# Patent

## Title
Enhancement of effectiveness of 5-fluorouracil in treatment of tumor metastases and cancer

## Abstract

Tumor growth and metastases in cancer patients are inhibited by administration of a combination therapy including effective amounts of 5-Fluorouracil and a methylol transfer agent such as taurolidine, taurultam or mixtures thereof.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
The present application is a divisional of Ser. No. 12/016,294, filed Jan. 18, 2008, now U.S. Pat. No. 7,910,580, which is a continuation of U.S. application Ser. No. 10/660,798, filed Sep. 12, 2003, now U.S. Pat. No. 7,345,039, which is a continuation-in-part of U.S. application Ser. No. 10/281,138, filed Oct. 28, 2002, now U.S. Pat. No. 6,815,441, which is a continuation-in-part of U.S. application Ser. No. 09/993,896, filed Nov. 27, 2001, now abandoned, which claims the benefit of U.S. Provisional Application No. 60/253,138, filed Nov. 28, 2000. U.S. application Ser. No. 10/281,138 is a divisional of U.S. application Ser. No. 09/583,902, filed Jun. 1, 2000, now U.S. Pat. No. 6,479,481 B1, which claims the benefit of U.S. Provisional Application No. 60/182,200, filed Feb. 14, 2000, U.S. Provisional Application No. 60/174,607, filed Jan. 5, 2000, U.S. Provisional Application No. 60/167,681, filed Nov. 29, 1999, U.S. Provisional Application No. 60/151,050, filed Aug. 27, 1999 and U.S. Provisional Application No. 60/137,421, filed Jun. 4, 1999.


BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to the field of treating tumor metastases and cancer.
2. Description of the Background Art
5-Fluorouracil (5-FU) is an antineoplastic drug with clinical activity in a variety of tumors, such as cancers of the colon and rectum, head and neck, liver, breast, and pancreas. One problem with 5-Fu is its extreme toxicity. Since 5-FU targets rapidly dividing cells, the primary toxic side effects are on bone marrow, intestinal mucousa and oral mucousa. Thus, leukocyte and platelet count decreases substantially after administration. Other side effects include stomatitis, diarrhea, nausea and vomiting. Neurological side effects include somnolence and ataxia. Other side effects include chest pain, myocardial necrosis and ischemia. Inflammatory reactions such as acute and chronic conjunctivitis leading to tear duct stenosis and ectropion also occur.
Monotherapy with 5-FU only results in tumor remission in about 20-25% of patients, and the average remission time is only about 6-8 months.
Although combination chemotherapy with 5-FU and other antineoplastic agents has been proposed, typically no substantive additional benefit is provided by the other antineoplastic agents over treatment with 5-FU alone.
Thus, there remains a significant need in the art for new and improved cancer treatment therapies.
SUMMARY OF THE INVENTION
In accordance with the present invention, tumor growth and metastasis is inhibited in a cancer patient by administering to said patient a combination therapy comprising effective amounts of 5-FU and a methylol transfer agent.


DETAILED DESCRIPTION OF THE INVENTION
It has surprisingly been found that methylol transfer agents such as taurolidine and taurultam substantially enhance or augment the antineoplastic effects of 5-FU in a combination therapy for inhibiting tumor metastases and treating cancer in patients. Such methylol transfer agents also substantially reduce the toxic side effects of 5-FU.
5-FU when used in accordance with the present invention includes biologically active derivatives or substantial equivalents thereof.
Methylol transfer agents include methylol-containing compounds such as taurolidine and taurultam. The compounds taurolidine and taurultam are disclosed in U.S. Pat. No. 5,210,083. Other suitable methylol-containing compounds may be found among those identified in PCT Publication No. WO 01/39763. Particularly preferred methylol transfer agents for utilization in accordance with the present invention are taurolidine, taurultam, biologically active derivatives thereof and mixtures thereof.
Particularly preferred embodiments involve treatment of cancers selected from the group consisting of colon cancer, rectal cancer and colo-rectal cancer, as well as inhibition of tumor metastases thereof.
Other cancers to which the combination therapy of the present invention is effective may include other carcinomas, sarcomas or lymphomas, cancers of the head and neck, liver cancer, breast cancer and pancreatic cancer. Cancers to which the present invention may be applicable include glioma, neuroblastoma, astrocytoma, carcinomatous meningitis, ovarian cancer, prostate cancer, central nervous system (CNS) cancer, lung cancer, gastric cancer, esophageal cancer, urinary bladder cancer, leukemia, lymphoma, melanoma, renal cell cancer and metastases thereof.
Effective daily dosage amounts of 5-FU may be in the range of about 0.1-1,000 mg per pharmaceutical dosage unit. Effective dosage amounts of 5-FU also may be in the range of about 100-5,000 mg/m2 body surface area, preferably about 200-1,000 mg/m2 body surface area, more preferably about 500-600 mg/m2 body surface area. 5-FU typically is provided in 250 mg or 500 mg ampules for injection, or 250 mg capsules for oral administration.
Effective dosage amounts of a methylol transfer agent in accordance with the present invention may comprise pharmaceutical dosage units within the range of about 90.1-1,000 mg/kg. Preferred dosages may be in the range of about 10-20 grams taurolidine, taurultam or a mixture thereof, per administration.
Pharmaceutical dosage units of the combined therapy of the present invention may be administered by any suitable route, which include oral, topical or peritoneal administration, e.g., subcutaneously, intraperitoneally, intramuscularly, or intravenously, e.g., by infusion or injection.
In preferred embodiments, 250 ml of taurolidine 2% solution is administered by intravenous infusion about 1-6 times per day, more preferably about 2-4 times per day, during a treatment period, concurrently or sequentially with administration of 5-FU at a preferred dosage within the range of about 500-600 mg/m2 body surface area. In accordance with one embodiment, 5-FU is administered by bolus intravenous injection at a dosage of 500 mg/m2 body surface area, 1-3 days per week for a total of three weeks, during a treatment period including administration of taurolidine and/or taurultam. In an alternative embodiment, a 600 mg/m2 intravenous bolus injection is administered 1-2 times per week during a three week treatment period, along with administration of taurolidine and/or taurultam as indicated above.
The present invention also is directed to a combination of 5-FU and a methylol transfer agent, in effective amounts for simultaneous, separate or sequential use for inhibiting tumor metastasis in a cancer patient. The invention also is directed to pharmaceutical combinations including pharmaceutical dosage units comprising effective amounts of 5-Fluorouracil and a methylol transfer agent for inhibiting tumor metastasis in a cancer patient, as well as to pharmaceutical compositions comprising such combinations.
In contrast with other antineoplastic agents, methylol transfer agents such as taurolidine and taurultam surprisingly and substantially enhance or augment the antineoplastic effects of 5-FU, and substantially reduce the extreme toxic side effects of 5-FU. Accordingly, with a combination therapy of 5-FU and a methylol transfer agent such as taurolidine and/or taurultam, the amount of 5-FU can be reduced to achieve the same activity as larger dosages of 5-FU alone, while encountering fewer toxic side effects. Alternatively, combination therapy in accordance with the present invention can be utilized with the same 5-FU dosage levels as monotherapy with 5-FU, while achieving enhanced antineoplastic results along with fewer side effects.
The invention is further illustrated by the following non-limiting example.
Example 1
The human colo-rectal cell lines SW 480 (primary), SW 620 (metastatic) and W 707 (metastatic) were incubated with the following: culture medium (control), taurolidine at 5, 10, 25, 50 and 100 pg/ml doses, and 5-Fluorouracil (5-FU) at 5, 10, 25, 50 and 100 μM doses. 5-FU was tested alone, and together with taurolidine. Cell proliferation, apoptosis and cell cycle were assessed.
There was a significant decrease in tumor cell proliferation at 24 hours. There was no significant increase in taurolidine-induced apoptosis and taurolidine did not alter the phases of the cell cycle. There was an increase in LDH release (p=0.0011), which correlated with inhibited tumor proliferation. Taurolidine was found to augment the effects of given doses of 5-FU (p=0.0001).

## Claims

1. A method of inhibiting tumor growth in a cancer patient receiving 5-Fluorouracil (5-FU) antineoplastic therapy while reducing the toxic side effects of 5-FU, comprising administering to said patient a combination therapy comprising an effective amount of a methylol transfer agent selected from the group consisting of taurolidine, taurultam and a mixture thereof to enhance the antineoplastic effects of 5-FU and to reduce the 5-FU dose needed to inhibit tumor growth in said patient.

2. The method of claim 1 wherein said tumor is a lymphoma, carcinoma or sarcoma.

3. The method of claim 1 wherein said tumor is a glioma, a neuroblastoma, an astrocytoma, carcinomatous meningitis, breast cancer, ovarian cancer, prostate cancer, pancreatic cancer, CNS cancer, liver cancer, lung cancer, gastric cancer, esophageal cancer, urinary bladder cancer, leukemia, melanoma, renal cell cancer, cancer in a patient's head, or cancer in a patient's neck.

4. The method of claim 1 wherein said tumor growth is metastatic tumor growth.

5. The method of claim 1 wherein said toxic side effects are selected from side effects on bone marrow, intestinal mucosa or oral mucosa, leukocyte or platelet count decreases, stomatitis, diarrhea, nausea, vomiting, neurological side effects, somnolence, ataxia, chest pain, myocardial necrosis, ischemia, inflammatory reactions, acute or chronic conjunctivitis, tear duct stenosis or ectropion.

6. The method of claim 1 wherein said 5-FU and said methylol transfer agent are administered simultaneously, separately or sequentially.

7. The method of claim 1 which comprises administering said methylol transfer agent at a dosage of about 0.1 to about 1,000 mg/kg.

8. The method of claim 1 which comprises administering said methylol transfer agent at a dosage of about 10-20 grams.

9. The method of claim 1 which comprises administering said 5-FU at a dosage of about 0.1-1,000 mg.

10. The method of claim 1 which comprises administering said 5-FU at a dosage of about 250 mg or 500 mg.

11. The method of claim 1 which comprises administering said 5-FU at a dosage of about 100-5,000 mg/m2 body surface area.

12. The method of claim 1 which comprises administering said 5-FU at a dosage of about 200-1,000 mg/m2 body surface area.

13. The method of claim 1 which comprises administering said 5-FU at a dosage of about 500-600 mg/m2 body surface area.

14. A combination comprising 5-FU and a methylol transfer agent selected from the group consisting of taurolidine, taurultam and a mixture thereof, wherein said methylol transfer agent substantially reduces the toxic side effects of said 5-FU.

15. The combination of claim 14 wherein said 5-FU and said methylol transfer agent are prepared as pharmaceutical dosage units for administration simultaneously, separately or sequentially.

16. A method of reducing the toxic side effects of 5-FU antineoplastic therapy in a cancer patient in need thereof, comprising administering to said patient an effective amount of a methylol transfer agent selected from the group consisting of taurolidine, taurultam and a mixture thereof to substantially enhance the antineoplastic effects of said 5-FU and to reduce the 5-FU dose needed to inhibit tumor growth and thereby reduce the toxic side effects of said 5-FU antineoplastic therapy.

17. The method of claim 16 wherein said tumor is a lymphoma, carcinoma or sarcoma.

18. The method of claim 16 wherein said tumor is a glioma, a neuroblastoma, an astrocytoma, carcinomatous meningitis, breast cancer, ovarian cancer, prostate cancer, pancreatic cancer, CNS cancer, liver cancer, lung cancer, gastric cancer, esophageal cancer, urinary bladder cancer, leukemia, melanoma, renal cell cancer, cancer in a patient's head, or cancer in a patient's neck.

19. The method of claim 16 wherein said tumor is a metastatic tumor.

20. The method of claim 16 wherein said toxic side effects are selected from side effects on bone marrow, intestinal mucosa or oral mucosa, leukocyte or platelet count decreases, stomatitis, diarrhea, nausea, vomiting, neurological side effects, somnolence, ataxia, chest pain, myocardial necrosis, ischemia, inflammatory reactions, acute or chronic conjunctivitis, tear duct stenosis or ectropion.

21. The method of claim 16 wherein said 5-FU and said methylol transfer agent are administered simultaneously, separately or sequentially.

22. The method of claim 16 which comprises administering said methylol transfer agent at a dosage of about 0.1 to about 1,000 mg/kg.

23. The method of claim 16 which comprises administering said methylol transfer agent at a dosage of about 10-20 grams.

24. The method of claim 16 which comprises administering said 5-FU at a dosage of about 0.1-1,000 mg.

25. The method of claim 16 which comprises administering said 5-FU at a dosage of about 250 mg or 500 mg.

26. The method of claim 16 which comprises administering said 5-FU at a dosage of about 100-5,000 mg/m2 body surface area.

27. The method of claim 16 which comprises administering said 5-FU at a dosage of about 200-1,000 mg/m2 body surface area.

28. The method of claim 16 which comprises administering said 5-FU at a dosage of about 500-600 mg/m2 body surface area.