(12) United States Patent
`Weckbecker
`
`(54) COMBINATION OF A SOMATOSTATIN
`ANALOGUE AND A RAPAMYCIN
`
`(75)
`
`Inventor: Gisbert Weckbecker, Biel-Benken
`(CH)
`
`(73) Assignee: Novartis AG, Basel (CH)
`
`( *) Notice:
`
`Subject to any disclaimer, the term of this
`patent is extended or adjusted under 35
`U.S.C. 154(b) by O days.
`
`(21) Appl. No.:
`
`09/194,957
`
`(22) PCT Filed:
`
`Jun. 11, 1997
`
`(86) PCT No.:
`
`PCT/EP97 /03036
`
`§ 371 Date:
`
`Dec. 7, 1998
`
`§ 102(e) Date: Dec. 7, 1998
`
`(87) PCT Pub. No.: WO97/47317
`
`PCT Pub. Date: Dec. 18, 1997
`
`I 1111111111111111 11111 111111111111111 IIIII IIIII lllll 111111111111111 11111111
`US006362164Bl
`US 6,362,164 Bl
`Mar.26,2002
`
`(10) Patent No.:
`(45) Date of Patent:
`
`(52) U.S. Cl. ............................. 514/16; 530/311; 514/2;
`540/456
`(58) Field of Search ............................................ 514/15
`
`(56)
`
`GB
`WO
`
`References Cited
`
`FOREIGN PATENT DOCUMENTS
`
`2 239 178 A
`WO 93 11130 A
`
`6/1991
`6/1993
`
`OTHER PUBLICATIONS
`
`Shi E.A., Cancer Research, vol. 55, pp. 1982-19088 (1995).
`*
`Grant et al., Circulation, vol. 89, No. 4, pp. 1511-1517
`(1994).
`Demoliou-Mason, Exp. Opin.Ther. Patents, vol. 4, No. 7,
`pp. 813-829 (1994).
`
`Primary Examiner-Michael Borin
`(74) Attorney, Agent, or Firm-Joseph J. Borovian
`
`(57)
`
`ABSTRACT
`
`(30)
`
`Foreign Application Priority Data
`
`Jun. 11, 1996
`Sep. 16, 1996
`
`(GB) ............................................. 9612171
`(GB) ............................................. 9619310
`
`A combination of a compound of the somatostatin class and
`a rapamycin macrolide is useful for the prevention or
`treatment of cell hyperproliferation.
`
`(51)
`
`Int. Cl.7 ......................... A61K 38/31; A61K 38/08
`
`13 Claims, No Drawings
`
`Breckenridge Exhibit 1152
`Breckenridge v. Novartis IPR2017-01592
`Weckbecker 164 Patent
`
`

`

`1
`COMBINATION OF A SOMATOSTATIN
`ANALOGUE AND A RAPAMYCIN
`
`US 6,362,164 Bl
`
`10
`
`2
`c) a dipeptide residue in which the individual amino acid
`residues are the same or different and are selected from
`those defined under a) and/orb) above, the a-amino
`group of amino acid residues a) and b) and the
`N-terminal amino group of dipeptide residues c) being
`optionally mono- or di-C1 _12alkylated or substituted by
`C1 _8 alkanoyl;
`A' is hydrogen or C1 _3 alkyl,
`Y 1 and Y 2 represent together a direct bond or each of Y 1
`and Y 2 is hydrogen
`B is -Phe- optionally ring-substituted by halogen, NO 2 ,
`NH2 , OH, C1 _3 alkyl and /or C1 _3 alkoxy (including
`pentafluoroalanine ), naphthylalanine or pyridylalanine,
`C is (L)-Trp- or (D)-Trp- optionally a-N-methylated and
`optionally benzene-ring-substituted by halogen, NO 2 ,
`NH2 , OH, C1 _3 alkyl and/or C1 _3 alkoxy,
`is Lys,
`4-aminocyclohexylAla
`4-aminocyclohexylGly,
`E is Thr, Ser, Val, Tyr, lie, Leu or an aminobutyric or
`aminoisobutyric acid residue,
`G is a group of formula
`
`D
`
`or
`
`/R11
`-COOR7, -CH20R10, -CON'-.
`
`or
`
`R12
`
`wherein
`R7 is hydrogen or C1 _3 alkyl,
`Rm is hydrogen or the residue of a physiologically
`acceptable, physiologically hydrolysable ester, e.g.
`formnyl, C2 _12alkylcarbonyl, benzoyl,
`R11 is hydrogen, C1 _3 alkyl, phenyl or C7_mphenylalkyl
`R12 is hydrogen, C1 _3 alkyl or a group of formula -CH
`(R13)-X1 ,
`R13 is CH2OH, ----(CH2) 2-OH, ----(CH2h-OH, -CH
`(CH3)OH, isobutyl, butyl, benzyl, naphthyl-methyl or
`indol-3-yl-methyl, and
`X1 is a group of formula
`
`The present invention relates to a pharmaceutical com(cid:173)
`bination and its use in the treatment of disorders associated 5
`with excess benign and malignant cell proliferation, e.g.
`tumors or intimal cell proliferation.
`There is a continuing need for the development of drugs
`having increased effectiveness in inhibiting or slowing down
`undesired cell proliferation, particularly in the cancer field
`and in vasculopathies.
`Accordingly, there is provided a pharmaceutical combi(cid:173)
`nation comprising a compound of the somatostatin class,
`and a rapamycin macrolide.
`The somatostatin class is a known class of small peptides 15
`comprising the naturally occurring somatostatin-14 and ana(cid:173)
`logues having somatostatin related activity, e.g. as disclosed
`by A S. Dutta in Small Peptides, Vol. 19, Elsevier (1993).
`By "somatostatin analogue" as used herein is meant any
`straight-chain or cyclic polypeptide having a structure based 20
`on that of the naturally occurring somatostatin-14 wherein
`one or more amino acid units have been omitted and/or
`replaced by one or more other amino radical(s) and/or
`wherein one or more functional groups have been replaced
`by one or more other functional groups and/or one or more 25
`groups have been replaced by one or several other isosteric
`groups. In general, the term covers all modified derivatives
`of the native somatostatin-14 which exhibit a somatostatin
`related activity, e.g. they bind to at least one somatostatin
`receptor (hSST-1, hSST-2, hSST-3, hSST4 or hSST-5), pref(cid:173)
`erably in the nMolar range, more preferably to at least the
`hSST-2 receptor in the nMolar range.
`Cyclic, bridge cyclic and straight-chain somatostatin
`analogues or derivatives are known and have been described
`together with processes for their production e.g. in U.S. Pat.
`Nos. 4,310,518 and 4,235,886, in European Patent Specifi(cid:173)
`cations EP-A-1295; 23,192; 29,310; 29,579; 30,920; 31,303;
`63,308; 70,021; 83,305; 215,171; 203,031; 214,872; 143,
`307; 298,732; 277,419; 389,180; 395,417; 450,480A2; in 40
`Belgian Patent Specification BE-A-900,089; and in WO
`91/09056; WO 97/01579; WO 97/14715, the contents
`thereof, in particular with respect to the compounds, being
`incorporated herein by reference.
`Preferred somatostatin analogues are e. g. compounds of
`formula I
`
`30
`
`35
`
`45
`
`(I)
`
`50
`
`/R14
`-COOR7, -CH20R10 or - co -N ,
`
`R1s
`
`wherein
`A is C1 _12alkyl, C7_mphenylalkyl or a group of formula
`RCO-, whereby
`i) R is hydrogen, C1 _11 alkyl, phenyl or C7_mphenylalkyl,
`or
`ii) RCO- is
`a) a D-phenylalanine residue optionally ring-substituted
`by halogen, NO 2 , NH 2 , OH, C1 _3 alkyl and/or
`C1 _3 alkoxy; or
`b) the residue of a natural or a synthetic a-amino-acid
`other than defined under a) above, or of a correspond(cid:173)
`ing D-amino acid, or
`
`55
`
`wherein
`R7 and Rm have the meanings given above,
`R14 is hydrogen or C1 _3 alkyl,
`R15 is hydrogen, C1 _3 alkyl, phenyl or C7_mphenylalkyl,
`and
`R16 is hydrogen or hydroxy,
`60 with the proviso that
`when R12 is -CH(R13)-X1 , then R11 is hydrogen or
`methyl,
`wherein the residues B, D and E have the L-configuration,
`and the residues in the 2- and 7-position each independently
`65 have the (L)- or (D)-configuration,
`in free form or in pharmaceutically acceptable salt or com(cid:173)
`plex form.
`
`Breckenridge Exhibit 1152
`Breckenridge v. Novartis IPR2017-01592
`Weckbecker 164 Patent
`
`

`

`US 6,362,164 Bl
`
`3
`Individual compounds of formula I suitable in accordance
`with the present invention are the following somatostatin
`analogues:
`
`4
`
`wherein
`X2 is a radical of formula (a) or (b)
`
`a.
`
`(D)Phe-Cys-Phe-(D)Trp-Lys-Thr-Cys-Thr-ol
`
`also known as octreotide
`
`b. (D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-ThrNH2
`
`c. (D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-TrpNH2
`
`also known as vapreotide
`
`d.
`
`(D)Trp-Cys-Phe-(D)Trp-Lys-Thr-Cys-ThrNH2
`
`e. (D)Phe-Cys-Phe-(D)Trp-Lys-Thr-Cys-ThrNH2
`
`f. 3-(2-(Naphthyl)-(D)Ala-Cys-Tyr-(D)Trp-Lys-Val-Cys-ThrNH2
`
`also known as lanreotide
`
`g. (D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-i3-Nal-NH2
`
`h. 3-(2-naphthyl)-Ala-Cys-Tyr-(D)Trp-Lys-Val-Cys-j3-Nal-NH2
`
`i.
`
`(D)Phe-Cys-i3-Nal-(D)Trp-Lys-Val-Cys-Thr-NH2
`
`j. (D)Phe-Cys-Tyr-(D)Trp-Lys-Leu-Cys-Thr-NH2
`
`k.
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Cys-Thr-NH2.
`
`A preferred compound of formula I is octreotide.
`
`5
`
`10
`
`15
`
`20
`
`25
`
`30
`
`35
`
`or
`
`(a)
`
`(b)
`
`--NH-CH-CO-
`
`i
`I
`
`CH2
`
`R2
`
`wherein
`R1 is optionally substituted phenyl,
`R2 is -Z1-CH2-R1 , -CH2-CO-O-CH2-R1 ,
`
`- -o -O -CH2 -R1 or
`
`---Q-on
`
`CH2-R1
`
`Compounds of formula I may exist e.g. in free form, salt
`form or in the form of complexes thereof. Acid addition salts
`may be formed with e.g. organic acids, polymeric acids and
`inorganic acids. Such acid addition salt forms include e.g. 40
`the hydrochlorides and acetates. Complexes are e.g. formed
`from compounds of the invention on addition of inorganic
`substances, e.g. inorganic salts or hydroxides such as Ca-
`and Zn-salts, and/or on addition of polymeric organic sub-
`stances.
`
`45
`
`wherein
`Z1 is O or S, and
`X3 is an a-amino acid having an aromatic residue on the
`Ca side chain, or an amino acid unit selected from Dab,
`Dpr, Dpm, His,(Bzl)HyPro, thienyl-Ala, cyclohexyl(cid:173)
`Ala and t.-butyl-Ala,
`the residue Lys of said sequence corresponding to the
`residue Lys9 of the native somatostatin-14.
`Such somatostatin analogues are e.g. disclosed in WO/
`97/01579, the contents thereof, in particular with respect to
`the specifically exemplified compounds, being incorporated
`herein by reference.
`Preferably the sequence of formula II as defined above
`corresponds to the residues at positions 8 through 11 of the
`somatostatin-14. More preferably the somatostatin analogue
`as disclosed above comprises a hexapeptide unit, the resi-
`55 dues at positions 3 through 6 of said hexapeptide unit
`comprising the sequence of formula II. More particularly the
`hexapeptide unit is cyclic, e.g. having a direct peptide
`linkage between the a-carbonyl group of the residue at
`position 6 and the a-amino group of the residue at position
`1.
`
`50
`
`60
`
`Further somatostatin analogues suitable for use in accor(cid:173)
`dance with the present invention are:
`
`cyclo [-Asn-Phe-Phe-DTrp-Lys-Thr-Phe-Gaba-], cyclo
`(Asu-Lys-Asn-Phe-Phe-Trp-Lys-Thr-Tyr-Thr-Ser), and
`
`(D)Nal-Glu-Tyr-(D)Trp-Lys-Val-Lys-Thr-NH2.
`
`According to an alternatively preferred embodiment of
`the invention, the somatostatin component of the combina(cid:173)
`tion is a somatostatin analogue comprising the amino acid
`sequence of formula (II)
`
`-(D/L)Trp-Lys-X2-X3 -
`
`65
`
`(II)
`
`While Lys, X2 and X3 in the sequence of formula II have
`the L-configuration, Trp may have the D- or L-configuration,
`preferably the D-configuration.
`X 2 is preferably a residue of formula (a) or (b), R2 being
`preferably -Z1-CH2-R1 or
`
`Breckenridge Exhibit 1152
`Breckenridge v. Novartis IPR2017-01592
`Weckbecker 164 Patent
`
`

`

`US 6,362,164 Bl
`
`5
`
`- -o -O -CH2 -R1 .
`
`6
`zza may have the D- or L-configuration. When zza is a
`natural or unnatural a-amino acid unit, it may suitably be
`e.g. Thr, Ser, Ala, Val, Ile, Leu, Nle, His, Arg, Lys, Nal, Pal,
`Tyr, Trp, optionally ring-substituted Phe or Na-benzyl-Gly.
`5 When zza is Phe, the benzene ring thereof may be substi(cid:173)
`tuted by e.g. NH2 , N0 2 , CH3 , OCH3 or halogen, preferably
`in para position. When zza is Phe, the benzene ring thereof
`is preferably unsubstituted.
`When A 1 comprises a Pro amino acid residue, any sub-
`10 stituent present on the praline ring, e.g. R3-NH-CO(cid:173)
`O- etc., is preferably in position 4. Such substituted praline
`residue may exist in the cis form, e.g.
`
`When X3 comprises an aromatic residue on the Ca side
`chain, it may suitably be a natural or unnatural a-amino
`acid, e.g. Phe, Tyr, Trp, Nal, Pal, benzothienyl-Ala, Tic and
`thyronin, preferably Phe or Nal, more preferably Phe. X3 is
`preferably an a-amino acid bearing an aromatic residue on
`the Ca side chain.
`When R1 is substituted phenyl, it may suitably be sub(cid:173)
`stituted by halogen, methyl, ethyl, methoxy or ethoxy e.g. in 15
`ortho and/or position. More preferably R1 is unsubstituted
`phenyl. Z1 is preferably 0.
`Representative somatostatin analogues comprising a resi(cid:173)
`due of formula II are e.g compounds of formula (III)
`
`20
`
`(II)
`
`-ob-c-
`
`N
`
`I
`
`II
`o
`
`cyclo [A-ZZ,-Trp-Lys-X2-X3]
`1
`2
`3
`4
`
`wherein
`X2 and X3 are as defined above,
`A 1 is a divalent residue selected from Pro,
`
`(R3-NH-CO-O)Pro-,
`
`I
`
`HO-Rs,-Pr,-,
`
`Rs-N-Rs,-Pro-,
`
`I
`
`R6
`
`I
`
`R3-NH-CO-O-Rb-CH(NR4)-CO-,
`
`I
`
`25
`
`as well as in the trans form. The present invention covers
`each geometric isomer individually as well as mixtures
`thereof.
`is (NRsR9-C 6 _2 alkylene-NH-CO-)Pro(cid:173)
`When A 1
`where NRsR9 forms a heterocyclic group, such group may
`be aromatic or saturated and may comprise one nitrogen or
`one nitrogen and a second heteroatom selected from nitro-
`30 gen and oxygen. Preferably the heterocyclic group is e.g.
`pyridyl or morpholino. C2 _6Alkylene in this residue is pref(cid:173)
`erably -CH2-CH2 - .
`Any acyl as Rs, R 6 , Rs and R9 in A 1 may be e.g. R18CO(cid:173)
`wherein R18 is H, C1 _4 alkyl, C2 _4 alkenyl, C3 _6cycloalkyl or
`35 benzyl, preferably methyl or ethyl. When R4a, or R1 7 in A 1
`is ring-substituted benzyl, the benzene ring may be substi(cid:173)
`tuted as indicated above for ZZa.
`A preferred group of compounds of formula III are such
`40 wherein A 1 is free of a lateral -NH-C0-0- moiety. A
`further group of preferred compounds of formula III are
`such wherein A 1 comprises a basic lateral radical, e.g. a
`R3-NH-CO-O- or
`
`45
`
`Rs-N-Rs,----
`
`1
`R6
`
`50
`
`wherein R3 is NRsR9-C2 _6 alkylene, guanidino-C2 _6
`alkylene or C2 _6alkylene-COOH, R3 a is H, C1 _4 alkyl or
`has independently one of the significances given for R3
`R3bis H or C1 _4 alkyl, Ra is OH or NRsR 6 , Rb is
`---(CH2 ) 1 _3-or-CH(CH3 ) - , R4 is Hor CH3 , R4 a is 55
`optionally ring-substituted benzyl, each of Rs and R6
`independently is H, C1 _4 alkyl, w-amino-C1 _4 alkylene,
`w-hydroxy-C1 _4 alkylene or acyl, Rs)s a direct bond or
`C1 _6alkylene, each of Rs and R9 independently is H,
`C1 _4 alkyl, w-hydroxy-C2 _4 alkylene, acyl or CH2 0H- 60
`(CHOH)c-CH2 - wherein c is 0, 1, 2, 3 or 4, or Rs
`and R9 form together with the nitrogen atom to which
`they are attached a heterocyclic group which may
`comprise a further heteroatom, and R17 is optionally
`ring-substituted benzyl, ---(CH2 ) 1 _3-0H, CH3-CH 65
`(OH)- or -(CH2 ) 1 _s-NRsR 6 , and
`zza is a natural or unnatural a-amino acid unit.
`
`moiety.
`A still further group of preferred compounds of formula
`III are such wherein the N-terminal amino acid comprises a
`substituted Pro, particularly 4-substituted Pro, e.g. com(cid:173)
`pounds of formula III wherein A 1 is 4-substituted Pro.
`Preferably A 1 is 4-(R3-NH-CO-O)Pro.
`Examples of somatostatin analogues comprising a residue
`of formula II include e.g. cyclo [ 4--(NH2-C2 H4-NH(cid:173)
`CO-O-)Pro-Phe-DTrp-Lys-Ser(Benzyl)-Phe].
`The term "macrolide" as used herein, refers to a macro(cid:173)
`cyclic lactone, for example a compound having a
`12-membered or larger lactone ring. Of particular interest
`are the "lactam macrolides", i.e. macrocyclic compounds
`having a lactam (amide) bond in the macrocycle in addition
`to a lactone (ester) bond, for example rapamycin and its
`numerous derivatives and analogues. Rapamycin is an
`immunosuppressive lactam macrolide that is produced by
`
`Breckenridge Exhibit 1152
`Breckenridge v. Novartis IPR2017-01592
`Weckbecker 164 Patent
`
`

`

`US 6,362,164 Bl
`
`7
`Streptomyces hygroscopicus, and having the structure
`depicted in Formula
`
`(A)
`
`See, e.g., McAlpine, J.B., et al., J. Antibiotics (1991) 44:
`688; Schreiber, S. L., et al., J. Am. Chem. Soc. (1991) 113:
`7433; U.S. Pat. No. 3 929 992. One group of rapamycin
`derivatives are 40-0-substituted derivatives of rapamycin
`having the structure of Formula IV:
`
`IV
`
`20
`
`25
`
`55
`
`wherein
`X4 is (H,H) or O;
`Y3 is (H,OH) or O;
`R20 and R21 are independently selected from H, alkyl,
`arylalkyl, hydroxyalkyl, dihydroxyalkyl,
`hydroxyalkoxycarbonylalkyl, hydroxyalkylaryalkyl,
`dihydroxyalkylarylalkyl, acyloxyalkyl, aminoalkyl,
`alkylaminoalkyl, alkoxycarbonylaminoalkyl, 60
`acylaminoalkyl, arylsulfonamidoalkyl, allyl,
`dihydroxyalky lally 1, dioxolany lally 1, dialky 1-
`dioxolany lalkyl, di( alkoxycarbony 1)-triazolyl-alky 1
`and hydroxyalkoxy-alkyl; wherein "alk-" or "alkyl"
`refers to C1 _6 alkyl, branched or linear, preferably 65
`C1 _3 alkyl,; "aryl" is phenyl or tolyl; and acyl is a radical
`derived from a carboxylic acid; and
`
`10
`
`15
`
`8
`R22 is methyl or R22 and R20 together form C2 _6 alkyl;
`provided that R20 and R21 are not both H; and hydroxy(cid:173)
`alkoxyalkyl is other than hydroxyalkoxymethyl.
`Such compounds are disclosed in WO 94/09010 the
`5 contents of which, in particular with respect to the specifi(cid:173)
`cally exemplified compounds, are incorporated herein by
`reference.
`A preferred compound is e.g. 40-O-(2-hydroxy)ethyl(cid:173)
`rapamycin (referred thereafter as Compound B).
`Further preferred rapamycin derivatives are e.g. those
`disclosed in WO 96/41807, the contents thereof, in particu(cid:173)
`lar with respect to the specifically exemplified compounds of
`formula I disclosed therein, being incorporated herein by
`reference. Particularly preferred are 32-deoxo-rapamycin,
`16-O-pent-2-ynyl-32-deoxo-rapamycin, 16-O-pent-2-ynyl-
`32-deoxo-40-O-(2-hydroxyethyl)-rapamycin, 16-O-pent-2-
`ynyl-32-(S)-dihydro-rapamycin and 1 6-O-pent-2-ynyl-32-
`(S)-dihydro-40-O-(2-hydroxyethyl)-rapamycin.
`Further rapamycin derivatives are known, e.g. carboxylic
`acid esters such as disclosed in WO 92/05179, amide esters
`such as disclosed in U.S. Pat. No. 5,118,677, carbamates
`such as described in U.S. Pat. No. 5,118,678, fluorinated
`esters such as disclosed in U.S. Pat. No. 5,100,883, acetals,
`e.g. in U.S. Pat. No. 5,151,413, silyl ethers, e.g. in U.S. Pat.
`No. 5,120,842, arylsulfonates and sulfamates, e.g. in U.S.
`Pat. No. 5 177 203, derivatives wherein the methoxy group
`at the position 16 is replaced with alkynyloxy, e.g. in WO
`30 95/16691 and further derivatives such as disclosed in WO
`93/11130, WO 94/02136, WO 94/02385 and WO 95/14023,
`all incorporated herein by reference.
`Rapamycin and above mentioned derivatives have been
`shown to have potent immunosuppressant properties. Rapa-
`35 mycin has also been shown to inhibit smooth muscle cell
`proliferation and to inhibit cancer growth.
`Somatostatin analogues, e.g. octreotide, vapreotide and
`lanreotide, have been disclosed i.a. to inhibit growth hor-
`40 mane secretion and to have an inhibiting effect on malignant
`tumor growth, e.g. in breast cancer. Octreotide and lan(cid:173)
`reotide have also been disclosed to inhibit smooth muscle
`cell proliferation.
`In accordance with the invention, it has now surprisingly
`45 been found that a combination of 2 active ingredients
`believed to act on basically different mechanisms such as a
`somatostatin analogue and rapamycin or a derivative
`thereof, can be combined and synergistically inhibit cell
`50 hyperproliferation.
`In accordance with the particular findings of the present
`invention, there is provided in a first aspect:
`1. Use of a compound of the somatostatin class, in free form
`or in pharmaceutically acceptable salt form, for manufac(cid:173)
`turing a pharmaceutical composition for use in synergis(cid:173)
`tically effective amounts in the prevention or treatment of
`cell hyperproliferation in combination with a rapamycin
`macrolide, e.g. for the manufacture of a kit as disclosed
`hereinafter.
`2. Use of a compound of the somatostatin class, in free form
`or in pharmaceutically acceptable salt form, in combina(cid:173)
`tion in synergistically effective amounts with a rapamycin
`macrolide for the prevention or treatment of cell hyper(cid:173)
`proliferation.
`3. A method for preventing or treating cell hyperprolifera(cid:173)
`tion in a subject in need of such treatment which com(cid:173)
`prises administering to such subject a synergistically
`
`Breckenridge Exhibit 1152
`Breckenridge v. Novartis IPR2017-01592
`Weckbecker 164 Patent
`
`

`

`US 6,362,164 Bl
`
`5
`
`10
`
`15
`
`9
`effective amount of a compound of the somatostatin class
`in free form or in pharmaceutically acceptable salt form,
`and a rapamycin macrolide.
`4. A kit or package for the treatment or prevention of cell
`hyperproliferation, said kit or package including a phar-
`maceutical composition comprising a compound of the
`somatostatin class in free form or in pharmaceutically
`acceptable salt form, and a pharmaceutical composition
`comprising a rapamycin macrolide. The kit or package
`may also contain instructions to use the pharmaceutical
`compositions in accordance with the present invention.
`According to the invention, the combination of a com-
`pound of the somatostatin class and a rapamycin macrolide
`is indicated for the prevention or treatment of malignant
`tumor growth, e.g. breast, lung, GEP tumors, pituitary
`adenomas, lymphomas, etc., for the prevention or treatment
`of proliferative vascular diseases, e.g. biologically or
`mechanically induced vascular injury causing intimal
`thickening, e.g. restenosis, atherosclerosis, vascular
`occlusion, injury following percutaneous transluminal corn- 20
`nary angioplasty, vascular surgery or transplantation
`surgery, transplant vasculopathies, for example chronic
`rejection of various tissues and organs such as heart, kidney,
`pancreas, lung, liver, bowel, trachea and combined heart(cid:173)
`lung.
`The combination is particularly indicated for preventing
`intimal smooth muscle cell hyperplasia, restenosis and vas(cid:173)
`cular occlusion in a mammal.
`Utility of the combination in the treatment of disorders
`and diseases as hereinbefore specified, may be demonstrated 30
`for example in accordance with the method hereinafter
`described.
`A In vitro Assay
`AR42J cell cultures are propagated in DMEM supple(cid:173)
`mented with 10% fetal calf serum (FCS) at 5% CO2 . Cells
`are grown in the absence of antibiotics or antifungal agents.
`Subconfluent AR42J cells growing in DMEM and supple(cid:173)
`mented with 10% FCS are trypsinized, diluted in DMEM+
`2.5% FCS and seeded in uncoated 96-well plates (5,000 to 40
`10,000 cells per well in 180 µl). After a 48-hr incubation
`period (Day 0), the number of cells in a separate control
`plate is determined both by counting cells in a Coulter
`counter and by the sulforhodamine B (SRB) staining assay.
`The cells are then exposed either to the somatostatin ana- 45
`logue alone, e.g. octreotide, or to rapamycin or a derivative
`thereof alone or to a combination of the somatostatin ana(cid:173)
`logue and rapamycin or its derivative up to 5 days at various
`concentrations. Total drug exposure lasts for up to 5 days
`following the first addition and SRB analysis as described
`above is performed e.g. on day 2 and day 5. Growth is
`determined as difference in absorbance (OD) between day 0
`and day x values (=delta OD). Calculations are made based
`on the fractional product method of Webb (Valeriote and 55
`Lin, 1975; Cory and Carter, 1986; Berenbaum, J. Theor.
`Biol. 114: 413-431, 1985) and the method by Chou and
`Talalay (Adv. Enz. Regul. 22: 27-55, 1984). If the measured
`cell growth (% of control) is <compared to the calculated
`cell growth, this shows evidence for a synergistic effect. 60
`Under these conditions a combination of a somatostatin
`analogue at a concentration of from 10-10 to 10- 6 M with a
`rapamycin macrolide thereof at a concentration of from 1 to
`1000 nM significantly inhibits the growth of the tumor cells. 65
`In this assay, the following results are obtained with
`octreotide alone, Compound B alone and a combination of
`
`10
`octreotide and Compound B. The synergy according to the
`Webb Method is confirmed by using the Chou-Talalay
`Method.
`
`Cell Growth (% of CONTROL)
`
`Concentration
`(nM)
`
`Cell Growth
`(LI.OD)
`(%)
`
`Observed
`(%)
`
`Calculated
`(Webb
`Method)
`(%)
`
`1.2
`12.0
`1.2 + 12.0
`
`664 ± 9
`397 ± 16
`420 ± 12
`103 ± 5
`
`100
`59.8
`63.3
`15.6
`
`37.9
`
`Control
`Octreotide
`Compound B
`Octreotide +
`Compound B
`
`B. In Vivo Assay
`The AR42J (AR4-2J) rat pancreatic tumor cell line is
`derived from an azaserine-induced exocrine pancreatic
`tumor (Jessop and Hay, 1980). It was obtained from ATCC.
`Cultures are propagated in DMEM supplemented with 10%
`fetal calf serum (FCS) at 5% CO 2 . Cells are grown in the
`absence of antibiotics or antifungal agents. Female nude
`25 mice (nu/nu Balbc-Afrom Iffa Credo, Lyon, France) weigh(cid:173)
`ing 19-22 g, are kept in groups of 5 animals in macrolon
`cages (type III, 16x22xll cm). The cages are placed in
`ventilated cabinets (Iffa Credo) that are maintained at 24±1 °
`C. The animals have free access to drinking water and a
`pathogen-free rodent diet (Diet A, Kliba, Basel,
`Switzerland). To initiate tumors from cultured cells, AR42J
`cells are trypsinized and 10xl06 tumor cells (in 0.2 ml) are
`injected subcutaneously (s.c.) into both flanks of nude mice.
`35 When tumors have reached a volume of 0.03 cm3
`, animals
`are randomized into control and treatment groups. Control
`animals receive placebo. Animals are treated as indicated
`below for 3 weeks with single agents or the drug combina(cid:173)
`tion. The somatostatin analogue is given as a single injection
`of a slow release form at 30 mg/kg s.c. The size of the
`tumors is determined with a caliper. To calculate the tumor
`volume in ml, the equation "volume ( ellipsoid)=lengthx
`depthxheightx0.52" was used.
`Results
`After 4 weeks, the following tumor sizes were deter(cid:173)
`mined.
`(Please note that values in the control group correspond to
`3 week values, since animals were killed afterwards for
`tumors that became excessively large.)
`
`50
`
`Treatment
`
`Control
`A) Compound B, 5 mg/kg p.o.
`B) Rapamycin, 5 mg/kg p.o.
`C) Octreotide pamoate
`(biodegradable, sustained release
`formulation), 30 mg/kg, single inj.
`Compound B + octreotide (C)
`Rapamycin + octreotide (C)
`
`Volume
`mm3
`
`4020
`3685
`2748
`2205
`
`130
`106
`
`SE
`
`579
`263
`325
`339
`
`75
`44
`
`C. Clinical trial
`Patients are included who have breast cancer as evidenced
`by histological biopsy (glandular analysis-EOA). They
`present a metastatic illness and/or loco-regional localization
`
`Breckenridge Exhibit 1152
`Breckenridge v. Novartis IPR2017-01592
`Weckbecker 164 Patent
`
`

`

`US 6,362,164 Bl
`
`10
`
`15
`
`11
`which is measurable and evaluable. If desired, patients may
`be included who are resistant to other treatment to conven(cid:173)
`tional therapy such as surgery, radiotherapy, other chemo(cid:173)
`therapy and/or hormone therapy.
`The patients present at least one target, on X-ray analysis, 5
`which is measurable or evaluable such as a primitive meta(cid:173)
`static tumor which is cutaneous or sub-cutaneous. It may be
`gangliar or visceral. Preferably, the patients have lesions
`which have progressed within the month preceding the trial
`and have an estimated survival time of at least 3 months.
`The rapamycin macrolide, e.g rapamycin or compound B
`is administered orally. The treatment is for at least 3 months
`or until complete remission. The response may be followed
`by conventional methodology, e.g. according to IUCC
`response criteria, e.g. progression, stabilization, partial or
`complete remission.
`The somatostatin analogue, e.g. octreotide, is adminis(cid:173)
`tered parenterally, e.g. subcutaneous, particularly in a con(cid:173)
`tinuous subcutaneous way by means of a portable syringe 20
`pump (infusion pump).
`According to the invention, the somatostatin analogue and
`the rapamycin macrolide are preferably administered in the
`form of a pharmaceutical composition. Rapamycin and its
`derivatives, e.g. Compound B, may be administered by any 25
`conventional route, in particular enterally, e.g. orally, e.g. in
`the form of tablets, capsules, drink solutions, emulsions or
`microemulsion preconcentrates, nasally, pulmonary (by
`inhalation), parenterally, e.g. in the form of injectable solu- 30
`tions or suspensions, or topically. Rapamycin and its deriva(cid:173)
`tives are preferably administered per os and the somatostatin
`analogue is preferably administered parenterally, e.g by
`infusion. The somatostatin analogue may also be adminis(cid:173)
`tered in a slow release form, e.g. as disclosed in UK Patent 35
`Specification 2,265,311B. The administration of each com(cid:173)
`ponent of the combination may take place either separately,
`simultaneously or sequentially, e.g. rapamycin or Com(cid:173)
`pound B may be administered at first followed later, e.g. 8
`to 24 hours later, by the somatostatin analogue.
`The amount of each component administered is deter(cid:173)
`mined taking into account various factors such as the
`etiology and severity of the disease, and the patient's con(cid:173)
`dition. Rapamycin or its derivatives may conveniently be 45
`administered at doses which are in the range used in immu(cid:173)
`nosuppressive applications such as prevention and treatment
`of graft vs. host disease, transplant rejection or autoimmune
`diseases e.g. at a daily dosage from about 0.5 to 500 mg as
`a single dose or in divided doses. Such doses may also be
`given intermittently, for example, every other day or every
`third day. The somatostatin analogue may be administered,
`e.g. subcutaneously, in a dosage range of about 100 µg to 10
`mg per day as a single dose or in divided doses. Thus 55
`octreotide may be administered at a dose of from 0.2 mg to
`10 mg twice or three times daily. When administered as a
`slow release form, such formulation may comprise the
`somatostatin peptide in a concentration from 2.0 to 10% by
`weight. The release period of such a formulation may be 60
`from 1 week to about 2 months. The combination of the
`somatostatin analogue with rapamycin or its derivative
`allows to maximize the antiproliferative effect.
`The invention contemplates that the active ingredients 65
`discussed herein may be utilized in combination with phar(cid:173)
`maceutically acceptable diluents and carriers.
`
`40
`
`50
`
`12
`FORMULATION EXAMPLES
`
`A. Somatostatin Formulations
`
`1. Ampoules
`
`Octreotide
`Mannitol
`Lactic acid ( 88 % )
`Sodium hydrogenocarbonate
`Water (inject. grade)
`Carbon dioxide
`
`0.5 mg
`45.0 mg
`3.4 mg
`to pH 4.2
`to 1 ml
`q.s.
`
`2. Biodegradable Sustained Release Formulation
`
`Octreotide Acetate
`Po 1 y(D L-lactide-co-gl yco lide)
`Sterile Mannitol
`Vehicle
`
`Carboxymethylcellulose
`Mannitol
`Water for injection
`
`4.65% (by weight)
`78.35%
`17%
`
`0.5% (by weight)
`0.6%
`98.9%
`
`B. Rapamycin ( or Derivative thereof) Formulation: e.g.
`Capsules
`
`Ethanol
`1,2-propylene glycol
`Refined oil
`Cremophor RH40
`Rapamycin or Compound B
`
`Total
`
`20.0 mg
`81.0 mg
`121.5 mg
`202.5 mg
`20.0 mg
`
`500 mg
`
`What is claimed is:
`1. A kit or package for the inhibition of cell
`hyperproliferation, said kit or package including a pharma(cid:173)
`ceutical composition comprising an analogue of
`somatostatin-14 binding to at least the hSST-2 receptor in
`the nMolar range selected from
`
`a)
`
`(D)Phe-Cys-Phe-(D)Trp-Lys-Thr-Cys-Thr-ol
`
`b)
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-ThrNH2
`
`c)
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-TrpNH2
`
`d)
`
`(D)Trp-Cys-Phe-(D)Trp-Lys-Thr-Cys-ThrNH2
`
`e)
`
`(D)Phe-Cys-Phe-(D)Trp-Lys-Thr-Cys-ThrNH2
`
`f)
`
`3-(2-(Naphthyl)-(D)Ala-Cys-Try-(D)Trp-Lys-Val-Cys-ThrNH2
`
`g)
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-j3-Nal-NH2
`
`Breckenridge Exhibit 1152
`Breckenridge v. Novartis IPR2017-01592
`Weckbecker 164 Patent
`
`

`

`13
`-continued
`
`US 6,362,164 Bl
`
`14
`-continued
`
`h)
`
`3-(2-(naphthyl)-Ala-Cys-Tyr-(D)Trp-Lys-Val-Cys-i3-Nal-NH2
`
`e)
`
`(D)Phe-Cys-Phe-(D)Trp-Lys-Thr-Cys-ThrNH2
`
`5
`
`i)
`
`j)
`
`(D)Phe-Cys-i3-Nal-(D)Trp-Lys-Val-Cys-Thr-NH2
`
`f)
`
`3-(2-(Naphthyl)-(D)Ala-Cys-Try-(D)Trp-Lys-Val-Cys-ThrNH2
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Leu-Cys-Thr-NH2 and
`
`10
`
`g)
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-j3-Nal-NH2
`
`k)
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Cys-Thr-NH2,
`
`h)
`
`3-(2-(naphthyl)-Ala-Cys-Tyr-(D)Trp-Lys-Val-Cys-j3-Nal-NH2
`
`in free form or in pharmaceutically acceptable salt form, and
`a pharmaceutical composition comprising a rapamycin mac(cid:173)
`rolide selected from rapamycin and 40-O-(2-hydroxyethyl)(cid:173)
`rapamycin, said compositions being present in synergistic
`effective amounts, together with instructions for use.
`2. A kit or package according to claim 1 wherein the
`analogue of somatostatin-14 is selected from
`
`15
`
`20
`
`i)
`
`(D)Phe-Cys-j3-Nal-(D)Trp-Lys-Val-Cys-Thr-NH2
`
`j)
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Leu-Cys-Thr-NH2and
`
`k)
`
`(D)Phe-Cys-Tyr-(D)Trp-Lys-Cys-Thr-NH2,
`
`25 in free form or pharmaceutically acceptable salt form; and 2)
`a rapamycin macrolide selected from rapamycin and 40-O(cid:173)
`(2-hydroxyethyl)-rapamycin, said somatastatin-14 analogue
`and macrolide being present in synergistic effective
`amounts.
`7. A composition according to claim 6 wherein the ana-
`logue of somatostatin-14 is selected from
`
`30
`
`I
`I
`
`I
`I
`
`a) (D)Phe-Cys-Phe-(D)Trp-Lys-Thr-Cys-Thr-ol
`
`c) (D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-ThrNH2, and
`
`a) (D)Phe-Cys-Phe-(D)Trp-Lys-Thr-Cys-Thr-ol
`
`I
`I
`
`I
`I
`
`c) (D)Phe-Cys-Tyr-(D)Trp-Lys-Val-Cys-ThrNH2, and
`
`f) 3-(2