DOSING REGIMENS FOR CYCLIN-DEPENDENT KINASE 7 (CDK7) INHIBITORS
The present invention provides for the use of various compositions, including compounds of Formula (I) or (Ia), or a species thereof, and pharmaceutically acceptable salts, stereoisomers, and isotopic forms thereof in treating a proliferative disease such as cancer in a patient. Administration of a compound or pharmaceutical composition at a dose and conforming to a dosing regimen described herein is expected to inhibit cyclin-dependent kinase 7 (CDK7), and thereby, treat the cancer.
1 . A method of treating a patient who has a cancer that is characterized by the presence of a solid tumor and associated with overexpression and/or aberrant activity of CDK7, the method comprising administering a pharmaceutical composition comprising a therapeutically effective amount of a compound of Formula (I)
or a pharmaceutically acceptable salt thereof, wherein
R 1 is methyl or ethyl, R 2 is methyl or ethyl, R 3 is 5-methylpiperidin-3-yl, 5,5-dimethylpiperidin-3-yl, 6-methylpiperdin-3-yl, or 6,6-dimethylpiperidin-3-yl, and R 4 is —CF 3 or chloro;
the pharmaceutical composition is formulated for oral administration; and
the compound or the pharmaceutically acceptable salt thereof is administered according to an intermittent dosing schedule requiring one or more cycles of treatment, each cycle of treatment lasting 14 days, during which the compound or the pharmaceutically acceptable salt thereof is administered once or twice daily for the first 7 days of the cycle at a dose of about 1-30 mg/day and withheld for the subsequent 7 days of the cycle.
2 . The method of claim 1 , wherein the cancer is a breast cancer, a gastrointestinal tract cancer, a lung cancer, a pancreatic cancer, a cancer of a reproductive organ, or a cancer of a bone or the surrounding soft tissue; and/or
the dose of the compound or the pharmaceutically acceptable salt thereof is about 1-10 mg/day.
3 . The method of claim 1 , wherein the cancer is
a breast cancer characterized as a hormone receptor-positive (HR+) breast cancer, an HR+, HER2-negative (HER2−) breast cancer, or a triple negative breast cancer (TNBC; ER−/PR−/HER2−, where PR stands for progesterone receptor);
a colorectal cancer;
a non-small cell lung cancer;
a pancreatic ductal adenocarcinoma (PDAC);
a uterine, fallopian tube, ovarian, or prostate gland cancer; or
an Ewing's sarcoma.
4 - 12 . (canceled)
13 . The method of claim 1 , wherein cancer cells in a biological sample obtained from the patient who has the cancer have been determined to (a) have elevated expression or activity of CDK7; (b) have a cellular phenotype in which a steroid or hormone receptor is overexpressed; (c) exhibit resistance to a previously administered anti-cancer agent; or (d) express an RB1 biomarker.
14 . The method of claim 1 , wherein the cancer has been determined to exhibit resistance to or has become refractory to treatment with a previously administered anti-cancer agent.
15 . The method of claim 1 , wherein the cancer has been determined to exhibit resistance to or has become refractory to treatment with a previously administered cyclin-dependent kinase 4/cyclin-dependent kinase 6 (CDK4/6) inhibitor, an antimetabolite, a B-cell lymphoma-2 (Bcl-2) inhibitor, a bromodomain and extra-terminal motif (BET) inhibitor, a cyclin-dependent kinase 9 (CDK9) inhibitor, an FMS-like tyrosine kinase 3 (FLT3) inhibitor, an inhibitor of the mitogen-activated protein kinase enzymes MEK1 or MEK2, a poly (ADP-ribose) polymerase (PARP) inhibitor, a phosphoinositide 3-kinase (PI3K) inhibitor, an inhibitor of the PI3K/AKT/mTOR pathway, a platinum-based therapeutic agent, a selective estrogen receptor modulator (SERM), a selective estrogen receptor degrader (SERD), or an agent that inhibits the production of estrogen.
16 . The method of claim 1 , wherein the cancer has been determined to exhibit resistance to or has become refractory to treatment with palbociclib, ribociclib, fulvestrant, venetoclax, alvocidib, trametinib, cobimetinib, binemetinib, olaparib, niraparib, alpelisib, apitolisib (GDC-0980), idelalisib, copanlisib, duvelisib, pictilisib, capecitabine, gedatolisib, cisplatin, oxaliplatin, nedaplatin, carboplatin, phenanthriplatin, picoplatin, satraplatin (JM216), triplatin tetranitrate, tamoxifen, raloxifene, toremifene, anastrozole, exemestane, or letrozole.
17 .- 18 . (canceled)
19 . The method of claim 1 , wherein (a) R 1 is methyl and R 2 is methyl or (b) R 1 is methyl and R 2 is ethyl.
20 . The method of claim 1 , wherein R 4 is —CF 3 .
21 . The method of claim 1 , wherein R 4 is chloro.
22 . The method of claim 1 , wherein R 3 is 5-methylpiperidin-3-yl.
23 . The method of claim 1 , wherein R 3 is 5,5-dimethylpiperidin-3-yl.
24 . The method of claim 1 , wherein R 3 is 6-methylpiperdin-3-yl.
25 . The method of claim 1 , wherein R 3 is 6,6-dimethylpiperidin-3-yl.
26 . The method of claim 1 , wherein the compound of Formula (I) conforms to Formula (Ia):
wherein R 3 is
27 . The method of claim 1 , wherein the compound of Formula (I) conforms to Formula (Ia):
wherein
R 3 is
R 4 is —CF 3 or chloro; and
(a) R 1 is methyl and R 2 is methyl or (b) R 1 is methyl and R 2 is ethyl.
28 . The method of claim 1 , wherein the compound of Formula (I) is
29 . The method of claim 1 , wherein the compound of Formula (I) is
30 . (canceled)
31 . The method of claim 1 , wherein the compound of Formula (I) or the pharmaceutically acceptable salt thereof constitutes a first anti-cancer agent, and the compound of Formula (I) or the pharmaceutically acceptable salt thereof is administered in combination with a second anti-cancer agent.
32 .- 203 . (canceled)
204 . The method of claim 31 , wherein the second anti-cancer agent is administered: at a dose and/or according to a dosing schedule previously approved by a regulatory agency; or
at a dose that is lower than a dose previously approved by a regulatory agency.
205 . The method of claim 31 , wherein the second anti-cancer agent is a B-cell lymphoma-2 (Bcl-2) inhibitor; a bromodomain and extra-terminal motif (BET) inhibitor; a cyclin-dependent kinase 4/cyclin-dependent kinase 6 (CDK4/6) inhibitor; a cyclin-dependent kinase 9 (CDK9) inhibitor; an FMS-like tyrosine kinase 3 (Flt3) inhibitor; a mitogen-activated protein kinase (MEK) inhibitor; a poly (ADP-ribose) polymerase (PARP) inhibitor; a phosphoinositide 3-kinase (PI3K) inhibitor or an inhibitor of the PI3K/AKT/mTOR pathway; a platinum-based therapeutic agent; a selective estrogen receptor modulator (SERM); a steroid receptor degradation agent (SERD); an aromatase inhibitor; or a taxane.
206 . The method of claim 205 , wherein the Bcl-2 inhibitor is venetoclax; the CDK4/6 inhibitor is palbociclib, ribociclib, trilaciclib, or abemaciclib; the CDK9 inhibitor is alvocidib/DSP-2033/flavopiridol, nanoflavopiridol, seliciclib, or voruciclib; the Flt3 inhibitor is crenolanib, gilteritinib, lestautinib, ponatinib, sorafenib, sunitinib, pacritinib, quizartinib, or midostaurin; the MEK inhibitor is trametinib, cobimetinib, or binemetinib; the PARP inhibitor is olaparib, rucaparib, talazoparib, velinarib, or niraparib; the PI3K inhibitor or the inhibitor of the PI3K/AKT/mTOR pathway is gedatolisib, apitolisib, idelalisib, copanlisib, develisib, pictilisib, alpelisib, or capecitabine; the platinum-based therapeutic agent is cisplatin, oxaliplatin, nedaplatin, carboplatin, phenanthriplatin, picoplatin, satraplatin, or triplatin tetranitrate; the SERM is tamoxifen, raloxifene, or toremifene; the SERD is fulvestrant; the aromatase inhibitor is exemestane, anastrasole, or letrozole; and the taxane is docetaxel, paclitaxel, or paclitaxel (protein bound).
207 . The method of claim 31 , wherein the second anti-cancer agent is 5-fluorouracil (5-FU) administered alone or in combination with one or more of leucovorin, methotrexate, and oxaliplatin.
208 . The method of claim 31 , wherein
the cancer is a breast cancer resistant to treatment with a CDK4/6 inhibitor and the second anti-cancer agent is a SERD, an aromatase inhibitor, or a taxane;
the cancer is a melanoma and the second anti-cancer agent is a MEK inhibitor administered alone or in combination with dabrafend, vemurafenib, or encorafenib;
the cancer is a triple-negative breast cancer, colorectal cancer, small cell lung cancer, or pancreatic ductal adenocarcinoma and the second anti-cancer agent is gemcitabine; or
the cancer is a non-small cell lung cancer, the second anti-cancer agent is paclitaxel or paclitaxel (protein bound), and the method further comprises administration of carboplatin.
209 . A method of treating a patient who has a hematologic cancer, the method comprising administering a pharmaceutical composition comprising a therapeutically effective amount of a compound of Formula (I)
or a pharmaceutically acceptable salt thereof, in treating a hematologic cancer, wherein
R 1 is methyl or ethyl, R 2 is methyl or ethyl, R 3 is 5-methylpiperidin-3-yl, 5,5-dimethylpiperidin-3-yl, 6-methylpiperdin-3-yl, or 6,6-dimethylpiperidin-3-yl, and R 4 is —CF 3 or chloro; and
the compound or the pharmaceutically acceptable salt thereof is administered according to an intermittent dosing schedule at a dose of about 1-30 mg/day.
210 . A method of treating a patient who has a cancer, the method comprising administering a pharmaceutical composition comprising a therapeutically effective amount of a compound of Formula (I)
or a pharmaceutically acceptable salt thereof, wherein
R 1 is methyl or ethyl, R 2 is methyl or ethyl, R 3 is 5-methylpiperidin-3-yl, 5,5-dimethylpiperidin-3-yl, 6-methylpiperdin-3-yl, or 6,6-dimethylpiperidin-3-yl, and R 4 is —CF 3 or chloro;
the cancer is characterized by the presence of a solid tumor or is a hematologic cancer; and
the compound or the pharmaceutically acceptable salt thereof constitutes a first anti-cancer agent that is administered according to a continuous daily dosing schedule at a dose of about 1-30 mg/day in combination with a second anti-cancer agent.