# Patent

## Title
Use of perifosine in combination with antimetabolites for the treatment of benign and malignant oncoses in humans and mammals

## Abstract

The invention relates to pharmaceutical compositions comprising alkylphosphocholines and antimetabolite antitumor substances. The pharmaceutical compositions of the invention are useful for the treatment of benign and malignant oncoses in humans and animals. Preferred alkylphosphocholines are described by the Formula II.




One such preferred alkylphosphocholine is perifosine.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a continuation of U.S. patent application Ser. No. 10/632,187, filed on Jul. 30, 2003, now U.S. Pat. No. 8,389,497, which claims the benefit of U.S. Provisional Application No. 60/399,615, filed Jul. 30, 2002, which is hereby incorporated by reference.


BACKGROUND OF THE INVENTION
Alkylphosphocholines are a new class of organic compounds, which exhibit diversified anti-neoplastic activities (M. Lohmeyer and R. Bittman, Antitumor Ether Lipids and Alkylphosphocholines, DOF, 19 (11), 1021-103 7 (1994)). The effect of the alkylphosphocholines in this connection may be based on different, molecular and biochemical mechanisms, some of which take place on the level of the plasma membrane of the cell.
It is well known that alkylphosphocholines influence inositol metabolism, the interaction with phospholipases or inhibition of protein kinase C and thus that this class of substances has a general influence on cellular signal transduction (K. Maly et al., Interference of New Alkylphospholipid Analogues With Mitogenic Signal Transduction, Anti-Cancer Drug Design, 10, 411-425 (1995); and P. Hilgard, et al., D21266, A New Heterocyclic Alkylphospho lipid with Antitumor Activity, Eur. J. Cancer, 33 (3), 442-446 (1997)). Thus, the alkylphosphocholine perifosine shows growth-inhibitory properties in relation to various melanoma, CNS, lung, colon, prostate and breast cancer cell lines with an IC50 ranging from 0.2 to 20 μM.
It is further known that perifosine blocks tumor cells in the G1-S and G2-M phase of the cell cycle (V. Patel, et al., A Novel Alkylphospholipid, Induces p.21 Waf1Expression in Squamous Carcinoma Cells through a p53-independent Pathway, Leading to Loss in Cyclin dependent Kinase Activity and Cell Cycle Arrest, Cancer Research 62, 1401-1409 (2002)).
It is known that the use of alkylphosphocholines before or together with radiation therapy leads its synergistic effects during the treatment of tumors (P. Principe et al., Evaluation of Combinations of Antineoplastic Ether Phospholipids and Chemotherapeutic Drugs, Anti-Cancer Drugs, 3 (6), 577-587 (1992)). It has also been reported that different glycerol-3-phospholipids, such as ET- 18-OOCH3, in combination with different DNA-interacting substances or tubulin binders increase the anti-tumor activity in vitro in a different tumor cell lines (P. Principe et al., Synergistic Cytotoxic Effect of Aza-alkylphospholipids in Association with Chemotherapeutic Drugs, J. Lipid Mediators Cell Signalling, 10 (1-2), 171-173 (1994)).
BRIEF SUMMARY OF THE INVENTION
Surprisingly, it was now possible to show that linear alkylphosphocholines of the general Formulas I and II are suitable for use in a combination according to the invention with other drug products for the treatment of benign and malignant oncoses in humans and mammals.
In this connection, the present invention relates to the novel use of alkylphosphocholine in combination with antitumor medications for art-recognized therapeutic activities attributed to the treatment of benign and malignant oncoses in humans and mammals.
It is therefore an object of this invention to provide a novel means of treating tumors with an inventive combination of linear alkylphosphocholines and anti-tumor substances.


DETAILED DESCRIPTION OF THE INVENTION
The present invention provides a novel use of linear alkylphosphocholines of the general Formulas I and II in an inventive combination with other medicinal drugs for the treatment of benign and malignant oncoses in humans and mammals. According to one aspect of the invention, the compounds of the general Formulas I and II can be used in an inventive combination with anti-tumor substances. Anti-tumor substances may be alkylating agents, anti-metabolites, plant alkaloids, platinum compounds, tumor antibiotics and agonists or antagonists of natural hormones. The anti-tumor substances may be selected from, but are not restricted to cis-platinum, carboplatinum, oxaliplatinum, bleomycin, doxorubicin, methotrexate, paclitaxel, docetaxel, vincristine, vinblastine, etoposide, teniposide, ifosfamide, cyclophosphamide, 5-fluorouracil, fludarabin, gemcitabine and cytarabine.
It is moreover possible for the alkylphosphocholines of the general Formula I and II to be employed in a claimed combination with inhibitors of signal transduction in the form of high and low molecular weight inhibitors of receptor and/or cytosolic kinases. These inhibitors may be selected from but not restricted to monoclonal antibodies and heterocyclic compounds.
The alkylphosphocholines of the general Formulas I and II, on which the invention is based, may be used in the form of finished medicinal drugs.
The compounds, on which the invention is based, are described by the general Formulas I and II:




in which, independently of one another,

    n, m, p, z is a whole number between 0 and 4,
    X is O, S, NH;
    R is hydrogen, a linear or branched C1 to C20 alkyl group, which may be saturated or unsaturated with one to three double and/or triple bonds and unsubstituted or optionally substituted at the same or at different carbon atoms with one, two or more halogen, nitro, cyano, hydroxy, C1 to C6 alkoxy, amino, mono-(C1 to C4) alkylamino or di-(C1 to C4) alkylamino groups,
    R1, R2, R3 independently of one another represent hydrogen, a linear or branched (C1 to C6) alkyl group, preferably methyl and ethyl, a (C3 to CO cyclo alkyl group, which may be unsubstituted or optionally substituted at the same or different carbon atoms with one, two or more halogen, nitro, cyano, hydroxy, C1 to C6 alkoxy, amino, mono-(Ci to C4) alkylamino or di-(C1 to C4) alkylamino groups.


According to a further aspect of the invention, a method for controlling tumors in humans and in mammals is provided and comprises administering at least one of the compounds of the general Formula I and II on which the invention is based to the human or a mammal in an amount effective for tumor treatment before or during a treatment with approved antitumor substances.
The therapeutically effective dose, to be administered for the treatment, of the particular compound of the general formula I and II on which the invention is based depends inter alia on the nature and the stage of the oncosis, the age and sex of the patient, the mode of administration and the duration of treatment.
The compounds on which the invention are based can be administered in a drug product as liquid, semisolid and solid drug forms. This takes place in the manner suitable in each case in the form of aerosols, oral powders, dusting powders and epipastics, uncoated tablets, coated tablets, emulsions, foams, solutions, suspensions, gels, ointments, pastes, pills, pastilles, capsules or suppositories.
EXAMPLES
Example 1
Administration of Perifosine (D-21266) in Combination with Cisplatin


    In vivo Experiment: DMBA-induced rat mammary carcinoma model
    Experimental Animal: Sprague-Dawley rat, female
    Procedure: The mammary carcinoma was induced by a single oral dose of DMBA. The animals received perifosine from day 0 to day 14 and were observed up to day 42. The weight of the tumor mass was estimated by palpation and comparison with plastic models. The initial weight is set equal to 100%.
    Administration: Perifosin 14×6.81 mg/kg p.o.
    
        Cis-platinum 4×1 mg/kg i.p.
    
    
    Effect: Reduction in the tumor was distinctly greater and longer through the combination treatment than through the single treatment in each case.












TABLE 1






Tumor Starting
Day 21, Change
p Test vs.


Treatment
Weight (g)
in %
Control


















Control
1.0
875
—


Perifosin (D-21266)
0.9
−25
<0.001


Cis-platinum
0.9
410
0.120


Perifosin (D-21266) +
0.8
−75
<0.001


Cis-platinum









Example 2
Administration of Perifosine in Combination with Cyclophosphamide


    In vivo Experiment: DMBA-induced rat mammary carcinoma model
    Experimental Animal: Sprague-Dawley rat, female
    Procedure: The mammary carcinoma was induced by a single oral dose of DMBA. The animals received perifosine from day 0 to day 14 and were observed up to day 42. The weight of the tumor mass was estimated by palpation and comparison with plastic models. The initial weight is set equal to 100%.
    Administration: Perifosine 14×6.81 mg/kg p.o.
    
        Cyclophosphamide 100 mg/kg, VZ 0, i.v.
    
    
    Effect: Reduction in the tumor was distinctly greater and longer through the combination treatment than through the single treatment in each case.












TABLE 2






Tumor Starting
Day 21, Change
p Test vs.


Treatment
Weight (g)
in %
Control


















Control
1.0
875
—


Perifosin (D-21266)
0.9
−25
<0.001


Cyclophosphamide
0.9
500
0.011


Perifosin (D-21266) +
0.8
−83.3
<0.001


Cyclophosphamide









Example 3
Administration of Perifosine in Combination with Adriamycin


    In vivo Experiment: DMBA-induced rat mammary carcinoma model
    Experimental Animal: Sprague-Dawley rat, female
    Procedure: The mammary carcinoma was induced by a single oral dose of DMBA. The animals received perifosine from day 0 to day 14 and were observed up to day 42. The eight of the tumor was mass was estimated by palpation and comparison with plastic models. The initial weight is set equal to 100%.
    Administration: Perifosine 14×6.81 mg/kg p.o.
    
        Adriamycin 4×2.15 mg/kg i.p.
    
    
    Effect: Reduction in the tumor was distinctly greater and longer through the combination treatment than through the single treatment in each case.












TABLE 3






Tumor Starting
Day 21, Change
p Test vs.


Treatment
Weight (g)
in %
Control


















Control
1.0
875
—


Perifosin (D-21266)
0.9
−25
<0.001


Adriamycin
1.0
781
0.197


Perifosin (D-21266) +
1.9
−70
<0.001


Adriamycin









In the manner described above, the present invention thus provides a method for the use of alkylphosphocholines in combination with antitumor medications for the treatment of benign and malignant oncoses in humans and mammals. While this invention has been described with reference to the preferred embodiments, these are illustrative only and not limiting, having been presented by way of example. Other modifications will become apparent to those skilled in the art by study of the specification and drawings. It is thus intended that the following appended claims include such modifications as fall within the spirit and scope of the present invention.

## Claims

1. A pharmaceutical composition for the treatment of benign or malignant oncoses, said composition comprising:
(a) perifosine;
(b) at least one antimetabolite antitumor substancselected from group consisting of 5-fluorouracil, cytarabine, and gemcitabine; and
(c) optionally, customary pharmaceutical carriers, excipients, and/or diluents.

2. The pharmaceutical composition according to claim 1, wherein said antimetabolite antitumor substance is 5-fluorouracil.

3. The pharmaceutical composition according to claim 1, wherein said antimetabolite antitumor substance is cytarabine.

4. The pharmaceutical composition according to claim 1, wherein said antimetabolite antitumor substance is gemcitabine.

5. The pharmaceutical composition according to claim 1, wherein said perifosine and said antimetabolite selected from the group consisting of 5-fluorouracil, cytarabine, and gemcitabine are components of a single unit dosage form.

6. The pharmaceutical composition according to claim 5, wherein said single unit dosage form is selected from the group consisting of aerosols, oral powders, dusting powders and epipastics, uncoated tablets, coated tablets, emulsions, foams, solutions, suspensions, gels, ointments, pastes, pills, pastilles, capsules and suppositories.