Patent Description:
Lung cancer is one of the most common malignant tumors in the world, and it is the cancer with the highest incidence and mortality in China. In the past thirty years, the growth rate of lung cancer in China has reached as high as <NUM>%, and the mortality rate is close to the incidence rate, accounting for about <NUM>% of the global total. Non-small cell lung cancer (NSCLC) accounts for about <NUM>%-<NUM>% of lung cancers. Compared with small cell lung cancer, non-small cell lung cancer has a lower degree of deterioration and a relatively late metastasis, but most patients (~<NUM>%) have been already in the middle and advanced stage when confirmed, the recurrence rate was high, and the <NUM>-year survival rate was less than <NUM>%.

EGFR mutations, ALK rearrangements, and ROS1 mutations are the most common driver genes in NSCLC. The mutation probabilities of ALK and ROS1 are approximately <NUM>-<NUM>%. the EGFR mutations are associated with <NUM>% of NSCLC, and as high as <NUM>% in Asians. A variety of molecularly targeted drugs for the mutations have been used clinically. The targeted drugs currently marketed for EGFR mutations include: icotinib, gefitinib and erlotinib of first generation for <NUM>, <NUM> exon mutations; afatinib of second generation for <NUM>, <NUM> exon mutations; and osimertinib (also referred as AZD9291 herein) of third generation for T790M mutation. The targeted drugs for ALK mutations include: crizotinib as first-generation of targeted drug, ceritinib, alectinib and brigatinib as second-generation of targeted drugs, lorlatinib as third-generation of targeted drug, and the like. However, the targeted drugs usually exhibit resistance about <NUM> year after administration. Thus, overcoming the drug resistance of the targeted drugs or delaying the drug resistance is one of the main objectives in drug research and development.

In one aspect, the invention provides an EGFR inhibitor for use in a method for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual, said method comprising administering to the individual a therapeutically effective amount of an ALK inhibitor , and a therapeutically effective amount of an EGFR inhibitor, as defined in the appended claims.

In another aspect, the invention provides a pharmaceutical composition as defined in the appended claims, comprising an ALK inhibitor and an EGFR inhibitor, as well as a pharmaceutically acceptable carrier.

In another aspect, the invention provides a kit as defined in the appended claims, comprising:.

Unless otherwise defined below, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art. References to techniques used herein are intended to refer to techniques that are generally understood in the art, including those obvious changes or equivalent replacements of the techniques for those skilled in the art. Whileit is believed that the following terms are well understood by those skilled in the art, the following definitions are set forth to better explain the invention.

As used herein, the terms "including", "comprising", "having", "containing" or "comprising", and other variants thereof, are inclusive or open, and do not exclude other unlisted elements or method steps.

As used herein, "FAK" refers to focal adhesion kinase, and "FAK inhibitor" refers to an agent having an inhibitory effect on FAK. In some embodiments, the FAK inhibitor also has an inhibitory effect on one or more other targets (e.g., ALK and/or ROS1).

As used herein, "ALK" refers to anaplasticlymphoma kinase, and "ALK inhibitor" refers to an agent having an inhibitory effect on ALK. In some embodiments, the ALK inhibitor also has an inhibitory effect on one or more other targets (e.g., FAK and/or ROS1).

As used herein, "ROS1" is a tyrosine protein kinase encoded by ROS1 proto-oncogene in human, and "ROS1 inhibitor" refers to an agent having an inhibitory effect on ROS1. In some embodiments, the ROS1 inhibitor also has an inhibitory effect on one or more other targets (e.g., FAK and/or ALK).

As used herein, "EGFR inhibitor" refers to an agent that selectively and efficiently inhibits an epidermal growth factor receptor (EGFR) that carries a certain mutation form.

The term "alkyl" as used herein, alone or as part of another group, refers to an unsubstituted straight or branched aliphatic hydrocarbon containing from <NUM> to <NUM> carbon atoms (ie, C<NUM>-<NUM> alkyl) or an indicated number of carbon atoms, for example, C<NUM> alkyl such as methyl, C<NUM> alkyl such as ethyl, C<NUM> alkyl such as n-propyl or isopropyl, C<NUM>-<NUM> alkyl such as methyl, ethyl, n-propyl or isopropyl, or the like. In one embodiment, the alkyl is C<NUM>-<NUM> alkyl. Non-limiting examples of C<NUM>-<NUM> alkyl include methyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl, tert-butyl, isobutyl, <NUM>-pentyl, hexyl, heptyl, octyl, nonyl and decyl. Examples of C<NUM>-<NUM> alkyl include methyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl, tert-butyl, and isobutyl.

The term "cycloalkyl" as used herein, alone or as part of another group, refers to a saturated or partially unsaturated (containing one or two double bonds) cyclic aliphatic hydrocarbon, which comprises <NUM> or <NUM> rings having <NUM> to <NUM> carbon atoms or an indicated number of carbon atoms (i.e., C<NUM>-<NUM> cycloalkyl). In one embodiment, the cycloalkyl has two rings. In one embodiment, the cycloalkyl has one ring. In another embodiment, the cycloalkyl group is selected from the group consisting of C<NUM>-<NUM> cycloalkyl groups. In another embodiment, the cycloalkyl group is selected from the group consisting of C<NUM>-<NUM> cycloalkyl groups. Non-limiting examples of cycloalkyl include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, cyclooctyl, norbornyl, decahydronaphthyl, adamantyl, cyclohexenyl, and cyclopentenyl.

The term "heterocycle" or "heterocyclyl" as used herein, alone or as part of another group, refers to a saturated or partially unsaturated (e.g., comprising one or two double bonds) cyclic group, which comprises <NUM>, <NUM> or <NUM> rings having <NUM> to <NUM> ring members (i.e., <NUM>- to <NUM>-membered heterocyclyl), wherein at least one carbon atom of one of the rings is replaced by a heteroatom. Each heteroatom is independently selected from the group consisting of atoms of oxygen, sulfur (including sulfoxide and sulfone) and/or nitrogen (which may be oxidized or quaternized). The term "heterocyclyl" is intended to include a group wherein -CH<NUM>- in the ring is replaced by - C(=O)-, for example, cyclic ureido (such as <NUM>-imidazolidinone) and cyclic amido (such as β-lactam, γ-lactam, δ-lactam, ε-lactam) and piperazin-<NUM>-one. In one embodiment, the heterocyclyl is a <NUM>- to <NUM>-membered cyclic group comprising <NUM> ring and <NUM> or <NUM> oxygen and/or nitrogen atoms. In one embodiment, the heterocyclyl is a <NUM>-, <NUM>- or <NUM>-membered cyclic group comprising <NUM> ring and <NUM> or <NUM> oxygen and/or nitrogen atoms. In one embodiment, the heterocyclyl is a <NUM>- or <NUM>-membered cyclic group comprising <NUM> ring and <NUM> or <NUM> oxygen and/or nitrogen atoms. The heterocyclyl can be attached to the remainder of molecule via any available carbon or nitrogen atom. Non-limiting examples of the heterocyclyl include dioxanyl, tetrahydropyranyl, <NUM>-oxopyrrolidin-<NUM>-yl, piperazin-<NUM>-one, piperazin-<NUM>,<NUM>-dione, <NUM>-imidazolidinone, piperidinyl, morpholinyl, piperazinyl, pyrrolidinyl and dihydroindolyl.

As used herein, the term "enantiomeric excess" or "ee" refers to a measure of how much one enantiomer is present relative to another enantiomer. For a mixture of R and S enantiomers, the enantiomeric excess in form of percentage is defined as |R - S|*<NUM>, wherein R and S respectively represents mole or weight parts thereof in the mixture, and R + S = <NUM>. After knowing the optical rotation of chiral substance, the enantiomeric excess in form of percentage is defined as ([α]obs/[α]max)* <NUM>, wherein [α]obs represents the optical rotation of the mixture of enantiomers, [α]max represents the optical rotation of pure enantiomer. Enantiomeric excess can be determined using a variety of analytical techniques, including NMR spectroscopy, chiral column chromatography, or optical rotation. The compound of the present invention may have an ee of about <NUM>% or more, such as about <NUM>% or more, <NUM>% or more, <NUM>% or more, <NUM>% or more, <NUM>% or more, <NUM>% or more, <NUM>% or more, <NUM>% or more, <NUM>% or more, <NUM>% or more, or <NUM>% or more.

The term "pharmaceutically acceptable salt", as used herein, includes both acid addition salts and base addition salts of a compound.

Suitable acid addition salts are formed from acids which form non-toxic salts. Examples include acetate, adipate, aspartate, benzoate, besylate, bicarbonate/carbonate, bisulfate/sulfate, borate, camphorsulfonate, citrate, cyclohexylaminosulfonate, ethanedisulfonate, ethanesulfonate, formate, fumarate, glucoheptonate, gluconate, glucuronate, hexafluorophosphate, hibenzate, hydrochloride/chloride, hydrobromide/bromide, hydroiodide/iodide, isethionate, lactate, malate, maleate, malonate, methanesulfonate, methylsulfate, naphthylate, <NUM>-naphthalenesulfonate, nicotinate, nitrate, orotate, oxalate, palmitate, pamoate, phosphate/hydrogen phosphate/dihydrogen phosphate, pyroglutamate, aldarate, stearate, succinate, tannate, tartrate, tosylate, trifluoroacetate and xinofoate.

Suitable base addition salts are formed from bases which form non-toxic salts. Examples include aluminum salts, arginine salts, benzathine benzylpenicillin salts, calcium salts, choline salts, diethylamine salts, diethanolamine salts, glycine salts, lysine salts, magnesium salts, meglumine salts, ethanolamine salts, potassium salts, sodium salts, tromethamine salts and zinc salts.

For a review of suitable salts, see "<NPL>). Methods for preparing the pharmaceutically acceptable salts of the compounds of the invention are known to those skilled in the art.

The term "solvate" as used herein is a substance formed by combination, physical binding and/or solvation of a compound of the invention with a solvent molecule, such as a disolvate, a monosolvate or a hemisolvate, wherein the ratio of the solvent molecule to the compound of the invention is about <NUM>:<NUM>, about <NUM>:<NUM> or about <NUM>:<NUM>, respectively. This kind of physical bonding involves ionization and covalent bonding (including hydrogen bonding) in different degrees. In some cases (e.g., when one or more solvent molecules are incorporated into crystal lattice of crystalline solid), the solvate can be isolated. Thus, the solvate comprises both solution phase and isolatable solvates. The compounds of the invention may be in solvated forms with pharmaceutically acceptable solvents (such as water, methanol and ethanol), and the present application is intended to encompass both solvated and unsolvated forms of the compounds of the invention.

One type of solvate is a hydrate. "Hydrate" relates to a specific subset of solvates wherein the solvent molecule is water. Solvates generally function in the form of pharmacological equivalents. The preparation of solvates is known in the art, see for example, <NPL>), which describes the preparation of a solvate of fluconazole with ethyl acetate and water. Similar methods for the preparation of solvates, hemisolvates, hydrates and the like are described by <NPL>) and <NPL>). A representative and non-limiting method for the preparation of solvate involves dissolving a compound of the invention in a desired solvent (organic solvent, water or a mixture thereof) at a temperature above <NUM> to about <NUM>, and then the solution is cooled at a rate sufficient to form a crystal, and the crystal is separated by a known method such as filtration. Analytical techniques such as infrared spectroscopy can be used to confirm the presence of the solvent in the crystal of the solvate.

"Pharmaceutically acceptable carrier" in the context of the present invention refers to a diluent, adjuvant, excipient or vehicle together with which the therapeutic agent is administered, and which is suitable for contacting a tissue of human and/or other animals within the scope of reasonable medical judgment, and without excessive toxicity, irritation, allergic reactions, or other problems or complications corresponding to a reasonable benefit/risk ratio.

The pharmaceutically acceptable carriers that can be used in the pharmaceutical compositions or kits of the invention include, but are not limited to, sterile liquids such as water and oils, including those oils derived from petroleum, animals, vegetables or synthetic origins, for example, peanut oil, soybean oil, mineral oil, sesame oil, etc. Water is an exemplary carrier when the pharmaceutical composition is administered intravenously. It is also possible to use physiological saline and an aqueous solution of glucose and glycerin as a liquid carrier, particularly for injection. Suitable pharmaceutical excipients include starch, glucose, lactose, sucrose, gelatin, maltose, chalk, silica gel, sodium stearate, glyceryl monostearate, talc, sodium chloride, skimmed milk powder, glycerin, propylene glycol, water, ethanol and the like. The pharmaceutical composition may further contain a small amount of a wetting agent, an emulsifier or a pH buffering agent as needed. Oral formulations may contain standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharin, cellulose, magnesium carbonate, and the like. Examples of suitable pharmaceutically acceptable carriers are as described in <NPL>).

The pharmaceutical compositions and the components of the kit of the invention may act systemically and/or locally. For this purpose, they may be administered via a suitable route, for example by injection (e.g., intravenous, intraarterial, subcutaneous, intraperitoneal, intramuscular administration, including instillation) or transdermal administration; or by oral, buccal, nasal, transmucosal, topical administration, in form of ophthalmic preparation or by inhalation.

For these routes of administration, the pharmaceutical compositions and the components of the kit of the invention may be administered in a suitable dosage form.

The dosage forms include, but are not limited to, tablets, capsules, troches, hard candy, pulvis, sprays, creams, ointments, suppositories, gels, pastes, lotions, ointments, aqueous suspensions, injectable solutions, elixirs, syrups.

The term "container" as used herein refers to a container for holding a pharmaceutical component. This container can be used for preparation, storage, transportation and/or stand-alone/bulk sale, which is intended to include bottles, cans, vials, flasks, syringes, tubes (e.g., those used in cream products), or any other containers for preparation, containment, storage or distribution of a drug product.

The term "specification/instruction" as used herein refers to an insert, a tag, a label, etc., which records information about a pharmaceutical component located in the container. The information as recorded is typically determined by the regulatory agency (e.g., the United States Food and Drug Administration) that governs the area in which the product is to be sold. Preferably, the package leaflet specifically lists an indication for which the use of the pharmaceutical component is approved. The package leaflet can be made of any material from which information contained therein or thereon can be read. Preferably, the package leaflet is a printable material (e.g., paper, plastic, cardboard, foil, adhesive paper or plastic, etc.) on which the desired information can be formed (e.g., printed or applied).

The term "effective amount" as used herein refers to an amount of active ingredient that, after administration, will relieve to some extent one or more symptoms of the condition being treated.

As used herein, "individual" includes a human or a non-human animal. Exemplary human individual includes a human individual (referred to as a patient) suffering from a disease (such as the disease described herein) or a normal individual. "Non-human animal" in the present invention includes all vertebrates, such as non-mammals (e.g., birds, amphibians, reptiles) and mammals, such as non-human primates, domestic animals, and/or domesticated animals (e.g., sheep, dogs, cats, cows, pigs, etc.).

As used herein, "cancer metastasis" refers to a cancer that spreads (metastasizes) from its original site to another area of the body. Almost all cancers have the potential to metastasize. Whether metastasis will occur depends on complex interactions between multiple tumor cell factors (including type of cancer, degree of maturation (differentiation) of tumor cells, location and age of cancer, and other factors that are not fully understood). There are three ways of metastasis: local expansion from a tumor to a surrounding tissue, arrival through bloodstream to a distant site, or arrival through lymphatic system to an adjacent or distant lymph node. Each cancer can have a representative diffusion route. Tumors are named according to their primary sites (for example, breast cancer that has metastasized to the brain is called metastatic breast cancer that metastasizes to the brain).

As used herein, "resistance" refers to that a cancer cell is resistant to chemotherapy. Cancer cells may acquire resistance to chemotherapy through a range of mechanisms, including mutation or overexpression of drug targets, inactivation of drugs, or elimination of drugs from cells.

The invention provides an EGFR inhibitor for use in a method for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual, said method comprising administering to the individual a therapeutically effective amount of an ALK inhibitor, and a therapeutically effective amount of an EGFR inhibitor.

In another embodiment, the invention provides a use of an ALK inhibitor in manufacture of a medicament in combination with an EGFR inhibitor for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual.

In another embodiment, the invention provides a use of an EGFR inhibitor in manufacture of a medicament in combination with an ALK inhibitor for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual.

In another embodiment, the invention provides a use of an ALK inhibitor in manufacture of a medicament for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual which is being treated with a cancer therapy containing an EGFR inhibitor.

In another embodiment, the invention provides an ALK inhibitor which is used in combination with an EGFR inhibitor for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual.

In another embodiment, the invention provides an EGFR inhibitor which is used in combination with an ALK inhibitor for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual.

In another embodiment, the invention provides one an ALK inhibitor which is used for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual which is being treated with a cancer therapy containing an EGFR inhibitor.

According to the invention, the ALK inhibitor is a compound of Formula I or II, or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

In a non-claimed embodiment, the ALK inhibitor is a compound of Formula III or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

In a non-claimed embodiment, the ALK inhibitor is a compound of Formula IV or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

In a non-claimed embodiment, the ALK inhibitor is a compound of Formula V or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

In a non-claimed embodiment, the ALK inhibitor is a compound of Formula VI or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

In a preferred embodiment, the ALK inhibitor is:.

Compounds <NUM>-<NUM> and <NUM>-<NUM> of the above table are not part of the invention.

In a preferred embodiment, the ALK inhibitor is <NUM>-chloro-N<NUM>-(<NUM>-isopropoxy-<NUM>-methyl-<NUM>-(<NUM>-(tetrahydro-<NUM>H-pyran-<NUM>-yl)-<NUM>,<NUM>,<NUM>,<NUM>-tetrahydropyridin-<NUM>-yl)phenyl)-N<NUM>-(<NUM>-(isopropylsulfonyl)phenyl)pyrimidine-<NUM>,<NUM>-diamine, or a pharmaceutically acceptable salt or hydrate thereof.

In a preferred aspect, the EGFR inhibitor is selected from the group consisting of icotinib, osimertinib (AZD9291), afatinib, Avitinib, gefitinib, erlotinib, lapatinibxylenesulphonate, neratinib, cetuximab, pamumab, vannameib, nexizumab, AG-<NUM>, tyrosine phosphorylation inhibitor AG <NUM>, CL-<NUM> , CL-<NUM>, oncogene inhibitor analog, PD <NUM>, PKC-<NUM>, PD <NUM>, tyrosine phosphorylation inhibitor <NUM>, butein, valanib dihydrochloride, tyrosine phosphorylation inhibitor <NUM>, AG <NUM>, tyrosine phosphorylation inhibitor AG <NUM>, AZD8931, CUDC-<NUM>, XL647, AG <NUM>, (+)shy-Aeroplysinin-<NUM>, PD <NUM>, OSI-<NUM> free base (demethyl erlotinib), WZ4002, tyrosine phosphorylation inhibitor B44, (-)enantiomer, tyrosine phosphorylation inhibitor B44, (+)enantiomer, PD161570, neratinib, HDS029, erlotinib-d6, lavendustin C methyl ester, RO <NUM>-<NUM>, tyrosine phosphorylation inhibitor AG <NUM>, AG <NUM>, AG <NUM>, RG-<NUM>, tyrosine phosphorylation inhibitor RG <NUM>, DAPH, BPIQ-II HCl salt, didesmethyl erlotinib hydrochloride, demethyl erlotinib acetate, PD <NUM> hydrochloride, BIBX <NUM>, GW2974, PD <NUM>, pilitinib, EGFR inhibitor III, AST <NUM>, gefitinib hydrochloride, ARRY334543, dacomitinib, gefitinib O-methyl-D3, OSI-<NUM>-d4, free base (demethyl erlotinib-d4), LFM-A12, BPDQ, tyrosine phosphorylation inhibitor <NUM>, tyrosine phosphorylation inhibitor AG <NUM>, BPIQ-I, gefitinib dihydrochloride, carnitinib dihydrochloride, GW <NUM> dihydrochloride, BIBU <NUM> dihydrochloride, TAK <NUM>, WZ <NUM>, WZ8040, O-demethyl gefitinib, O-demorpholinopropyl gefitinib, TAK <NUM>, CGP 74514A.

According to the invention, the EGFR inhibitor is afatinib, Avitinib or osimertinib (AZD9291).

In a preferred aspect, the cancer is selected from the group consisting of bladder cancer, breast cancer, cervical cancer, colon cancer (including colorectal cancer), esophageal cancer, esophageal squamous cell carcinoma, head and neck cancer, liver cancer, lung cancer (including small cell lung cancer and non-small cell lung cancer), melanoma, myeloma, rhabdomyosarcoma, inflammatory myofibroblastic tumor, neuroturbo chargeoma, pancreatic cancer, prostate cancer, kidney cancer, renal cell carcinoma, sarcoma (including osteosarcoma), skin cancer (including squamous cell carcinoma), gastric cancer, testicular cancer, thyroid cancer, uterine cancer, mesothelioma, cholangiocarcinoma, leiomyosarcoma, liposarcoma, nasopharyngeal carcinoma, neuroendocrine carcinoma, ovarian cancer, salivary gland cancer, metastasis caused by spindle cell carcinoma, anaplastic large cell lymphoma, thyroid undifferentiated carcinoma, non-Hodgkin's lymphoma, Hodgkin's lymphoma, and hematological malignancies, such as acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML).

According to the invention, the cancer is a tumor carrying an EGFRT790M mutation, wherein the tumor is non-small cell lung cancer.

In a preferred embodiment, the ALK inhibitor is administrated in an amount of from <NUM>/day to <NUM>/day, such as an amount of <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM>/day.

In a preferred embodiment, the ALK inhibitor is administrated in an amount of from <NUM> ng/kg to <NUM>/kg, <NUM>µg/kg to <NUM>/kg, or <NUM>/kg to <NUM>/kg per unit dose, for example, administrated in an amount of <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg per unit dose, and administrated with one or more (e.g., <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM>) unit doses per day.

In a preferred embodiment, the EGFR inhibitor is administrated in an amount of from <NUM>/day to <NUM>/day, for example, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM>/day.

In a preferred embodiment, the EGFR inhibitor is administrated in an amount of from <NUM> ng/kg to <NUM>/kg, from <NUM>µg/kg to <NUM>/kg, or from <NUM>/kg to <NUM>/kg per unit dose, for example, administrated in an amount of <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg,<NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>µg/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM> /kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg, <NUM>/kg per unit dose, and administered with one or more (e.g., <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, or <NUM>) unit doses per day.

In a preferred embodiment, the ALK and the EGFR inhibitor are administered together, simultaneously, sequentially or alternately.

In a preferred embodiment, the ALK inhibitor and/or the EGFR inhibitor are administered continuously for at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, or at least <NUM> days.

In a preferred embodiment, the ALK inhibitor and/or the EGFR inhibitor are administered for one or more (e.g., <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM>) courses of treatment, in which each of the courses lasts at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, at least <NUM> days, or at least <NUM> days; and there is an interval of <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> days, two weeks, three weeks or four weeks between every two courses of treatment.

In a preferred embodiment, when there are a plurality of courses of treatment, the amount of the ALK inhibitor and/or EGFR inhibitor administered in each course of treatment is same or different. In a more preferred embodiment, the amount of the ALK inhibitor and/or EGFR inhibitor administered during the previous course of treatment is <NUM>-<NUM> times, preferably <NUM>-<NUM> times, such as <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM> times, the amount administered during the subsequent course of treatment.

In a preferred embodiment, the ALK inhibitor as well as the EGFR inhibitor are administrated via the same (e.g., oral) or different routes (e.g., oral and parenteral (e.g., injection), respectively).

In a preferred embodiment, the EGFR inhibitor is administrated in a lower dose in comparison with the dose of EGFR inhibitor that is administered alone or when the ALK inhibitor is not administered.

In a preferred embodiment, the ALK inhibitor enhances the therapeutic efficacy of EGFR inhibitor in treatment of a cancer and/or reduces a side-effect of EGFR inhibitor in treatment of a cancer.

In a preferred aspect, the disclosure provides a use of an ALK inhibitor in manufacture of a medicament for enhancing the efficacy of an EGFR inhibitor in treatment of a cancer and/or reducing a side-effect of an EGFR inhibitor in treatment of a cancer.

In a preferred embodiment, the individual suffers from an advanced cancer.

In a preferred embodiment, the individual suffers from a refractory cancer, a recurrent cancer or a drug-resistant cancer, in particular a cancer that is resistant to a cancer therapy comprising an EGFR inhibitor.

In another embodiment, the invention provides a use of an ALK inhibitor in manufacture of a medicament in combination with an EGFR inhibitor for treating an individual with a drug-resistant cancer, particularly a cancer resistant to a cancer therapy containing the EGFR inhibitor.

In another embodiment, the invention provides a pharmaceutical composition comprising an ALK inhibitor as defined above and an EGFR inhibitor defined above and a pharmaceutically acceptable carrier.

In another embodiment, the invention provides a kit comprising:.

In order to make the objects and technical solutions of the present invention clearer, the present invention will be further described below in conjunction with specific example. Further, specific experimental methods not mentioned in the following examples were carried out in accordance with a conventional experimental method.

The abbreviations in the context have the following meanings:.

Tert-butyl <NUM>-(<NUM>,<NUM>,<NUM>,<NUM>-tetramethyl-<NUM>,<NUM>,<NUM>-dioxaborolan-<NUM>-yl)-<NUM>,<NUM>-dihydropyridine-<NUM>(<NUM>)-carboxylate (<NUM>, <NUM> mmol), Pd(dppf)Cl<NUM> (<NUM>, <NUM> mmol), and K<NUM>CO<NUM> (<NUM>, <NUM> mmol) were added to a solution of <NUM>-bromo-<NUM>-fluoro-<NUM>-methyl-<NUM>-nitrobenzene (<NUM>, <NUM> mmol) in DME-H<NUM>O (<NUM>, <NUM>:<NUM> mixture). The mixture was stirred at <NUM> for <NUM> hr under nitrogen. The reaction was cooled to room temperature and the product was extracted with ethyl acetate. Solvent was removed under reduced pressure and the residue was purified by silica gel chromatography with hexane/ethyl acetate (<NUM>/<NUM>, v/v) to afford the title compound of Step A (<NUM>, <NUM> % yield) as a slightly yellow oil.

<NUM>H NMR (<NUM>, CDCl<NUM>) δ ppm <NUM> (d, J = <NUM>, <NUM>), <NUM> (d, J = <NUM>, <NUM>), <NUM> (s, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM> - <NUM> (m, <NUM>), <NUM> (s, <NUM>), <NUM> (s, <NUM>).

To a solution of tert-butyl <NUM>-(<NUM>-fluoro-<NUM>-methyl-<NUM>-nitrophenyl)-<NUM>,<NUM>-dihydropyridine-<NUM>(<NUM>)-carboxylate (<NUM>, <NUM> mmol) in <NUM> of <NUM>-propanol, Cs<NUM>CO<NUM> (<NUM>, <NUM> mmol) was added. The mixture was stirred at <NUM> overnight, and after cooling to room temperature, most of the <NUM>-propanol was evaporated under reduced pressure. Water was added, and the solution was extracted with ethyl acetate. The organic layers were combined, dried over anhydrous Na<NUM>SO<NUM>, concentrated, and the crude product was purified by silica gel chromatography with hexane/ethyl acetate (<NUM>/<NUM>, v/v) to afford the title compound of Step B (<NUM>, <NUM>%) as a yellow oil.

<NUM>H NMR (<NUM>, CDCl<NUM>) δ <NUM> (s, <NUM>), <NUM> (s, <NUM>), <NUM> (s, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (s, <NUM>), <NUM> (s, <NUM>), <NUM> (d, J = <NUM>, <NUM>).

To a solution of tert-butyl <NUM>-(<NUM>-isopropoxy-<NUM>-methyl-<NUM>-nitrophenyl)-<NUM>,<NUM>-dihydropyridine-<NUM>(<NUM>)-carboxylate (<NUM>, <NUM> mmol) in dichloromethane (<NUM>), trifluoroacetic acid (<NUM>) was added and the reaction mixture was stirred at room temperature for <NUM> hr. The dichloromethane and trifluoroacetic acid were removed under vacuum and <NUM> of dichloromethane was added, washed with saturated NaHCO<NUM> solution. The water layer was extracted with dichloromethane for additional two times (<NUM> each). The organic layers were combined, washed with brine, dried over Na<NUM>SO<NUM> and evaporated. The residue was dissolved in dichloromethane (<NUM>) and tetrahydro-<NUM>-pyran-<NUM>-one (<NUM>, <NUM> mmol), sodium triacetoxyborohydride (<NUM>, <NUM> mmol) and acetic acid (<NUM>, <NUM> mmol) were then added. The reaction was stirred at room temperature overnight. The reaction was quenched by adding water (<NUM>), and extracted with dichloromethane (3x100 mL). The organic layers were combined, washed with brine, dried over Na<NUM>SO<NUM>, concentrated and purified by silica gel column chromatography with ethyl acetate/methanol (<NUM>/<NUM>, v/v) to afford the title compound of Step C (<NUM>, <NUM> % for two steps) as a yellow oil.

<NUM>H NMR (<NUM>, CDCl<NUM>) δ <NUM> (s, <NUM>), <NUM> (s, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> - <NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM>-<NUM>(m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (s, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (d, J = <NUM>, <NUM>).

To a solution of <NUM>-(<NUM>-isopropoxy-<NUM>-methyl-<NUM>-nitrophenyl)-<NUM>-(tetrahydro-<NUM>-pyran-<NUM>-yl)-<NUM>,<NUM>,<NUM>,<NUM>-tetrahydropyridine (<NUM>, <NUM> mmol) in <NUM> of ethanol was added <NUM> of <NUM> % HCl, followed by iron powder (<NUM>, <NUM> mmol). The mixture was stirred at <NUM> for <NUM> hr. The reaction was cooled to room temperature and the iron powder was filtered off. Ethanol was removed under reduced pressure and the title compound of Step D was obtained as pale yellow oil (<NUM>, <NUM> % yield). MS m/z=<NUM> [M+H].

<NUM>-Isopropoxy-<NUM>-methyl-<NUM>-(<NUM>-(tetrahydro-<NUM>-pyran-<NUM>-yl)-<NUM>,<NUM>,<NUM>,<NUM>-tetrahydropyridin-<NUM>-yl)aniline (<NUM>, <NUM> mmol), <NUM>,<NUM>-dichloro-N-(<NUM>-(isopropylsulfonyl)phenyl)pyrimidin-<NUM>-amine (<NUM>, <NUM> mmol), Xantphos (<NUM>, <NUM> mmol), Pd(OAc)<NUM> (<NUM>, <NUM> mmol), and Cs<NUM>CO<NUM> (<NUM>, <NUM> mmol) were dissolved in anhydrous THF (<NUM>). N<NUM> was bubbled through the reaction mixture for <NUM>, and then the reaction vessel was sealed and heated under microwave irradiation to <NUM> for <NUM>. The mixture was filtered and the filtrate concentrated under reduced pressure. After concentration, the crude product was purified by prep-HPLC (gradient from <NUM> % to <NUM> % acetonitrile in water) to the title compound of Step E (<NUM>, <NUM> % yield).

<NUM>H NMR (<NUM>, DMSO-d<NUM>) δ <NUM> (s, <NUM>), <NUM> (d, J = <NUM>, <NUM>), <NUM> (s, <NUM>), <NUM> (s, <NUM>), <NUM> (dd, J = <NUM>, <NUM>, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM> (s, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM> (s, <NUM>), <NUM> - <NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> - <NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM> (d, J = <NUM>, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM> (s, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (d, J = <NUM>, <NUM>), <NUM> (d, J = <NUM>, <NUM>).

The obtained compound was prepared as a methanesulfonate (Compound <NUM>) for use in the following examples.

Cell plating: Anti-proliferative effects were detected by a CCK-<NUM> (Cell Counting Kit-<NUM>) assay based on water soluble tetrazolium salt (WST). The cells were seeded in <NUM>-well plates, and only <NUM>µL of complete medium was added to each negative control group. <NUM>µL of complete medium cell suspension was added to each well to be tested, and the cell density was (<NUM>-<NUM>)×<NUM>^<NUM>/ hole.

Dosing (protection from light): In <NUM>-well culture plates, according to the sensitivity of different cells to different drugs, the highest concentration was selected as <NUM>, and <NUM> concentrations were obtained by serial dilution in a ratio of <NUM>:<NUM>. <NUM>µL of compound was added to each well and <NUM>-<NUM> replicate wells were made for per concentration. After the compound was added, <NUM>-well plates were incubated in a <NUM>% CO<NUM> incubator at <NUM>. After <NUM> hours of action by using <NUM> different concentrations of the drug with <NUM> fixed doses of Compound <NUM>, the combination effect of Compound <NUM> and the drug was tested.

Reading: At the end of the culture, the old solution was removed from the well to be tested, and <NUM>µl/well CCK-<NUM> test solution (containing <NUM>% CCK-<NUM>, <NUM>% FBS in the corresponding medium) was added. The plates were continuously incubated at <NUM> for <NUM>-<NUM> hours in a CO<NUM> incubator.

The OD values were measured using a microplate reader (SpectraMax Plus <NUM>, Molecular Devices, LLC. , US) under A450 nm. Using the average OD value of <NUM> replicate wells, the percentage of cell viability was calculated by the following formula: <MAT>.

IC<NUM> values were calculated using Graphpad Prism <NUM> software for nonlinear regression data analysis method. The results are shown in <FIG> and Table <NUM>.

For combination experiments, cell viability was calculated by normalization of the mean OD values of <NUM> replicate wells of single drug control. The comparison of the IC<NUM> values obtained from the curves of combined drugs of administration and single drug of administration shows that the two compounds achieved synergistic effect (the curve of the combined drugs of administration shifted to the left).

A subcutaneous xenograft tumor model of human tumor immunodeficient mice was established by cell inoculation: tumor cells in logarithmic growth phase were collected, counted, resuspended in <NUM>×PBS, and the cell suspension concentration was adjusted to <NUM>-<NUM>×<NUM><NUM>/mL. The tumor cells were inoculated subcutaneously in the right side of immunodeficient mice with a <NUM> syringe (<NUM> gauge needle), <NUM>-<NUM>×<NUM><NUM>/<NUM>/mouse. All animal experiments were strictly in accordance with the specifications for the use and management of experimental animals in Gima Gene Co. and Suzhou Ascentage Pharma Co. The calculation of relevant parameters refers to the Chinese NMPA "Guidelines for Non-Clinical Research Techniques of Cytotoxic Anti-tumor Drugs".

Animal body weight and tumor size were measured twice weekly during the experiment. The state of the animal and the presence or absence of death were observed every day. The growth of tumor and the effects of treatment on normal behavior of animals were monitored routinely, specifically involving experimental animal activity, feeding and drinking, weight gain or loss, eyes, clothing hair and other abnormalities. The deaths and clinical symptoms observed during the experiment were recorded in the raw data. All operations for administration and measurement of mouse body weight and tumor volume were performed in a clean bench. According to the requirements of the experimental protocol, after the end of the last administration, plasma and tumor tissues were collected, weighed and photographed. The plasma and tumor samples were frozen at -<NUM> for ready-to-use.

Tumor volume (TV) is calculated as: TV = a×b<NUM>/<NUM>, wherein a and b represent the length and width of the tumor to be measured, respectively.

The relative tumor volume (RTV) is calculated as: RTV = Vt/V<NUM>, wherein V<NUM> is the tumor volume at the start of grouping and administration, and Vt is the tumor volume measured on the t day after administration.

The evaluation index of anti-tumor activity is the relative tumor proliferation rate T/C (%), and the calculation formula thereof is: relative tumor proliferation rate T/C (%) = (TRTV/CRTV) × <NUM>%, TRTV is the RTV of treatment group, CRTV is the RTV of solvent control group. <MAT> <MAT>.

Evaluation criteria for therapeutic efficiency: According to the <NPL>), when T/C (%) value is ≤<NUM>% and statistical analysis shows p<<NUM>, efficiency is confirmed. A dose of drug is considered to be severely toxic if the body weight of mouse is reduced by more than <NUM>% or the number of drug-related deaths exceeds <NUM>%.

According to the description by <NPL>, synergy analysis was evaluated using the following formula: synergy factor = ((A/C) × (B/C)) / (AB/C); A = RTV value of drug A alone group; B = RTV value of drug B alone group; C = RTV value of the solvent control group, and AB= RTV value of the A and B combination group. Synergistic factor ><NUM> indicates that synergy is achieved; synergy factor = <NUM> indicates that additive effect is achieved; and synergy factor <<NUM> indicates that antagonistic effect is achieved.

In in vitro cell experiments, NSCLC H1975 cells carrying EGFRT790M mutation was very sensitive to a combination of Compound <NUM> and an EGFR inhibitor (<FIG>). Subsequently, a H1975 cell-derived mouse xenograft tumor model was established to evaluate the anti-tumor effects of Compound <NUM> in combination with EGFR inhibitor AZD9291 (osimertinib) or afatinib. The dosage regimens are as follows:.

As shown in <FIG> and Table <NUM>, after <NUM> days of administration, the T/C values of single AZD9291 and its combination with Compound <NUM> were <NUM>% and <NUM>%, respectively; the T/C values of single afatinib and its combination with Compound <NUM> were <NUM>% and <NUM>%, respectively. The regression rate of a combination of AZD9291 and Compound <NUM> was <NUM>%, in which the complete regression (CR) rate was about <NUM>%, and the partial regression (PR) rate was <NUM>%. After discontinuation of administration, the tumor rebound was gradually observed in the single AZD9291 group, and no tumor was observed in the combination group of AZD9291 and Compound <NUM>.

The results showed that the anti-tumor effect of Compound <NUM> in combination with EGFR inhibitor was significantly superior to that of the singe drug, and synergistic effect was obtained, and Compound <NUM> could overcome or delay the resistance to the third-generation EGFR inhibitor osimertinib.

In in vitro cell experiments, NSCLC H1975 cells carrying EGFRT790M mutation was very sensitive to a combination of Compound <NUM> and an EGFR inhibitor AZD9291 (osimertinib) (<FIG>). Subsequently, human NSCLC H1975 derived xenograft mode was established to evaluate the anti-tumor effect of Compound <NUM> in combination with the EGFR inhibitor AZD9291 (osimertinib). The dosing regimen was as follows:.

As shown in <FIG> and Table <NUM>, after <NUM> days of administration, the T/C values of single AZD9291 and its combination with Compound <NUM> were <NUM>% and <NUM>%, respectively. The regression rate of a combination of AZD9291 and compound <NUM> was <NUM>%, wherein the complete regression (CR) rate was <NUM>%, and the partial regression (PR) rate was <NUM>%.

The results show that the anti-tumor effect obtained by a combination of Compound <NUM> and EGFR inhibitor was obviously superior to that obtained by the single drug, and the synergistic effect was observed.

In addition, at the end of the study, the range of weight loss in mice with weight loss was less than about <NUM>%, and thus it was considered that no severe toxicity occurred at all doses of the administration groups.

In in vitro cell experiments, NSCLC H1975 cells carrying EGFRT790M mutation was very sensitive to some <NUM>rd generation of EGFR inhibitors (<FIG>). Therefore, in this experiment, a human H1975 cell-derived xenograft tumor model was established to evaluate the anti-tumor effect of Compound <NUM> in combination with EGFR inhibitor AZD9291 (osimertinib), and the anti-tumor effect of FAK selective inhibitor Defactinib in combination with AZD9291 (osimertinib). The dosing regimen was as follows:.

As shown in <FIG> and Table <NUM>, after <NUM> days of administration, the T/C values of single AZD9291 and its combination with Compound <NUM> were <NUM>% and <NUM>%, respectively. As comparison, after <NUM> days of administration, the T/C values of single AZD9291 and its combination with Defactinib were <NUM>% and <NUM>%, respectively. After day <NUM> of administration, the Compound <NUM> + AZD9291 group had a synergistic factor of <NUM> and the Defactinib + AZD9291 group had a synergistic factor of <NUM>. Accordingly, it was considered that the anti-tumor effect of the FAK selective inhibitor, Defactinib, was lower than that of Compound <NUM> when combined with AZD9291.

In addition, at the end of the study, the range of weight loss in mice with weight loss was less than about <NUM>%, and it was considered that no severe toxicity occurred at all doses of the administration groups.

In in vitro cell experiments, NSCLC H1975 cells carrying EGFRT790M mutation was very sensitive to some <NUM>rd generation of EGFR inhibitors (<FIG>). Therefore, in this experiment, a human H1975 cell-derived mouse xenograft tumor model was established to evaluate the anti-tumor effect of Compound <NUM> in combination with EGFR inhibitor AZD9291 (osimertinib), and the anti-tumor effect of ALK selective inhibitors Ensartinib in combination with AZD9291 (osimertinib). The dosage regimen was as follows:.

As shown in <FIG> and Table <NUM>, after <NUM> days of administration, the T/C values of single AZD9291 and its combination with Compound <NUM> were <NUM>% and <NUM>%, respectively. As comparison, after <NUM> days of administration, the T/C values of single AZD9291, its combination with Ensartinib, and its combination with Compound <NUM> were <NUM>%, <NUM>% and <NUM>, respectively. The regression rate of of AZD9291 in combination with Compound <NUM> was <NUM>%, wherein the complete regression rate (CR) was <NUM>%, and the partial regression rate (PR) was <NUM>%. After <NUM> days of administration, the compound <NUM> + AZD9291 group had a synergistic factor of <NUM>, and the Ensartinib + AZD9291 group had synergistic factor of <NUM>. Accordingly, it was considered that when combined with AZD9291, the anti-tumor effect of the ALK selective inhibitor Ensartinib is lower than that of Compound <NUM>.

In in vitro cell experiments, NSCLC H1975 cells carrying EGFRT790M mutation was very sensitive to some <NUM>rd generation of EGFR inhibitors (<FIG>). Therefore, in this experiment, a human H1975 cell-derived mouse xenograft tumor model was established to evaluate the anti-tumor effect of Compound <NUM> in combination with EGFR inhibitor Avitinib, and the anti-tumor effect of ALK selective inhibitors Ensartinib in combination with EGFR inhibitor Avitinib. The dosage regimen was as follows:.

As shown in <FIG> and Table <NUM>, after <NUM> days of administration, the T/C values of Avitinib and its combination with Compound <NUM> were <NUM>% and <NUM>%, respectively. As comparison, after <NUM> days of administration, the T/C values of single Avitinib and its combination with Ensartinib were <NUM>% and <NUM>%, respectively. After <NUM> days of administration, the Compound <NUM> + Avitinib group had a synergistic factor of <NUM>; and the Ensartinib + Avitinib group had a synergistic factor of <NUM>. Accordingly, it was considered that, when combined with Avitinib, the anti-tumor effect of the ALK selective inhibitor Ensartinib was lower than that of Compound <NUM>.

In addition, at the end of the study, the body weight in mice was not significantly reduced, and it was considered that no severe toxicity occurred at all doses of the administration groups.

In in vitro cell experiments, NSCLC H1975 cells carrying EGFRT790M mutation was very sensitive to some <NUM>rd generation of EGFR inhibitors (<FIG>). Therefore, in this experiment, a human H1975 cell-derived mouse xenograft tumor model was established to evaluate the anti-tumor effect of Compound <NUM> in combination with AZD9291 (osimertinib), and the anti-tumor effect of Compound <NUM> in combination with EGFR inhibitor Avitinib. The dosage regimen was as follows:.

As shown in <FIG> and Table <NUM>, after <NUM> days of administration, the T/C values of single Compound <NUM> and its combination with AZD9291 (osimertinib) were <NUM>% and <NUM>%, respectively. As comparison, after <NUM> days of administration, the T/C values of single Compound <NUM> and its combination with Avitinib were <NUM>% and <NUM>%, respectively. After <NUM> days of administration, the Compound <NUM> + AZD9291 group had a synergistic factor of <NUM>; and the Compound <NUM> + Avitinib group had a synergistic factor of <NUM>. Accordingly, it was considered that both a combination of Compound <NUM> with AZD9291 and a combination of Compound <NUM> with Avitinib showed anti-tumor effects, while a combination of Compound <NUM> (osimertinib) had more potent anti-tumor effect.

Various modifications of the invention in addition to those described herein will be apparent to those skilled in the art. Such modifications, provided that they are covered by the claims, are also intended to fall within the scope of the appended claims.

The disclosure is also directed to the following items (which are not necessarily part of the invention. The invention is defined by the claims):.

A method for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual, comprising administering to the individual a therapeutically effective amount of one or more of a FAK inhibitor, an ALK inhibitor and a ROS1 inhibitor, and a therapeutically effective amount of an EGFR inhibitor. The method according to item <NUM>, wherein the ALK inhibitor is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

The method according item <NUM> or <NUM>, wherein the ALK inhibitor is a compound of Formula II or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

The method according to any one of items <NUM> to <NUM>, wherein the ALK inhibitor is a compound of Formula III or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

The method according to any one of items <NUM> to <NUM>, wherein the ALK inhibitor is a compound of Formula IV or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

The method according to any one of items <NUM> to <NUM>, wherein the ALK inhibitor is a compound of Formula V or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

The method according to any one of items <NUM> to <NUM>, wherein the ALK inhibitor is a compound of Formula VI or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:.

The method according to any one of items <NUM> to <NUM>, wherein the ALK inhibitor is a compound in the following table or a pharmaceutically acceptable salt or solvate thereof:.

Claim 1:
An EGFR inhibitor for use in a method for treating or suppressing a cancer, reducing its severity, lowering its risk or inhibiting its metastasis in an individual, comprising administering to the individual a therapeutically effective amount of an ALK inhibitor of formula I or II, or a pharmaceutically acceptable salt or solvate thereof:
<CHM>
wherein:
R1a and R1b are independently selected from the group consisting of hydrogen, C<NUM>-<NUM> alkyl, and C<NUM>-<NUM> cycloalkyl;
R2a and R2b are independently selected from the group consisting of hydrogen, C<NUM>-<NUM> alkyl, and C<NUM>-<NUM> cycloalkyl;
R<NUM> is selected from the group consisting of hydrogen, C<NUM>-<NUM> alkyl, C<NUM>-<NUM> cycloalkyl, and <NUM>- to <NUM>-membered heterocyclyl,
R<NUM> is selected from the group consisting of C<NUM>-<NUM> alkyl and C<NUM>-<NUM> cycloalkyl;
R<NUM> is halo;
R<NUM> is selected from the group consisting of C<NUM>-<NUM> alkyl and C<NUM>-<NUM> cycloalkyl; and
R<NUM> is selected from the group consisting of hydrogen, C<NUM>-<NUM> alkyl, and C<NUM>-<NUM> cycloalkyl,
with proviso that when R1a, R1b, R2a, and R2b are each hydrogen, then R<NUM> is selected from the group consisting of C<NUM>-<NUM> cycloalkyl and <NUM>- to <NUM>-membered heterocyclyl;
<CHM>
wherein:
R1a and R1b are independently selected from the group consisting of hydrogen, C<NUM>-<NUM> alkyl, and C<NUM>-<NUM> cycloalkyl;
R2a and R2b are independently selected from the group consisting of hydrogen, C<NUM>-<NUM> alkyl, and C<NUM>-<NUM> cycloalkyl; and
R<NUM> is selected from the group consisting of hydrogen, C<NUM>-<NUM> alkyl, C<NUM>-<NUM> cycloalkyl, and <NUM>- to <NUM>-membered heterocyclyl;
and a therapeutically effective amount of the EGFR inhibitor;
wherein the EGFR inhibitor is afatinib, osimertinib (AZD9291) or Avitinib; and
wherein the cancer is non-small cell lung cancer carrying an EGFRT790M mutation.