Method of treating a brain tumor

Related Art This application is related to U.S. Provisional Application No. 62/129,623, filed March 6, 2015, and U.S. Provisional Application No. 62/249,807, filed November 2, 2015, the disclosures of which are incorporated in their entireties. which is incorporated herein by reference).

TECHNICAL FIELD This invention relates to the fields of chemistry and medicine. More particularly, the present invention relates to methods of treating brain tumors with plinabulin.

Cancers of the brain and nervous system are among the most difficult to treat. The prognosis of these cancer patients depends on the type and location of the tumor as well as its stage of development. Due to the many types of brain cancer, life expectancy after onset can be months or 1-2 years. Treatment consists primarily of surgical resection and radiation therapy. Chemotherapy is also used, but the range of suitable chemotherapeutic agents is limited, probably because most therapeutic agents do not sufficiently penetrate the blood-brain barrier to treat brain tumors. The use of known chemotherapeutic agents in addition to surgery and radiation does little to extend the survival rates obtained with surgery and radiation alone. Accordingly, there is a need for improved treatment options for brain tumors and an urgent unmet medical need in this setting.

Glioblastoma multiforme (GBM) is the most common adult primary brain tumor and is noted for its mortality and lack of response to current therapies. There has been no substantial improvement in treatment options in recent years, and only minimal improvement in survival prospects for patients with GBM. For GBM, life expectancy after onset is approximately 6-12 months. In addition, there are no approved drugs for the treatment of metastatic brain tumors with an average life expectancy of 4-6 months after onset. Therefore, there remains an urgent need for improved treatments for brain cancer.

<p>Some embodiments relate to methods of treating brain tumors comprising administering an effective amount of plinabulin to a subject in need thereof.</p><p>Some embodiments relate to a method of inhibiting growth of brain tumor cells comprising contacting brain tumor cells with plinabulin.</p><p>Some embodiments relate to a method of inducing apoptosis in brain tumor cells comprising contacting brain tumor cells with plinabulin.</p><p>Some embodiments relate to methods of inhibiting brain tumor progression comprising administering an effective amount of plinabulin to a subject in need thereof.</p>

<figref num="1">Figures 1a-1d show an anterior neuronal genetically modified mouse model (GEMM) of glioblastoma (GBM) that mimics human pathology. Figure 1a shows T2 MRI images of human GBM showing peritumoral edema; Figure 1b shows T2 MRI images of mouse GBM showing peritumoral edema; Figure 1d shows a human photomicrograph image of H&amp;E staining of GBM showing microvessel proliferation; Fig. 1d shows a mouse photomicrograph image of H&amp;E staining of GBM showing characteristic pseudopaly necrosis and microvessel proliferation.</figref><figref num="2A">Figures 2A and 2B show T2-weighted MRI images. FIG. 2A shows tumor size in mice with PDGF-induced gliomas treated with vehicle, temozolomide, or fractionated radiation.</figref><figref num="2B">Figures 2A and 2B show T2-weighted MRI images. Figure 2B shows the survival rate of mice with PDGF-induced gliomas treated with vehicle, temozolomide or fractionated radiation.</figref><figref num="3">Shows the survival rate of control and plinabulin-treated glioblastoma tumor-bearing mice.</figref><figref num="4">Figure 3 shows the survival rate of mice with PDGF-induced gliomas characterized by expression of KRAS mutations treated with a combination of plinabulin, temozolomide, and radiation and a combination of temozolomide and radiation.</figref>

Plinabulin, (3Z,6Z)-3-benzylidene-6-{[5-(2-methyl-2-propanyl)-1H-imidazol-4-yl]methylene}-2,5-piperazinedione, is the natural compound phenyl It is a synthetic analogue of ahistin. Plinabulin can be readily prepared according to the methods and procedures described in US Pat. Nos. 7,064,201 and 7,919,497, which are hereby incorporated by reference in their entirety. Some embodiments are for the treatment of brain tumors, including but not limited to metastatic brain tumors, anaplastic astrocytoma, glioblastoma multiforme, oligodendroglioma, ependymoma, and mixed glioma. regarding the use of plinabulin. Some embodiments relate to the use of plinabulin for inhibition of brain tumor cell growth using plinabulin. Some embodiments relate to the use of plinabulin for the induction of apoptosis in brain tumor cells using plinabulin. Some embodiments relate to the use of plinabulin to inhibit progression of brain tumors. Some embodiments relate to the use of plinabulin in combination with additional therapeutic agents or radiation to inhibit progression of brain tumors.

Definitions 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. All patents, applications, published applications, and other publications are incorporated by reference in their entirety. Where there are multiple definitions of terms herein, the ones in this section apply unless otherwise specified.

As used herein, "subject" refers to a human or non-human mammal such as a dog, cat, mouse, rat, cow, sheep, pig, goat, non-human primate or bird such as a chicken, and It means any other vertebrate or invertebrate.

The term "mammal" is used in its normal biological sense. Specifically, therefore, primates including monkeys (chimpanzees, apes, monkeys) and humans, cows, horses, sheep, goats, pigs, rabbits, dogs, cats, rodents, rats, mice, guinea pigs, etc. are included. but not limited to this.

As used herein, an "effective amount" or "therapeutically effective amount" is effective in alleviating to some extent one or more symptoms of a disease or condition, or reducing the likelihood of developing the disease or condition. Represents the amount of therapeutic agent that contains healing.

As used herein, "treat," "treatment," or "treating" refers to administering a compound or pharmaceutical composition to a subject for prophylactic and/or therapeutic purposes.

The term "prophylactic treatment" refers to treating a subject who has not yet shown symptoms of the disease or condition but is susceptible to or otherwise at risk of a particular disease or condition, thereby treating the patient represents a reduction in the likelihood of contracting the disease or condition. The term "therapeutic treatment" refers to administration of treatment to a subject already suffering from a disease or condition.

The term "pharmaceutically acceptable salt" refers to salts that retain the biological effectiveness and properties of compounds and are not biologically or otherwise deleterious for pharmaceutical uses. In most cases, the compounds disclosed herein are capable of forming acid and/or base salts through the presence of amino and/or carboxyl groups or groups similar thereto. Pharmaceutically acceptable acid addition salts can be formed with inorganic and organic acids. Inorganic acids from which salts can be derived include, for example, hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, and the like. Organic acids from which salts can be derived include, for example, acetic acid, propionic acid, glycolic acid, pyruvic acid, oxalic acid, maleic acid, malonic acid, succinic acid, fumaric acid, tartaric acid, citric acid, benzoic acid, cinnamic acid, mandel acid, methanesulfonic acid, ethanesulfonic acid, p-toluenesulfonic acid, salicylic acid and the like. Pharmaceutically acceptable salts can also be formed with inorganic and organic bases. Inorganic bases from which salts can be derived include, for example, bases containing sodium, potassium, lithium, ammonium, calcium, magnesium, iron, zinc, copper, manganese, aluminum, etc.; particularly preferred are ammonium salts, potassium salts, sodium salts, calcium salts and magnesium salts. In some embodiments, treatment of a compound disclosed herein with an inorganic base causes the compound to lose its reactive hydrogen to form Li⁺, Na⁺, K⁺, Mg²⁺and Ca²⁺Salt forms containing inorganic cations such as are obtained. Organic bases from which salts can be derived include, for example, primary, secondary, and tertiary amines, substituted amines including naturally occurring substituted amines, cyclic amines, basic ion exchange resins, etc., especially isopropylamine, trimethylamine, Diethylamine, triethylamine, tripropylamine, and ethanolamine. Many such salts are known in the art.

In some embodiments, compositions can further comprise one or more pharmaceutically acceptable diluents. In some embodiments, a pharmaceutically acceptable diluent can include Corifor® (polyethylene glycol (15)-hydroxystearate). In some embodiments, a pharmaceutically acceptable diluent can include propylene glycol. In some embodiments, pharmaceutically acceptable diluents can include colifol and propylene glycol. In some embodiments, the pharmaceutically acceptable diluent can comprise Corifol and propylene glycol, wherein the total weight of the diluent is about 40% by weight of Corifol and the propylene glycol is about 60% by weight. In some embodiments, the composition can further comprise one or more other pharmaceutically acceptable excipients.

Standard pharmaceutical formulation techniques are used herein, such as those described in Remington's The Science and Practice of Pharmacy, 21st Ed., Lippincott Williams &amp; Wilkins (2005), which is incorporated herein by reference in its entirety. can be used to manufacture a pharmaceutical composition as described in Accordingly, some embodiments include: (a) a safe and therapeutically effective amount of plinabulin or a pharmaceutically acceptable salt thereof; and (b) a pharmaceutically acceptable carrier, diluent, excipient, or It includes pharmaceutical compositions comprising the combination.

Other embodiments include co-administration of plinabulin and the additional therapeutic agent, either in separate compositions or in the same composition. Accordingly, some embodiments include (a) a safe and therapeutically effective amount of plinabulin, or a pharmaceutically acceptable salt thereof, and (b) a pharmaceutically acceptable carrier, diluent, excipient, or a first pharmaceutical composition comprising the combination; and a second comprising (a) a safe and therapeutically effective amount of an additional therapeutic agent and (b) a pharmaceutically acceptable carrier, diluent, excipient, or combination thereof including pharmaceutical compositions. Some embodiments provide (a) a safe and therapeutically effective amount of plinabulin or a pharmaceutically acceptable salt thereof; (b) a safe and therapeutically effective amount of an additional therapeutic agent; and (c) a drug A pharmaceutical composition comprising a pharmaceutically acceptable carrier, diluent, excipient, or a combination thereof.

Administration of the pharmaceutical compositions described herein can be, but is not limited to, oral, sublingual, buccal, subcutaneous, intravenous, intranasal, topical, transdermal, intradermal, intraperitoneal, intramuscular, and intrapulmonary. It can be any of the accepted methods of administration of agents that serve similar utilities, including intravaginal, intrarectal, or intraocular. Oral and parenteral administration are routine in treating the indications that are the subject of preferred embodiments.

The term "pharmaceutically acceptable carrier" or "pharmaceutically acceptable excipient" includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents. Including agents and the like. The use of such media and agents for pharmaceutical agents is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredient, it is contemplated for use in therapeutic compositions. In addition, it may contain various adjuvants as commonly used in the art. A discussion of the inclusion of various ingredients in pharmaceutical compositions can be found, for example, in Gilman et al. (Eds.) (1990); Goodman and Gilman's: The Pharmacological Basis of Therapeutics, 8th Ed., Pergamon Press (see full text). which is incorporated herein by reference.

Some examples of substances that can serve as pharmaceutically acceptable carriers or components thereof are sugars such as lactose, glucose and sucrose; starches such as corn and potato starch; sodium carboxymethylcellulose, ethylcellulose, and methylcellulose. cellulose and its derivatives such as tragacanth powder; malt; gelatin; talc; solid lubricants such as stearic acid and magnesium stearate; polyols such as glycol, glycerin, sorbitol, mannitol and polyethylene glycol; alginic acid; emulsifiers such as Tween; humectants such as sodium lauryl sulfate; pyrogen-free water; isotonic saline; and phosphate buffer.

The compositions described herein are preferably provided in unit dosage form. As used herein, a "unit dosage form" is a composition containing an amount of a compound or composition suitable for administration to an animal, preferably mammalian, subject in one administration in accordance with good medical practice. is. However, formulation in a single or unit dosage form does not imply that the dosage form is administered once daily or once per course of treatment. Such dosage forms will be administered once, twice, three times or more times daily, and may be administered by infusion over a period of time (eg, from about 30 minutes to about 2-6 hours). , or may be administered as a continuous infusion, and although one administration is not specifically excluded, it may be given more than once during the course of treatment. Those skilled in the art will recognize that formulation does not specifically anticipate the overall course of treatment and such determinations are left to those skilled in the art of therapy rather than formulation.

The useful compositions can be administered by a variety of routes of administration, including oral, sublingual, buccal, nasal, rectal, topical (including transdermal and intradermal), ocular, intracerebral, intracranial, intrathecal, intrathecal, and arterial. It can be in any form suitable for internal, intravenous, intramuscular, or other parenteral routes of administration. Oral and nasal compositions will be recognized by those skilled in the art to include compositions administered by inhalation and manufactured by available methods. A variety of pharmaceutically acceptable carriers well known in the art may be used, depending on the particular route of administration desired. Pharmaceutically acceptable carriers include, for example, solid or liquid fillers, diluents, hydrotropic agents, surface active agents, and encapsulating substances.

Pharmaceutically active substances may optionally be included that do not substantially interfere with the activity of the compound or composition. The amount of carrier used with a compound or composition is sufficient to provide a practical amount of substance to be administered per unit dose of compound. Techniques and compositions for formulating dosage forms useful in the methods described herein are described in the following references, all of which are incorporated herein by reference: Modern Pharmaceutics, 4th Ed. , Chapters 9 and 10 (Banker &amp; Rhodes, editors, 2002); Lieberman et al., Pharmaceutical Dosage Forms: Tablets (1989); and Ansel, Introduction to Pharmaceutical Dosage Forms 8th Edition (2004).

A variety of oral dosage forms are available, including solid forms such as tablets, capsules (eg, liquid and solid gel capsules), granules, and mixed powders. Compressed tablets, triturated tablets, enteric-coated tablets, sugar-coated tablets, film-coated tablets, or multiple compressions, containing suitable binders, lubricants, diluents, disintegrants, coloring agents, flavoring agents, flow-inducing agents, and melting agents. It can be a tablet. Liquid oral dosage forms include aqueous solutions, emulsions, suspensions, non-effervescents containing suitable solvents, preservatives, emulsifying agents, suspending agents, diluents, sweeteners, melting agents, coloring agents and flavoring agents. solutions and/or suspensions reconstituted from effervescent granules, and effervescent formulations reconstituted from effervescent granules.

Pharmaceutically acceptable carriers suitable for the formulation of unit dosage forms for oral administration are well known in the art. Tablets usually contain inert diluents such as calcium carbonate, sodium carbonate, mannitol, lactose and cellulose; binders such as starch, gelatin and sucrose; disintegrants such as starch, alginic acid and croscarmellose; magnesium stearate; Lubricants such as stearic acid and talc include conventional pharmaceutically compatible adjuvants. Glidants such as silicon dioxide can be used to improve the flow properties of the powder mixture. Colorants such as FD&amp;C dyes can be used for appearance. Sweeteners and flavors such as aspartame, saccharin, menthol, peppermint, and fruit flavors are useful adjuvants for chewable tablets. Capsules typically contain one or more solid diluents disclosed above. The selection of carrier components depends on minor secondary considerations such as taste, cost, and shelf stability, and can be readily made by one skilled in the art.

Oral compositions also include solutions, emulsions, suspensions and the like. Pharmaceutically acceptable carriers suitable for formulation of such compositions are well known in the art. Typical components of carriers for syrups, elixirs, emulsions and suspensions include ethanol, glycerol, propylene glycol, liquid sucrose, sorbitol and water. For suspending agents, typical suspending agents include methylcellulose, sodium carboxymethylcellulose, AVICEL RC-591, tragacanth and sodium alginate; typical wetting agents include lectin and polysorbate 80; Typical preservatives include methylparaben and sodium benzoate. Oral liquid compositions may contain one or more ingredients such as sweetening, flavoring and coloring agents disclosed above.

Such compositions are conventionally manufactured, usually using pH- or time-dependent coatings, so that the subject composition is released in the gastrointestinal tract in the vicinity of the desired topical application or at various times over which the desired action is prevalent. It may be coated by a method. Such dosage forms typically include, but are not limited to, one or more of cellulose acetate phthalate, polyvinyl acetate phthalate, hydroxypropyl methylcellulose phthalate, ethyl cellulose, Eudragit coating, waxes and shellac. not.

The compositions described herein may optionally contain other active medicinal ingredients.

Other compositions useful for achieving systemic delivery of the subject compounds include sublingual, buccal and nasal dosage forms. Such compositions typically comprise one or more of soluble filler substances such as sucrose, sorbitol and mannitol; and binders such as acacia, microcrystalline cellulose, carboxymethylcellulose and hydroxypropylmethylcellulose. Glidants, lubricants, sweeteners, colorants, antioxidants and flavors disclosed above may also be included.

Liquid compositions formulated for topical ophthalmic use are formulated for topical administration to the eye. Sometimes formulation considerations (eg, drug stability) may not require optimal comfort, but may maximize comfort as much as possible. Where comfort cannot be maximized, liquids may be formulated to be patient acceptable for topical ophthalmic applications. Additionally, ophthalmically acceptable liquids may be packaged for single use or may contain a preservative to prevent contamination over multiple uses.

For ophthalmic use, solutions or medicaments are often formulated with saline as the primary vehicle. Preferably, ophthalmic solutions may be maintained at a comfortable pH using an appropriate buffer system. The formulations may also contain conventional pharmaceutically acceptable preservatives, stabilizers and surfactants.

Preservatives that may be used in the pharmaceutical compositions disclosed herein include, but are not limited to, benzalkonium chloride, PHMB, chlorobutanol, thimerosal, phenylmercuric acetate, and phenylmercuric nitrate. . A useful surfactant is, for example, Tween 80. Similarly, a variety of useful vehicles may be used in the ophthalmic formulations disclosed herein. These vehicles include, but are not limited to, polyvinyl alcohol, povidone, hydroxypropylmethylcellulose, poloxamer, carboxymethylcellulose, hydroxyethylcellulose and purified water.

A tonicity adjusting agent may be added as necessary or convenient. Tonicity adjusting agents include, but are not limited to, salts, particularly sodium chloride, potassium chloride, mannitol and glycerin, or other suitable ophthalmically acceptable tonicity adjusting agents.

Various buffers and means for adjusting pH may be used so long as the resulting formulation is ophthalmically acceptable. For many compositions the pH will be between 4 and 9. Thus, buffers include acetate buffers, citrate buffers, phosphate buffers and borate buffers. Acids or bases may be used to adjust the pH of these formulations, as necessary.

Ophthalmically acceptable antioxidants include, but are not limited to, sodium metabisulfite, sodium thiosulfate, acetylcysteine, butylated hydroxyanisole and butylated hydroxytoluene.

Another excipient component that may be included in the ophthalmic formulation is a chelating agent. A useful chelating agent is disodium edetate (EDTA), although other chelating agents may alternatively or in conjunction with it.

For topical use, creams, ointments, gels, solutions or suspensions, etc., containing the compositions disclosed herein are used. Topical formulations may generally consist of pharmaceutical carriers, co-solvents, emulsifiers, penetration enhancers, preservative systems, and emollients.

For intravenous administration, the compositions described herein may be dissolved or dispersed in a pharmaceutically acceptable diluent such as saline or dextrose solution. Appropriate excipients may be included to achieve the desired pH and include, but are not limited to, NaOH, sodium carbonate, sodium acetate, HCl, and citric acid. In various embodiments, the pH of the final composition ranges from 2-8, or preferably from 4-7. Antioxidant excipients can include sodium bisulfite, acetone-sodium bisulfite, sodium formaldehyde sulfoxylate, thiourea, and EDTA. Other non-limiting examples of suitable excipients found in the final intravenous composition include sodium or potassium phosphate, citric acid, tartaric acid, gelatin, and carbohydrates such as glucose, mannitol, and dextran. can be Further acceptable excipients are described in Powell, et al., Compendium of Excipients for Parenteral Formulations, PDA J Pharm Sci and Tech 1998, 52 238-311 and Nema et al., Excipients and Their Role in Approved Injectable Products: Current Usage and Future Directions, PDA J Pharm Sci and Tech 2011, 65 287-332, both of which are incorporated herein by reference in their entirety. (incorporated in ). Antimicrobial agents may be included to achieve bacteriostatic or fungistatic solutions, including phenylmercuric nitrate, thimerosal, benzethonium chloride, benzalkonium chloride, phenol, cresol, and chlorobutanol. Not limited.

Compositions for intravenous administration may also be provided to the healthcare provider in alternative solid form for reconstitution with a suitable diluent, such as sterile water, saline, or aqueous dextrose, shortly prior to administration. In other embodiments, the compositions are provided in liquid formulations ready for parenteral administration. In still other embodiments, the composition is provided in a liquid formulation that is further diluted prior to administration. In embodiments involving administering a combination of a composition described herein and another agent, the combination may be provided to the healthcare provider as a mixture, or the healthcare provider may administer the two agents prior to administration. may be mixed or the two agents may be administered separately.

The actual dosage of the active compounds described herein will depend on the particular compound and the condition being treated; selection of the appropriate dosage is well within the knowledge of the skilled artisan. In some embodiments, a single dose of plinabulin or other therapeutic agent is about 5 mg/m2 of body surface area.²~150mg/m², about 5 mg/m of body surface area²~100mg/m², about 10 mg/m of body surface area²~100mg/m², about 10 mg/m of body surface area²~80mg/m², about 10 mg/m of body surface area²~50mg/m², about 10 mg/m of body surface area²~40mg/m², about 10 mg/m of body surface area²~30mg/m², about 13.5 mg/m of body surface area²~100mg/m², about 13.5 mg/m of body surface area²~80mg/m², about 13.5 mg/m of body surface area²~50mg/m², about 13.5 mg/m of body surface area²~40mg/m², about 13.5 mg/m of body surface area²~30mg/m², about 15 mg/m of body surface area²~80mg/m², about 15 mg/m of body surface area²~50mg/m², about 15 mg/m of body surface area²~30mg/m²can be In some embodiments, a single dose of plinabulin or other therapeutic agent is about 13.5 mg/m2 of body surface area.²~30mg/m²can be In some embodiments, a single dose of plinabulin or other therapeutic agent is about 5 mg/m2 of body surface area.², about 10 mg/m², about 12.5mg/m², about 13.5mg/m², about 15mg/m², about 17.5mg/m², about 20mg/m², about 22.5mg/m², about 25mg/m², about 27.5 mg/m², about 30mg/m², about 40mg/m², about 50mg/m², about 60mg/m², about 70mg/m², about 80mg/m², about 90mg/m², or about 100 mg/m²can be

In some embodiments, a single dose of plinabulin or other therapeutic agent is about 5 mg to about 300 mg, about 5 mg to about 200 mg, about 7.5 mg to about 200 mg, about 10 mg to about 100 mg, about 15 mg to about 100 mg, about 20 mg to about 100 mg, about 30 mg to about 100 mg, about 40 mg to about 100 mg, about 10 mg to about 80 mg, about 15 mg to about 80 mg, about 20 mg to about 80 mg, about 30 mg to about 80 mg, about 40 mg to about 80 mg, about 10 mg It can be from about 60 mg, from about 15 mg to about 60 mg, from about 20 mg to about 60 mg, from about 30 mg to about 60 mg, or from about 40 mg to about 60 mg. In some embodiments, a single dose of plinabulin or other therapeutic agent can be about 20 mg to about 60 mg, about 27 mg to about 60 mg, about 20 mg to about 45 mg, about 27 mg to about 45 mg. In some embodiments, a single dose of plinabulin or other therapeutic agent is about 5 mg, about 10 mg, about 12.5 mg, about 13.5 mg, about 15 mg, about 17.5 mg, about 20 mg, about 22.5 mg, about 25 mg, It can be about 27 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg, about 90 mg, about 100 mg, about 125 mg, about 150 mg, or about 200 mg.

The duration of administration can be multi-week treatment cycles as long as the tumor remains under control and the regimen is clinically tolerated. In some embodiments, a single dosage of plinabulin or other therapeutic agent can be administered once weekly, preferably once on each of days 1 and 8 of a three-week (21 day) treatment cycle. In some embodiments, a single dosage of plinabulin or other therapeutic agent is administered once weekly, twice weekly, 3 times weekly, 4 times weekly, 5 times weekly, 6 times weekly, or 1 week, 2 weeks. , daily during a 3-week, 4-week, or 5-week treatment cycle. It can be administered on the same or different days of each week of the treatment cycle.

Treatment cycles can be repeated as long as the regimen is clinically tolerated. In some embodiments, the treatment cycle is repeated n times, where n is an integer ranging from 2-30. In some embodiments, n is 2, 3, 4, 5, 6, 7, 8, 9, or 10. In some embodiments, a new treatment cycle can occur immediately after the previous treatment cycle is completed. In some embodiments, a new treatment cycle can occur some time after completion of the previous treatment cycle.

In some embodiments, the compositions described herein can be used in combination with other therapeutic agents. In some embodiments, the compositions described herein can be administered or used in combination with treatments such as chemotherapy, radiation therapy, and biological therapy.

Methods of Treatment Some embodiments relate to methods of treating brain tumors comprising administering to a subject in need thereof an effective amount of plinabulin.

In some embodiments, the brain tumor is selected from metastatic brain tumor, anaplastic astrocytoma, glioblastoma multiforme, oligodendroglioma, ependymoma, meningioma, mixed glioma, and combinations thereof be able to. In some embodiments, the brain tumor is glioblastoma multiforme. In some embodiments, the brain tumor is a metastatic brain tumor.

In some embodiments, the brain tumor is anaplastic astrocytoma, central neurocytoma, choroid plexus carcinoma, choroid plexus papilloma, choroid plexus tumor, germinal dysplastic neuroepithelial tumor, ependymal tumor, fibrous Astrocytoma, giant cell glioblastoma, glioblastoma multiforme, cerebral glioma, gliosarcoma, hemangiopericytoma, medulloblastoma, medulloepithelioma, meningeal carcinomatosis, neuroblastoma, neurocytoma, oligoastrocytoma, oligodendroglioma, optic nerve sheath meningioma, childhood ependymoma, pilocytic astrocytoma, pineoblastoma, pineocytoma, pleomorphic hypocytoma Differentiated neuroblastoma, xanthoastrocytoma multiforme, primary central nervous system lymphoma, sphenoid meningioma, subependymal giant cell astrocytoma, subependymoma, central nervous system myeloma, and trilateral retinoblastoma.

In some embodiments, the method can include administering an additional therapeutic agent. In some embodiments, the additional therapeutic agent is temozolomide, bevicizumab, everolimus, carmustine, lomustine, procarbazine, vincristine, irinotecan, cisplatin, carboplatin, methotrexate, etoposide, vinblasatine, bleomycin, It can be actinomycin, cyclophosphamide, or ifosfamide. In some embodiments, the additional therapeutic agent can be temozolomide. In some embodiments, the additional therapeutic agent can be lomustine.

In some embodiments, the method can further comprise subjecting the subject to radiation therapy. In some embodiments, radiation therapy can be whole brain radiation, fractionated radiation therapy, and radiosurgery.

In some embodiments, the brain tumor is characterized by expression of a mutated form of KRAS. In some embodiments, the brain tumor is characterized by expression of a non-KRAS mutated gene.

In some embodiments, the methods described herein can further comprise identifying a patient with a cancer characterized by expressing a mutated form of KRAS. In some embodiments, the methods described herein can further comprise identifying a patient with a cancer characterized by expressing wild-type KRAS. In some embodiments, identifying a patient can include determining whether the patient has a KRAS mutation. Some embodiments relate to a method of treating cancer in a patient identified as having a KRAS mutation, the method comprising administering to the patient a pharmaceutically effective amount of plinabulin, the patient comprising: (ii) isolating DNA from the sample; (iii) amplifying the KRAS gene or fragment thereof in the isolated DNA; and (iv) whether there are mutations in the amplified KRAS gene. Detecting is identified by determining whether a patient has a cancer characterized by a KRAS mutation.

Some embodiments relate to a method of inhibiting growth of brain tumor cells comprising contacting brain tumor cells with plinabulin. In some embodiments, contacting comprises administering an effective amount of plinabulin to a subject with brain tumor cells. In some embodiments, the brain tumor is glioblastoma multiforme.

Some embodiments relate to a method of inducing apoptosis in brain tumor cells comprising contacting brain tumor cells with plinabulin. In some embodiments, contacting comprises administering an effective amount of plinabulin to a subject with brain tumor cells. In some embodiments, the brain tumor is glioblastoma multiforme.

Some embodiments relate to a method of inhibiting brain tumor progression comprising administering to a subject in need thereof an effective amount of plinabulin.

The following examples are included to further illustrate the invention. Of course, the examples should not be construed as specifically limiting the invention. Variations of these examples within the scope of the claims are within the purview of those skilled in the art and are considered to be within the scope of the description and claimed invention herein. The reader, skilled in the art using this disclosure, and skilled in the art, can prepare and use the present invention without a comprehensive example.

<p>Example 1 The mouse model of glioma used was a PDGF-induced GEMM of glioma that mimics the proneural molecular subgroup of glioblastoma (GBM). This model is based on somatic cell-specific gene transfer; a replication-competent ALV splice acceptor (RCAS) retroviral system instills specific genetic mutations within a tightly regulated window of differentiation in a cell type-specific manner. made it possible. The RCAS/tv-a system used RCAS retroviral vectors to infect mice transgenic to express the RCAS receptor (tv-a) in specific cell populations. Here, we generated gliomas by RCAS-mediated transfer of PDGF into nestin-expressing cells in the brain. We expressed nestin in stem/progenitor cell populations in the brain and showed it to be a marker for cancer stem cells in the perivascular region (PVN) in both human and mouse brain tumors. PDGF-induced gliomas developed with full penetrance when combined with Ink4a-arf-/- deletion by 4-5 weeks post-infection. These tumors closely mimicked the 'proneural' subtype of GBM where CDKN2A (encoding both p16INK4A and p14ARF) deletion was observed in 56% of 'proneural' human gliomas. Tumor cell structures that define human gliomas, such as Scherrer's structures, microvascular proliferation and pseudopalisade necrosis, were reconstituted in this GEMM as shown in Figures 1a-1d. Specifically, Figure 1a shows T2 MRI images of human GBM showing peritumoral edema; Figure 1b shows T2 MRI images of mouse GBM showing peritumoral edema; Human photomicrograph images of H&amp;E staining of GBM with characteristic pseudopalisade necrosis and microvascular proliferation are shown; Figure 1d is mouse photomicrograph of H&amp;E staining of GBM with characteristic pseudopalisade necrosis and microvascular proliferation. Show the image.</p><p>Glioma cells migrated along white matter tracks, surrounded neurons and blood vessels, and accumulated at the rim of the brain within the subpial space. In this regard, the glioma PDGF-induced GEMM closely resembles PVN-GBM and represents an excellent experimental system for defining interactions between tumor and non-neoplastic cells in the intratumoral microenvironment.</p><p>A PDGF-induced model of glioma was used to determine the response to radiation and temozolomide, as shown in Figures 2A and 2B. Figure 2A shows tumor size in mice with PDGF-induced gliomas treated with vehicle, temozolomide, or fractionated radiation; Figure 2B shows survival rates in mice with PDGF-induced gliomas treated with vehicle, temozolomide, or fractionated radiation. show.</p><p>Glioma-bearing mice were identified by symptoms and confirmed by T2-weighted MRI. These mice were treated with either vehicle, temozolomide at 25 mg/kg daily for 12 days, or fractionated irradiation (total of 20 Gy) at doses of 2 Gy (Gray) daily for 5 days every week for 2 weeks. The two top images in Figure 2A show untreated (vehicle) tumor growth; in contrast, temozolomide-treated and irradiated tumors shrank in volume over the same period. These tumors recurred after treatment and all animals died of recurrent tumors as shown by survival curves for these matched cohorts of mice. The data were: 1) tested in this mouse model, 2) the effects of these treatments on mouse survival closely mimicked the human condition, 3) all mice died of disease, and 4) the number of mice in these mouse cohorts was reduced. Relatively identical results demonstrated support for the use of this experimental paradigm to detect survival differences in this study.</p><p>We generated mice with PDGF-induced gliomas using RCAS/tv-a. Mice were transgenic with expression of the RCAS receptor (tv-a) from the nestin promoter and an ink4a/arf background and lox-stop-lox luciferase, RCAS-PDGF, or RCAS-PDGF. Infected in combination with RCAS-KRAS expressing G12D mutant KRAS. The resulting tumors developed within the first 4-5 weeks in this background for PDGF alone and approximately one week earlier for tumors arising from the combination of PDGF and RCAS. Tumors have histologic features of GBM and can be identified using symptoms of lethargy and poor grooming, MRI scans with T2-weighted sequencing, or bioluminescence imaging with the IVIS system. For radiotherapy, mice were treated cranially with 10 Gy per day for a single dose. This treatment extended the median survival of a cohort of GBM-bearing mice by approximately 3 weeks, as shown in Figure 2B. These treated mice began to gain weight, showed symptomatic improvement within days, and their MRI imaging features showed stabilization or reduction in tumor size before recurrence and death.</p><p>Plinabulin was tested on mice with PDGF-induced gliomas expressing G12D mutant KRAS. Four- to six-week-old nestin-tv-a/ink4a-arf mice were anesthetized with isoflurane and injected with RCAS-PDGF-B-HA, RCAS-KRAS transfected into Df-1 cells. Using a stereotaxic frame with a 26-gauge needle attached to a Hamilton syringe, 2 x 10⁵Mice were injected with 1 microliter of a 1:1 mixture of RCAS-PDGF-B-HA/RCAS-KRAS. Cells were injected into the right frontal lobe, adjusted to 1.75 mm lateral, 0.5 mm lateral, and 2 mm deep. Mice were carefully monitored for weight loss and subjected to testing if they lost &gt;0.3 grams over a total of two consecutive days or showed external signs of tumor. In the KRAS group, mice were injected intraperitoneally with plinabulin 7.5 mg/kg twice weekly for 10 weeks. In the control group, mice were injected with plinabulin diluent alone (40% by weight colifol and 60% by weight propylene glycol). Mice were monitored for lethargy, hunched posture, loss of appetite, external signs of tumor growth, agitation, weight loss and gross failure to thrive. Mice were sacrificed if they lost more than 20% of their body weight, were immobile, were unable to feed, or weighed less than 14 grams in males/12 grams in females. mouse, CO₂brains were harvested and stored overnight in 10% neutral buffered formalin, then replaced with Flex80 and stored at 4°C.</p><p>Figure 3 shows the survival rate of mice with glioblastomas containing the G12D Kras mutation. As shown in Figure 3, mice with the PDGF-induced model of glioblastoma generally had significantly better survival in the plinabulin-treated group when compared to the control group (p=0.001).</p><p>Example 2 Mice bearing PDGF-induced gliomas expressing G12D mutant KRAS were prepared using the procedure described in Example 1 and used in this experiment. Four- to six-week-old nestin-tv-a/ink4a-arf mice were anesthetized with isoflurane and injected with RCAS-PDGF-B-HA, RCAS-KRAS transfected into Df-1 cells. Using a stereotaxic frame with a 26-gauge needle attached to a Hamilton syringe, 2 x 10⁵Mice were injected with 1 microliter of a 1:1 mixture of RCAS-PDGF-B-HA/RCAS-KRAS. Cells were injected into the right frontal lobe, adjusted to 1.75 mm lateral, 0.5 mm lateral, and 2 mm deep. Mice were carefully monitored for weight loss and subjected to testing if they lost &gt;0.3 grams over a total of two consecutive days or showed external signs of tumor.</p><p>Mice were put into two test groups. One group was treated with a combination of temozolomide (TMZ), radiation and plinabulin: irradiated at 10gy x 1, TMZ and plinabulin 7.5 mg/kg in plinabulin diluent intraperitoneally twice a week on Mondays and Thursdays for 10 weeks. bottom. Another group, a control group, was treated with a combination of TMZ and radiation: irradiated with 10gy×1 and TMZ administered intraperitoneally twice a week on Mondays and Thursdays for 10 weeks. Mice were monitored for lethargy, hunched posture, loss of appetite, external signs of tumor growth, agitation, weight loss and gross failure to thrive. Mice were sacrificed if they lost more than 20% of their body weight, were immobile, were unable to feed, or weighed less than 14 grams in males/12 grams in females. CO the mouse₂brains were harvested and stored O/N in 10% neutral buffered formalin, then replaced with Flex80 and stored at 4°C. As shown in Figure 4, mice with the PDGF-induced model of glioblastoma generally had significantly better survival in the TMZ + radiotherapy group when compared to the control group receiving plinabulin + TMZ + radiation (p =0.0149).</p>