Patent Description:
Cancer is the most common and serious disease that threatens human health, and research and development of anticancer drugs are important for extending the life expectancy of cancer patients. In recent years, the rapid development of cancer genomics and molecular medicine and the development of new anticancer drugs have much advanced cancer therapies, but there is still a need for new therapeutic agents. Colorectal cancer is a malignant tumor in the appendix, colon, and rectum, which occurs at the mucous membrane, the innermost surface of the large intestine. In South Korea, colorectal cancer is the first common cancer after stomach cancer. Recent westernization of the dietary pattern has led to a steep increase in the incidence of colorectal cancer. In the last decade, the mortality of colorectal cancer has increased by about <NUM> %, with the rate continuously increasing.

The treatment of colorectal cancer can be conducted by surgical dissection, chemotherapy, and radiotherapy. For polyps, which are in the pre-stage of colorectal cancer or for early-stage colorectal cancer localized on polyps, colonic polypectomy is curative. After the development of fluorouracil (<NUM>-FU) in the <NUM>, chemotherapy has been used for both cancer of the colon and rectum, with the aid of the five antitumor agents irinotecan, oxaliplatin, capecitabine, TAS-<NUM>, and <NUM>-FU, which were approved by the FDA. Also, application has been made of targeted therapy with the five approved agents cetuximab, panitumumab, bevacizumab, aflibercept, and regorafenib which target epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), and vascular endothelial growth factor receptor (VEGF-R). However, it is still urgent to develop a colorectal cancer therapy that has excellent anticancer effects, stability, and in vivo absorptivity.

The mTOR (mechanistic target of rapamycin) protein, which functions as a serine/threonine kinase, is a core signaling pathway factor that regulates cellular processes including cell growth, cell cycle, protein synthesis, and glucose metabolism. Among others, mTOR is a critical protein responsible for cell growth signaling pathway and becomes abnormally active in <NUM> % of solid cancer cells. In cancer cells, mTOR and its upstream factors (PI3K and Akt) are known to undergo the greatest modification. The activation of mTOR signals in cancer is caused by mutation of mTOR gene itself and the upstream oncogenes (PI3K and Akt) and tumor suppressors (e. , PTEN and TSC1/<NUM>). Hence, suppression of the mTOR-associated signaling pathway may inhibit protein synthesis, lipid synthesis, and cell growth and provoke cell autophagy, culminating in cell death. Therefore, there is a need for developing an mTOR-associated signaling inhibitor to inhibit cancer cell growth and induce cancer cell death.

<CIT> discloses the use of lomitapide for the treatment of cancer having a high LDL requirement such as hematologic cancers including acute myeloid leukemia or solid tumors such as brain tumors, lung tumors, breast carcinoma, bladder cancer or gastric carcinoma or endometrial adenocarcinoma.

Leading to the present disclosure, intensive and thorough research, conducted by the present inventors, into the development of a compound to inhibit cancer cell growth and induce cancer cell death, resulted in the finding that a composition including an mTOR signaling inhibitor as an active ingredient is effective for treating cancer.

Therefore, the present disclosure aims to provide a pharmaceutical composition including an mTOR signaling inhibitor as an active ingredient for prevention or treatment of cancer as defined in the claims.

In particular, the present invention provides a pharmaceutical composition for use in the prevention or treatment of cancer, the pharmaceutical composition comprising (a) lomitapide, a pharmaceutically acceptable salt thereof, or an optical isomer thereof, and (b) fluorouracil, irinotecan, or an anti-PD1 antibody as an active ingredient, wherein the cancer is colorectal cancer or melanoma.

The mTOR signaling inhibitor refers to a substance that inhibits the activity of mTOR itself or the activity of an upstream factor that upregulates the activity of mTOR. Examples of the targets the activity of which is down-regulated by the mTOR signaling inhibitor include mTOR, PI3K, Akt, S6K, and S6, but are not limited thereto.

In the present invention, the mTOR signaling inhibitor is lomitapide, a pharmaceutically acceptable salt thereof, or an optical isomer thereof.

Lomitapide (sold under the brand names Jaxtapid (US) and Lojuxta (EU)) is an orphan drug used as a lipid-lowering agent for the treatment of familial hypercholesterolemia, developed by Aegerion Pharmaceuticals. The US Food and Drug Administration (FDA) approved lomitapide in December <NUM>, <NUM>, as an orphan drug to reduce LDL cholesterol, total cholesterol, apolipoprotein B, and non-high-density lipoprotein (non-HDL) cholesterol in people with homozygous familial hypercholesterolemia.

Lomitapide has the IUPAC name of N-(<NUM>,<NUM>,<NUM>-trifluoroethyl)-<NUM>-[<NUM>-[<NUM>-[[[<NUM>'-(trifluoromethyl)[<NUM>,<NUM>'-biphenyl]<NUM>-yl]carbonyl]amino]-<NUM>-piperidinyl]butyl]-<NUM>-fluoren-<NUM>-caboxamide.

In an embodiment of the present disclosure, lomitapide is represented by the following Chemical Formula I:.

In the present invention, the cancer is colorectal cancer or melanoma.

The composition used in the present disclosure may contain a pharmaceutically acceptable carrier in addition to the active ingredient lomitapide, a pharmaceutically acceptable salt thereof, or an optical isomer thereof.

So long as it is typically used for formulations, any pharmaceutically acceptable carrier may be contained in the composition used in the present disclosure. Examples of the pharmaceutically acceptable carrier include, but are not limited to, lactose, dextrose, sucrose, sorbitol, mannitol, starch, acacia gum, calcium phosphate, alginate, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone, cellulose, water, syrup, methyl cellulose, methyl hydroxybenzoate, propyl hydroxybenzoate, talc, magnesium stearate, and mineral oil.

The pharmaceutical composition used in the present disclosure may further contain, in addition to the above ingredients, a lubricant, a humectant, a sweetener, a flavorant, an emulsifier, a suspending agent, a preservative, and the like. For a detail of suitable pharmaceutically acceptable carriers and preparations, reference may be made of <NPL>).

The pharmaceutical composition used in the present disclosure can be administered orally or parenterally via, for example, intrathecal, intravenous, subcutaneous, intradermal, intramuscular, intraperitoneal, intrasternal, intratumoral, intranasal, intracerebral, intracranial, intrapulmonary, and intrarectal routes, but with no limitations thereto.

A suitable dosage of the pharmaceutical composition used in the present invention varies depending on factors such as formulation method, mode of administration, patient's age, weight, sex, pathological condition, and diet, the duration of administration, the route of administration, excretion rate, and response sensitivity, Usually, the skilled practitioner can easily determine and prescribe the effective dosage (pharmaceutically effective amount) for the desired treatment or prophylaxis. According to a preferred embodiment of the present disclosure, the daily dosage of the pharmaceutical composition used in the present disclosure is in the range of <NUM>-<NUM>/kg.

As used herein, the term "pharmaceutically effective amount" means an amount sufficient to prevent or treat the aforementioned diseases.

As used herein, the term "prevention" means prophylactic or protective treatment of a disease or disease state. As used herein, the term "treatment" refers to reduction, suppression, sedation or eradication of a disease state.

The pharmaceutical composition used in the present disclosure is formulated using a pharmaceutically acceptable carrier and/or excipient, according to the method that is easily conducted by a person having ordinary skills in the art to which the present disclosure pertains, and the pharmaceutical composition may be prepared into a unit dosage form or may be inserted into a multidose container. Here, the dosage form may be prepared in various ways, such as oral formulation, injection formulation, etc., may be a solution in an oily or aqueous medium, a suspension, an emulsion, an extract, a powder, a suppository, a granule, a tablet, or a capsule, and may further contain a dispersant or a stabilizer.

According to an embodiment of the present disclosure, the pharmaceutical composition including lomitapide used in the present disclosure has the effect of inhibiting the mTOR signaling pathway and upregulating the expression of a protein involved in an autophagy mechanism of cells.

The term "autophagy", as used herein, refers to the natural, conserved degradation of the cell that removes unnecessary or dysfunctional components through a cellular regulated mechanism.

There are autophagy-related genes including genes encoding for ULK1, mTOR, ATG family, and DDIT4.

ULK1, encoded by a ULK1 gene, is a protein kinase necessary for the initiation of autophagy. Under the condition of high mTOR activity, the activity of ULK1 is suppressed. When the mTOR activity is inhibited, ULK1 is activated to initiate the autophagy-related signaling.

mTOR, which is a protein kinase, is a core component which is essentially responsible for the inhibition of autophagy as well as the regulation of growth and activity of cells. mTOR mediates the regulation of autophagy by directly phosphorylating ULK1 and various autophagy proteins. In the condition of inhibiting mTOR activity, autophagy is actively promoted on the contrary.

Genes in the ATG family, which consist of about <NUM> autophagy-related genes, play pivotal roles in the onset and progression of autophagy. They are responsible for the overall process of autophagy including the initiation of autophagy, the formation of autophagy membranes, the recognition of a substrate to be degraded, and the fusion of autophagy membranes with liposomes.

DDIT4, also known as REDD1, regulates mTOR via TSC protein. Thus, an increased level of DDIT4 induces the downregulation of mTOR, leading to an increase in autophagy activity.

According to an embodiment of the present disclosure, the pharmaceutical composition used in the present disclosure has the effect of suppressing the growth of cancer cells and inhibiting the growth of tumor in vivo. Therefore, the pharmaceutical composition used in the present disclosure has inhibitory activity against colorectal cancer and melanoma.

In the present invention, the composition further includes an anticancer agent selected from the group consisting of fluorouracil, irinotecan, and an anti-PD1 antibody.

In an embodiment of the present disclosure, the composition may contain lomitapide at a concentration of <NUM> to <NUM>.

According to an embodiment of the present disclosure, a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of fluorouracil exhibits a synergistic anticancer effect against the colorectal cancer cell line HCT116, more specifically, with the highest synergistic peak detected in a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of fluorouracil.

According to an embodiment of the present disclosure, a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of irinotecan exhibits a synergistic anticancer effect against the colorectal cancer cell line HCT116, more specifically, with the highest synergistic peak detected in a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of irinotecan.

According to an embodiment of the present disclosure, a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of fluorouracil exhibits a synergistic anticancer effect against the colorectal cancer cell line HT29,
According to an embodiment of the present disclosure, a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of irinotecan exhibits a synergistic anticancer effect against the colorectal cancer cell line HT29, more specifically, with the highest synergistic peak detected in a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of irinotecan.

According to an embodiment of the present disclosure, a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of fluorouracil exhibits a synergistic anticancer effect against the colorectal cancer cell line SW480.

According to an embodiment of the present disclosure, a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> of irinotecan exhibits a synergistic anticancer effect against the colorectal cancer cell line SW480, more specifically, with the highest synergistic peak detected in a combination of <NUM> to <NUM> of lomitapide and <NUM> to <NUM> or <NUM> to <NUM> of irinotecan.

PD-<NUM> is a key immune checkpoint receptor expressed by activated T and B cells and mediates immunosuppression. PD-<NUM> is a member of the CD28 family of receptors, which include CD28, CTLA-<NUM>, ICOS, PD-<NUM>, and BTLA. Two cell surface glycoprotein ligands for PD-<NUM> have been identified: programmed death-<NUM> (PD-L1) and programmed death ligand-<NUM> (PD-L2). These ligands are expressed on various human cancer cells as well as antigen-presenting cells and have been shown to downregulate cytokine secretion and T cell activation upon binding to PD-<NUM>. Inhibition of the PD-<NUM>/PD-L1 interaction mediates potent antitumor activity in preclinical models.

According to another aspect thereof, the present disclosure provides a pharmaceutical composition for use in a method for prevention or treatment of cancer, the method comprising a step of administering to a subject a pharmaceutical composition according to the invention, wherein the cancer is colorectal cancer or melanoma.

As used herein, the term "administration" or "administer" refers to the direct application of a therapeutically effective amount of the composition of the present disclosure to a subject (i.e., an object) which suffers from or is likely to suffer from the diseases, thereby forming the same amount thereof in the body of the subject.

The term "therapeutically effective amount" of the composition refers to the content of the composition, which is sufficient to provide a therapeutic or prophylactic effect to a subject to be administered, and thus the term has a meaning including "prophylactically effective amount".

As used herein, the term "subject" is intended to encompass mammals including humans, mice, rats, guinea pigs, dogs, cats, horses, cow, pigs, monkeys, chimpanzee, baboon, or rhesus monkeys. Specifically, the subject of the present disclosure is a human.

Since the method for preventing or treating cancer of the present disclosure includes a step of administering the pharmaceutical composition according to an aspect of the present disclosure, the overlapping descriptions therebetween are omitted to avoid undue complexity of the specification.

Features and advantages of the present disclosure are summarized as follows:
The present disclosure provides a pharmaceutical composition for use in the prevention or treatment of cancer, the pharmaceutical composition comprising (a) lomitapide, a pharmaceutically acceptable salt thereof, or an optical isomer thereof, and (b) fluorouracil, irinotecan, or an anti-PD1 antibody as an active ingredient, wherein the cancer is colorectal cancer or melanoma.

The composition used in the present disclosure exhibits the efficacy of suppressing the growth of cancer cells and killing cancer cells and as such, can be used as an anticancer agent.

A better understanding of the present disclosure may be obtained through the following examples, which are set forth to illustrate, but are not to be construed to limit the present disclosure.

Throughout the description, the term "%" used to express the concentration of a specific material, unless otherwise particularly stated, refers to (wt/wt) % for solid/solid, (wt/vol) % for solid/liquid, and (vol/vol) % for liquid/liquid.

NCM460 (human colon normal cell), HCT116 (human colon cancer cell, p53 wild-type), HT29 (human colon cancer cell, p53 mutant), SW480 (human colon cancer cell, p53 mutant), MC38 (mouse colorectal cancer cell), and B16F10 (mouse melanoma cell) were purchased from ATCC (American Type Culture Collection, Virginia, USA).

NCM460 and HCT116 cells were cultured in McCoy's 5a medium (Sigma Aldrich, Missouri, USA) supplemented with <NUM> glutamine, <NUM>% penicillin-streptomycin, and <NUM>% fetal bovine serum (FBS) at <NUM> under <NUM>% CO<NUM>. HT29 and SW480 cells were cultured RPMI medium (Sigma Aldrich, Missouri, USA) supplemented with <NUM> glutamine, <NUM>% penicillin-streptomycin, and <NUM>% fetal bovine serum (FBS) at <NUM> under <NUM>% CO<NUM>. MC38 and B16F10 cells were cultured in DMEM medium (Sigma Aldrich, Missouri, USA) supplemented with <NUM> glutamine, <NUM>% penicillin-streptomycin, and <NUM>% fetal bovine serum (FBS) at <NUM> under <NUM>% CO<NUM>.

HCT116, HT29, and SW480 cells were seeded into <NUM>-well plates and treated with or without predetermined concentrations of individual drugs alone or in combination for <NUM> hours. In each well, DMSO was used at a final concentration of <<NUM> %. The concentrations used were observed to be free of toxicity. For assay, the following drugs were employed.

HCT116 cells were seeded at a density of <NUM>,<NUM> cells/well, and HT29 and SW480 cells were each seeded at a density of <NUM>,<NUM> cells/well. After incubation for <NUM> hours, <NUM>µL of an assay reagent (CellTiter-Glo® Reagent) was added to each well. Luminescence was read using VICTOR X Multilabel Reader (PerkinElmer, Massachusetts, USA) and used to calculate cell viability (%).

Drug synergy was evaluated using an HSA model. HSA scores were divided into three ranges of > <NUM>, -<NUM> ~ <NUM>, and < -<NUM>, which account for synergistic, additive, and antagonistic efficacies, respectively. Scores were given as individual points in each column of 4x4, 3x3, and 2x7 matrices of drug doses, and distributions of overall drug responses are depicted in two- and three-dimensional contour graphs.

In this assay, it was observed that synergic effects were obtained when lomitapide was used in combination with a conventional colorectal cancer drug, that is, <NUM>-FU or irinotecan (<FIG>).

For mouse homograft tumor model, experiments were conducted using female C57B6/N mice (wild-type, <NUM> weeks old) with MC38 colorectal cancer and B16F10 melanoma cell lines. MC38 colorectal cancer and B16F10 melanoma cell lines were each subcutaneously injected at a dose of <NUM> x <NUM><NUM> cells. Lomitapide used in the two models was formulated with <NUM> % saline, <NUM> % PEG300, <NUM> % Tween-<NUM>, and <NUM> % DMSO.

From <NUM> days after the DMC38 colorectal cancer cells injection, lomitapide was intraperitoneally injected five times at a dose of <NUM>/kg, and anti-PD-<NUM> mAb (clone RMP1-<NUM>, BioXCell, West Lebanon, NH, USA) or rat IgG2a iso-type control (clone 2A3, BioXCell, BE0089) in PBS was administered at a dose of <NUM>/kg at days <NUM>, <NUM>, <NUM>, and <NUM> (<FIG> and <FIG>).

For B16F10 skin melanoma, from <NUM> days after the tumor injection, lomitapide was intraperitoneally injected at a dose of <NUM>/kg three times at days <NUM>, <NUM>, and <NUM>, and anti-PD-<NUM> mAb (clone RMP1-<NUM>, BioXCell, West Lebanon, NH, USA) or rat IgG2a iso-type control (clone 2A3, BioXCell, BE0089) was administered at a dose of <NUM>/kg at days <NUM>, <NUM>, <NUM>, and <NUM>. The mice were euthanized immediately when signs of pain were observed, the body weight was reduced by <NUM>% compared to the normal weight, or the tumor volume exceeded <NUM>,<NUM><NUM> (<FIG> and <FIG>).

Through the two experiments, it was observed that lomitapide significantly suppressed and reduced tumor growth in the mouse homograft model, compared to the control. Even when compared to the test groups treated with the anti-PD-<NUM> mAb, tumor growth was greatly suppressed and reduced in the lomitapide-treated group. Treatment with lomitapide and anti-PD-<NUM> mAb in combination synergistically reduced the tumor size.

In addition, MC38 colorectal cancer cells were analyzed for immunocytes (CD4+, CD4+/CD44+, CD8+, CD8+/IFNη, Foxp3, NK, and NK/IFNγ). Levels of immunocytes in the group treated with lomitapide alone were observed to be superior (CD4+, NK, NK/IFNγ) or similar (CD4+/CD44+, CD8+, CD8+/IFNη, and Foxp3) to the group treated with anti-PD-<NUM> mAb alone. All of the immunocytes were remarkably increased om the test group treated with the two drugs in combination (<FIG>).

Claim 1:
A pharmaceutical composition for use in the prevention or treatment of cancer, the pharmaceutical composition comprising (a) lomitapide, a pharmaceutically acceptable salt thereof, or an optical isomer thereof, and (b) fluorouracil, irinotecan, or an anti-PD1 antibody as an active ingredient, wherein the cancer is colorectal cancer or melanoma.