of the drug (median 520 mg/day; range 120-680 mg/day). At
data cutoff, the median (range) cumulative exposure to TG101348 for
the 43 subjects was 380 days (170-767). The number of treatment
cycles completed ranged from 7-29; 39 subjects (66%), including 27
(68%) from the MTD cohort completed 12 treatment cycles. At data
cutoff, 28%, and 14% of subjects who entered the extension study
had completed 18 and 24 treatment cycles, respectively. The median
(range) treatment dose during the extension phase was 440 mg/day
(120-680 mg/day).
[0152] Pharmacokinetics:
[0153] Peak plasma concentration of TG101348 was achieved 1-4 hours
after dosing. TG101348 showed greater than dose-proportional
increases in plasma PK parameters (C.sub.max and AUC.sub.0-4)
(Table 8 and FIG. 12). Mean steady-state C.sub.max and AUC.sub.0-t
values increased approximately 54- and 88-fold, respectively, over
a 27-fold increase in dose. The terminal phase half-life at steady
state remained similar across all doses (16 to 34 hours),
consistent with linear drug elimination. FIG. 18 shows a plot of
mean plasma TG101348 concentrations versus time on a linear plot
after once daily oral doses (Cycle 1; Day 28). The figure shows the
IC50, IC90, and 3 times IC90 (3.times.IC90) values for TG101348 in
relation to the plasma concentration of TG101348 over time. A dose
of 520 mg/day exhibited a plasma concentration TG101348 that was
above 3.times.IC90 over the course of at least 24 hours after the
dose was administered. A dose of 360 mg/day exhibited a Cmax above
3.times.IC90 and a plasma concentration of TG101348 that was above
IC90 over the course of at least 24 hours after the dose was
administered.
TABLE-US-00009 TABLE 8 Mean (SD) plasma pharmacokinetic parameters
following multiple daily doses of TG101348 (Cycle 1, Day 28) in
MF-TG101348-001 Dose/Day 30 mg 60 mg 120 mg 240 mg 360 mg 520 mg
680 mg 800 mg Parameter (n = 3) (n = 3) (n = 3) (n = 3) (n = 3) (n
= 3) (n = 27) (n = 5) C.sub.max 81.85 257.33 556.67 1796.67 1717.33
3886.67 3064.07 4380.00 (ng/mL) (95.630) (121.138) (135.500)
(648.254) (1558.705) (3560.707) (1129.671) (1764.809) T.sub.max*
(hr) 2.00 (0.5, 1.00 (1.0, 2.00 (0.5, 2.00 (2.0, 2.00 (2.0, 4.00
(4.0, 4.00 (0.0, 2.25 (2.0, 4.0) 4.0) 4.0) 2.1) 4.0) 4.0) 8.3) 4.0)
AUC.sub.(0-t) 806.76 2426.53 7645.69 26193.40 23879.05 61749.22
55111.68 70840.97 (hr*ng/mL) (806.973) (1048.264) (2810.740)
(11767.460) (16898.162) (57240.295) (25702.038) (32668.886)
T.sub.1/2 (hr) 20.94 15.68 24.42 20.77 21.39 20.94 33.71 23.99
(7.039) (3.464) (8.434) (6.238) (7.090) (5.006) (33.674) (9.674)
.lamda.z (1/hr) 0.0354 0.0456 0.0305 0.0352 0.0353 0.0343 0.0301
0.0331 (0.01016) (0.00918) (0.00932) (0.00903) (0.01309) (0.00723)
(0.01421) (0.01321) *T.sub.max is presented as median (min, max) SD
indicates standard deviation; C.sub.max, peak plasma concentration;
T.sub.max, the time to the maximal concentration; AUC.sub.(0-t),
area under the concentration-time curve from time zero to the last
measurable concentration; T.sub.1/2, terminal half-life; and
.lamda.z, the elimination rate constant.
[0154] Safety Profile:
[0155] The DLT in 2 of 6 patients treated at 800 mg/day was
asymptomatic grade 3 or 4 hyperamylasemia (with or without
hyperlipasemia) that was reversible. The most common
non-hematologic adverse events at least possibly related to
TG101348 included predominantly grade 1 nausea, diarrhea and
vomiting; grade 3 events were reported overall/in the MTD cohort
for 3%/5%, 10%/13%, and 3%/3% of subjects, respectively, and there
were no Grade 4 events (Table 9). These adverse events were
dose-dependent, with grade 3 occurrences observed almost
exclusively with a TG101348 starting dose of >680 mg/day. The
gastrointestinal symptoms were largely self-limited or controlled
by symptomatic treatment and/or dose reduction. Other adverse
events (Grades 3/4; overall/MTD cohort) included asymptomatic
increases in serum lipase (10%/15%), AST (2%/3%). ALT (7%/8%),
creatinine (0%/0%) and alkaline phosphatase (0%/0%) (Table 9).
TABLE-US-00010 TABLE 9 Treatment-Emergent Non-Hematologic Adverse
Events Considered at Least Possibly Related to TG101348 and
Reported for .gtoreq. 0% of Subjects MTD Cohort All Subjects (n =
40) (n = 59) Severity Severity Severity Severity Adverse Events
Grade 1-2 Grade 3- Grade 1- Grade 3-4 Gastrointestinal disorders
Nausea 31 2 (5.0%) 39 2 (3.4%) Diarrhea 25 5 32 6 (10.2%) Vomiting
27 1 (2.5%) 32 2 (3.4%) Abdominal pain 4 (10.0%) 0 6 (10.2%) 0
General disorders Anorexia 6 (15.0%) 0 8 (13.6%) 0 Edema peripheral
4 (10.0%) 0 6 (10.2%) 0 Abnormal laboratory values Hyperlipasemia 9
(22.5%) 6 10 6 (10.2%) Alanine 9 (22.5%) 3 (7.5%) 11 4 (6.8%)
aminotransferase increased Aspartate 13 1 (2.5%) 15 1 (1.7%)
aminotransferase increased Blood creatinine 11 0 14 0 increased
Blood alkaline 9 (22.5%) 0 10 0 phosphatase increased Hypocalcemia
6 (15.0%) 1 (2.5%) 7 (11.9%) 1 (1.7%) Skin and subcutaneous tissue
disorders Skin exfoliation 8 (20.0%) 0 8 (13.6%) 0 Dry skin 6 (15%)
0 6 (10.2%) 0
[0156] Grade 3/4 hematological adverse events considered related to
TG101348 included anemia (35% of 37 subjects who were not
transfusion dependent at baseline), thrombocytopenia (24%) and/or
neutropenia (10%) (Table 10). The majority of treatment-emergent
cytopenias were noted in the first three cycles of treatment. Of
the 13 subjects who developed grade 3/4 anemia (all in the MTD
cohort). 67% entered the study with grade 2 anemia. Emergence of
transfusion requirement was significantly lower for subjects who
initiated treatment at 240-520 mg/day (33%) as opposed to 680
mg/day (72%). Of the 14 subjects with grade 3/4 thrombocytopenia, 4
and 5 subjects entered the study with grade 1 and 2
thrombocytopenia, respectively.
TABLE-US-00011 TABLE 10 Treatment-Emergent Hematologic Adverse
Events Considered at Least Possibly Related to TG101348 and
Reported for .gtoreq.10% of Subjects MTD Cohort All Subjects (n =
40) (n = 59) Severity Severity Severity Severity Grade 1-2 Grade
3-4 Grade 1-2 Grade 3-4 Anemia* 2 (8.3%) 13 (54.2%) 3 (8.1%) 13
(35.1%) Throm- 8 (20.0%) 11 (27.5%) 10 (17.0%) 14 (23.7%)
bocytopenia Neutropenia 2 (5.0%) 4 (10.0%) 2 (3.4%) 6 (10.2%)
*Events reported only for subjects who were not transfusion
dependent at study entry (MTD Cohort, n = 24; All Subjects, n = 37)
are presented.
[0157] At data cutoff, no unique safety findings have emerged with
continued dosing of TG101348 beyond 6 cycles of therapy.
[0158] Serious adverse events considered at least possibly related
to TG101348 occurred in 8 subjects and included asymptomatic
hyperlipasemia, thrombocytopenia/neutropenia, depression, tumor
lysis syndrome, cerebrovascular accident, and dehydration (Table
11). One subject discontinued treatment due to Grade 4
thrombocytopenia; all other events were reversible and subjects
were able to resume treatment at a lower dose after resolution of
the adverse event.
TABLE-US-00012 TABLE 11 Serious Adverse Events Assessed by
Investigators as at Least Possibly Related to Therapy
(MF-TG101348-001 and MF-TG101348-002) Starting Dose/ Onset From
CTCAE Dose at Event Start of Dosing Severity Action Taken Subject #
Event (mg/day) (days) Grade With Study Drug Outcome 105-013
Thrombocytopenia 240/360 215 4 None Recovered/resolved
Thrombocytopenia 240/360 247 4 Permanently discontinued Not
recovered/ not resolved Hyperlipasemia 240/0 356 4 None
Recovered/resolved 104-015 Depression 360/520 256 3* Permanently
discontinued Not recovered/ not resolved 106-024 Nausea 800/680 87
2 Stopped temporarily Recovered/resolved Vomiting 800/680 87 2
Stopped temporarily Recovered/resolved Diarrhea 800/680 87 3
Stopped temporarily Recovered/resolved Dehydration 800/680 87 2
Stopped temporarily Recovered/resolved Tumor lysis syndrome 800/440
366 3 Stopped temporarily Recovered/resolved Dehydration 800/400
474 3 None Recovered/resolved 106-033 Pleuritic pain 680/680 8 2
Stopped temporarily Recovered/resolved 106-045 Dehydration 680/440
170 3 Stopped temporarily Recovered/resolved 101-047 Neutropenia
680/680 52 2 Stopped temporarily Recovered/resolved 105-056
Cerebrovascular 680/680 22 4 Stopped temporarily Recovered/resolved
accident Gallbladder pain 680/520 95 3 Stopped temporarily
Recovered/resolved with sequelae 105-059 Hyperlipasemia 680/680 8 3
Stopped temporarily Recovered/resolved Hyperlipasemia 680/520 28 3
Stopped temporarily Recovered/resolved Cardiac arrest 680/360 42 5
Permanently discontinued Fatal *Subject died (suicide)
approximately 12 weeks after discontinuation of study drug.
One subject presented with severe pulmonary hypertension and right
heart failure during cycle 4 (at 240 mg/day); the event was
considered unrelated to TG101348 per the investigator.
[0159] Fifteen (25%) subjects discontinued treatment during the
first 6 cycles of therapy (Table 12). Reasons for discontinuation
included treatment-related adverse events (n=6); investigator
decision/intercurrent illness (n=3) or withdrawal of consent (n=6).
Eight of 43 subjects (19%) discontinued treatment during the
extension study, including 3 because of adverse events following a
total of 24 to 46 weeks on therapy (Table 12).
TABLE-US-00013 TABLE 12 Subjects discontinuing study due to death,
toxicity, withdrawal of consent, or intercurrent illness
MF-TG101348-001 Reasons for Discontinuation (Table 12 A) Starting
Dose at Duration of Dose Termination Treatment Subject (mg/day)
(mg/day) (days) Reason 102-002 30 30 2 Investigator discretion -
previously undiagnosed cardiac condition with long QT.sub.c
interval 106-009 120 240 109 Patient withdrew consent 101-011 240
240 100 Patient withdrew consent 102-019 520 520 42 Adverse event -
neutropenia (grade 3; probably related) 102-023 800 680 70
Investigator discretion - recurrent Waldenstrom's macroglobulinemia
104-027 800 680 77 Adverse event - thrombocytopenia (grade 4;
possibly related) 106-028 800 520 44 Adverse event -
thrombocytopenia (grade 4; possibly related) 104-029 680 680 44
Adverse event - endocarditis (grade 3; not related), embolic stroke
(grade 3; not related) 101-032 680 680 8 Investigator discretion -
Acquired factor VIII inhibitor 101-040 680 520 24 Adverse events -
diarrhea (grade 3; possibly related) 103-043 680 360 68 Patient
withdrew consent 103-046 680 680 26 Patient withdrew consent
102-051 680 600 108 Patient withdrew consent 102-054 680 680 75
Patient withdrew consent 105-059 680 360 27 Adverse event - cardiac
arrest (grade 5; possibly related) MF-TG101348-002 Reasons for
Discontinuation (Table 12B) Cumulative Starting Dose at Duration of
Dose Termination Treatment Subject (mg/day) (mg/day) (days) Reason
101-005 60 360 196 Investigator discretion - lack of response to
treatment 106-010 120 520 185 Investigator discretion 105-013 240
360 321 Adverse event - thrombocytopenia (grade 4; probably
related) 104-015 360 520 257 Adverse event - depression (grade 3;
possibly related) 106-016 360 680 527 Investigator discretion -
lack of response to treatment 104-017 520 200 309 Investigator
discretion - disease progression 105-021 680 520 357 Patient
withdrew consent 101-047 680 320 233 Adverse event - elevated
creatinine (grade 2; possibly related)
[0160] Three subjects had disease progression (doses at study start
and discontinuation are indicated): one each with progressive
hepatosplenomegaly and ascites with superimposed endocarditis
(cycle 2; 680 and 520 mg/day), accelerated myelofibrosis (cycle 13;
520 and 200 mg/day), and leukemic transformation (cycle 2; 520 and
520 mg/day).
[0161] Responses are shown below.
[0162] Splenomegaly:
[0163] The onset of spleen response was rapid, and generally seen
within the first 2 cycles. By cycle 6, 36 subjects (61%) had
experienced a minimum 25% decrease in palpable spleen size,
including 65% in the MTD cohort (intent-to-treat analysis). By this
time-point, a .gtoreq.50% decrease in palpable spleen size
persistent for at least 8 weeks (i.e. Clinical Improvement ("CI")
per IWG-MRT criteria) had been observed in 39% and 45% of subjects
overall and in the MTD cohort, respectively. Spleen responses per
treatment cycle for the MTD cohort are shown in FIG. 13. Three of 4
subjects (75%) with JAK2V617F-negative MF who completed 6 cycles of
treatment achieved CI. The lowest starting dose at which CI was
observed was 240 mg/day. The median time (range) to CI across doses
was 141 days (41 to 171), and 113 days (41-170) for the MTD cohort.
By cycle 12, spleen responses (CI) were observed in 48% and 50% of
subjects, for the overall and MTD cohorts, respectively. The mean
(standard deviation) duration of spleen response per IWG-MRT
criteria was 315 (.+-.129) days and 288 (.+-.76) days for the
overall and MTD cohorts, respectively.
[0164] Constitutional Symptoms:
[0165] Thirty five subjects in the MTD cohort endorsed the presence
and severity of early satiety, fatigue, night sweats, cough, and
pruritus on an 11-point scale (0=absence of symptoms to 10=worst
imaginable symptoms) at baseline and at the end of at least one
cycle. Symptoms were categorized as "absent" (score=0), "mild"
(score=1-3), "moderate" (score=4-7), or "severe" (score=8-10).
[0166] Early satiety was reported by 29 (85%) subjects at baseline.
After 2 cycles of treatment (n=27), 56% reported complete
resolution of this symptom (FIG. 14A). Fatigue was reported at
baseline by 26 (76%) subjects. After 6 cycles (n=16), 63% reported
improvement and 25% complete resolution of this symptom (FIG. 14B).
Night sweats were reported at baseline by 14 (40%) subjects. After
1 cycle, 64% of subjects had complete resolution of this symptom;
after 6 cycles, this proportion had increased to 89% (n=9) (FIG.
14C). Cough was reported at baseline by 13 (37%) subjects. After 1
cycle (n=12), 75% reported improvement and 67% complete resolution
of this symptom. Pruritus was reported by 8 (23%) subjects at
baseline. After 1 cycle, 75% had improvement, with 50% reporting
complete resolution. Responses in constitutional symptoms were
durable in most instances.
[0167] Body Weight:
[0168] At the end of 6 and 12 cycles, the median body weight was
stable relative to baseline for the overall and MTD cohorts (Table
13).
TABLE-US-00014 TABLE 13 Change in weight during study treatment
Baseline 6 Cycles 12 Cycles MTD MTD MTD Overall Cohort Overall
Cohort Overall Cohort Weight (kg) (n = 57) (n = 38) (n = 43) (n =
28) (n = 36) (n = 26) Median (range) 75.6 77.7 76.9 77.7 76.1 76.5
(48.2-105.2) (48.2-96.1) (51.4-105.8) (51.4-97.6) (49.8-106.8)
(49.8-99.5) Change from n/a n/a 0.4 0.6 0.7 0.35 baseline Median
(-11.7-8.9) (-9.2-8.9) (-10.7-13.7) (-10.7-13.7) (range) kg
indicates kilograms; n, number, and MTD, maximum tolerated dose
[0169] Leukocytosis and Thrombocytosis:
[0170] Leukocytosis (WBC count >11.times.10.sup.9/L) was present
at baseline in 33 subjects (56%), 28 of whom completed 6 cycles of
treatment; of these, 18 were in the MTD cohort. Following 6 cycles,
16 subjects across doses (57%) and 13 subjects in the MTD cohort
(72%) achieved a normal WBC count (FIG. 15); following 12 cycles,
14 of 25 (56%) across doses and 10 of 17 (59%) in the MTD cohort
had normal WBC counts.
[0171] Thrombocytosis (platelet count >450.times.10.sup.9/L) was
noted at baseline for 10 (17%) subjects across doses and 7 (19%) in
the MTD cohort (n=37), all of whom completed 6 cycles of therapy.
At this time point, 90% and 100% of subjects across doses and in
the MTD cohort, respectively, achieved a normal platelet count;
following 12 cycles, 7 of 8 subjects (88%) across doses and all 6
subjects in the MTD cohort had a normal platelet count.
[0172] JAK2V617F Allele Burden:
[0173] Fifty-one subjects (86%) were JAK2V617F-positive, with a
median (range) allele burden of 20% (3%-100%); of these, 23 (45%)
had a "significant" allele burden (defined as >20% at baseline)
with a median (range) of 60% (23%-100%). For the overall
mutation-positive subjects, there was a significant decrease in the
JAK2V617F allele burden after 6 cycles (p=0.04) and 12 cycles of
treatment (p=0.01) (FIGS. 16A and 16B). After 6 and 12 cycles of
treatment, the median (range) allele burden was 17% (0%-100%) and
19% (0%-100%), respectively. Similarly, for the 23 subjects with
baseline JAK2V617F allele burden of >20%, there was a
significant and even more pronounced decrease in the JAK2V617F
allele burden after 6 cycles (p=0.002) and 12 cycles of treatment
(p=0.002) (FIGS. 16C and 16D). After 6 and 12 cycles of treatment,
the median (range) allele burden was 31% (4%-100%) and 32%
(7%-100%), respectively. After 6 cycles, 16 of 20 subjects (80%)
with baseline allele burden >20% who reached this time-point
exhibited a median 61% (range 6% to 96%) decrease, and 9 subjects
(45%) had a >50% decrease in JAK2V617F allele burden. In
contrast, 4 subjects (20%) exhibited an increase (18%, 21%, 30%,
and 58%). Eighteen subjects (78%) of the group with allele burden
>20% completed 12 cycles of treatment with a median 50% (range
29% to 82%) decrease, and 7 (39%) subjects had a >50% decrease
in JAK2V617F. Three (17%) subjects exhibited an increase in allele
burden (7%. 18%, and 22%), and 2 others with 100% allele burden at
baseline exhibited no change.
[0174] Discussion:
[0175] A significant proportion of patients treated in this study
experienced rapid, substantial, and durable control of symptomatic
splenomegaly, leukocytosis, thrombocytosis, and constitutional
symptoms. In addition, there was also evidence for a significant
reduction in genomic disease burden that indicates potential for
disease modifying activity. There were responses in MF patients who
were JAK2V617F negative. It is unknown whether the subjects in this
study have other mutations in the JAK-STAT signal transduction
pathway such as MPL, LNK or as yet unknown alleles (Pardanani A D
et al., Blood 108:3472-3476, 2006; Oh S T et al., Blood First
Edition Paper, prcpublishcd online Apr. 19, 2010; DOI
101182/blood-2010-02-270108 2010; Pardanani A et al., Leukemia In
press:2010).
[0176] The clinical study results show that TG101348 therapy can be
discontinued without prior dose reduction or tapering. Subjects
that were discontinued (whether or not recontinued at a later date)
did not experience "cytokine rebound". This indicates that the
treatment may be discontinued without prior dose reduction.
[0177] Cytokine rebound in the context of myelofibrosis is a
phenomenon that has occurred in patients receiving therapy other
than TG101348 therapy and were discontinued for any reason. In some
cases, the discontinued patients experienced severe symptoms
including acute spleen size enlargement and relapse of
constitutional symptoms. In some cases, the discontinued patients
experienced life-threatening hemodynamic disturbances (Wadleigh and
Tefferi, Clinical Advances in Hematology & Oncology, 8:557-563,
2010).
[0178] Of note, among small molecule inhibitors of the JAK-STAT
pathway in MF, TG101348 appeared to be unique in its ability to
induce a significant and sustained decrease in JAK2V617F mutant
allele burden. Without wishing to be bound by any theory, it
appeared that the effect of JAK2 inhibition on disease burden was
the basis for evidence of clinical efficacy in myelofibrosis with
TG101348, as opposed to an indirect anti-cytokine effect that may
play a major role in responses to JAK family antagonists that have
off-target activity for JAK1 as well as for JAK2. In support of
this, there were no consistent changes in levels of
pro-inflammatory cytokines (interleukin ("IL")-6, IL-2, IL-8, and
TNF-.alpha.) relative to baseline during the course of TG101348
treatment (FIG. 17). In contrast, and consistent with the on-target
activity of TG101348 for JAK2, increases in serum EPO and to a
lesser extent TPO levels relative to baseline were observed after
treatment initiation (data not shown).
[0179] The DLT (asymptomatic hyperamylasemia, sometimes with
hyperlipasemia) for TG101348 was observed with other small molecule
inhibitors including nilotinib (Kantarjian H M et al., Blood
110:3540-3546, 2007). Gastrointestinal adverse events were frequent
in this study but accounted for treatment discontinuation in only
one subject. These symptoms occurred as early as after the first
administered dose, and demonstrated a clear dose-dependent
relationship. The myelosuppressive effects of TG101348 were also
dose-dependent.
[0180] While the MTD (680 mg/day) of TG101348 was the most
efficacious dose, it was also associated with the highest incidence
of adverse events. Therefore, a lower starting dose (e.g. 400-500
mg/day) may provide an optimal risk/benefit balance. Furthermore,
because myelofibrosis is a heterogeneous disease, a dynamic dosing
schedule may maximize the opportunity for identifying a
patient-specific optimal dose.
[0181] These observations suggest that, in addition to MF, TG101348
may also have a potential role for the treatment of PV and ET.
Example 4. Synthesis of TG101348
Example 4.1
N-tert-Butyl-3-(2-chloro-5-methyl-pyrimidin-4-ylamino)-benzenesulfonamide
(Intermediate)
Example 4.1(a)
##STR00003##
[0183] A mixture of 2-chloro-5-methyl-pyrimidin-4-ylamine (1) (0.4
g, 2.8 mmol), 3-bromo-N-tert-butyl-benzenesulfonamide (2) (1.0 g,
3.4 mmol), Pd.sub.2(dba).sub.3 (0.17 g, 0.19 mmol), Xantphos (0.2
g, 3.5 mmol) and cesium carbonate (2.0 g. 6.1 mmol) was suspended
in dioxane (25 mL) and heated at reflux under the argon atmosphere
for 3 h. The reaction mixture was cooled to room temperature and
diluted with DCM (30 mL). The mixture was filtered and the filtrate
concentrated in vacuo. The residue was dissolved in EtOAc and
hexanes added until solid precipitated. After filtration, the title
compound (1.2 g, 98%) was obtained as a light brown solid. It was
used in the next step without purification. MS (ES+): m/z 355
(M+H).sup.+.
Example 4.1(b)
##STR00004##
[0185] The Intermediate was synthesized from
2,4-dichloro-5-methylpyrimidine (SM1) and
N-t-butyl-3-aminobenzenesulfonamide (SM2) in the following steps:
(1) Mix MeOH (6.7 UOa) and SM1 (Combi Blocks) (UOa); (2) Add SM2
(1.15 UOa, 082eq) and H.sub.2O (8.5 UOa); (3) Heat 45.degree. C.,
20h, N.sub.2, IPC CPL SM2<2%; (4) Cool 20.degree. C.: (5)
Centrifuge, N.sub.2; (6) Wash H.sub.2O (2.1 UOa)+MeOH (1.7 UOa);
(7) Mix solid in H.sub.2O (4.3 UOa)+MeOH (3.4 UOa); (8) Centrifuge,
N.sub.2; (9) Wash H.sub.2O (2.1 UOa)+MeOH (1.7 UOa); and (10) Dry
45.degree. C. vacuum, 15h. Obtained Intermediate, mass 49.6 kg
(UOb); Yield 79%; OP: 99.6%.
Example 4.2
N-tert-Butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyr-
imidin-4-yl)amino]benzenesulfonamide
##STR00005##
[0186] Example 4.2(a)
[0187] A mixture of
N-tert-Butyl-3-(2-chloro-5-methyl-pyrimidin-4-ylamino)-benzenesulfonamide
(Intermediate) (0.10 g, 0.28 mmol) and
4-(2-pyrrolidin-1-yl-ethoxy)-phenylamine (3) (0.10 g, 0.49 mmol) in
acetic acid (3 mL) was sealed in a microwave reaction tube and
irradiated with microwave at 150.degree. C. for 20 min. After
cooling to room temperature, the cap was removed and the mixture
concentrated. The residue was purified by HPLC and the corrected
fractions combined and poured into saturated NaHCO.sub.3solution
(30 mL). The combined aqueous layers were extracted with EtOAc
(2.times.30 mL) and the combined organic layers washed with brine,
dried over anhydrous Na.sub.2SO.sub.4
References