The use of a gonadotropin releasing hormone analog or mime thereof for the preparation of a pharmaceutical composition as an adjunctive for the invasive treatment of carcinomas

Abstract: A growth such as a tumor, hypertrophied tissue or cyst is biopsied or more completely excised subsequent to the administration of an effective amount of a gonadotropin releasing hormone analog or other inhibitor of ovarian steroid production or action.

Description: BACKGROUND OF THE INVENTION Almost 100 years ago it was recognized that breast cancer exhibited a degree of hormone dependency. Disease regression was achieved through estrogen ablation. Studies of normal breast tissue indicate that endogenous hormones of the menstrual cycle influence rates of cell division and cell death. Speroff, The Breast, in: Speroff, Ed., Clinical Gynecologic Endocrinology & Infertility, Fourth Edition, Baltimore Williams & Williams: 1989: 629:91-119. Estrogen levels rise sharply and then fall in the absence of progesterone during the follicular phase of the cycle. Following ovulation, levels of these hormones increase and then decline before the onset of menses. The pattern of cyclic hormone concentration has been shown to influence both immune parameters and growth factors. Laboratory studies has revealed that estrogen influences the growth fraction of human breast adenocarcinomics. When both estrogen and progesterone are present, this growth factor is significantly depressed. Jones, Influence of Steroid Hormones on the Growth Fraction of Human Breast Carcinomas, Am. J. Clin. Pathol. 1987, 88:132-138. Retardation of human breast cancer cells in the presence of progesterone has also been observed. Additionally, the inhibition of growth of a human epithelial ovarian cancer xenografts with cetrorelix is disclosed in Tetsu y.et al. Proc. Natl. Acad. Sci. vol 91 (1994). Furhtermore, the inhibition of ovarian cancer cell proliferation in vivo and in vitro has been disclosed Takagih,et al., Gynecologic Oncology, Vol. 58 (1995). The use of cetrorelix for the treatment of benign prostatic hypoplasia and prostatic cancer is known from: Gonzalez-Barcena b. et al., The Prostate, vol. 24 (1994). Cancer cells may be released into the circulation during surgery or other invasive procedures. It has therefore been suggested that a short, preoperative course of tamoxifen may be beneficial. McGuire, The Optical Timing of Mastectomy: Low Tide or High Tide?, Ann. Intern. Med. 1991, 115:401-403, Editorial. Some clinicians have proposed administering progesterone at the time of surgery to enhance prognosis by interrupting metastatic seeding. The present invention contemplates the acute administration of a GnRH analog (or mime) as a pretreatment to invasive procedures such as surgery for breast, prostate or other cancers in order to decrease the reoccurrence rate. Administration results in the suppression of gonadal steroid dependent growth factors and neovascular processes that contribute to metastasis or recurrence in situ . It is accordingly the object of the present invention to provide an adjunctive method to be employed in conjunction with the excisement of a neoplasm, cysts or portion thereof. This and other objects of the invention will become apparent to those of ordinary skill in this from the following detailed description. SUMMARY OF THE INVENTION This invention relates to the use of a gonadotropin releasing hormone analog or mime thereof for the preparation of a pharmaceutical composition for decreasing the reoccurrence rate of carcinomas. Said pharmaceutical composition is to be administered as a therapy adjunctive to an invasive procedure and more particularly, is to be administered to a person prior to a procedure such as excising a growth or portion thereof. DESCRIPTION OF THE INVENTION In accordance with the present invention, the conventional invasive procedure for excising a growth (or portion thereof) is carried out but additionally, a gonadotropin releasing hormone analog or other inhibitor of ovarian steroidal supply impact ("mime") is administered before that procedure is effected. The gonadotropin releasing hormone is a small polypeptide produced in the hypothalamus and is sometimes termed gonadotropic releasing hormone, luteinizing hormone releasing hormone, GnRH or LHRH. Analogs in the form of antagonists and agonists are known and either can be used. The present invention preferably employs the gonadotropin releasing hormone antagonist. A GnRH antagonist acts by classical competitive receptor occupancy at the level of the GnRH receptor in the anterior pituitary. The effect is realized quickly and the more active antagonists can extinguish bioactive gonadotropin secretion within minutes, and in turn deplete gonadal estrogen, progesterone and androgen synthesis and secretion to castrate levels within the first day of treatment without a "flare effect" (stimulation of the receptor system), and in turn, without a delay in therapeutic benefit and without a transient exacerbation by temporary elevations of estrogen and androgen. Examples of gonadotropin releasing hormone antagonists can be found, iter alia, in United States Patents 4,409,208, 4,547,370, 4,565,804, 4,569,927, 4,619,914, and 5,198,533 and in WO 89/01944. Examples of such antagonists include Antide™ (a decapeptide represented by the formula D-Ac-D-2-Nal 1 -DpClPhe 2 -D-3-Pal 3 -Ser 4 -NiLys 5 -D-NicLys 6 -Leu 7 -ILys 8 -Pro 9 -D-Ala 10 ), [Ac-D4ClDPhe 1 , D4ClDPhe 2 , DTrp 3 , DArg 6 , DAla 10 ] GnRH, [Ac-4ClDPhe 2 , D 3 Pal 3 , Arg 5 , D 2 Nal 6 , DAla 10 ] GnRH, [Ac-D2-Nal 1 , 4ClDPhe 2 , DTrp 3 , DArg 6 , DAla 10 ] GnRH, [Ac-D 2 Nal 1 , 4FDPhe 2 , DTrp 3 , DArg 6 ] GnRH, [Ac-D 2 Nal 1 , 4ClDPhe 2 , DTrp 3 , DhArg(Et 2 ) 6 , DAla 10 ] GnRH, and [Ac-Nal 1 , DME4ClPhe 2 , DPal 3 , Ser 4 , Tyr 5 , DArg 6 , Leu 7 , ILys 8 , Pro 9 , DAla 10 ] GnRH. Bauer, W.et Al. Proc. Eur. Pept. Symp. 23RD (1995) discloses compositions comprising Article™ and compositions comprising the antagonist Azaline™ are known from Tapanainen z. s. et al, Molecular Endocrinol., Vol. 7, (1993). Further, a substitute for the gonadotropin releasing hormone antagonist or agonist can be employed. The inhibitors of steroid production or action are entities which mimic the activity of the antagonist sufficiently to reversibly inactivate gonadal response or impact of ovarian steroids, including the blockade of gonadotropin stimulated steroidogenesis. Examples include recombinant DNA derived gonadotropins, desialated gonadotropins whether natural or DNA derived, antibodies to gonadotropins, gonadotropic subunit parts, inhibitors of gonadotropin receptor activations (i.e., cell messengers), inhibin/activin and their analogs, and the like. The gonadotropin releasing hormone antagonists or other inhibitors employed in the present invention can be administered in the form of pharmaceutically acceptable non-toxic salts or complexes. The salts include acid addition salts such as for instance hydrochloride, hydrobromide, sulfate, phosphate, nitrate, oxalate, fumarate, gluconate, tannate, maleate, acetate, benzoate, succinate, alginate, malate, ascorbate, tartrate and the like. The complexes can be with metals such as for example zinc, barium, calcium, magnesium, aluminum and the like. Any known gonadotropin releasing hormone analog or other inhibitor can be employed. Also any mode of administration heretofore employed for such agents can also be employed in the practice of the present invention. Thus, the route of administration can be any conventional route where the analog is active, for instance orally, intravenously, subcutaneously, intramuscularly, sublingually, percutaneously, rectally, intranasally or intravaginally. Similarly, the administration form can be a tablet, dragee, capsule, pill, nasal mist, aerosol, solutions suspensions, suppositories and the like. As a rule of thumb, the amount of gonadotropin releasing hormone analog or inhibitor administered is that sufficient to adjust the circulating estrogen to a value below about 20 pg/ml and preferably below about 10 pg/ml. Depending on the particular active agent employed, the dose administered is generally about 0.001 to 5 mg/kg, preferably about 0.05 to 5 mg/kg when administered intramuscularly. Also depending upon the particular agent employed, a single administration may suffice, although one or more additional administrations can be employed over a time period of about one week or up to 30 days, including daily, weekly or monthly. Since the effects of the administration last for several days, it is preferred that the initial gonadotropin releasing hormone antagonist or mime administration occur at least one day before the surgical procedure. The excising of the growth or a portion thereof (e.g. a biopsy) is carried out in conventional fashion before endogenous estrogen or progesterone production has been restored spontaneously and causes reversion to preadministration condition. In order to demonstrate the present invention, an individual is administered the gonadotropin releasing hormone antagonist specified below intramuscularly or subcutaneously. One day later, a biopsy is effected. The antagonist and amount, which is administered after suspension in sesame oil, are: Analog or Mime Dose mg/kg/day Antide™ 0.3 Azaline B™ 0.05 [Ac-D4ClDPhe 1 , D4ClDPhe 2 , DTrp 3 , DArg 6 , DAla 10 ] GnRH 0.5 [Ac-4ClDPhe 2 , D 3 Pal 3 , Arg 5 , D 2 Nal 6 , DAla 10 ] GnRH 0.5 [Ac-D2-Nal 1 , 4ClDPhe 2 , DTrp 3 , DArg 6 , DAla 10 ] GnRH 0.5 [Ac-Nal 1 , DME4ClPhe 2 , DPal 3 , Ser 4 , Tyr 5 , DArg 6 , Leu 7 , ILys 8 , Pro 9 , DAla 10 ] GnRH 0.5 Application of the components, compositions and methods of this invention for the medical and/or pharmaceutical use which are described in this text may be accomplished by any clinical, medical or pharmaceutical methods or techniques as are presently or prospectively known to those skilled in the art.

Claims: Use of a gonadotropin releasing hormone analog or mime thereof for the preparation of a pharmaceutical composition for decreasing the reoccurrence rate of carcinomas, wherein the pharmaceutical composition is to be administered as an adjunctive by the invasive treatment of said carcinomas. The use according to claim 1, wherein the gonadotrepin releasing hormone analog is a GnFH antagonist. The use according to claim 2, wherein the antagonist is Antide™. The use according to claim 2, wherein the antagonist is Azaline B™. The use according to any one of claims 1 to 4, wherein the dosage is about 0.001 to 5 mg/kg, preferably about 0.5 to 5 mg/kg.

Inventors: HODGEN GARY D, HODGEN, GARY D.
Applicants: HAMPTON ROADS MEDICAL COLLEGE, THE MEDICAL COLLEGE OF HAMPTON ROADS
Application year: 1997
Main classification: A61K38
IPC codes: A61K38