Patent Description:
Cancer has a major impact on society across the world. Cancer is the second most common cause after cardiovascular disease responsible for human death. The National Cancer Institute estimates that in <NUM>, approximately <NUM>,<NUM>,<NUM> new cases of cancer will be diagnosed in the United States and <NUM>,<NUM> people will die from the disease.

Chronic myeloid leukemia (CML) is a type of cancer that starts in certain blood forming cells of the bone marrow. CML cells contain an abnormal gene, BCR-ABL, that isn't found in normal cells. This gene makes a protein, BCR-ABL, which causes CML cells to grow and reproduce out of control. BCR-ABL is a type of protein known as a tyrosine kinase. Drugs known as tyrosine kinase inhibitors (TKIs) that target BCR-ABL are the standard treatment for CML.

Imatinib (Gleevec®) is the first drug to specifically target the BCR-ABL tyrosine kinase protein for treating CML. However, emerging acquired resistance to imatinib has become a major challenge for clinical management of CML. More than <NUM> resistance-related BCR-ABL mutants have been identified in the clinic, among which the "gatekeeper" T315I is most common mutation, as it accounts for approximately <NUM>-<NUM>% of all clinically acquired mutants.

Great efforts have been devoted to identifying second generation of BCR-ABL inhibitors to overcome imatinib resistance. Nonetheless, the second-generation inhibitors are not capable of inhibiting the most refractory BCR-ABLT315I mutant. BCR-ABLT315I induced drug resistance remains an unmet clinical challenge for CML treatment. Accordingly, there is a continuing need for new and more effective treatment. The methods of the present invention present cancer patients with new options.

The dependent claims depict other embodiments of the invention. Any embodiment not falling under the scope of the appended claims does not form part of the invention. The present invention relates to a compound of formula (I):
<CHM>.

In certain embodiments, the cancer is hematological malignancy.

In certain embodiments, the hematological malignancy is leukemia, including chronic myelogenous leukemia.

In certain embodiments, the method is the use in the treatment of the patient with chronic myeloid leukemia resistant to current tyrosine kinase inhibitor therapies.

In certain embodiments, the patient with chronic myeloid leukemia resistant to the current tyrosine kinase inhibitor therapies is caused by BCR-ABL mutations.

In certain embodiments, BCR-ABL mutation is T315I, E255K/V, G250E, H396P, M351T, Q252H, Y253F/H, or BCR-ABLWT mutations.

In certain embodiments, BCR-ABL mutation is T315I mutation.

In certain embodiments, the compound of formula (I), or pharmaceutically acceptable salt thereof is administered orally to the patients in need such treatment.

In certain embodiments, the compound of formula (I), or pharmaceutically acceptable salt thereof is administered once every other day (QOD) during the <NUM>-day treatment cycle.

In one embodiment, the compound of formula (I) is a compound of formula (I-A):
<CHM>
or a pharmaceutically acceptable salt thereof.

In certain embodiments, the compound of formula (I) or formula (I-A) is administered once every other day in an amount of about <NUM>, about <NUM>, about <NUM>, or about <NUM>.

In certain embodiments, the compound of formula (I) or formula (I-A) is administered once every other day in an amount of about <NUM> or about <NUM>.

In certain embodiments, the compound of formula (I) or formula (I-A) is administered once every other day in an amount of about <NUM>, about <NUM>, or about <NUM>.

The present invention also relates to a method of inhibiting BCR-ABL mutants as defined in the claims.

In certain embodiments, the present invention relates to a method of inhibiting BCR-ABL mutants, comprising contacting a compound of formula (I) or a salt thereof with BCR-ABL mutants, wherein the BCR-ABL mutants is T315I, E255K/V, G250E, H396P, M351T, Q252H, Y253F/H, or BCR-ABLWT.

In certain embodiments, the present invention relates to a method of inhibiting BCR-ABL mutants, comprising contacting a compound of formula (I) or a salt thereof with BCR-ABL mutants selected from T315I.

The present invention also provides a pharmaceutical composition for use in treating hematological malignancy as defined in the claims.

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

The term "about" is used herein to mean approximately, in the region of, roughly, or around. When the term "about" is used in conjunction with a numerical range, it modifies that range by extending the boundaries above and below the numerical values set forth. In general, the term "about" is used herein to modify a numerical value above and below the stated value by a variance of <NUM>%.

The term "comprises" refers to "includes, but is not limited to.

As used herein, the terms "treatment," "treat," and "treating" refer to reversing, alleviating, delaying the onset of, or inhibiting the progress of a disease or disorder, or one or more symptoms thereof, including but not limited to therapeutic benefit. In some embodiments, treatment is administered after one or more symptoms have developed. In some embodiments, treatment may be administered in the absence of symptoms. For example, treatment may be administered to a subject prior to the onset of symptoms (e.g., in light of a history of symptoms and/or in light of genetic or other susceptibility factors). Treatment may also be continued after symptoms have resolved, for example to prevent or delay their recurrence.

Therapeutic benefit includes eradication and/or amelioration of the underlying disorder being treated such as cancer; it also includes the eradication and/or amelioration of one or more of the symptoms associated with the underlying disorder such that an improvement is observed in the subject, notwithstanding that the subject may still be afflicted with the underlying disorder. In some embodiments, "treatment" or "treating" includes one or more of the following: (a) inhibiting the disorder (for example, decreasing one or more symptoms resulting from the disorder, and/or diminishing the extent of the disorder); (b) slowing or arresting the development of one or more symptoms associated with the disorder (for example, stabilizing the disorder and/or delaying the worsening or progression of the disorder); and/or (c) relieving the disorder (for example, causing the regression of clinical symptoms, ameliorating the disorder, delaying the progression of the disorder, and/or increasing quality of life.

As used herein, "administering" or "administration" of the compound of formula (I) or formula (I-A) or a pharmaceutically acceptable salt thereof encompasses the delivery to a patient a compound or a pharmaceutically acceptable salt thereof, using any suitable formulation or route of administration, e.g., as described herein.

As used herein, the term "therapeutically effective amount" or "effective amount" refers to an amount that is effective to elicit the desired biological or medical response, including the amount of a compound that, when administered to a subject for treating a disorder, is sufficient to effect such treatment of the disorder. The effective amount will vary depending on the disorder, and its severity, and the age, weight, etc. of the subject to be treated. The effective amount may be in one or more doses (for example, a single dose or multiple doses may be required to achieve the desired treatment endpoint). An effective amount may be considered to be given in an effective amount if, in conjunction with one or more other agents, a desirable or beneficial result may be or is achieved. Suitable doses of any co-administered compounds may optionally be lowered due to the combined action, additive or synergistic, of the compound.

As used herein, "delaying" development of a disorder mean to defer, hinder, slow, stabilize, and/or postpone development of the disorder. Delay can be of varying lengths of time, depending on the history of the disease and/or the individual being treated.

As used herein, "patient" to which administration is contemplated includes, but is not limited to, humans (i.e., a male or female of any age group, e.g., a pediatric subject (e.g., infant, child, adolescent) or adult subject (e.g., young adult, middle-aged adult or senior adult)) and/or other primates (e.g., cynomolgus monkeys, rhesus monkeys).

As used herein, "pharmaceutically acceptable" or "physiologically acceptable" refer to compounds, salts, compositions, dosage forms and other materials which are useful in preparing a pharmaceutical composition that is suitable for veterinary or human pharmaceutical use.

As used herein, the term "pharmaceutically acceptable salt" refers to those salts which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of humans and lower animals without undue toxicity, irritation, allergic response and the like, and are commensurate with a reasonable benefit/risk ratio. Pharmaceutically acceptable salts are well known in the art. For example, <NPL>. Pharmaceutically acceptable salts of Compound <NUM> include those derived from suitable inorganic and organic acids and bases. Examples of pharmaceutically acceptable, nontoxic acid addition salts are salts of an amino group formed with inorganic acids such as hydrochloric acid, hydrobromic acid, phosphoric acid, sulfuric acid and perchloric acid or with organic acids such as acetic acid, oxalic acid, maleic acid, tartaric acid, citric acid, succinic acid or malonic acid or by using other methods used in the art such as ion exchange. Other pharmaceutically acceptable salts include adipate, alginate, ascorbate, aspartate, benzenesulfonate, benzoate, bisulfate, borate, butyrate, camphorate, camphorsulfonate, citrate, cyclopentanepropionate, digluconate, dodecylsulfate, ethanesulfonate, formate, fumarate, glucoheptonate, glycerophosphate, gluconate, hemisulfate, heptanoate, hexanoate, hydroiodide, <NUM>-hydroxy-ethanesulfonate, lactobionate, lactate, laurate, lauryl sulfate, malate, maleate, malonate, methanesulfonate, <NUM>-naphthalenesulfonate, nicotinate, nitrate, oleate, oxalate, palmitate, pamoate, pectinate, persulfate, <NUM>-phenylpropionate, phosphate, pivalate, propionate, stearate, succinate, sulfate, tartrate, thiocyanate, p-toluenesulfonate, undecanoate, valerate salts, and the like. Although pharmaceutically acceptable counter ions will be preferred for preparing pharmaceutical formulations, other anions are quite acceptable as synthetic intermediates. Thus it may be pharmaceutically undesirable anions, such as iodide, oxalate, trifluoromethanesulfonate and the like, when such salts are chemical intermediates.

As used herein, alkyl refers to methyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl, isobutyl, or tert-butyl. Alkyl groups can be substituted or unsubstituted.

As used herein, cycloalkyl refers to cyclopropyl, cyclobutyl, cyclopentyl or cyclohexyl. Cycloalkyl groups can be substituted or unsubstituted.

As used herein alkoxy refers to methoxy, ethoxy, propoxy, isopropoxy butoxy, isobutoxy, sec-butoxy, or tert-butoxy. Alkoxy groups can be substituted or unsubstituted.

As used herein, halogen refers to fluorine, chlorine, bromine or iodine.

As used herein, compound of formula (I) has the following structure:
<CHM>
wherein R<NUM> is hydrogen, C<NUM>-<NUM> alkyl, C<NUM>-<NUM> cycloalkyl, C<NUM>-<NUM> alkyloxy, or phenyl; and R<NUM> is hydrogen, C<NUM>-<NUM> alkyl, C<NUM>-<NUM> cycloalkyl, or halogen.

As used herein, the compound of formula (I-A) has the following structure:
<CHM>.

The chemical name for the compound of (I-A) is <NUM>-(<NUM>-(<NUM>-pyrazolo[<NUM>,<NUM>-b]pyridin-<NUM>-yl)ethynyl)-<NUM>-methyl-N-(<NUM>-((<NUM>-methylpiperazin-<NUM>-yl)methyl)-<NUM>-(trifluoromethyl)phenyl)-benzamide.

As used herein, the compounds of formula (I) or (I-A) include any tautomer forms. As a non-limiting example, tautomerization may occur in the pyrazole and pyrimidine groups.

The compounds of formula (I) or formula (I-A) or a pharmaceutically acceptable salt thereof can be obtained according to the production methods described in <CIT>.

The compounds of formula (I) or (I-A) are novel, selective potent inhibitors against a broad spectrum of BCR-ABL mutations, including T315I, E255K/V, G250E, H396P, M351T, Q252H, Y253F/H, or BCR-ABLWT.

The compounds of formula (I) or formula (I-A) or a pharmaceutically acceptable salt thereof are also potent inhibitors against other kinases including KIT, BRAF, DDR1, PDGFR, FGFR, FLT3, RET, SRC, TIE1, and TIE2.

Also provided herein are pharmaceutical compositions and dosage forms, comprising compounds of formula (I) or formula (I-A) or a pharmaceutically acceptable salt thereof, and one or more pharmaceutically acceptable excipients. Compositions and dosage forms provided herein may further comprise one or more additional active ingredients. Compounds of formula (I) or formula (I-A) or a pharmaceutically acceptable salt thereof may be administered as part of a pharmaceutical composition as described.

In some embodiment, provided is a method for hematological malignancy in a patient, comprising administering to the patient a therapeutically effective amount of a compound of formula (I):
<CHM>
or a pharmaceutically acceptable salt thereof, wherein R<NUM> is hydrogen, C<NUM>-<NUM> alkyl, C<NUM>-<NUM> cycloalkyl, C<NUM>-<NUM> alkyloxy, or phenyl; and R<NUM> is hydrogen, C<NUM>-<NUM> alkyl, C<NUM>-<NUM> cycloalkyl, or halogen.

In certain embodiments, the compound of formula (I) is a compound of formula (I-A):
<CHM>
or a pharmaceutically acceptable salt thereof.

In certain embodiments, the method is in the use in the treatment of the patient with chronic myeloid leukemia resistant to current tyrosine kinase inhibitor therapies, wherein resistant to the current tyrosine kinase inhibitor therapies is caused by BCR-ABL mutations.

Examples of the current tyrosine kinase inhibitors include, but not limit to, imatinib, dasatinib, nilotinib, bosutinib, ponatinib, or bafetinib,.

In a more preferred embodiment of the invention, the method of the invention relates to a method for use in treating a hematological malignancy resistant to Ponatinib.

Ponatinib is a third-generation inhibitor of BCR-ABL for the treatment of Chronic Myelogenous Leukemia (CML) carrying the T315I mutation, Ph + ALL (Philadelphia chromosome positive ALL), and CML and Ph + ALL that are not responsive to other Tyrosine Kinase Inhibitors (TKIs). Although Ponatinib is clinically active against most BCR-ABL single mutations, a part of patients still do not respond consistently to Ponatinib (see: <NPL>). Studies have shown that the compound mutation of BCR-ABL may be involved in clinical drug resistance of CML and Ph + ALL to Ponatinib. For example, in Ph + ALL, the E255V/T3151 double mutation can produce <NUM>-fold resistance compared to the T315I single mutation, and other compound mutations such as Q252H/T315I, T315I/M351I and T3151/F359V are also less sensitive to Ponatinib (see: <NPL>). In CML, patients containing both T315I and other mutations are more resistant than patients with single mutation T315I (see: <NPL>).

In a preferred embodiment of the invention, the inhibitory effect of the compound of formula (I) and Ponatinib on BCR-ABL complex mutant cell proliferation is confirmed by constructing a stably transfected cell line with BCR-ABL complex mutation, and a potential therapeutic approach to overcome Ponatinib resistance is provided.

The invention proves that the compound of the formula (I-A) has better antiproliferative effect than Ponatinib on Ba/F3 cells with complex mutations of BCR-ABLE255V/T315I, BCR-ABLY253H/E255V, BCR-ABLT315M, BCR-ABLY253H/T315I, BCR-ABLY253H/F359V and BCR-ABLT315I/F317L. The results suggest that the compound of formula (I-A) is a potential candidate drug for overcoming the resistance of Ponatinib caused by BCR-ABL complex mutation.

In certain embodiments, the compound of formula (I), or pharmaceutically acceptable salt thereof is administered once every one, two, or three days during the treatment cycle. The said treatment cycle may be <NUM>-<NUM> days, preferably <NUM>-35days, more preferably <NUM>-day treatment cycle.

In certain embodiments, the compound of formula (I) or formula (I-A) is administered every day, or once every other day (QOD), or once every three days, particularly once every other day. The amount of administration is from <NUM> to <NUM>, preferably from <NUM> to <NUM>, more preferably from <NUM> to <NUM>. In the most preferable embodiments, it is in an amount of about <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>.

In certain embodiments, the compound of formula (I) or formula (I-A) is formulated into a dosage unit to be administered every day, or once every other day (QOD), or once every three days, particularly once every other day. The amount of the dosage unit is from <NUM> to <NUM>, preferably from <NUM> to <NUM>, more preferably from <NUM> to <NUM>.

In certain embodiments, the inhibition is in vitro or in vivo.

In certain embodiments, the inhibition is in a patient with chronic myeloid leukemia resistant to current tyrosine kinase inhibitor therapies.

In certain embodiments, the present invention provides a medicament or pharmaceutical composition comprising the compound of formula (I) or formula (I-A) or pharmaceutically acceptable salt thereof for treat hematological malignancy, including chronic myelogenous leukemia.

In certain embodiments, the present invention relates to the use of a compound of formula (I) or (I-A), or pharmaceutically acceptable salt thereof in the manufacture of medicament for the treatment of hematological malignancy, including chronic myelogenous leukemia.

In certain embodiments, the compound of formula (I) or (I-A) is in a solid dosage form.

In certain embodiments, the cancer is newly diagnosed.

In certain embodiments, the cancer is relapsed.

In certain embodiments, the cancer is refractory.

The present disclosure describes various embodiments. A person of ordinary skill in the art reviewing the disclosure will readily recognize that various embodiments can be combined in any variation. For example, embodiments of the disclosure include treatment of various disorders, patient populations, administrations of dosage forms, at various dosages, minimization of various adverse events, and improvements in various efficacy measures, etc. Any combinations of various embodiments are within the scope of the disclosure.

As used herein, the term "survival" refers to the patient remaining alive, and includes progression-free survival (PFS) and overall survival (OS). Survival can be estimated by the Kaplan-Meier method, and any differences in survival are computed using the stratified log-rank test.

As used herein, the term "progression-free survival (PFS)" refers to the time from treatment (or randomization) to first disease progression or death. For example it is the time that the patient remains alive, without return of the cancer (e.g., for a defined period of time such as about one month, two months, three months, three and a half months, four months, five months, six months, seven months, eight months, nine months, about one year, about two years, about three years, about five years, about <NUM> years, about <NUM> years, about <NUM> years, about <NUM> years, etc.) from initiation of treatment or from initial diagnosis. Progression-free survival can be assessed by Response Evaluation Criteria in Solid Tumors (RECIST).

The term "overall survival" refers to the patient remaining alive for a defined period of time (such as about one year, about two years, about three years, about four years, about five years, about <NUM> years, about <NUM> years, about <NUM> years, about <NUM> years, etc.) from initiation of treatment or from initial diagnosis.

Non-limiting examples of hematologic malignancies also include amyloidosis, acute myeloid leukemia (AML); chronic myelogenous leukemia (CML) including accelerated CML and CML blast phase (CML-BP); acute lymphoblastic leukemia (ALL); chronic lymphocytic leukemia (CLL); Hodgkin's disease (HD); non-Hodgkin's lymphoma (NHL), including follicular lymphoma and mantle cell lymphoma; B-cell lymphoma; T-cell lymphoma; multiple myeloma (MM); Waldenstrom's macroglobulinemia; myelodysplastic syndromes (MDS), refractory anemia (RA), refractory anemia with ringed siderblasts (RARS), refractory anemia with excess blasts (RAEB), and RAEB in transformation (RAEB-T); and myeloproliferative syndromes.

For cancer therapy, efficacy may be measured by assessing the duration of survival, duration of progression-free survival (PFS), the response rates (RR) to treatments, duration of response, and/or quality of life.

The term "pharmaceutically acceptable carrier" is used herein to refer to a material that is compatible with a recipient subject, preferably a mammal, more preferably a human, and is suitable for delivering an active agent to the target site without terminating the activity of the agent. The toxicity or adverse effects, if any, associated with the carrier preferably are commensurate with a reasonable risk/benefit ratio for the intended use of the active agent.

The pharmaceutical compositions of this disclosure can be manufactured by methods well known in the art such as conventional granulating, mixing, dissolving, encapsulating, lyophilizing, or emulsifying processes, among others. Compositions may be produced in various forms, including granules, precipitates, particulates, or powders.

The term "orally" refers to administering a composition that is intended to be ingested. Examples of oral forms include, but are not limited to, tablets, pills, capsules, powders, granules, solutions or suspensions, and drops. Such forms may be swallowed whole or may be in chewable form.

Solid dosage forms for oral administration include capsules, tablets, pills, powders, and granules. In such solid dosage forms, the active ingredient is mixed with at least one inert, pharmaceutically acceptable excipient or carrier such as sodium citrate or dicalcium phosphate and/or a) fillers or extenders such as starches, lactose, sucrose, glucose, mannitol, and silicic acid; b) binders such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinylpyrrolidinone, sucrose, and acacia; c) humectants such as glycerol; d) disintegrating agents such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate; e) solution retarding agents such as paraffin; f) absorption accelerators such as quaternary ammonium compounds; g) wetting agents such as, for example, cetyl alcohol and glycerol monostearate; h) absorbents such as kaolin and bentonite clay, and i) lubricants such as talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate, and mixtures thereof. In the case of capsules, tablets and pills, the dosage form may also comprise buffering agents such as phosphates or carbonates.

Solid compositions may also be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose or milk sugar as well as high molecular weight polyethylene glycols and the like. The solid dosage forms of tablets, dragees, capsules, pills, and granules can be prepared with coatings and shells such as enteric coatings and other coatings well known in the pharmaceutical formulating art. They may optionally contain opacifying agents and can also be of a composition such that they release the active ingredient(s) only, or preferentially, in a certain part of the intestinal tract, optionally, in a delayed manner. Examples of embedding compositions that can be used include polymeric substances and waxes.

In solid dosage forms the active ingredients may be mixed with at least one inert diluent such as sucrose, lactose or starch. Such dosage forms may also comprise, as is normal practice, additional substances other than inert diluents, e.g., tableting lubricants and other tableting aids such a magnesium stearate and microcrystalline cellulose. In the case of capsules, tablets and pills, the dosage forms may also comprise buffering agents.

The active ingredients can also be in micro-encapsulated form with one or more excipients as noted above.

A single-agent, open-label dose escalation and dose expansion Phase I study to assess the safety, preliminary efficacy, pharmacokinetic (PK) and pharmacodynamic (PD) properties of orally administered the compound of formula (I-A) in the TKI-resistant patients with chronic phase (CP) or accelerated phase (AP) CML.

Methods: the compound of formula (I-A) was administered orally once every other day (QOD) in <NUM>-days cycles at <NUM> dose cohorts ranging from <NUM> to <NUM>. The eligible patients received treatments until disease progression or intolerable toxicities. The primary efficacy endpoint in the CML AP and CP patients, was complete hematological response (CHR) and major cytogenetic response (MCyR) respectively, MCyR includes partial cytogenetic response (PCyR) and complete cytogenetic response (CCyR). Blood samples were collected at various time points on Day <NUM>-<NUM> and Day <NUM>-<NUM> during cycle <NUM> for PK analyses. BCR-ABL inhibition was evaluated using tyrosine phosphorylation of CRKL and STAT5 in peripheral blood mononuclear cell (PBMCs) collected from the patients before and <NUM>, <NUM>, <NUM> and <NUM> hours post the compound of formula (I-A) treatments on Day <NUM>, <NUM> and <NUM> during cycle <NUM>.

To determine the safety and RP2D (recommended phase <NUM> dose) of the compound of formula (I-A) in patients with resistant /refractory CML.

To examined the safety of the compound of formula (I-A) in resistant /refractory CML patients.

To evaluate the pharmacokinetic characteristics of the compound of formula (I-A).

To evaluate the efficacy of the compound of formula (I-A) in resistant /refractory CML patients.

In certain embodiments, patients who meet the following criteria may receive the treatments:.

In certain embodiments, patients who has the following criteria may exclude from the treatments:.

<NUM> patients (CP n=<NUM> and AP n=<NUM>) enrolled received ≥<NUM> cycle of the compound of formula (I-A) treatment, only <NUM> patient withdrew from the study due to disease progression. Median age was <NUM> (range: <NUM>-<NUM>) years. Median interval from CML diagnosis to starting the compound of formula (I-A) -treatment was <NUM> (<NUM>-<NUM>) years. Sixty-one (<NUM>%) patients received ≥<NUM> prior lines of TKI-therapy. Fifty-three (<NUM>%) patients had BCR-ABL mutations and <NUM> (<NUM>%) had T315I mutation at baseline.

With a median follow-up of <NUM> (<NUM>-<NUM>) cycles, the compound of formula (I-A) treatment was well-tolerated in all dose cohorts other than the <NUM> cohort. In all patients, <NUM> (<NUM>%) patients experienced ≥<NUM> treatment related adverse events (TRAEs) and <NUM> (<NUM>%) experienced TRAE(s) of grade <NUM>-<NUM> (Table <NUM>). There was no patient withdrawal from the study because of TRAEs. Two out of <NUM> patients in the <NUM> cohort experienced dose-limiting toxicity (DLT) and the compound of formula (I-A) treatment at <NUM> QOD was considered as maximum toxic dosage (MTD).

The anti-leukemic activities of the compound of formula (I-A) treatment were observed in this study. Sixty-five (<NUM>%) patients including <NUM> (<NUM>%) CP and <NUM> (<NUM>%) AP patients achieved CHR at the dose of <NUM> to <NUM> within <NUM> cycles. In <NUM> evaluable patients receiving the compound of formula (I-A) -treatment ≥<NUM> cycles, <NUM> (<NUM>%) achieved MCyR including <NUM> (<NUM>%) CP and <NUM> (<NUM>%) AP patients at the dose of <NUM> to <NUM>, and <NUM> (<NUM>%) patients achieved CCyR including <NUM> (<NUM>%) CP and <NUM> (<NUM>%) AP patients. Total <NUM> (<NUM>%) CP patients achieved MMR. More than <NUM>% of the patients achieved MCyR or MMR at the end of cycle The compound of formula (I-A) was highly active in patients with or without T315I mutation at baseline (Table <NUM>).

Following oral administration of the compound of formula (I-A) treatment at doses ranging from <NUM> to <NUM>, the peak concentration was reached at <NUM>-<NUM> hrs. The elimination appeared to be linear with a mean terminal T<NUM>/<NUM> of <NUM>-<NUM> hrs on Day <NUM>, <NUM>-<NUM> hours on Day <NUM>, respectively (the window period of the observation time is <NUM> hrs). The ratios for AUC0-t and Cmax of the compound of formula (I-A) treatment on Day <NUM> versus Day <NUM> ranged from <NUM> to <NUM> and from <NUM> to <NUM>, respectively. Thus, the compound of formula (I-A) exhibited an approximately dose proportional increase in Cmax and AUC0-t following single or multiple oral administration dose ranging from <NUM> to <NUM>. PD study results demonstrated that reduction of CRKL phosphorylation was schedule and dose-dependent, ≥<NUM>% reduction was observed at doses ranging <NUM>-<NUM>.

<FIG> illustrate the efficacy (CHR n%) of the compound of formula (I-A) in a phase <NUM> study.

Wherein, <FIG> shows that <NUM>% of the total <NUM> CML-CP patients achieved CHR, including <NUM> patients of T315I+ (<NUM>% achieved CHR) and <NUM> patients of T315I- (<NUM>% achieved CHR).

<FIG> shows that <NUM>% of the total <NUM> CML-AP patients achieved CHR, including <NUM> patients of T315I+ (<NUM>% achieved CHR) and <NUM> patients of T315I- (<NUM>% achieved CHR).

<FIG> illustrate the efficacy (MCyR n%) of the compound of formula (I-A) in a phase <NUM> study.

Wherein, <FIG> shows that <NUM>% of the total <NUM> CML-CP patients achieved MCyR, wherein <NUM>% of them achieved PCyR, and <NUM>% achieved CCyR. <NUM>% of the <NUM> patients of T315I+ achieved MCyR (of which <NUM>% achieved PCyR, and <NUM>% achieved CCyR); <NUM>% of the <NUM> patients of T315I- achieved MCyRa (wherein <NUM>% achieved PCyR, and <NUM>% achieved CCyR).

<FIG> shows that <NUM>% of the total <NUM> CML-AP patients achieved MCyR. Wherein, <NUM>% of the <NUM> patients of T315I+ achieved CCyR; <NUM> patients of T315I- had a response rate of <NUM>.

<FIG> illustrate the efficacy (MCyR n%) of the compound of formula (I-A) with specific doses (CP) in a phase <NUM> study.

Wherein, <FIG> shows that, when a dose of <NUM> is administered, <NUM>% of the total <NUM> CML-CP patients achieved MCyR (wherein <NUM>% achieved PCyR and <NUM>% achieved CCyR). Wherein <NUM>% of the <NUM> patients of T315I+ achieved MCyR (wherein <NUM>% achieved PCyR and <NUM>% achieved CCyR); <NUM>% of the <NUM> patients of T315I- achieved MCyR (wherein <NUM>% achieved PCyR and <NUM>% achieved CCyR).

<FIG> shows that, when a dose of <NUM> is administered, <NUM>% of the total <NUM> CML-CP patients achieved MCyR (wherein <NUM>% achieved PCyR and <NUM>% achieved CCyR). Wherein <NUM>% of the <NUM> patients of T315I+ achieved MCyR (all of the <NUM>% achieved CCyR); <NUM>% of the <NUM> patients of T315I- achieved MCyR (wherein <NUM>% achieved PCyR and <NUM>% achieved CCyR).

<FIG> shows that, when a dose of <NUM> is administered, <NUM>% of the total <NUM> CML-CP patients achieved MCyR (wherein <NUM>% achieved PCyR and <NUM>% achieved CCyR). Wherein <NUM>% of the <NUM> patients of T315I+ achieved MCyR (of which <NUM>% achieved CCyR, and <NUM>% achieved PCyR); <NUM>% of <NUM> the patients of T315I- achieved MCyR (wherein <NUM>% achieved PCyR and <NUM>% achieved CCyR).

<FIG> illustrate MMR (MCyR n%) of the compound of formula (I-A) in a phase <NUM> study.

Wherein <FIG> shows that <NUM>% of the total <NUM> CML-CP patients achieved MMR, wherein <NUM>% of the <NUM> patients of T315I+ achieved MMR; <NUM>% of the <NUM> patients of T315I-achieved MMR.

<FIG> shows that <NUM>% of the total <NUM> CML-AP patients achieved MMR. Wherein, <NUM>% of the <NUM> patients of T315I+ achieved MMR; <NUM>% of the <NUM> patients of T315I- achieved MMR.

<FIG> illustrate the plasma concentration-time profiles of the compound of formula (I-A) in a phase <NUM> study.

As shown in <FIG> and Tables <NUM>-<NUM>, the preliminary results of the phase <NUM> clinical study showed that the compound of formula (I-A), a novel <NUM>rd-generation TKI, is safe and highly active in treatment of the TKI-resistant patients with CML-CP and CML-AP, with or without T315I mutation.

Further Efficacy and Safety Results of Phase <NUM> Study of the compound of formula (I-A) in Patients with Resistant Chronic Myeloid Leukemia.

The compound of formula (I-A) is designed for treatment of patients with chronic myeloid leukemia (CML) resistant to current TKI-therapies including those with T315I mutation. This experiment is focus on the efficacy and safety assessment of the compound of formula (I-A) in a relatively long term.

An open-label, <NUM>+<NUM> dose escalation, phase <NUM> trial of the compound of formula (I-A) design to determine maximum tolerated dose (MTD) and identify dose-limiting toxicities (DLTs) in patients with chronic phase (CP/CML-CP) or accelerated phase (AP/CML-AP) CML resistant to or intolerant of ≥ <NUM> prior TKIs or patients with BCR-ABL T315I M after ≥<NUM> prior TKI is ongoing. The compound of formula (I-A) was administered once every other day (QOD) in <NUM>-day cycles at <NUM> dose cohorts ranging from <NUM> to <NUM>. The eligible patients received continuous treatment until disease progression or unacceptable toxicity, consent withdrawal, or death. The primary efficacy endpoints were major cytogenetic response (MCyR) for CP and complete hematological response (CHR) for AP. MCyR includes partial cytogenetic response (PCyR) and complete cytogenetic response (CCyR). Blood samples were collected at various time points on Day <NUM>-<NUM> and Day <NUM>-<NUM> during cycle <NUM> for PK analyses.

Total <NUM> patients including <NUM> CML-CP and <NUM> CML-AP, wherein <NUM> (<NUM>%) are male patients, had received the compound of formula (I-A) as a single agent QOD doses. A total of <NUM> (<NUM>%) patients with T315I mutation were included. Median duration of follow-up was <NUM> (range, <NUM>-<NUM>). Median age was <NUM> years (range <NUM>-64y). Median interval from CML diagnosis to starting the compound of formula (I-A) treatment was <NUM> years (range <NUM>-<NUM>. Most Patients (<NUM>%) had baseline ECOG status <NUM>-<NUM>. Patients were heavily pretreated, <NUM> (<NUM>%) patients received ≥<NUM> prior lines of TKI-therapy. Two out of <NUM> patients at <NUM> cohort experienced DLT, and <NUM> QOD was considered as MTD. After MTD determined, dose expansion was implemented in the dose levels of <NUM>, <NUM> and <NUM> QOD. A total of <NUM> patients were included in expansion part.

The compound of formula (I-A) was well-tolerated in all dose cohorts with an exception of <NUM> cohort. In all patients, <NUM> (<NUM>%) patients experienced ≥<NUM> treatment related adverse events (TRAEs), the most frequent TRAEs were reported as grade <NUM> or grade <NUM>. The most common grade <NUM>/<NUM> TRAEs were hematological AEs, including thrombocytopenia (<NUM>%). The incidences of AEs tended to be dose-dependent. No death and no CTCAE grade <NUM> events have occurred on study. The incidence of common TRAEs (≥ <NUM>%) are shown in Table <NUM>.

The compound of formula (I-A) showed the potent anti-leukemic activities at doses ≥ <NUM> QOD. In sixty-eight (<NUM>%) evaluable patients, the compound of formula (I-A) showed potent anti-leukemic activities in CML patients. In the <NUM> evaluable patients with non-CHR at baseline, <NUM> (<NUM>%) achieved CHR including <NUM> out of <NUM> (<NUM>%) CP patients and <NUM> out of <NUM> (<NUM>%) AP patients, respectively. In the <NUM> evaluable patients with non-CCyR at baseline, <NUM> out of <NUM> (<NUM>%) CP patients achieved MCyR including <NUM> (<NUM>%) CCyR; and <NUM> out of <NUM> (<NUM>%) AP patients, achieved MCyR including <NUM> (<NUM>%) CCyR, respectively. In the <NUM> evaluable patients, <NUM> out of <NUM> (<NUM>%) CP patients and <NUM> out of <NUM> (<NUM>%) AP patients achieved MMR, respectively. The compound of formula (I-A) showed highly efficacious in the patients with T315I mutation (Table <NUM>, <FIG>). The response rate and the depth of response tended to be time dependent (<FIG>).

<NUM> patients (<NUM> CP, <NUM> AP) had withdrawal from the study, including progressive disease (n = <NUM>, <NUM> CP and <NUM> AP), intolerant AEs (n=<NUM>), consent withdraw (n=<NUM>), and secondary breast cancer (n=<NUM>). The progression free survival (PFS) rate at <NUM>-month was <NUM>% in the CP patients and <NUM>% in the AP patients (<FIG>).

Following a single oral administration of the compound of formula (I-A) at doses from <NUM>-<NUM>, the peak concentration of the compound of formula (I-A) was reached between <NUM>-<NUM> on Day <NUM>, with median Tmax ranging from <NUM>-<NUM>. The elimination appeared to be linear with a mean terminal T<NUM>/<NUM> of <NUM> to <NUM> on Day <NUM>. Peak concentration of the compound of formula (I-A) were observed at <NUM>~<NUM> on Day <NUM>, With median Tmax ranging from <NUM>-<NUM>.

The mean terminal T<NUM>/<NUM> ranged from <NUM> to <NUM> on Day <NUM> (both of the watching time window is <NUM> hrs). The mean ratios AUC <NUM>-<NUM> and Cmax of the compound of formula (I-A) on Day <NUM> to that on Day <NUM> ranged from <NUM> to <NUM> and from <NUM> to <NUM>, respectively, suggesting moderate accumulation with once every other day dosing regimen. Reduction of CRKL phosphorylation in PBMCs, a biomarker of BCR-ABL inhibition, has shown to be dose and time dependent in <NUM> evaluable patients treated with the compound of formula (I-A).

Conclusions: the compound of formula (I-A) exhibits significant and durable antitumor activity, it is well tolerated in the patients with TKI-resistant CML, including those patients with T315I mutation. The progression free survival (PFS) rate at <NUM>-month was <NUM>% in the CP patients and <NUM>% in the AP patients.

In preclinical in vivo studies, compound of the formula (I-A) induced complete regression of subcutaneous tumors in a human CML xenograft model and an isogenic model derived from murine Ba/F3 cells expressing BCR-ABLWT or BCR-ABLT315I mutants, and significantly improved the survival rate of isogenic leukemia mice carrying Ba/F3 cells having BCR-ABLWT or BCR-ABLT315I. For a mouse model of Ba/F3 tumor carrying BCR-ABLT315I, the (I-A) compound was administered orally once every two days (q2d), or once every three days (q3d), and imatinib was administered once a day (qd) as a control, the results were shown in <FIG>: compound of the formula (I-A) significantly prolonged the survival of BCR-ABLT315I expressing Ba/F3 tumor bearing mice in a dose-dependent manner.

In this experiment, BCR-ABL complex mutation cells were used to determine the inhibitory effect of the compound of the formula (I-A) and Ponatinib on the proliferation of BCR-ABL complex mutation cells. The experiment proved that the compound of the formula (I-A) was a potential effective medicament capable of overcoming the drug resistance of the Ponatinib. Ba/F3 cells stably expressing BCR-ABL (F359V, H396R, E255K, Y253H, T315I, F317L) mutations were provided by the Institute of Life and Health, Guangzhou Academy of Sciences.

The solution of the sample (the compound of the formula (I-A) or Ponatinib) to be tested with a <NUM>-dose concentration obtained by serial dilution was added proportionally at <NUM>µl/well in a <NUM>-well culture plate. The dilution was used as a cell blank control (excluding the sample to be tested, which was added to the cells). In addition, a negative control (excluding the sample to be tested and cells) was prepared. In addition to the negative control wells, <NUM>µl of complete medium cell suspension was added to each well. The dilution was added to the negative control wells at <NUM>µl/well. <NUM> repeated wells were set in the experiment. Cells were incubated for <NUM> hours at <NUM> in a CO<NUM> incubator. <NUM>µl of CCK-<NUM> detection solution (Shanghai Life iLab Biotech Co. , LTD, Cat# D3100L4057) was added to each well, incubating at <NUM> for <NUM> hours in a CO<NUM> incubator. The OD value was measured at A450nm by a microplate reader.

The percentage of cell viability was calculated using the following formula: <MAT>.

The IC<NUM> was calculated using a non-linear regression data analysis method of Graphpad Prism <NUM> software (Golden software, Golden, Colorado, USA).

The compound of the formula (I-A) has better anti-proliferation effect on Ba/F3 cells with complex mutations of BCR-ABLE255V/T315I, BCR-ABLY253H/E255V, BCR-ABLT315M, BCR-ABLY253H/T315I BCR-ABLY253H/F359V, BCR-ABLT315I/F317L than Ponatinib, the IC<NUM> value of the compound of the formula (I-A) was <NUM>-<NUM> folds lower than the IC<NUM> value of Ponatinib (Table <NUM>). The results suggest that the compound of the formula (I-A) is a potential candidate drug for overcoming the drug resistance of Ponatinib caused by BCR-ABL complex mutation.

Claim 1:
A compound of formula (I):
<CHM>
or a pharmaceutically acceptable salt thereof,
wherein R<NUM> is hydrogen, C<NUM>-<NUM> alkyl, C<NUM>-<NUM> cycloalkyl, C<NUM>-<NUM> alkyloxy, or phenyl; and R<NUM> is hydrogen, C<NUM>-<NUM> alkyl, C<NUM>-<NUM> cycloalkyl, or halogen;
for use in a method of treating cancer in a patient, comprising administering to the patient a therapeutically effective amount of a compound of formula (I),
wherein the cancer is chronic myeloid leukemia resistant to the current tyrosine kinase inhibitor therapies caused by BCR-ABL mutations, and
wherein the tyrosine kinase inhibitor is Ponatinib.