Abstract:
A method for treating or preventing alopecia which is induced by an antineoplastic compound is disclosed which is based on the administration of a particular tellurium or selenium derivative to a patient prior to the administration of a antineoplastic agent to said patent.

Description:
BACKGROUND OF THE INVENTION 
     Alopecia which is the partial or complete loss of hair may result from antineoplastic chemotherapy. In recent years toxic alopecia which is by antineoplastic chemotherapy has become a more common problem as the use of chemotherapy for neoplastic diseases has expanded. This is one of the toxic effects that is seen frequently with alkylating agents, anti-metabolites, plant alkaloids, anti-tumor antibiotics and interferons is alopecia. This problem is particularly distressing to patients who are recovering from chemotherapy because it persists after any period of hospitalization is required and causes many patients deep psychological difficulties. 
     A composition obtained from the bacteria Serratia marcescens has been used to protect against the alopecia which is associated with the use of cytosine arabinoside and doxorubicin. This composition had no effect on alopecia which was induced by cyclophosphamide. 
     The applicants have discovered that alopecia associated with the therapeutic doses of antineoplastic agents may be avoided or reduced by the prior concomitant or subsequent administration of an effective amount of an effective tellurium compound. 
     It is therefore a primary object of the invention to provide a method for preventing and/or treating alopecia. 
     SUMMARY OF THE INVENTION 
     The invention comprises a method for preventing or treating alopecia associated with therapeutic doses of antineoplastic agents, said method comprising administering an effective amount of a tellurium compound. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The tellurium compounds for use in the invention include those of the formula: ##STR1## or 
     
         TeO.sub.2 or complexes of TeO.sub.2                        (C) 
    
     
         or 
    
     
         PhTeCl.sub.3                                               (D) 
    
     
         or 
    
     
         TeX.sub.4, when X is Cl, Br or F 
    
     
         or 
    
     
         (C.sub.6 H.sub.5).sub.4 P+(TeCl.sub.3 (O.sub.2 C.sub.2 H.sub.4))--(E) 
    
     wherein Q is Te or Se; t is 1 or 0; u is 1 or 0; v is 1 or 0; R, R 1 , R 2 , R 3 , R 4 , R 5 , R 6 , R 7 , R 8 , and R 9  are the same or different and are independently selected from the group consisting of hydrogen, hydroxyalkyl of 1 to 5 carbons, hydroxy, alkyl or from 1 to 5 carbon atoms, halogen, haloalkyl of 1 to 5 carbon atoms, carboxy, alkylcarbonylalkyl of 2 to 10 carbons, alkanoyloxy of 1 to 5 carbon atoms, carboxyalkyl of 1 to 5 carbons atoms, acyl, amido, cyano, amidoalkyl of 1 to 5 carbons, N-monoalkylamidoalkyl of 2 to 10 carbons, N,N-dialkylamidoalkyl of 4 to 10 carbons, cyanoalkyl of 1 to 5 carbons alkoxy of 1 to 5 carbon atoms, alkoxyalkyl of 2 to 10 carbon atoms and --COR 10  wherein R 10  is alkyl of 1 to 5 carbons; and X is halogen; while the ammonium salt is illustrated, it is understood that other pharmaceutically acceptable salts such as K+ are within the scope of the invention. The compounds with the five membered rings are preferred. 
     As used herein and in the appended claims, the term alkyl of 1 to 5 carbon atoms includes straight and branched chain alkyl groups such as methyl; ethyl; n-propyl; n-butyl, and the like; the term hydroxyalkyl of 1 to 5 carbon atoms includes hydroxymethyl; hydroxyethyl; hydroxy-n-butyl; the term halkoakyl of 1 to 5 carbon atoms includes chloromethyl; 2-iodoethyl; 4-bromo-n-butyl; iodoethyl; 4-bromo-n-pentyl and the like; the term alkanoyloxy of 1 to 5 carbon atoms includes acetyl, propionyl, butanoyl and the like; the term carboxyalkyl includes carboxymethyl, carboxyethyl, ethylenecarboxy and the like; the term alkylcarbonylalkyl includes methanoylmethyl, ethanoylethyl and the like; the term amidoalkyl includes --CH 2  CONH 2  ; --CH 2  CH 2  CONH 2  ; --CH 2  CH 2  CH 2  CONH 2   and the like; the term cyanoalkyl includes --CH 2  CN; --CH 2  CH 2  CN; --CH 2  CH 2  CH 2  CN and the like; the alkoxy, of 1 to 5 carbon atoms includes methoxy, ethoxy, n-propoxy, n-pentoxy and the like; the terms halo and halogen are used to signify chloro, bromo, iodo and fluoro; the term acyl includes R 16  CO wherein R 16  is H or alkyl of 1 to 5 carbons such as methanoyl, ethanoyl and the like; the term aryl includes phenyl, alkylphenyl and naphthyl; the term N-monoalkylamidoalkyl includes --CH 2  CH 2  CONHCH 3 , --CH-- 2  CONHCH 2  CH 3  ; the term N,N-dialkylamidoalkyl includes --CH 2  CON(CH 3 ) 2  ; CH 2  CH 2  CON(CH 2  --CH 3 ) 2 . Compounds which are based on tellurium are the presently preferred compounds of the invention. The tellurium bas-d compounds that are preferred include those of the formula: ##STR2## wherein X is halogen. The preferred halogen species is chloro. 
     Other compounds which are based on tellurium and may be used in the practice of the invention include PhTeCl 3 , TeO 2  and TeX 4  (C 6  H 5 ) 4  P+ (TeCl 3  (O 2  C 2  H 4 ))-- (Z. Naturforsh, 36, 307-312 (1981). Compounds of the following structure are also included: ##STR3## 
     Other compounds useful for the practice of invention include: ##STR4## wherein R 11 , R 12 , R 13  and R 14  are independently selected from the group consisting of hydrogen, hydroxy-alkyl of 1-5 carbon atoms, hydroxy and alkyl of 1-5 carbons atoms. 
     Useful dihydroxy compounds for use in the preparation of compounds of structure A or B, include those of formula I wherein R, R 1 , R 4  and R 5  are as shown in the Table: 
     
                       TABLE______________________________________ ##STR5##                      (I)R         R.sub.1      R.sub.4      R.sub.5______________________________________H         H            H            HH         Cl           H            HH         OCH.sub.3    H            HH         COOCH.sub.3  H            HH         H            CN           HH         CHO          H            HH         H            COOH         HH         CH.sub.2 COOH                  H            HH         H            CH.sub.2 COOCH.sub.3                               HH         I            H            HH         H            Br           HH         H            CONH.sub.2   HH         H            CH.sub.2 OH  HH         COOH         H            H______________________________________ 
    
     Other dihydroxy compounds for use in the preparation of compounds A and B include those of formula II wherein R, R 1 , R 2 , R 3 , R 4  and R 5  are as shown in the Table: 
     
         ______________________________________ ##STR6##                     (II)R   R.sub.1  R.sub.2  R.sub.3 R.sub.4  R.sub.5______________________________________H   H        H        H       H        HH   H        Cl       H       H        HH   CH.sub.2 OH        H        H       H        HH   H        OH       H       H        HH   H        H        CH.sub.3                         H        HH   H        H        CH.sub.2 Cl                         H        HH   H        H        COOH    H        HH   H        H        CH.sub.2 COOH                         H        HH   H        H        CHO     H        HH   H        H        H       H        CH.sub.2 CHOH   H        CONH.sub.2                 H       H.sub.2  CH.sub.3H   H        H        CN      H        HH   H        H        H       CH.sub.2 COHN.sub.2                                  HH   H        H        COOCH.sub.3                         H.sub.3  HH   H.sub.3  OCH.sub.3                 H       H        H______________________________________ 
    
     Other dihydroxy compounds for use in making compound of formula A and B include those of formula III wherein R, R 1 , R 2 , R 3 , R 4  and R 5  are as shown in the Table. 
     
         ______________________________________ ##STR7##                     (III)R   R.sub.1    R.sub.2  R.sub.3                        R.sub.4  R.sub.5                                     R.sub.8                                          R.sub.9______________________________________H   H          H        H    H        H   H    HH   H          Cl       H    H        H   H    HH   H          H        H    Br       H   H    HH   H          OCH.sub.3                   H    H        H   H    HH   H          CONH.sub.2                   H    H        H   H    HH   Br         H        H    H        H   H    HH   H          H        H    CH.sub.2 COOH                                 H   H    HH   H          Cl       Cl   H        H   H    HH   CH.sub.2 COOH          H        H    H        H   H    HH   H          CH.sub.3 H    H        H   H    HH   CH.sub.3   H        H    H        H   H    HH   CH.sub.2 Cl          H        H    H        H   H    HH   H          H        I    H        H   H    HH   CH.sub.2 CN          H        H    H        H   H    HH   H          H        H    CH.sub.2 CH.sub.2 OH                                 H   H    H______________________________________ 
    
     Additional dihydroxy compound include those of formula IV wherein R, R 1 , R 2 , R 3 , R 4  and R 5  are as shown in the Table. 
     
         __________________________________________________________________________ ##STR8##                                (IV)R  R.sub.1 R.sub.2            R.sub.3                R.sub.4                      R.sub.5                         R.sub.6                                R.sub.7                                  R.sub.8                                     R.sub.9__________________________________________________________________________H  H       H     H   H     H  H      H H  HH  H       Cl    H   H     H  Cl     H H  HH  H       Cl    Cl  H     H  H      H H  HH  H       CONCH.sub.3            H   H     H  Br     H H  HH  H       Br    H   H     H  CON(CH.sub.3).sub.2                                H H  HH  H       H     OCH.sub.3                H     H  H      H H  HH  H       H     H   OCH.sub.3                      H  H      H H  HH  H       H     H   CH.sub.2 COOH                      H  H      H H  HH  H       COOH  H   H     H  H      H H  HH  CH.sub.3      H     H   H     H  H      H H  HCH.sub. 3   H       H     H   H     CH.sub.3                         H      H H  HH  CH.sub.2 CH.sub.3      H     H   H     H  H      Cl                                  H  HH  CH.sub.2 CN      H     H   CH.sub.2 OH                      H  H      H H  HH  H       H     I   H     H  H      H CN HH  CH.sub.2 CH.sub.2 COOH      H     H   H     H  H      H H  HH  H       CHO   H   H     H  H      H H  HH  H       H     F   H     H  H      H H  H__________________________________________________________________________ 
    
     Compounds of the following formula are also included: ##STR9## herein R 15 , R 16 , R 17  and R 18  are independently selected from halogen, alkyl of 1-5 carbons; aryl, acyl of 1-5 carbon hydroxyalkyl of 1-5 carbons and aminoalkyl of 1-5 carbons may be made by reacting the appropriate di, tri or tetrahaloselenide or telluride with the appropriate hydroxy compound which may be of the formula: HO--R 19  ; wherein R 19  ; is alkyl of 1 to 5 carbons, haloalkyl of 1 to 5 carbons, aryl, alkylaryl, alkylamido of 1 to 5 carbons, alkylcarbonyl of 1 to 5 carbons, cyanoalkyl of 1 to 5 carbons, cyanoalkyl of 1 to 5 carbons, and an alkoxyalkyl of 2 to 10 carbons. Specific examples of R 16  include methyl, ethyl, n-propyl, phenyl, tolyl, amidoethyl, cyanomethyl, methyloxymethyl and CH 2  CH 2  COOH. 
     These compounds are described in U.S. Pat. No. 4,761,490 which is incorporated by reference. In addition, TeCl 4  ; TeBr 4  and compounds which give in aqueous solution TeO 2  preferably in the form of a complex such as for example TeO 2  complex with citric acid or ethylene glycol. 
     The antineoplastic agents include alkylating agents such as nitrogen mustard, cyclophosphamide, melphan, and chlorambucil. The antimetabolites include purine antagonists such as 6-mercaptopurine and 6-thioguanine; pyrimidine antagonist are cytarabine, 5-fluorouracil, 5-floxuridine, and methotrexate. Plant alkaloids include vincristine, vinblastine, colchicine, etoposide and teniposide. Anti tumor antibiotics include dactinomycin, doxorubicin, daunomycin and mitomycin. 
     The tellurium compound may be administered by systemic administration by the intramuscular, intravenous or intraperitoneal route to mammals including humans, at doses of 0.025 to 0.5 mg/Kg of body weight every second day. 
     The invention also includes the treatment or prevention of alopecia by the topical administration of an effective tellurium onto to an area of the body where it is desired to cause hair to grow or to prevent the loss of hair associated with therapeutic doses of antineoplastic agents. This aspect of the invention is applicable to the prevention of hair loss. Generally, any non-toxic vehicle may be used as a carrier for the tellurium compound at an effective concentration which will induce hair growth and/or retard and/or prevent hair loss. 
     Examples of suitable vehicles include petrolatum, Aquaphor, Neobase, propylene glycol, glycerin and the like. These base materials are described in Remington&#39;s Pharmaceutical Sciences 17th Ed. Mack Publishing (1985), pp. 1301-1306 which is incorporated herein by reference. Generally, from 1 mg to 2.5 mg/Kg of body weight is applied once daily to the area to be treated. A preferred method of application is based on the use of a vehicle which is a thick liquid having a concentration of 200 μg of tellurium compound/0.2 ml of solution. 
     When the method of the invention is practiced by parental administration, it may be preferred to administer the tellurium compound by subcutaneous injection at multiple sites (e.g. one injection per sq cm) within the affected area. The doses will be 0.25 mg/Kg to 2.5 mg/Kg of body weight given once daily, or in divided doses in an appropriate vehicle such as PBS. If desired, a dose regimen based on alternate day therapy may be used. 
     The tellurium compound should be administered prior to the administration of any neoplastic agent for optimal results. Simultaneous or subsequent administration of the tellurium compound with the antineoplastic agent may also be utilized. 
     The tellurium compound may be administered rally at 2.5 mg/Kg to 7.5 mg/Kg of body weight given once daily. If desired, a dose regimen based on alternate day therapy may be used. 
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Example 1 
     The present invention is intended for use primarily in humans. In order to demonstrate the efficacy of the method of the invention, an animal model was chosen to carry out a controlled study to demonstrate the efficacy of the invention according to the method of Hussein et al., Science, Vol. 249, 28 September 1990, pp. 1564-1566. 
     Sprauge Dawley rats, 8 days old were supplied by the Animal Supply Center of Bar-Ilan University, Israel. Arabinoside (ARC-C) was obtained from the Upjohn Company; cyclophosphamide (CTX) was obtained from Sigma; adriamycin (ADX) was obtained from Farmitalia and ammonium-trichloro (O,O&#39;-dioxoethylene) tellurate was synthesized by the Department of Chemistry, Bar-Ilan University. 
     Arabinoside was injected intraperitoneally at a dose of 25 or 50 mg/kg day alone or with ammonium-trichloro (O,O&#39;dioxoethylene)tellurate, dissolved in PBS, daily or every other day 2 hours prior to the administration of arabinoside. The cycle of treatment lasted 7 days. On day 9, the results were observed and graded according to the following protocol: 
     
         ______________________________________No detectable alopcia        0Mild alopecia (hair loss &lt;50%)                        1+Moderately severe alopecia (hair loss &gt;50%)                        2+Total or virtually total alopecia (hair loss &gt;79%)                        3+______________________________________ 
    
     The observed results were as follows: 
     
         __________________________________________________________________________                    AlopeciaTreatment        No. of Subjects                    0  1+  2+  3+__________________________________________________________________________(a)  arabinoside-C  3       0  0   0   3  25 mg/kg daily (× 7 days)(b)  arabinoside-C  4       0  4   0   0  25 mg/kg/i.p. ammonium  trichloro (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (daily) (× 7 days)(c)  arabinoside-C  4       0  4   0   0  25 mg/kg/i.p. ammonium  trichlolo (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP (every  other day × 7 days)(d)  arabinoside-C  4       0  0   0   4  50 mg/kg/i.p. (× 7 days)(e)  arabinoside-C  4       0  3   1   0  50 mg/kg/i.p.  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (daily × 7 days)(f)  arabinoside-C  4       0  1   3   0  50 mg/kg/i.p.  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (every other day × 7 days)__________________________________________________________________________ 
    
     A second experiment was carried out using the same procedure which is outlined above. The results were as follows: 
     
         __________________________________________________________________________                    AlopeciaTreatment        No. of Subjects                    0  1+  2+  3+__________________________________________________________________________(g)  arabinoside-C  8       -- --  --  8  25 mg/kg/i.p.  (× 7 days)(h)  arabinoside-C  6       6  --  --  --  25 mg/kg/i.p. (× 7 days)  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (daily) (× 7 days)(i)  arabinoside-C  6       6  --  --  --  25 mg/kg/i.p. ammonium  trichloro (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP (every  other day × 7 days)(j)  arabinoside-C  8       -- --  --  8  50 mg/kg/i.p. (× 7 days)(k)  arabinoside-C  6       6  --  --  --  50 mg/kg/i.p. × 7 days  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (daily × 7 days)(l)  arabinoside-C  6       -- 1   2   3  50 mg/kg/i.p.  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (every other day × 7 days)__________________________________________________________________________ 
    
     The results of these experiments shows that the addition of ammonium trichloro (O,O&#39;-dioxoethylene)tellurate to a treatment regimen which is based on arabinoside-C almost completely avoids alopecia when given daily and provides some protection from alopecia when given every other day. A histological examination of the skin of arabinoside-C treated subjects shows almost complete loss of hair follicles while the subjects who are treated with arabinoside-C and ammonium trichloro (O,O&#39;-dioxoethylene) tellurate showed no hair loss or reduced hair loss. 
     EXAMPLE 2 
     An experiment was carried out to determine the effect of ammonium trichloro(O,O&#39;-dioxoethylene)tellurate on preventing the alopecia which is induced by cyclophosphamide using the procedure of Example 1. 
     The results are as follows: 
     
         __________________________________________________________________________                    AlopeciaTreatment        No. of Subjects                    0  1+  2+  3+__________________________________________________________________________(a)  cyclophosphamide             8      -- 2   3   5  20 mg/kg/i.p. (× 7 days)(b)  cyclophosphamide             8      0  4   0   0  20 mg/kg/i.p.  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (daily for 7 days)(c)  cyclophosphamide            10      -- 3   5   2  20 mg/kg/i.p.  (× 7 days)(d)  cyclophosphamide            10      -- 4   5   1  20 mg/kg/i.p.  (× 7 days)  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (daily × 7 days)(e)  cyclophosphamide             5      1  3   1   --  20 mg/kg/i.p. × 7 days(f)  cyclophosphamide             5      2  2   1   --  20 mg/kg/i.p. × 7 days  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  daily × 7 days(g)  cyclosphosphamide            10      -- 10  --  --  20 mg/Kg/i.p. × 7 days(h)  cyclophosphamide            10      6  4   --  --  20 mg/Kg/i.p. ×  7 days  ammonium trichloro  (O,O&#39;-dioxoethylene)  tellurate 0.5 mg/Kg/IP  (daily × 7 days)__________________________________________________________________________ 
    
     This study shows that ammonium trichloro (O,O&#39;-dioxoethylene)tellurate, at a level of 0.5 mg/kg/i.p., in conjunction with cyclophosphamide provides a mild protection against cyclophosphamide induced alopecia. 
     EXAMPLE 3 
     A number of Sprague Dawley rats were subjected to treatment with arabinoside C 25 mg/kg with ammonium trichloro (O,O&#39;-dioxoethylene)tellurate by subcutaneous injection. The control compound was PBS. The results were as follows: 
     
         ______________________________________           Exp. 1 Exp. 2   Exp. 3______________________________________ammonium trichloro             3/4      5/7      7/10(O,O&#39;-dioxoethylene)tellurate0.25 mg/Kg/s.c daily × 7 daysPBS               0/3      0/6      ND*______________________________________ *ND = not done 
    
     EXAMPLE 4 
     A stock composition of 1 mg. of ammonium trichloro (O,O&#39;-dioxoethylene) tellurate in 1 ml. of glycerin was prepared. The stock composition was diluted with glycerin to give the following concentrations per ml. so that the stated dose could be applied topically by application of 1 ml. of solution. The solution was applied to the entire back surface of rats once daily for a period of 7 days. Two hours after each treatment the rats were injected with 25 mg/kg of arabinoside-C once daily. Control rats were treated with a glycerin and injected with arabinoside-C. The following results were observed: 
     
         ______________________________________Concentrationof Ammonium trichloro(O,O&#39;-dioxoethylene)          Grade oftellurate (μg/rat)          Alopecia*  No. of rats in Group______________________________________200            3          5100            2          550             0          520             1          510             3          5 0             4          5______________________________________ *0 = no alopecia; 1 = less than 20% alopecia; 2 = less than 50% alopecia; 3 = more than 50% alopecia; 4 = total alopecia. 
    
     A dose response effect was observed which is attributed to the ammonium trichloro (O,O&#39;-dioxoethylene) tellurate. All control animals that were treated with arabinoside-C showed 100% alopecia whereas 100% of the rats treated with 50 ug of ammonium trichloro (O,O&#39;-dioxoethylene) tellurate showed 0% alopecia. 
     EXAMPLE 5 
     A phase II chemotherapy trial was carried out in patients having unresectable and metastatic non-small cell lung tumors. The chemotherapy was based on carboplatinum 300.0 mg/m 2  /IV daily and etoposide 200.0 mg/m 2  on day 3, 5 and 7 for a total of 12 weeks of chemotherapy which was given to group I. In addition to the same chemotherapy, ammonium trichloro (O,O&#39;-dioxoethylene)tellurate was given to Group II at a dose of 3 mg/m 2  three times a week starting two weeks before the chemotherapy and continued for 12 weeks after the chemotherapy. The alopecia of both groups was observed 12 weeks after the chemotherapy and was as follows: 
     
         ______________________________________ALOPECIA SCORE0         I        II      III    IV    Total______________________________________Group 68      22       29    28     2     149I     45.64%  14.77%   19.46%                        18.79% 1.35%Group 122     26       40    12     0     200II    61.00%  13.00%   20.00%                        6.00%  0.00%______________________________________ 0 -- no alopecia I -- casual alopecia II -- &gt;50% alopecia III -- &lt;50% alopecia IV -- total alopecia