Macrocyclic compounds as ROS1 kinase inhibitors
Methods for inhibiting a ROS1 kinase with compounds of Formula I: and pharmaceutically acceptable salts thereof, wherein ring A, ring B, W, m, D, R 2 , R 2a , R 3 , R 3a , and Z are as defined herein. The compounds and methods provided herein are useful in the treatment of cancer (e.g., ROS1-associated cancers as defined herein).
1. A method for treating a ROS1-associated cancer in a subject in need thereof, wherein the cancer has developed resistance to a first ROS1 inhibitor, and wherein the cancer has been identified as having one or more ROS1 inhibitor resistance mutations, the method comprising administering
(6R,15R)-9-fluoro-15-methyl-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.0 2,6 .0 7,12 .0 21,25 ]pentacosa-1(24),7,9,11,18(25),19,22-heptaen-17-one;
or a pharmaceutically acceptable salt thereof.
2. The method of claim 1 , wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesetinib.
3. The method of claim 2 , wherein the first ROS1 inhibitor is alectinib.
4. The method of claim 2 , wherein the first ROS1 inhibitor is brigatinib.
5. The method of claim 2 , wherein the first ROS1 inhibitor is cabozantinib.
6. The method of claim 2 , wherein the first ROS1 inhibitor is ceritinib.
7. The method of claim 2 , wherein the first ROS1 inhibitor is crizotinib.
8. The method of claim 2 , wherein the first ROS1 inhibitor is entrectinib.
9. The method of claim 2 , wherein the first ROS1 inhibitor is lorlatinib.
10. The method of claim 2 , wherein the first ROS1 inhibitor is mesetinib.
11. The method of claim 1 , wherein the one or more ROS1 inhibitor resistance mutations comprise one or more amino acid substitutions at an amino acid position selected from 1186, 1935, 1945, 1946, 1947, 1948, 1951, 1958, 1959, 1961, 1962, 1971, 1974, 1981, 1982, 1986, 1990, 1993, 1994, 2000, 2002, 2004, 2008, 2009, 2010, 2011, 2016, 2019, 2020, 2022, 2026, 2028, 2029, 2030, 2032, 2033, 2035, 2036, 2039, 2040, 2052, 2059, 2060, 2075, 2077, 2078, 2087, 2091, 2092, 2094, 2098, 2099, 2100, 2101, 2106, 2107, 2112, 2113, 2116, 2125, 2127, 2128, 2131, 2134, 2139, 2141, 2142, 2148, 2151, 2154, 2155, 2160, 2165, 2181, 2184, 2201, 2205, 2207, 2209, 2212, and 2224.
12. The method of claim 1 , wherein the one or more ROS1 inhibitor resistance mutations comprise one or more amino acid substitutions selected from S1186F, E1935G6, L1945Q, T1946S, L1947R, L1947M, R1948S, L1951R, L1951V, E1958V, V1959E, E1961K, G1962E, G1971E, E1974K, T1981M, L1982F, L1982R, 51986Y, 51986F, E1990G, E1990L, E1993K, F1994L, L2000V, 52002N, F2004L, F20041, F2004V, F2004C, N2008H, 12009L, L2010M, K2011N, C2016G, N2019D, N2019Y, E2020K, Q2022H, L2026M, L2028M, M2029K, E2030K, G2032R, D2033G, D2033N, L20351, T20361, T2036N, R2039G, R2039H, R2039M, R2039N, R2039S, K2040E, K2040Q, T2052S, L2059P, C2060G, F2075C, F20751, F2075V, H2077P, R2078W, V20871, D2091N, Y2092N, 52094N, V20981, K2099N, 12100V, G2101A, A2106P, R2107T, N2112K, D2113N, D2113G, R2116T, R2116K, V2125G, V2125L, W2127G, M2128T, E2131D, E2131K, M2134I, T2139I, T2139S, Q2141H, 52142Y, G2148E, I2151N, I2154M, L2155S, Q2160H, H2165D, E2181D, R2184T, E2201D, R2205I, T2207I, H2209P, Q2212H, Q2212P, and N2224K.
13. The method of claim 1 , wherein the one or more ROS1 inhibitor resistance mutations comprise one or more amino acid substitutions at an amino acid position selected from 2026, 2032, and 2033.
14. The method of claim 13 , wherein the one or more ROS1 inhibitor resistance mutations comprise one or more amino acid substitutions selected from L2026M, G2032R, and D2033N.
15. The method of claim 1 , wherein the ROS1-associated cancer is selected from the group consisting of: lung cancer, colorectal cancer, gastric cancer, adenocarcinoma, small bowel adenocarcinoma, cholangiocarcinoma, glioblastoma, ovarian cancer, angiocarcinoma, congenital gliobastoma multiforme, papillary thyroid carcinoma, inflammatory myofibroblastic tumour, a spitzoid neoplasm, anaplastic large cell lymphoma, diffuse large B cell lymphoma, and B-cell acute lymphoblastic leukemia.