Methods of using (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid for treatment of certain hematologic disorders
Methods of treating, preventing or managing hematologic disorders, such as leukemia are disclosed. The methods encompass the administration of SNS-595. Also provided are methods of treatment using this compound with chemotherapy, radiation therapy, hormonal therapy, biological therapy or immunotherapy. In certain embodiments, the method of treatment comprise administering SNS-595 in combination with Ara-C. Pharmaceutical compositions and single unit dosage forms suitable for use in the methods are also disclosed.
1 . A method of treating leukemia comprising administering to a mammal having a leukemia a therapeutically effective combination of an enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid and Ara-C, wherein the Ara-C is administered in a total amount of about 5-1500 mg/m 2 per day for at least one day.
2 . The method of claim 1 , wherein the leukemia is chronic lymphocytic leukemia, chronic myelocytic leukemia, acute lymphoblastic leukemia or acute myelogenous leukemia.
3 . The method of claim 2 , wherein the acute lymphoblastic leukemia originates in the blast cells of the bone marrow, thymus or lymph nodes.
4 . The method of claim 3 , wherein the acute lymphoblastic leukemia is a T-cell leukemia.
5 . The method of claim 4 , wherein the T-cell leukemia is a peripheral T-cell leukemia, T-cell lymphoblastic leukemia, cutaneous T-cell leukemia or adult T-cell leukemia.
6 . The method of claim 1 , wherein the leukemia is an acute myelogenous leukemia.
7 . The method of claim 6 , wherein the acute myelogenous leukemia is a myeloblastic leukemia or promyelocytic leukemia.
8 . The method of claim 1 , wherein the leukemia is relapsed, refractory or resistant to conventional therapy.
9 . The method of claim 8 , wherein the relapsed or refractory leukemia is de novo acute myeloid leukemia or secondary acute myeloid leukemia.
10 . The method of claim 9 , wherein the secondary acute myeloid leukemia is a therapy related acute myeloid leukemia.
11 . The method of any one of claim 1 , further comprising administering a therapeutically effective amount of another second active agent or a support care therapy.
12 . The method of claim 11 , wherein the other second active agent is a therapeutic antibody that specifically binds to a cancer antigen, hematopoietic growth factor, cytokine, anti-cancer agent, antibiotic, cox-2 inhibitor, immunomodulatory agent, immunosuppressive agent, corticosteroid or a pharmacologically active mutant or derivative thereof.
13 . The method of claim 11 , wherein the second active agent is an alkylating agent, an anti-neoplastic antibiotic, an anti-metabolite, a platinum coordination complex, a topoisomerase II inhibitor or radiation.
14 . The method of claim 11 , wherein the second active agent is etoposide, daunomycin, actinomycin D, mitomycin C, cisplatin, carboplatin, premetrexed, methotrexate, 5-Fu, wortmannin, geldanamycin, gemcitabin or a combination thereof.
15 . The method of claim 1 or 11 wherein the amount of Ara-C is about 200-400 mg/m 2 /day.
16 . The method of claim 1 or 11 wherein the amount of Ara-C is about 400 mg/m 2 /day.
17 . The method of claim 1 or 11 wherein the amount of Ara-C is about 10-50 mg/m 2 /day.
18 . The method of claim 1 or 11 wherein the amount of Ara-C is about 20 mg/m 2 /day.
19 . The method of 18 wherein the amount of Ara-C is administered as 10 mg/m 2 twice a day.
20 . The method of claim 18 wherein the Ara-C is administered subcutaneously for 10 days.
21 . The method of claim 20 wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered twice a week.
22 . The method of claim 21 wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid administered twice a week is at a dose of about 10-40 mg/m 2 .
23 . The method of claim 21 wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered twice a week for two weeks.
24 . The method of claim 20 wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered once a week.
25 . The method of claim 24 wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered at a dose of 10 mg/m 2 -90 mg/m 2 .
26 . The method of claim 24 wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered once a week for three weeks.
27 . The method of claim 1 or 11 , wherein the amount of enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid administered is from about 1 to about 150 mg/m 2 .
28 . The method of claim 1 or 11 , wherein the amount of enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid administered is from about 10 to about 120 mg/m 2 .
29 . The method of claim 1 or 11 , wherein the amount of enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid administered is from about 10 to about 90 mg/m 2 per week.
30 . The method of claim 1 or 11 , wherein the amount of enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid administered is about 40 to about 80 mg/m 2 per week.
31 . The method of claim 1 or 11 wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered as an IV injection.
32 . The method of claim 1 or 11 , wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered twice per week.
33 . The method of claim 15 , wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered intravenously twice per week and Ara-C is intravenously administered continuously over a treatment cycle of 5 days.
34 . The method of claim 33 , wherein Ara-C is administered at 400 mg/m 2 /day.
35 . The method of claim 33 , wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered on day 1 and day 4 of said treatment cycle of 5 days.
36 . The method of claim 33 , wherein the treatment cycle is repeated at least once.
37 . The method of claim 33 , wherein the treatment cycle is repeated at least two times.
38 . The method of claim 33 , wherein the treatment cycle is repeated at least three times.
39 . The method of claim 1 or 11 , wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered 8 to 16 hours after the start of at least one Ara-C administration.
40 . The method of claim 1 or 11 wherein the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid is administered within 24 hours before or after the start of at least one Ara-C administration.
41 . The method of claim 1 or 11 wherein Ara-C is administered immediately after administration of the enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid.
42 . The method of claim 1 or 11 , wherein the mammal is a human.
43 . A combination comprising an enantiomerically pure (+)-1,4-dihydro-7-[(3S,4S)-3-methoxy-4-(methylamino)-1-pyrrolidinyl]-4-oxo-1-(2-thiazolyl)-1,8-naphthyridine-3-carboxylic acid and Ara-C.