Patent Publication Number: US-2012035183-A1

Title: Cancer Treatment Method

Description:
BACKGROUND OF THE INVENTION 
     The present invention relates to a method of treating cancer in a mammal by administration of 4-quinazolinamines in combination with other anti-neoplastic compounds. In particular, the method relates to methods of treating cancers by administration of a combination of N-{3-chloro-4-[(3-fluorobenzyl)oxy]phenyl}-6-[5-({[2-(methanesulphonyl)ethyl]amino}methyl)-2-furyl]-4-quinazolinamine or salts or solvates thereof along with additional anti-neoplastic compounds. 
     Effective chemotherapy for cancer treatment is a continuing goal in the oncology field. Generally, cancer results from the deregulation of the normal processes that control cell division, differentiation and apoptotic cell death. Apoptosis (programmed cell death) plays essential roles in embryonic development and pathogenesis of various diseases, such as degenerative neuronal diseases, cardiovascular diseases and cancer. One of the most commonly studied pathways, which involves kinase regulation of apoptosis, is cellular signaling from growth factor receptors at the cell surface to the nucleus (Crews and Erikson, Cell, 74:215-17, 1993). In particular, cellular signalling from the growth factor receptors of the erbB family. 
     There is significant interaction among the erbB family that regulates the cellular effects mediated by these receptors. Six different ligands that bind to EGFR include EGF, transforming growth factor, amphiregulin, heparin binding EGF, betacellulin and epiregulin (Alroy &amp; Yarden, FEBS Letters, 410:83-86, 1997; Burden &amp; Yarden, Neuron, 18: 847-855, 1997; Klapper et al., Proc Natl Acad Sci, 4994-5000, 1999). Herugulins, another class of ligands, bind directly to HER3 and/or HER4 (Holmes et al., Science, 256:1205, 1992; Klapper et al., 1997, Oncogene, 14:2099-2109; Peles et al., Cell, 69:205, 1992). Binding of specific ligands induces homo- or heterodimerization of the receptors within members of the erbB family (Carraway &amp; Cantley, Cell, 78:5-8, 1994; Lemmon &amp; Schlessinger, Trends Biochem Sci, 19:459-463, 1994). In contrast with the other erbB receptor members, a soluble ligand has not yet been identified for HER2, which seems to be transactivated following heterodimerization. The heterodimerization of the erbB-2 receptor with the EGFR, HER3, and HER4 is preferred to homodimerization (Klapper et al., 1999; Klapper et al., 1997). Receptor dimerization results in binding of ATP to the receptors catalytic site, activation of the receptors tyrosine kinase, and autophosphorylation on C-terminal tyrosine residues. The phosphorylated tyrosine residues then serve as docking sites for proteins such as Grb2, Shc, and phospholipase C, that, in turn, activate downstream signaling pathways, including the Ras/MEK/Erk and the PI3K/Akt pathways, which regulate transcription factors and other proteins involved in biological responses such as proliferation, cell motility, angiogenesis, cell survival, and differentiation (Alroy &amp; Yarden, 1997; Burgering &amp; Coffer, Nature, 376:599-602, 1995; Chan et al., Ann Rev Biochem, 68:965-1014,1999; Lewis et al., Adv Can Res, 74:49-139,1998; Liu et al., Genes and Dev, 13:786-791, 1999; Muthuswamy et al., Mol &amp; Cell Bio, 19,10:6845-6857,1999; Riese &amp; Stern, Bioessays, 20:41-48, 1998). 
     Several strategies including monoclonal antibodies (Mab), immunoconjugates, anti-EGF vaccine, and tyrosine kinase inhibitors have been developed to target the erbB family receptors and block their activation in cancer cells (reviewed in (Sridhar et al., Lancet, 4,7:397-406,2003)). Because ErbB2-containing heterodimers are the most stable and preferred initiating event for signaling, interrupting both erbB2 and EGFR simultaneously is an appealing therapeutic strategy. A series of 6-thiazolylquinazoline dual erbB-2/EGFR TK inhibitors that possess efficacy in pre-clinical models for cancer have been synthesized (Cockerill et al., Biorg Med Chem Lett, 11:1401-1405,2001; Rusnak et al., Can Res, 61:7196-7203, 2001a; Rusnak et al., Mol Can Ther, 1:85-94,2001b). GW572016 is a 6-furanylquinazoline, orally active, reversible dual kinase inhibitor of both EGFR and erbB2 kinases (Rusnak et al., 2001b). In human xenograft studies, GW572016 has shown dose-dependent kinase inhibition, and selectively inhibits tumor cells overexpressing EGFR or erbB2 (Rusnak et al., 2001b; Xia et al., Oncogene, 21:6255-6263, 2002). 
     Combination therapy is rapidly becoming the norm in cancer treatment, rather than the exception. Oncologists are continually looking for anti-neoplastic compounds which when utilized in combination provides a more effective and/or enhanced treatment to the individual suffering the effects of cancer. Typically, successful combination therapy provides improved and even synergistic effect over monotherapy. 
     SUMMARY OF THE INVENTION 
     The present inventors have now identified novel cancer treatment methods which include administration of N-{3-chloro-4-[(3-fluorobenzyl)oxy]phenyl}-6-[5-({[2-(methanesulphonyl)ethyl]amino}methyl)-2-furyl]-4-quinazolinamine (GW572016) as well as salts and/or solvates thereof in combination with additional anti-neoplastic compounds. 
     In a first aspect of the present invention, there is provided a method of treating a susceptible cancer in a mammal, comprising: administering to said mammal therapeutically effective amounts of 
     (i) A Compound of Formula (I″) 
     
       
         
         
             
             
         
       
     
     and 
     (ii) Dasatinib. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     As used herein the term “neoplasm” refers to an abnormal growth of cells or tissue and is understood to include benign, i.e., non-cancerous growths, and malignant, i.e., cancerous growths. The term “neoplastic” means of or related to a neoplasm. 
     As used herein, the term “effective amount” means that amount of a drug or pharmaceutical agent that will elicit the biological or medical response of a tissue, system, animal or human that is being sought, for instance, by a researcher or clinician. Furthermore, the term “therapeutically effective amount” means any amount which, as compared to a corresponding subject who has not received such amount, results in improved treatment, healing, prevention, or amelioration of a disease, disorder, or side effect, or a decrease in the rate of advancement of a disease or disorder. The term also includes within its scope amounts effective to enhance normal physiological function. 
     As is well known in the art, cancers or tumors are frequently metastatic, in that a first (primary) locus of cancerous tumor growth spreads to one or more anatomically separate sites. As used herein, reference to “a tumor” in a subject includes not only the primary tumor, but metastatic tumor growth as well. In a like manner reference to cancer or cancer treatment includes primary and metatatic cancer and treatment of the primary cancer and metastatic cancerous sites as well as prevention or recurrence of primary or metastatic cancer growth. 
     “EGFR”, also known as “erbB-1”, and “erbB-2” are protein tyrosine kinase transmembrane growth factor receptors of the erbB family. Protein tyrosine kinases catalyse the phosphorylation of specific tyrosyl residues in various proteins involved in the regulation of cell growth and differentiation (A. F. Wilks, Progress in Growth Factor Research, 1990, 2, 97-111; S. A. Courtneidge, Dev. Supp. I, 1993, 57-64; J. A. Cooper, Semin. Cell Biol., 1994, 5(6), 377-387; R. F. Paulson, Semin. Immunol., 1995, 7(4), 267-277; A. C. Chan, Curr. Opin. Immunol., 1996, 8(3), 394-401). The ErbB family of type I receptor tyrosine kinases includes ErbB1 (also known as the epidermal growth factor receptor (EGFR or HER1)), erbB2 (also known as Her2), erbB3, and erbB4. These receptor tyrosine kinases are widely expressed in epithelial, mesenchymal, and neuronal tissues where they play a role in regulating cell proliferation, survival, and differentiation (Sibilia and Wagner,  Science,  269: 234 (1995); Threadgill et al.,  Science,  269: 230 (1995)). Increased expression of wild-type erbB2 or EGFR, or expression of constitutively activated receptor mutants, transforms cells in vitro (Di Fiore et al., 1987; DiMarco et al,  Oncogene,  4: 831 (1989); Hudziak et al.,  Proc. Natl. Acad. Sci. USA.,  84:7159 (1987); Qian et al.,  Oncogene,  10:211 (1995)). Increased expression of erbB2 or EGFR has been correlated with a poorer clinical outcome in some breast cancers and a variety of other malignancies (Slamon et al.,  Science,  235: 177 (1987); Slamon et al.,  Science,  244:707 (1989); Bacus et al,  Am. J. Clin. Path,  102:S13 (1994)). 
     As used herein, the term “solvate” refers to a complex of variable stoichiometry formed by a solute (in this invention, compounds of formula (I) or a salt thereof) and a solvent. Such solvents for the purpose of the invention may not interfere with the biological activity of the solute. Examples of suitable solvents include, but are not limited to, water, methanol, ethanol and acetic acid. Preferably the solvent used is a pharmaceutically acceptable solvent. Examples of suitable pharmaceutically acceptable solvents include, without limitation, water, ethanol and acetic acid. Most preferably the solvent used is water. 
     As recited above the present invention is directed to cancer treatment methods which includes administration of N-{3-chloro-4-[(3-fluorobenzyl)oxy]phenyl}-6-[5-({[2-(methanesulphonyl)ethyl]amino}methyl)-2-furyl]-4-quinazolinamine (GW572016) as well as salts and/or solvates thereof in combination with other anti-neoplastic compounds. 
     The methods of cancer treatment disclosed herein includes administering a compound of formula (I): 
     
       
         
         
             
             
         
       
     
     or salts or solvates thereof. 
     In another embodiment, the compound is a compound of formula (I′) which is the ditosylate salt of the compound of formula (I) or anhydrate or hydrate forms thereof. The ditosylate salt of the compound of formula (I) has the chemical name N-{3-chloro-4-[(3-fluorobenzyl)oxy]phenyl}-6-[5-({[2-(methanesulphonyl)ethyl]amino}methyl)-2-furyl]-4-quinazolinamine (GW572016) ditosylate and is also known as lapatinib. 
     
       
         
         
             
             
         
       
     
     In one embodiment, the compound is the anhydrous ditosylate salt of the compound of formula (I′). In another embodiment, the compound is a compound of formula (I″) which is the monohydrate ditosylate salt of the compound of formula (I′). 
     
       
         
         
             
             
         
       
     
     The free base, HCl salts, and ditosylate salts of the compound of Formula (I) may be prepared according to the procedures of International Patent Application No. PCT/EP99/00048, filed Jan. 8, 1999, and published as WO 99/35146 on Jul. 15, 1999, referred to above and International Patent Application No. PCT/US01/20706, filed Jun. 28, 2001 and published as WO 02/02552 on Jan. 10, 2002 and according to the appropriate Examples recited below. One such procedure for preparing the ditosylate salt of the compound of formula (I) is presented following in Scheme 1. 
     
       
         
         
             
             
         
       
       
         
         
             
             
         
       
     
     In scheme 1, the preparation of the ditosylate salt of the compound of formula (III) proceeds in four stages: Stage 1: Reaction of the indicated bicyclic compound and amine to give the indicated iodoquinazoline derivative; Stage 2: preparation of the corresponding aldehyde salt; Stage 3: preparation of the quinazoline ditosylate salt; and Stage 4: monohydrate ditosylate salt preparation. 
     Lapatinib ditosylate monohydrate is commercially available as an orange tablet as TYKERB® from GlaxoSmithKline. Lapatinib ditosylate monohydrate is a dual inhibitor of EGFR and erbB-2 and is indicated in combination with Xeloda® for the treatment of patients with advanced or metastatic breast cancer whose tumors overexpress Her2 (erbB-2) and who have received prior therapy including an anthracycline, a taxane, and Herceptin® (trastuzumab). 
     Typically, the salts of the present invention are pharmaceutically acceptable salts. Salts encompassed within the term “pharmaceutically acceptable salts” refer to non-toxic salts of the compounds of this invention. Salts of the compounds of the present invention may comprise acid addition salts derived from a nitrogen on a substituent in a compound of the present invention. Representative salts include the following salts: acetate, benzenesulfonate, benzoate, bicarbonate, bisulfate, bitartrate, borate, bromide, calcium edetate, camsylate, carbonate, chloride, clavulanate, citrate, dihydrochloride, edetate, edisylate, estolate, esylate, fumarate, gluceptate, gluconate, glutamate, glycollylarsanilate, hexylresorcinate, hydrabamine, hydrobromide, hydrochloride, hydroxynaphthoate, iodide, isethionate, lactate, lactobionate, laurate, malate, maleate, mandelate, mesylate, methylbromide, methylnitrate, methylsulfate, monopotassium maleate, mucate, napsylate, nitrate, N-methylglucamine, oxalate, pamoate (embonate), palmitate, pantothenate, phosphate/diphosphate, polygalacturonate, potassium, salicylate, sodium, stearate, subacetate, succinate, tannate, tartrate, teoclate, tosylate, triethiodide, trimethylammonium and valerate. Other salts, which are not pharmaceutically acceptable, may be useful in the preparation of compounds of this invention and these form a further aspect of the invention. 
     In one embodiment, the cancer treatment method is a method of treating a susceptible cancer wherein the compound of formula (I″) is administered with dasatinib. In one embodiment, the susceptible cancer is breast cancer. In one embodiment, the breast cancer overexpresses EGFR and/or erbB-2. In another embodiment, the susceptible cancer is head and neck cancer. In one embodiment, the head and neck cancer cancer overexpresses EGFR and/or erbB-2. 
     Dasatinib, N-(2-chloro-6-methylphenyl)-2-[[6-[4-(2-hydroxyethyl)-1-piperazinyl]-2-methyl-4-pyrimidinyl]amino]-5-thiazolecarboxamide,monohydrate; is commercially available as a white tablet as SPRYCEL® from BristolMyersSquibb. Dasatinib is indicated for the treatment of adult patients with chronic, accelerated, or myeloid or lymphoid blast phase chronic myeloid leukemia (CML). Dasatinib is a multikinase inhibitor, including BCR-ABL, SRC family (SRC, LCK, YES, FYN), c-kit, EPHA2, and PDGFRβ kinases, that exerts its antineoplastic activity by inhibiting one or more of these kinases and disrupting the pathways associated with the same. 
     In one embodiment, the cancer treatment method is a method of treating a susceptible cancer wherein the compound of formula (I″) is administered with GSK690693 and vitamin D or a vitamin D metabolite. In one embodiment, the susceptible cancer is prostate cancer. In one embodiment, the prostate cancer overexpresses EGFR and/or erbB-2. In another embodiment, the prostate cancer overexpresses Akt kinase. 
     In one embodiment, the cancer treatment method is a method of treating a susceptible cancer wherein the compound of formula (I″) is administered with GSK690693 and calcitrol. In one embodiment, the susceptible cancer is prostate cancer. In one embodiment, the prostate cancer overexpresses EGFR and/or erbB-2. In another embodiment, the prostate cancer overexpresses Akt kinase. 
     In one embodiment, the cancer treatment method is a method of treating a susceptible cancer wherein the compound of formula (I″) is administered with vitamin D or a vitamin D metabolite. In one embodiment, the susceptible cancer is prostate cancer. In one embodiment, the prostate cancer overexpresses EGFR and/or erbB-2. 
     In one embodiment, the cancer treatment method is a method of treating a susceptible cancer wherein the compound of formula (I″) is administered with calcitrol. In one embodiment, the susceptible cancer is prostate cancer. In one embodiment, the prostate cancer overexpresses EGFR and/or erbB-2. 
     In one embodiment, the cancer treatment method is a method of treating a susceptible cancer wherein GSK690693 is administered with vitamin D or a vitamin D metabolite. In one embodiment, the susceptible cancer is prostate cancer. In another embodiment, the prostate cancer overexpresses Akt kinase. 
     In one embodiment, the cancer treatment method is a method of treating a susceptible cancer wherein GSK690693 is administered with calcitrol. In one embodiment, the susceptible cancer is prostate cancer. In another embodiment, the prostate cancer overexpresses Akt kinase. 
     GSK690693 is the Compound of Formula (II) 
     
       
         
         
             
             
         
       
     
     or salts or solvates thereof. 
     The compound of formula (II) has the chemical name 4-(2-(4-amino-1,2,5-oxadiazol-3-yl)-1-ethyl-7-{[(3S)-3-piperidinylmethyl]oxy}-1H-imidazo[4,5-c]pyridin-4-yl)-2-methyl-3-butyn-2-ol and has been found to an inhibitor of all three isoforms of Akt kinase: Akt1, Akt2, and Akt3. 
     The compound of Formula (II) may be prepared according to the procedures of International Patent Application No. PCT/US2006/043513, filed Nov. 9, 2006, and published as WO 07/058850 on May 24, 2007. 
     Vitamin D is well known in the art and widely available commercially as is the vitamin D metabolite calcitrol. Calcitrol is 1,25-dihydroxy vitamin D3 [1,25(OH)2D3]. 
     In one embodiment, the cancer treatment method is a method of treating a susceptible cancer wherein the compound of formula (I″) is administered with bevacizumab. In one embodiment, the susceptible cancer is breast cancer. In one embodiment, the breast cancer overexpresses EGFR and/or erbB-2. In another embodiment, the susceptible cancer is colo-rectal cancer. In one embodiment, the colo-rectal cancer overexpresses EGFR and/or erbB-2. In another embodiment, the susceptible cancer is lung cancer. In one embodiment, the lung cancer overexpresses EGFR and/or erbB-2. In another embodiment, the lung cancer is non-small cell lung cancer. 
     Bevacizumab, is a recombinant humanized monoclonal IgG1 antibody that binds to and inhibits the human vascular endothelial growth factor (VEGF). Bevacizumab is commercially available as an IV infusion as AVASTIN® from Genentech. Dasatinib is indicated with 5-fluorouracil based chemotherapy for the treatment of patients with colo-rectal carcinoma; with carboplatin and paclitaxel for advanced or metastatic non-squamous, non-cell lung cancer; and with paclitaxel for HER2 negative metastatic breast cancer. Bevacizumab binds VEGF on the surface of endothelial cells thereby having an anti-angiogenic effect on tumor cells. 
     Combination therapies according to the present invention thus include the administration of the compound of formula (I″) as well as use of at least one other anti-neoplastic agent. Such combination of agents may be administered together or separately and, when administered separately this may occur simultaneously or sequentially in any order, both close and remote in time. The amounts of the compound of formula (I″) and the other pharmaceutically active agent(s) and the relative timings of administration will be selected in order to achieve the desired combined therapeutic effect. 
     Also contemplated in the present invention are pharmaceutical combinations including compounds of the Formula (I″) and at least one anti-neoplastic agent. Such compounds of formulae (I″) and the at least one anti-neoplastic agent are as described above and may be utilized in any of the combinations described above in the method of treating cancer of the present invention. 
     While it is possible that, for use in the cancer treatment methods of the present invention therapeutically effective amounts of a compound of formula (I″) as well as salts or solvates thereof, may be administered as the raw chemical, it is possible to present the active ingredient as a pharmaceutical composition. Accordingly, the invention further provides pharmaceutical compositions, which may be administered in the cancer treatment methods of the present invention. The pharmaceutical compositions include therapeutically effective amounts of a compound of formula (I″) or salts or solvates thereof, and one or more pharmaceutically acceptable carriers, diluents, or excipients. The carrier(s), diluent(s) or excipient(s) must be acceptable in the sense of being compatible with the other ingredients of the formulation and not deleterious to the recipient thereof. 
     Pharmaceutical formulations may be presented in unit dose forms containing a predetermined amount of active ingredient per unit dose. Such a unit depends, for example, on the condition being treated, the route of administration and the age, weight and condition of the patient. Preferred unit dosage formulations are those containing a daily dose or sub-dose, as herein above recited, or an appropriate fraction thereof, of an active ingredient. Furthermore, such pharmaceutical formulations may be prepared by any of the methods well known in the pharmacy art. 
     The compound of formula (I″) may be administered by any appropriate route. Suitable routes include oral, rectal, nasal, topical (including buccal and sublingual), vaginal, and parenteral (including subcutaneous, intramuscular, intraveneous, intradermal, intrathecal, and epidural). It will be appreciated that the preferred route may vary with, for example, the condition of the recipient of the combination. 
     Pharmaceutical formulations adapted for oral administration may be presented as discrete units such as capsules or tablets; powders or granules; solutions or suspensions in aqueous or non-aqueous liquids; edible foams or whips; or oil-in-water liquid emulsions or water-in-oil liquid emulsions. 
     For instance, for oral administration in the form of a tablet or capsule, the active drug component can be combined with an oral, non-toxic pharmaceutically acceptable inert carrier such as ethanol, glycerol, water and the like. Powders are prepared by comminuting the compound to a suitable fine size and mixing with a similarly comminuted pharmaceutical carrier such as an edible carbohydrate, as, for example, starch or mannitol. Flavoring, preservative, dispersing and coloring agent can also be present. 
     Capsules are made by preparing a powder mixture as described above, and filling formed gelatin sheaths. Glidants and lubricants such as colloidal silica, talc, magnesium stearate, calcium stearate or solid polyethylene glycol can be added to the powder mixture before the filling operation. A disintegrating or solubilizing agent such as agar-agar, calcium carbonate or sodium carbonate can also be added to improve the availability of the medicament when the capsule is ingested. 
     Moreover, when desired or necessary, suitable binders, lubricants, disintegrating agents and coloring agents can also be incorporated into the mixture. Suitable binders include starch, gelatin, natural sugars such as glucose or beta-lactose, corn sweeteners, natural and synthetic gums such as acacia, tragacanth or sodium alginate, carboxymethylcellulose, polyethylene glycol, waxes and the like. Lubricants used in these dosage forms include sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate, sodium chloride and the like. Disintegrators include, without limitation, starch, methyl cellulose, agar, bentonite, xanthan gum and the like. Tablets are formulated, for example, by preparing a powder mixture, granulating or slugging, adding a lubricant and disintegrant and pressing into tablets. A powder mixture is prepared by mixing the compound, suitably comminuted, with a diluent or base as described above, and optionally, with a binder such as carboxymethylcellulose, an aliginate, gelatin, or polyvinyl pyrrolidone, a solution retardant such as paraffin, a resorption accelerator such as a quaternary salt and/or an absorption agent such as bentonite, kaolin or dicalcium phosphate. The powder mixture can be granulated by wetting with a binder such as syrup, starch paste, acadia mucilage or solutions of cellulosic or polymeric materials and forcing through a screen. As an alternative to granulating, the powder mixture can be run through the tablet machine and the result is imperfectly formed slugs broken into granules. The granules can be lubricated to prevent sticking to the tablet forming dies by means of the addition of stearic acid, a stearate salt, talc or mineral oil. The lubricated mixture is then compressed into tablets. The compounds of the present invention can also be combined with free flowing inert carrier and compressed into tablets directly without going through the granulating or slugging steps. A clear or opaque protective coating consisting of a sealing coat of shellac, a coating of sugar or polymeric material and a polish coating of wax can be provided. Dyestuffs can be added to these coatings to distinguish different unit dosages. 
     Oral fluids such as solution, syrups and elixirs can be prepared in dosage unit form so that a given quantity contains a predetermined amount of the compound. Syrups can be prepared by dissolving the compound in a suitably flavored aqueous solution, while elixirs are prepared through the use of a non-toxic alcoholic vehicle. Suspensions can be formulated by dispersing the compound in a non-toxic vehicle. Solubilizers and emulsifiers such as ethoxylated isostearyl alcohols and polyoxy ethylene sorbitol ethers, preservatives, flavor additive such as peppermint oil or natural sweeteners or saccharin or other artificial sweeteners, and the like can also be added. 
     Where appropriate, dosage unit formulations for oral administration can be microencapsulated. The formulation can also be prepared to prolong or sustain the release as for example by coating or embedding particulate material in polymers, wax or the like. 
     The agents for use according to the present invention can also be administered in the form of liposome delivery systems, such as small unilamellar vesicles, large unilamellar vesicles and multilamellar vesicles. Liposomes can be formed from a variety of phospholipids, such as cholesterol, stearylamine or phosphatidylcholines. 
     Agents for use according to the present invention may also be delivered by the use of monoclonal antibodies as individual carriers to which the compound molecules are coupled. The compounds may also be coupled with soluble polymers as targetable drug carriers. Such polymers can include polyvinylpyrrolidone, pyran copolymer, polyhydroxypropylmethacrylamide-phenol, polyhydroxyethylaspartamidephenol, or polyethyleneoxidepolylysine substituted with palmitoyl residues. Furthermore, the compounds may be coupled to a class of biodegradable polymers useful in achieving controlled release of a drug, for example, polylactic acid, polepsilon caprolactone, polyhydroxy butyric acid, polyorthoesters, polyacetals, polydihydropyrans, polycyanoacrylates and cross-linked or amphipathic block copolymers of hydrogels. 
     Pharmaceutical formulations adapted for transdermal administration may be presented as discrete patches intended to remain in intimate contact with the epidermis of the recipient for a prolonged period of time. For example, the active ingredient may be delivered from the patch by iontophoresis as generally described in Pharmaceutical Research, 3(6), 318 (1986). 
     Pharmaceutical formulations adapted for topical administration may be formulated as ointments, creams, suspensions, lotions, powders, solutions, pastes, gels, sprays, aerosols or oils. 
     For treatments of the eye or other external tissues, for example mouth and skin, the formulations are preferably applied as a topical ointment or cream. When formulated in an ointment, the active ingredient may be employed with either a paraffinic or a water-miscible ointment base. Alternatively, the active ingredient may be formulated in a cream with an oil-in-water cream base or a water-in-oil base. 
     Pharmaceutical formulations adapted for topical administrations to the eye include eye drops wherein the active ingredient is dissolved or suspended in a suitable carrier, especially an aqueous solvent. 
     Pharmaceutical formulations adapted for topical administration in the mouth include lozenges, pastilles and mouth washes. 
     Pharmaceutical formulations adapted for rectal administration may be presented as suppositories or as enemas. 
     Pharmaceutical formulations adapted for nasal administration wherein the carrier is a solid include a coarse powder having a particle size for example in the range 20 to 500 microns which is administered in the manner in which snuff is taken, i.e. by rapid inhalation through the nasal passage from a container of the powder held close up to the nose. Suitable formulations wherein the carrier is a liquid, for administration as a nasal spray or as nasal drops, include aqueous or oil solutions of the active ingredient. 
     Pharmaceutical formulations adapted for administration by inhalation include fine particle dusts or mists that may be generated by means of various types of metered dose pressurised aerosols, nebulizers or insufflators. 
     Pharmaceutical formulations adapted for vaginal administration may be presented as pessaries, tampons, creams, gels, pastes, foams or spray formulations. 
     Pharmaceutical formulations adapted for parenteral administration include aqueous and non-aqueous sterile injection solutions which may contain anti-oxidants, buffers, bacteriostats and solutes which render the formulation isotonic with the blood of the intended recipient; and aqueous and non-aqueous sterile suspensions which may include suspending agents and thickening agents. The formulations may be presented in unit-dose or multi-dose containers, for example sealed ampoules and vials, and may be stored in a freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid carrier, for example water for injections, immediately prior to use. Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules and tablets. 
     It should be understood that in addition to the ingredients particularly mentioned above, the formulations may include other agents conventional in the art having regard to the type of formulation in question, for example those suitable for oral administration may include flavoring agents. 
     Oral formulations for the ditosylate salt of the compound of Formula (I) are described in International Patent Application No. PCT/US2006/014447, filed Apr. 18, 2006, and published as WO 2006/113649 on Oct. 26, 2006. 
     As indicated, therapeutically effective amounts of a specific compound of formula (I″) is administered to a mammal. Typically, the therapeutically effective amount of one of the administered agents of the present invention will depend upon a number of factors including, for example, the age and weight of the mammal, the precise condition requiring treatment, the severity of the condition, the nature of the formulation, and the route of administration. Ultimately, the therapeutically effective amount will be at the discretion of the attendant physician or veterinarian. In one embodiment, the mammal is a human. 
     The following examples are intended for illustration only and are not intended to limit the scope of the invention in any way. 
     EXAMPLES 
     As used herein the symbols and conventions used in these processes, schemes and examples are consistent with those used in the contemporary scientific literature, for example, the  Journal of the American Chemical Society or the Journal of Biological Chemistry.  Standard single-letter or three-letter abbreviations are generally used to designate amino acid residues, which are assumed to be in the L-configuration unless otherwise noted. Unless otherwise noted, all starting materials were obtained from commercial suppliers and used without further purification. Specifically, the following abbreviations may be used in the examples and throughout the specification: 
     
       
         
           
               
               
             
               
                   
               
             
            
               
                 g (grams); 
                 mg (milligrams); 
               
               
                 L (liters); 
                 ml (milliliters); 
               
               
                 μL (microliters); 
                 psi (pounds per square inch); 
               
               
                 M (molar); 
                 mM (millimolar); 
               
               
                 N (Normal) 
                 Kg (kilogram) 
               
               
                 i.v. (intravenous); 
                 Hz (Hertz); 
               
               
                 MHz (megahertz); 
                 mol (moles); 
               
               
                 mmol (millimoles); 
                 RT (room temperature); 
               
               
                 min (minutes); 
                 h (hours); 
               
               
                 mp (melting point); 
                 TLC (thin layer chromatography); 
               
               
                 T r  (retention time); 
                 RP (reverse phase); 
               
               
                 DCM (dichloromethane); 
                 DCE (dichloroethane); 
               
               
                 DMF (N,N-dimethylformamide); 
                 HOAc (acetic acid); 
               
               
                 TMSE (2-(trimethylsilyl)ethyl); 
                 TMS (trimethylsilyl); 
               
               
                 TIPS (triisopropylsilyl); 
                 TBS (t-butyldimethylsilyl); 
               
            
           
           
               
            
               
                 HPLC (high pressure liquid chromatography); 
               
            
           
           
               
               
            
               
                 THF (tetrahydrofuran); 
                 DMSO (dimethylsulfoxide); 
               
               
                 EtOAc (ethyl acetate); 
                 DME (1,2-dimethoxyethane); 
               
               
                 EDTA 
                 ethylenediaminetetraacetic acid 
               
               
                 FBS 
                 fetal bovine serum 
               
               
                 IMDM 
                 Iscove&#39;s Modified Dulbecco&#39;s medium 
               
               
                 IMS 
                 Industrial Methylated Spirits 
               
               
                 PBS 
                 phosphate buffered saline 
               
               
                 RPMI 
                 Roswell Park Memorial Institute 
               
               
                 RIPA buffer 
                 * 
               
               
                 RT 
                 room temperature 
               
               
                   
               
               
                 * 150 mM NaCl, 50 mM Tris-HCl, pH 7.5, 0.25% (w/v) -deoxycholate, 1% NP-40, 5 mM sodium orthovanadate, 2 mM sodium fluoride, and a protease inhibitor cocktail. 
               
            
           
         
       
     
     Unless otherwise indicated, all temperatures are expressed in ° C. (degrees Centigrade). All reactions conducted under an inert atmosphere at room temperature unless otherwise noted. 
     Example 1  
     Dosing with Lapatinib and Dasatinib 
     Cell Lines and Culture: 
     Breast tumor cell lines, BT-474, SK-Br-3, MDA-MB-453, MDA-MB-231 and T47D and head and neck squamous cell carcinoma line, SCC15 were purchased from the American Type Culture Collection. Breast tumor cell line JIMT-1 was obtained from DSMZ (Germany); LL1-BT-474-J4 (J4) breast cell clone was developed by single-cell cloning of BT-474 (HER2+ breast, highly sensitive to lapatinib) which had been exposed to increasing concentrations of lapatinib up to 3 μM. The LICR-LON-HN5 head and neck carcinoma cell line (HN5) was a gift from the Institute of Cancer Research, Surrey, U.K. HN5C2 was developed by single-cell cloning of HN5 which had been exposed to increasing concentrations of lapatinib. 
     BT-474, SK-Br-3, JimT-1, MDA-MB-453, MDA-MB-231 and T47D and SCC15 were cultured in a humidified incubator at 37° C. in 95% air, 5% CO 2  in the RPMI 1640 containing 10% fetal bovine serum (FBS) media. J4 was cultured in RPMI 1640 containing 10% FBS and 1 μM lapatinib; HN5 was in Dulbecco&#39;s modified Eagle medium (DMEM) containing 5% FBS and HN5 C2 was maintained in DMEM containing 5% FBS and 1 μM lapatinib. 
     Cell Growth Inhibition Assay and Data Analysis: 
     Cell growth inhibition was determined via CellTiter-Glo cell viability assays. Cells were seeded in a 96-well tissue culture plate (NUNC 136102) with the following plating densities in their respective media at 1000 or 2000 cells/well dependent on cell growth rate. J4 and HN5C2 were washed with PBS and plated in their culture media without lapatinib. Approximately 24 hours after plating, cells were exposed to compounds (lapatinib and/or dasatinib) as follows; cells were treated with ten, two-fold serial dilutions of compound or a combination of the two agents at a constant ratio. The cells were incubated in the presence of the compounds for 3 days. ATP levels were determined by adding Cell Titer Glo® (Promega), incubating for 20 minutes then a luminescent signal was read on the SpectraMax M5 plate with a 0.5 sec integration time. Cell growth was calculated relative to vehicle (DMSO) treated control wells. The concentration of compound that inhibits 50% of control cell growth (IC 50 ) was interpolated using nonlinear regression with the equation, y=(A+(B−A)/(1+((C/x)̂D)))), where A is the minimum response (y min ), B is the maximum response (y max ), C is the inflection point of the curve (EC 50 ) and D is the Hill coefficient. Combination Index (CI) values were calculated with the interpolated IC 50  values and the mutually non-exclusive equation derived by Chou and Talalay: CI=D a /IC 50(a) +D b /IC 50(b) +(D a *D b )/(IC 50(a) *IC 50(b) ), where IC 50(a)  was the IC 50  of the inhibitor A, IC 50(b)  was the IC 50  for the inhibitor B, D a  was the concentration of the inhibitor A in combination with the inhibitor B that inhibited 50% of cell growth and D b  was the concentration of inhibitor B in combination with the inhibitor A that inhibited 50% of cell growth. When the CI value was between 0.9 and 1.10, the combination of the two agents was deemed additive. Combination Index values less than 0.9 were considered indicative of synergy. Combination Index values&gt;1.10 indicated antagonism. 
     Results 
     Dasatinib is an oral multi-kinase inhibitor (including BCR/ABL and Src family tyrosine kinases) approved for use in patients with chronic myelogenous leukemia (CML) after imatinib treatment and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Lapatinib is a potent, oral, small-molecule, dual inhibitor of EGFR and HER2 tyrosine kinases that is approved in combination with capecitabine for the treatment of HER2-positive metastatic breast cancer. The effect of cell growth inhibition by dasatinib alone and in combination with lapatinib was determined via CellTiter-Glo cell viability assay in seven breast (JIMT-1, BT-474, SK-BR-3, MDA-MB-453, MDA-MB-231, T47D and LL1-BT-474-J4) and three head and neck (SCC15, HN5 and HN5C2) tumor cell lines. JIMT-1, LL1-BT-474-J4 (J4) and HN5C2 are lapatinib resistant cell lines. JIMT-1, a HER2+ lapatinib intrinsically resistant breast tumor cell line, was derived from a patient who was resistant to trastuzumab. Both J4 and HN5C2 are lapatinib acquired resistant clones developed by single-cell cloning of BT-474 (HER2+, highly sensitive to lapatinib) or HN5 which had been exposed to increasing concentrations of lapatinib respectively. 
     In breast tumor cell lines, an epithelial-to mesenchymal transition (post-EMT) breast cancer subtype line MDA-MB-231 is sensitive to dasatinib while luminal subtype lines including SK-Br-3, BT-474, MDA-MB-453 and T47D are relatively resistant to dasatinib. JIMT-1, a basal subtype HER2+breast tumor line is sensitive to dasatinib. In contrast, LL1-BT-474-J4, a HER2+ lapatinib resistant cell clone is also resistant to dasatinib, gefitinb and trastuzumab, but retains sensitivity to taxol and HSP90 inhibitors. Both SCC15 and HN5C2 head and neck tumor lines are highly sensitive to dasatinib. Furthermore, dasatinib in combination with lapatinib resulted in a synergistic effect of cell growth inhibition in JIMT-1, SCC15 and HN5 cells. The combination effects of dasatinib and lapatinib in SK-BR-3, BT-474, MDA-MB-453 and HN5C2 cells are either additive or similar to the most active single agent alone. 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 Cell growth inhibition effect by dasatinib alone and in combination 
               
               
                 with lapatinib in breast and head and neck tumor cells. 
               
            
           
           
               
               
               
               
               
               
            
               
                   
                   
                 HER 
                 Dasatinib 
                 Lapatinib 
                 Combination 
               
               
                 Cell Lines 
                 Subtype 
                 Status 
                 (IC50, uM) 
                 (IC50, uM) 
                 Index (CI) 
               
               
                   
               
            
           
           
               
               
               
               
               
               
               
            
               
                 Breast 
                 JIMT1 
                 basal 
                 HER2+ 
                 0.40 
                 14.70 
                 0.23, 0.22 
               
               
                   
                 SK-BR-3 
                 luminal 
                 HER2+ 
                 6.64 
                 0.22 
                 Similar to 
               
               
                   
                   
                   
                   
                   
                   
                 Lapatinib alone 
               
               
                   
                 BT474 
                 luminal 
                 HER2+ 
                 10.12 
                 0.09 
                 Similar to 
               
               
                   
                   
                   
                   
                   
                   
                 Lapatinib alone 
               
               
                   
                 MDA-MB- 
                 luminal 
                 HER2+ 
                 &gt;10 uM 
                 4.79 
                 Similar to 
               
               
                   
                 453 
                   
                   
                   
                   
                 Lapatinib alone 
               
               
                   
                 MDA-MB- 
                 post 
                 Normal 
                 0.23 
                 &gt;10 uM 
                 Similar to 
               
               
                   
                 231 
                 EMT 
                   
                   
                   
                 Dasatinib alone 
               
               
                   
                 T47D 
                 luminal 
                 Normal 
                 8.96 
                 &gt;10 uM 
                 Not Active 
               
               
                   
                 LL1-BT474- 
                 luminal 
                 HER2+ 
                 &gt;10 uM 
                 10.86 
                 Not Active 
               
               
                   
                 J4 
               
               
                 HNSCC 
                 SCC15 
                   
                 HER1+ 
                 0.06 
                 0.65 
                 0.33, 0.46 
               
               
                   
                 HN5 
                   
                 HER1+ 
                 6.40 
                 9.55 
                 0.10, 0.06 
               
               
                   
                 HN5C2 
                   
                 HER1+ 
                 0.17 
                 9.78 
                 0.86 ± 0.15