HK1169950B - Method of treating proliferative disorders and other pathological conditions mediated by bcr-abl, c-kit, ddr1, ddr2 or pdgf-r kinase activity - Google Patents

Description

The present invention relates to a regimen for the administration of a pyrimidylaminobenzamide of formula I wherein Py denotes 3-pyridyl, R₁ represents hydrogen, R₂ represents 5-(4-methyl-1H-imidazol-1-yl)-3-(trifluoromethyl)-phenyl; and R₄ represents methyl; or of a pharmaceutically acceptable salt thereof, for the treatment of proliferative disorders, particularly solid and liquid tumors, and other pathological conditions mediated by the Bcr-Abl oncoprotein, the cell transmembrane tyrosine kinase receptor c-Kit, DDR1 (discoidin domain receptor 1), DDR2 (discoidin domain receptor 2) or PDGF-R (platelet derived growth factor receptor) kinase activity.

The compound of formula I, wherein Py denotes 3-pyridyl, R₁ represents hydrogen, R₂ represents 5-(4-methyl-1H-imidazol-1-yl)-3-(trifluoromethyl)-phenyl and R₄ represents methyl, is known under the International Non-proprietary Name "nilotinib". Nilotinib (4-methyl-3-[[4-(3-pyridinyl)-2-pyrimidinyl]amino]-N-[5-(4-methyl-1H-imidazol-1-yl)-3-(trifluoromethyl)phenyl] benzamide) is approved and marketed in the form of its monohydrochloride monohydrate salt under the brand name Tasigna™. Nilotinib is an ATP-competitive inhibitor for Bcr-Abl and also inhibits c-Kit, DDR1, DDR2 and PDGF-R kinase activity at clinically relevant concentrations (see M. Hazarika et al., Clin. Cancer Res. 2008; 14(17): 5325-5331, and N. P. van Erp et al., Cancer Treatment Reviews 2009; 35: 692-706). Tasigna™ is available as 200 mg hard gelatin capsule for oral administration for the treatment of Philadelphia-positive chronic myeloid leukaemia (CML) in the chronic phase (CP) and accelerated phase (AP) in patients resistant to or intolerant of at least one prior therapy including imatinib. For the treatment of CML a daily dose of 800 mg of nilotinib is applied in two doses of 400 mg each.

The effect of food on the pharmacokinetic parameters of 400 mg oral dose of nilotinib in the capsule formulation mentioned above was studied in human subjects. The concomitant administration of nilotinib with food significantly increased subjects exposure. In said study the total exposure (AUC_0-t) was 82 % (see C. Tanaka et al., J. Clin. Oncol. 2006 ASCO Annual Meeting Proceedings, vol. 24, no. 18S, p. 3095) and C_max was 112 % after a high fat breakfast, whereas the increase in total exposure (AUC_0-t) was 29 % and C_max was 55 % after a light breakfast given 30 minutes prior to dosing. In view of these findings, it is recommended that nilotinib shall not be taken with a meal in order to minimize the effect of food on nilotinib bioavailability. A statement in this regard is, for instance, included in sections 4.2, 4.4 and 4.5 of the SPC (Summary of Product Characteristics) of the marketing authorization for Tasigna™ issued by the European Medicines Agency (EMEA). Concurrent intake of grapefruit juice also resulted in a modest increase in nilotinib absorption; C_max increased by 60% and AUC increased by 29% (Yin OQ, Gallagher N, Li A, et al. J Clin Pharmacol. 2010; 50:188-194).

Certain patients, for instance elderly patients and pediatric patients, sometimes have difficulties to swallow hard gelatin capsules as a whole. For those patients, suffering from a proliferative disorder, particularly a solid and liquid tumor disorder, or other pathological conditions mediated by Bcr-Abl, c-Kit, DDR1, DDR2 or PDGF-R kinase activity, an alternative dosage form for nilotinib is required. For pediatric patients also dosage flexibility is desirable in order to allow dosage adjustment in accordance with body weight.

It was now surprisingly found that the problem described above can be resolved by oral administration of nilotinib dispersed in a fruit preparation.

More specifically, as shown in the Examples, a single oral administration of 400 mg nilotinib (contents of two 200 mg nilotinib capsules), each dispersed in one teaspoon of applesauce is bioequivalent to a single oral administration of 400 mg nilotinib given as intact capsules. However, the same amount dispersed in plain non-fat yogurt is not found to be bioequivalent.

Hence, disclosed herein is a method of treating a proliferative disorder or other pathological conditions mediated by Bcr-Abl, c-Kit, DDR1, DDR2 or PDGF-R kinase activity comprising oral administration of an effective dose of a pyrimidylaminobenzamide of formula I wherein the radicals have the meanings as provided above, or of a pharmaceutically acceptable salt thereof, and, optionally, other pharmaceutically acceptable carriers, dispersed in apple sauce, to a human patient in need thereof.

The general terms used hereinbefore and hereinafter preferably have within the context of this disclosure the following meanings, unless otherwise indicated:

• Where the plural form is used for compounds, salts, and the like, this is taken to mean also a single compound, salt, or the like.

Pyrimidylaminobenzamides within the scope of formula I, wherein py is 3-pyridyl and the process for their manufacture, pharmaceutical compositions containing the same as well as the use for treatment of neoplastic diseases, in particular leukemia, are disclosed in WO 04/005281 . WO 2006/119154 discloses the use of said compound for the treatment of systemic mastocytosis.

Pharmaceutically acceptable salts of pyrimidylaminobenzamides of formula I, wherein py is 3-pyridyl, are especially those disclosed in WO2007/015871 . In one preferred embodiment nilotinib is employed in the form of its monohydrochloride monohydrate. WO2007/015870 discloses certain polymorphs of nilotinib and pharmaceutically acceptable salts thereof useful for the present invention. A suitable formulation for the administration of nilotinib monohydrochloride monohydrate is described in WO2008/037716 .

As used herein, the expression "a proliferative disorder or other pathological conditions mediated by Bcr-Abl, c-Kit, DDR1, DDR2 or PDGF-R kinase activity" activity means melanoma, especially melanoma harboring c-KIT mutations, breast cancer, cancer of the colon, lung cancer, cancer of the prostate or Kaposi's sarcoma, gastrointestinal stromal tumors (GIST), acute myeloid leukemia (AML), leukemia which responds to an inhibition of the Abl tyrosine kinase activity, such as chronic myeloid leukemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL), mesothelioma, systemic mastocytosis, hypereosinophilic syndrome (HES), fibrosis, especially hepatic fibrosis and renal fibrosis, rheumatoid arthritis, polyarthritis, scleroderma, lupus erythematosus, graft-versus host diseases, neurofibromatosis, pulmonary hypertension, especially, pulmonary arterial hypertension, Alzheimer's disease, seminomas and dysgerminomas and psoriasis. Preferably, the regime described herein is applied in the following disorders and conditions: GIST, CML, Ph+ ALL, systemic mastocytosis, HES, fibrosis, scleroderma, neurofibromatosis and pulmonary arterial hypertension.

In one embodiment of the present invention the disorder is selected from CML and Ph+ ALL, more preferably CML.

In another embodiment of the present invention the disorder is selected from GIST and melanoma, especially melanoma harboring c-KIT mutations.

In another embodiment of the present invention the disorder is selected from systemic mastocytosis and HES.

In a further embodiment of the present invention the disorder is selected from systemic scleroderma, neurofibromatosis and pulmonary arterial hypertension.

As used herein, the expression "C_max" means maximum peak concentration in plasma.

As used herein, the expression "AUC" means area under the plasma concentration curve.

The language "oral administration of a pyrimidylaminobenzamide of formula I dispersed in a fruit preparation" as used herein preferably means that the compound of formula I alone or together with at least one suitable pharmaceutical carrier is dispersed in a fruit preparation and administered, preferably manually, to the mouth of the human patient with a suitable device, e.g. a spoon. If desired, 100 to 250 ml of water can be consumed together with the fruit preparation.

As used herein, the term "fruit preparation" means a juice, sauce or puree prepared from apples. In one preferred embodiment of the invention, the fruit preparation employed is applesauce. Suitable applesauce is available under the brands Andros® applesauce, Mott's® applesauce and Odenwald Apfelmus (Odenwald-Früchte GmbH, Germany). Grapefruit is known to affect the kinetics of drug up-take in human patients. Hence, the term "fruit preparation" does not encompass any juice, sauce or puree prepared from grapefruit.

For the purposes of the present invention, the total daily dose of nilotinib can be adjusted to the needs of the patients depending, in particular on the disease to be treated and the disease status of the patient under treatment, but in any event will not exceed a total daily dose of 800 mg.

In one embodiment of the invention, the content of two 200 mg nilotinib capsules as disclosed in WO2008/037716 are each dispersed in one teaspoon of applesauce resulting in a single oral administration of 400 mg nilotinib.

Preferably, the mixture of the compound of formula I dispersed in fruit preparation should be taken immediately after its preparation, wherein "immediately" for the purpose of the present invention means within a time frame of 30 minutes, preferably within 15 minutes, more preferably within 5 minutes and most preferably within 2 minutes after preparation.

The instant invention relates to a pyrimidylaminobenzamide of formula I wherein Py denotes 3-pyridyl, R₁ represents hydrogen, R₂ represents 5-(4-methyl-1H-imidazol-1-yl)-3-(trifluoromethyl)-phenyl; and R₄ represents methyl; or a pharmaceutically acceptable salt thereof, for the treatment of a proliferative disorder or other pathological conditions mediated by Bcr-Abl, c-Kit, DDR1, DDR2 or PDGF-R kinase activity, wherein the compound of formula (I) or a pharmaceutically acceptable salt thereof and, optionally, pharmaceutically acceptable carriers, is orally administered dispersed in apple sauce.

Furthermore, disclosed herein is the use of a pyrimidylaminobenzamide of formula I wherein Py denotes 3-pyridyl, R₁ represents hydrogen, R₂ represents 5-(4-methyl-1H-imidazol-1-yl)-3-(trifluoromethyl)-phenyl; and R₄ represents methyl; or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the treatment of a proliferative disorder or other pathological conditions mediated by Bcr-Abl, c-Kit, DDR1, DDR2 or PDGF-R kinase activity, wherein the medicament is designated to be dispersed in apple sauce, optionally together with pharmaceutically acceptable carriers, and orally administered to a human patient in need thereof.

EXAMPLES Example 1: In vitro stability tests

The content of nilotinib capsules prepared as disclosed in WO2008/037716 is dispersed in yogurt or applesauce. It is shown that nilotinib is stable at room temperature for 15 minutes with mean nilotinib recovery between 97.6 to 99.9 %.

Example 2: Randomized, open label, three-period crossover single-center study in 48 healthy subjects comparing the bioavailability of nilotinib when administered as intact capsule or the capsule content mixed with yogurt or applesauce in healthy volunteers (HV)

The HV between 18 and 65 years obtain under fasted conditions either a single oral administration of 400 mg nilotinib with two intact 200 mg nilotinib capsules (treatment A); a single oral administration of 400 mg nilotinib with the content of two 200 mg nilotinib capsules each dispersed in one teaspoon of non-fat plain yogurt (treatment B); or a single oral administration of 400 mg nilotinib with the content of two 200 mg nilotinib capsules each dispersed in one teaspoon of applesauce (treatment C). Serial blood samples for serum nilotinib concentration determination are collected for up to 72 hous after each nilotinib administration. All treatments were administered with 240 mL of water, in the morning, after an overnight fast of at least 10 hours. Subjects continued to fast until 4 hours after administration. Standardized meals were served at 4 hours (lunch) and 10 hours (dinner) after nilotinib administration. Consumption of grapefruit, grapefruit juice, or any caffeinated beverages within 48 hours of study initiation was prohibited.

Serum nilotinib concentrations were determined from blood samples collected at pre-dose (0 hour) and 0.5, 1, 2, 3, 4, 5, 6, 8, 10, 12, 24, 36, 48, and 72 hours post-nilotinib administration on days 1, 13, and 25. At each time point, 2.5 mL of whole blood was drawn using a Serum Separator Vacutainer^® (Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA) tube. The tube was allowed to stand vertically at room temperature for 30 minutes prior to centrifugation at 5°C for 10 minutes at 1100 g. Immediately after centrifugation, the upper serum sample was transferred and stored frozen at ≤ -15°C until shipped to the analytical site for sample analyses.

Serum concentrations of nilotinib were measured using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay as described previously, with slight modifications (Larson RA, le Coutre PD, Reiffers J et al. J Clin Oncol 28:7s, 2010 (suppl; abstr 6501)). Nilotinib and the internal standard, [M+4]nilotinib, were extracted from a 100 µL serum sample with 700 µL of methyl tertiary-butyl ether (MTBE). The MTBE layer was transferred, evaporated to dryness, and reconstituted with 400 µL of an acetonitrile and 0.2% formic acid mixture (40:60, v/v). Chromatography was carried out using a Phenomenex Synergi™ Polar-RP column (particle size 4 µm, 50 mm x 2 mm i.d.) (Phenomenex, Inc, Torrance, California) held at room temperature. Elution of the analytes was performed using a isocratic elution at a flow rate of 0.5mL/min with mobile phases of 0.2% formic acid in 10 mM aqueous ammonium formate : 0.2% formic acid in acetonitrile (60:40, v/v). Detection was performed by MS/MS in positive ion mode on a Sciex API4000 mass spectrometer (Applied Biosystem, USA) with multiple reaction monitoring of m/z 530→289 for nilotinib and 534→293 for the internal standard. The lower limit of quantification for nilotinib was 2.50 ng/mL using a 100 µL serum sample. Precision of the assay at each QC level was <11% and the accuracy ranged from 95.2% to 104.3%.

Following the administration of a single oral dose of 400-mg nilotinib as two 200-mg intact capsules, the peak serum concentration of nilotinib occurred at a median time (t_max) of 4.0 hours, and the C_max values averaged 398 ng/mL. The mean t_1/2 of nilotinib was found to be 19.8 hours. These results are in agreement with those observed in previous studies in healthy volunteers who received a same 400-mg oral dose of nilotinib as intact capsules. Compared with the administration of 400-mg nilotinib as two 200-mg intact capsules (Treatment A), the systemic exposure of nilotinib was found to be generally higher following the administration of nilotinib as two capsule contents (400 mg) mixed with yogurt (Treatment B). The geometric mean values of C_max, AUC_0-tlast, and AUC_0-inf of nilotinib were increased by 31%, 11%, and 8% respectively. The 90% CIs of the geometric mean ratio (Treatment B vs A) of nilotinib C_max, AUC_0-t and AUC_0-∞ were 1.22-1.41, 1.05-1.06, and 1.02-1.15, respectively.

Administration of the contents of two nilotinib capsules (400 mg) dispersed in applesauce (Treatment C), showed similar exposure compared with administration of nilotinib as intact capsules (Treatment A). The geometric mean ratio (Treatment C vs A) of nilotinib C_max, AUC_0-tlast, and AUC_0-inf was 0.95, 0.99, and 0.97 respectively, and the corresponding 90% CIs were 0.88-1.02, 0.94-1.04, and 0.90-1.03 respectively.

The results are summarized in Table 1.

PK Parameter	Geometric mean		Ratio and 90% CIs BvsA
	Treatment A (intact capsule)	Treatment B (mixed with yogurt)
Tmax (h)	4.0	4.0	-0.02 (-8.0, 6.0)
Cmax (ng/mL)	398	525	1.31 (1.22 - 1.41)
AUC0-t (ng*h/mL)	11 223	12 559	1.11 (1.05 - 1.16)
AUC0-∞ (ng*h/mL)	11 965	13 655	1.08 (1.02 - 1.15)
	19.7	21.0	NA

	Treatment A (intact capsule)	Treatment C (mixed with applesauce)	Ratio and 90% CIs C vs A
Tmax (h)	4.0	3.0	-0.02 (-6.00, 6.07)
Cmax (ng/mL)	398	378	0.95 (0.88 - 1.02)
AUC0-t(ng*h/mL)	11 223	11 214	0.99 (0.94 - 1.04)
AUC0-∞ (ng*h/mL)	11 965	12 105	0.97 (0.90 - 1.03)
	19.7	20.6	NA

The studies allow the following conclusions:

• ▪ Single oral administration of 400 mg nilotinib, with two 200 mg nilotinib capsules content, each dispersed in one teaspoon of non-fat plain yogurt is not bioequivalent to a single oral administration of 400 mg nilotinib given as intact capsules.
• ▪ Single oral administration of 400 mg nilotinib, with two 200 mg nilotinib capsules content, each dispersed in one teaspoon of applesauce is bioequivalent to a single oral administration of 400 mg nilotinib given as intact capsules.

The studies also show that the administration of nilotinib in a fruit preparation is safe and well tolerated by human subjects.

Claims (3)

1. A pyrimidylaminobenzamide of formula (I) wherein Py denotes 3-pyridyl, R₁ represents hydrogen, R₂ represents 5-(4-methyl-1H-imidazol-1-yl)-3-(trifluoromethyl)-phenyl; and R₄ represents methyl; or a pharmaceutically acceptable salt thereof, for the treatment of a proliferative disorder or other pathological conditions selected from melanoma, especially melanoma harboring c-KIT mutations, breast cancer, cancer of the colon, lung cancer, cancer of the prostate or Kaposi's sarcoma, gastrointestinal stromal tumors (GIST), acute myeloid leukemia (AML), leukemia which responds to an inhibition of the Abl tyrosine kinase activity, chronic myeloid leukemia (CML), Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL), mesothelioma, systemic mastocytosis, hypereosinophilic syndrome (HES), fibrosis, hepatic fibrosis, renal fibrosis, rheumatoid arthritis, polyarthritis, scleroderma, lupus erythematosus, graft-versus host diseases, neurofibromatosis, pulmonary hypertension, pulmonary arterial hypertension, Alzheimer's disease, seminomas, dysgerminomas and psoriasis, wherein the compound of formula (I) or a pharmaceutically acceptable salt thereof and, optionally, pharmaceutically acceptable carriers, is orally administered dispersed in apple sauce.
2. A pyrimidylaminobenzamide of formula (I) for use according to claim 1 in the form of its monohydrochloride monohydrate salt.
3. A pyrimidylaminobenzamide of formula (I) or a pyrimidylaminobenzamide of formula (I) in the form of its monohydrochloride monohydrate salt for use according to claim 1, wherein the pathological condition is selected from CML and Ph+ ALL.