健喬拚併購 擴大市占 2017-12-04 00:19經濟日報 記者黃文奇/台北報導 健喬併購再啟,擴大產品戰線。健喬信元1日宣布新的併購案,以1
安成藥業 發言日期106/12/01 發言時間18:35:22 發言人欒君儀 發言人職稱投資人關係處長 發言人電話02-2657-3350主旨 補充:
健喬拚併購 擴大市占 2017-12-04 00:19經濟日報 記者黃文奇/台北報導 健喬併購再啟,擴大產品戰線。健喬信元1日宣布新的併購案,以1
安成藥業 發言日期106/12/01 發言時間18:35:22 發言人欒君儀 發言人職稱投資人關係處長 發言人電話02-2657-3350主旨 補充:
健永將撤興櫃 尋求那斯達克掛牌 發稿時間:2017/12/01 (中央社記者韓婷婷台北1日電)
微創正前開髖關節置換手術 勁報 2017/12/03【勁報記者于郁金/連凱斐/臺南報導】
陽性確診為HIV?大陸首見「陰性」愛滋患者 謝婷婷 2017-12-03 大陸發現首例「陰性」HIV合併卡波西氏肉瘤的愛滋患者。
長庚持股逾2800億 難與台塑清楚切割 2017/12/03 長庚醫院爭議不斷,引發外界諸多質疑,
掌醫院如掌金庫 長庚持有集團股票來自創辦人王永慶及王永在所捐贈,
陽明校長資格爭議 潘文忠:尊重遴委會 2017年12月01日 【記者江禹嬋/台北報導】
蘋果與史丹佛大學合作醫學研究,用Apple Watch隨時偵測心律不整 文/林妍溱 | 2017-12-01發表 Apple Watch的感測器利用每秒閃爍數百次的綠LED光及光電二極體
加快生技業專利布局 台英簽署生物材料寄存MOU 2017年12月03日 00:05 中時 王玉樹 生物科技業的佳音。經濟部智慧財產局訪歐,與英國簽屬「
新型人造肌肉有望給心臟打"補丁"2017-12-03來源:
Beating Heart Patch is Large Enough to Repair the Human Heart NOVEMBER 28, 2017 Beating patch is as strong and electrically active as healthy adult heart By Ken Kingery Biomedical engineers at Duke University have created a fully functioning artificial human heart muscle large enough to patch over damage typically seen in patients who have suffered a heart attack. The advance takes a major step toward the end goal of repairing dead heart muscle in human patients. The study appears online in Nature Communications on November 28, 2017. "Right now, virtually all existing therapies are aimed at reducing the symptoms from the damage that's already been done to the heart, but no approaches have been able to replace the muscle that's lost, because once it's dead, it does not grow back on its own," said Ilia Shadrin, a biomedical engineering doctoral student at Duke University and first author on the study. "This is a way that we could replace lost muscle with tissue made outside the body." Unlike some human organs, the heart cannot regenerate itself after a heart attack. The dead muscle is often replaced by scar tissue that can no longer transmit electrical signals or contract, both of which are necessary for smooth and forceful heartbeats. The end result is a disease commonly referred to as heart failure that affects over 12 million patients worldwide. New therapies, such as the one being developed by Shadrin and his advisor Nenad Bursac, professor of biomedical engineering at Duke, are needed to prevent heart failure and its lethal complications. Current clinical trials are testing the tactic of injecting stem cells derived from bone marrow, blood or the heart itself directly into the affected site in an attempt to replenish some of the damaged muscle. While there do seem to be some positive effects from these treatments, their mechanisms are not fully understood. Fewer than one percent of the injected cells survive and remain in the heart, and even fewer become cardiac muscle cells. Heart patches, on the other hand, could conceivably be implanted over the dead muscle and remain active for a long time, providing more strength for contractions and a smooth path for the heart's electrical signals to travel through. These patches also secrete enzymes and growth factors that could help recovery of damaged tissue that hasn't yet died. For this approach to work, however, a heart patch must be large enough to cover the affected tissue. It must also be just as strong and electrically active as the native heart tissue, or else the discrepancy could cause deadly arrhythmias. This is the first human heart patch to meet both criteria. "Creating individual cardiac muscle cells is pretty commonplace, but people have been focused on growing miniature tissues for drug development," said Bursac. "Scaling it up to this size is something that has never been done and it required a lot of engineering ingenuity." The cells for the heart patch are grown from human pluripotent stem cells -- the cells that can become any type of cell in the body. Bursac and Shadrin have successfully made patches using many different lines of human stem cells, including those derived from embryos and those artificially forced or "induced" into their pluripotent state. Various types of heart cells can be grown from these stem cells: cardiomyocytes, the cells responsible for muscle contraction; fibroblasts, the cells that provide structural framework for heart tissue; and endothelial and smooth muscle cells, the cells that form blood vessels. The researchers place these cells at specific ratios into a jelly-like substance where they self-organize and grow into functioning tissue. Finding the right combination of cells, support structures, growth factors, nutrients and culture conditions to grow large, fully functional patches of human heart tissue has taken the team years of work. Every container and procedure had to be sized up and engineered from scratch. And the key that brought it all together was a little bit of rocking and swaying. "It turns out that rocking the samples to bathe and splash them to improve nutrient delivery is extremely important," said Shadrin. "We obtained three-to-five times better results with the rocking cultures compared to our static samples." The results improved on the researchers' previous patches, which were one square centimeter and four square centimeters. They successfully scaled up to 16 square centimeters and five to eight cells thick. Tests show that the heart muscle in the patch is fully functional, with electrical, mechanical and structural properties that resemble those of a normal, healthy adult heart. "This is extremely difficult to do, as the larger the tissue that is grown, the harder it is to maintain the same properties throughout it," said Bursac. "Equally challenging has been making the tissues mature to adult strength on a fast timescale of five weeks while achieving properties that typically take years of normal human development." Bursac and Shadrin have already shown that these cardiac patches survive, become vascularized and maintain their function when implanted onto mouse and rat hearts. For a heart patch to ever actually replace the work of dead cardiac muscle in human patients, however, it would need to be much thicker than the tissue grown in this study. And for patches to be grown that thick, they need to be vascularized so that cells on the interior can receive enough oxygen and nutrients. Even then, researchers would have to figure out how to fully integrate the heart patch with the existing muscle. "Full integration like that is really important, not just to improve the heart's mechanical pumping, but to ensure the smooth spread of electrical waves and minimize the risk of arrhythmias," said Shadrin. "We are actively working on that, as are others, but for now, we are thrilled to have the 'size matters' part figured out," added Bursac. The research is part of a seven-year, $8.6 million grant from the National Institutes of Health. With the large heart patches in hand, the Bursac team is collaborating with researchers at the University of Alabama at Birmingham to develop procedures to successfully integrate the patch onto the hearts of pigs. Another affiliated team of researchers at the University of Wisconsin-Madison is working to develop improved stem cells for creating the main cell types that compose these heart patches, in the hopes of minimizing an immune response to the delivery of the engineered tissues. This research was supported by Foundation Leducq and the National Institutes of Health (R01HL104326, R01HL12652, UG3TR002142, U01HL134764, 5T32GM007171, F30HL122079).
CITATION: "Cardiopatch platform enables maturation and scale-up of human pluripotent stem cell-derived engineered heart tissues," Ilya Y. Shadrin, Brian W. Allen, Ying Qian, Christopher P. Jackman, Aaron L. Carlson, Mark E. Juhas, and Nenad Bursac. Nature Communications, 2017. DOI: 10.1038/s41467-017-01946-x
發展幹細胞產業鏈 接軌國際 2017-12-04 00:19經濟日報 陳菀均 上(11)月16日美國食品藥物管理局(FDA)
抗胰臟癌 南開大學科研邁大步 2017年12月04日 04:10 旺報 資料來源:今晚報(江珊) 記者近日從南開大學獲悉,該校藥物化學生物學國家重點實驗室、
扮演關鍵角色 大量文獻報導,
復發機率下降 既有研究表明,癌細胞在「壞死」的過程中會形成一個低氧環境,
中研院免疫機制新發現 癌症治療新契機 發稿時間:2017/11/28(中央社記者余曉涵台北28日電
Extrachromosomal telomere repeat DNA is linked to ALT development via cGAS-STING DNA sensing pathway/ Nature Structural & Molecular Biology, 06 November 2017 Extrachromosomal telomere repeat (ECTR) DNA is unique to cancer cells that maintain telomeres through the alternative lengthening of telomeres (ALT) pathway, but the role of ECTRs in ALT development remains elusive. We found that induction of ECTRs in normal human fibroblasts activated the cGAS-STING-TBK1-IRF3 signaling axis to trigger IFNβ production and a type I interferon response, resulting in cell-proliferation defects. In contrast, ALT cancer cells are commonly defective in sensing cytosolic DNA. We found that STING expression was inhibited in ALT cancer cell lines and transformed ALT cells. Notably, the ALT suppressors histone H3.3 and the ATRX–Daxx histone chaperone complex were also required to activate the DNA-sensing pathway. Collectively, our data suggest that the loss of the cGAS-STING pathway may be required to evade ECTR-induced anti-proliferation effects and permit ALT development, and this requirement may be exploited for treatments specific to cancers utilizing the ALT pathway.
溫熱療法 腹膜癌末治療新選擇 【大紀元2017年11月27日訊】(
手術結合熱療 腹膜癌化治療的新選擇 而今,經過20多年醫療技術的研究發展,
精良儀器及技術是最佳醫療服務保障 50多歲的謝先生經常腹痛,到阮綜合醫院就診,
杏國新藥 發言日期106/11/28 發言時間14:28:25 發言人蘇慕寰 發言人職稱總經理 發言人電話(02)2764-0826 主旨 本公司SB05_(EndoTAG-1)抗腫瘤新藥經美國專利商
Method of administering a cationic liposomal preparation Dec 4, 2015 - SynCore Biotechnology Co., Ltd. The present invention relates to the use of pharmaceutical preparations comprising paclitaxel for administration to a human patient in need thereof. SynCore Biotechnology Co., Ltd. Treatment of Triple Receptor Negative Breast Cancer
Description CROSS REFERENCE TO RELATED APPLICATIONS This application is a continuation of co-pending U.S. patent application Ser. No. 11/919,700, filed Oct. 31, 2007 entitled "Method of Administering a Cationic Liposomal Preparation," which is a U.S. National Phase Application of International Application No. PCT/EP2006/004185, filed May 4, 2006, which claims the benefit of European Patent Application No. 05 009 847.4 filed May 4, 2005, all of which are expressly incorporated herein by reference in their entirety. The present invention relates to the use of pharmaceutical preparations comprising paclitaxel for administration to a human patient in need thereof. The use of antimitotic drugs, such as taxanes, as therapeutic agents for human patients suffering from diseases which are connected with enhanced mitosis are well known in the art. Paclitaxel has a unique mechanism of action and a broad spectrum of antiproliferative activity because paclitaxel binds to microtubules and promotes tubulin polymerisation and stabilizes the assembled microtubules. As a result, paclitaxel blocks the cell cycle at prophase resulting in an accumulation of cells in the G2/M phase. Unfortunately, paclitaxel has extreme low solubility in water, which makes it difficult to provide a suitable dosage form. Currently, paclitaxel is formulated and administered in a vehicle containing Cremophor EL (a polyethoxylated castor oil) and ethanol in a 50:50 (vol/vol) ratio. This solution is diluted 1:10 in saline before being administered to humans. However, various severe side reactions, such as hypersensitivity and hypertensive reactions, nephrotoxicity and neurotoxicity, for example, have been reported in patients due to Cremophor EL formulation. Further, even though paclitaxel (among other antitumor drugs) is a potent, well-established standard antitumor drug ({Rowinsky, 1995 1}, {Awada, 2002 2}, {Seidman, 2003 3}, {Romanini, 2003 4}), drug-unresponsive tumors and metastases are observed frequently in cancer patients ({Blom, 1996 5}, {Modi, 2002 6}, {Ozols, 2003 7}). Genetically instable, rapidly dividing tumor cells gain the capacity to overcome the growth inhibitory effect of a selected anti-cancer drug ({Vogelstein, 1988 8}, {Kerbel, 1991 9}). This capacity is usually not limited to a single drug (first line treatment) but extends to other drugs which are used after development of the first resistance. Hence, this phenomenon is called multi drug resistance (MDR). As the number of available and approved anti-neoplastic drugs is very limited for many cancer types, many patients succumb since their cancer tissues express MDR-related genes. The obvious problem, therefore, is to find methods and means to kill drug-resistant tumors, especially drug resistant cells, which are already resistant against the respective drug. A number of approaches were taken to deal with the above mentioned problems. The conventional strategy is to increase doses up to the maximal tolerated dose (MTD) and attempt to eradicate all tumor cells as quickly and completely as possible ({Schünemann, 1999 10}, {Heidemann,1997 11}). It is obvious that this strategy causes severe side effects and can not be extended to longer periods. Therefore, this treatment schedule consists of cycles of one short treatment period (usually 1 day-1 week) at MTD and a treatment-free interval of several weeks (usually 3-4 weeks), to allow the patient to recover from the obligatory side effects ({Schünemann, 1999 10}, {Heidemann, 1997 11}, {Romanini, 2003 4}). In many instances, tumor growth can also restart during these drug-free periods. Most importantly, this approach fails in many patients where tumor cells develop a high level of resistance which enables them to accommodate with drug concentrations at the MTD. The patients become therapy refractory. The most common solution is to start treatment with a second drug (second line treatment) ({Blom, 1996 5}, {Awada, 2002 2}, {Seidman, 2003 3}, {Heinemann, 2003 12}, {Thigpen, 2003 13}). In the best case, the second line treatment is successful and tumor response is documented. A common experience however is that tumors only respond for a certain time leading to a temporary regression of the tumor. After that, tumors become also resistant to the second drug. It is possible to start treatment with a third drug (third line treatment). However, tumors may become also resistant to the third drug. Continuing with this strategy leads to development of multi drug resistant tumors which are finally refractory to all available anti-cancer drugs ({Blom, 1996 5}, {Seidman, 2003 3}, {Thigpen, 2003 13}). Another possibility is to treat patients immediately with a combination of 2 or more drugs ({Heinemann, 2003 12}, {Kuenen, 2002 14}, {Sledge, 2003 15}, {Ozols, 2003 7}, {Reck, 2003 17}, {Romanini, 2003 4}). This strategy can be more successful as it decreases the likelihood for development of a double drug resistance. However, this strategy needs to explore time and cost intensively suitable drug combinations. A second disadvantage is that the side effects may also increase ({Kuenen, 2002 14}, {Ozols, 2003 7}). The therapeutic window concomitantly becomes small and the toxic effects may overlay the envisioned therapeutic benefit. Also in this case, multi drug resistance may develop and the therapy becomes ineffective ({Zimpfer-Rechner, 2003 18}, {Sledge, 2003 15}, {Sledge, 2003 16}, {Ozols, 2003 7}). The consequence of the negative experiences with such traditional treatment strategies is to develop more and more new drugs to extend the above described treatment options. Obviously, it is a very time and cost intensive race for more potent drugs which will eventually lead in many cases to therapy refractory tumors. In recent years, this recognition has led to a new approach to circumvent tumor resistance. It is based on the assumption that the MDR is caused by overexpression of enzymes which enable cells to expel chemotherapeutic drugs. The most famous member of this category of enzymes is called p-glycoprotein (p-gp). It is located in the cytoplasmic membrane and exports in an ATP-driven way ({Nobmann, 2001 19}, {Thomas, 2003 20}) compounds like paclitaxel or doxorubicin ({Harker, 1985 21}, {Fenner, 2002 22}, {Kiesewetter, 2003 23}). This notion led to the development of p-gp inhibitors which are meant to reverse p-gp mediated drug resistance. Hence the term chemosensitizers was coined for this class of molecules. One of the first examples tested was verapamil. Clinical studies, however, revealed unsatisfactory results, possibly due to low specific activity ({Thomas, 2003 20}, {Kohler, 2003 24}). The further research led to a second generation of compounds which again were found not to be clinically applicable ({Leonard, 2002 25}, {Thomas, 2003 20}). Today a few substances of the third generation, one known as tariquidar, are in clinical trials ({Agrawal, 2003 26}, {Callies, 2003 27}). The usefulness and broad applicability of these compounds is, however, still unclear ({Leonard, 2002 25}, {Thomas, 2003 20}). Even though much improved in comparison to first generation chemosensitizers, third generation compounds also cause side effects and may have unforeseen consequences for the whole body. Extensive clinical testing is needed and it is so far uncertain if such approaches can become general practice in the future ({Leonard, 2002 25}, {Thomas, 2003 20}). Different delivery systems have been used to enhance the effect of paclitaxel and/or reduce toxicity. Liposomes are one of many carriers that have been developed to enhance aqueous solubility and thus efficiency, combined with less toxicity. U.S. Pat. Nos. 5,648,090, 5,424,073 and 6,146,659 (Rahman et al.) provide a liposomal encapsulated paclitaxel for a method for treating cancer in mammals. These patents disclose a method of administering to the host a pharmaceutical composition of a therapeutically effective amount of liposomes which include a liposome forming material, cardiolipin, and an agent such as paclitaxel, or an antineoplastic derivative of paclitaxel, or a mixture thereof, with a pharmaceutically acceptable excipient. In U.S. Pat. No. 6,146,659, a method of administering a taxane to a patient is provided by administering taxane over a period of less than an hour in an amount from about 75 to 300 mg/m2, wherein the taxane is liposomally encapsulated. The liposomes disclosed therein are negatively charged. Since the disclosure of McDonald et al., U.S. Pat. No. 5,837,283, it is known that positively charged liposomes specifically target angiogenic endothelial cells. Strieth et al., 2004, Int. J. Cancer 110, 117-124 describe experiments in Syrian Golden hamsters using paclitaxel in cationic liposomes. The animals were treated with liposomal paclitaxel in a dose schedule three times a week. The problem underlying the present invention was to provide an improved method of administering paclitaxel to a subject in need thereof in a therapeutically effective amount without severe side effects. The treatment schedule should minimize the time spent in clinical treatment for infusions while maintaining optimal treatment results. The solution to the above problem is achieved by providing the embodiments characterized in the claims. A first aspect relates to the use of a cationic liposomal preparation comprising at least one cationic lipid from about 30 mole % to about 99.9 mole %, paclitaxel in an amount of at least about 0.1 mole % and at least one neutral and/or anionic lipid from about 0 mole % to about 70 mole % for the manufacture of a pharmaceutical composition for administration (i) once in a week, (ii) twice in a week or (iii) a combination of (i) and (ii), wherein the monthly dose is about 0.1 mg/kg bw to about 20 mg/kg bw. The combination (iii) of a once weekly administration (i) and a twice weekly administration (ii) is a weekly or biweekly alternating schedule. Surprisingly, it was found in contrast to postulated anti-angiogenic neovascular targeting schedules, which favour daily dosing or multiple weekly dosing (Strieth et al. 2004, Int. J. Cancer 110, 117-124), that cationic liposomal preparations comprising a taxane, particularly paclitaxel are even more efficient in treating cancer even in a weekly or biweekly dosing schedule. It was unexpectedly found that a continuous application of cationic liposomal paclitaxel once or twice a week at a low dose over a longer period of time, such as e.g. for several weeks, preferably at least seven weeks, is equally or even more effective than frequent applications of 3-5 times a week at a low dose over a shorter time period, e.g. of about four weeks interrupted by pause intervals of a week or several days. Furthermore, it was unexpectedly found that a continuous application of cationic liposomal paclitaxel once or twice a week at a low dose over a longer period of time, e.g. of about several weeks or months, preferably of at least about seven weeks, is equally or even more effective than a once a week high dose application interrupted by pause intervals over a shorter period of time, e.g. of about four weeks. Liposomal preparations comprising paclitaxel as disclosed herein can be used in combination therapy with a further active agent. A twice weekly application schedule was found to be especially suitable in combination therapy with a further active agent, particularly with gemcitabine. Furthermore, the twice weekly schedule was found to be particularly suitable for combination therapy of liposomal paclitaxel, especially cationic liposomal paclitaxel (EndoTAG-1) in combination with gemcitabine in the treatment of pancreatic cancer, adenocarcinoma of the pancreas. General advantages of the administration of liposomal paclitaxel are: high amounts of the active ingredient selective targeting improved efficacy lower side effects compared to traditional chemotherapy or to a preparation of neutral or anionic liposomes reduction of disease related pain improvement of quality of life stabilization of body weight during treatment synergistic effects with traditional therapy regimes Particular advantages of an once or twice weekly dosing schedule are as follows: less physical burden for the patient due to longer recovery times fewer hospitalization events the administration over a longer time frame of several weeks or months, preferably of at least seven weeks, is equally or even more efficatious than frequent applications over a shorter period of time The advantages of the once or twice weekly dosing schedule result in an improved quality of life for the patient. The present pharmaceutical composition can be administered at a monthly dose of about 0.25 mg up to about 100 mg, particularly up to about 60 mg of liposomal paclitaxel/kg body weight (bw) of a patient, preferably of about 0.5 mg up to about 30 mg of liposomal paclitaxel/kg bw and more preferably of about 1.0 mg up to about 15 mg of liposomal paclitaxel/kg bw. In a preferred embodiment the monthly dose ranges from between about 1 mg/kg bw to about 15 mg/kg, or about 0.5 mg/kg bw to about 7.5 mg/kg bw, about 2.2 mg/kg bw to about 12.3 mg/kg bw, about 1.1 to about 6.2 mg/kg bw, about 2.2 mg/kg bw to about 9 mg/kg bw, about 1.1 mg/kg bw to about 4.5 mg/kg bw, about 4.5 mg/kg bw to about 12.5 mg/kg bw or most preferably about 2.3 mg/kg bw to about 6.3 mg/kg bw. A single unit dose ranges from between about 0.01 mg/kg bw to about 100 mg/kg bw, preferably between about 0.2 mg/kg bw to about 60 mg/kg bw, or is more preferably about 0.28 mg/kg bw, about 1.13 mg/kg bw or most preferably about 1.88 mg/kg bw. In a preferred embodiment of the present invention the pharmaceutical composition is administered at a single unit dose ranging from about 0.01 to about 10 mg/kg bw, particularly about 0.05 to about 5 mg liposomal paclitaxel per kg of body weight. Preferably, a single dose is about 0.1 mg/kg bw to about 2.5 mg/kg bw, about 0.05 mg/kg bw to about 1.25 mg/kg bw, about 0.25 mg/kg bw to about 1.54 mg/kg bw, about 0.14 mg/kg bw to about 0.75 mg/kg bw, about 0.56 mg/kg bw to about 1.88 mg/kg bw, about 0.29 mg/kg bw to about 0.94 mg/kg bw, about 0.28 mg/kg bw to about 1.13 mg/kg bw or most preferably about 0.14 mg/kg bw to about 0.57 mg/kg bw. In a further preferred embodiment, the suitable dose of liposomal paclitaxel for application to a human patient is in an amount of about 0.01 to 2.5, preferably 0.02 to 1.88, and more preferably 0.25 to 1.88 mg/kg bw, particularly 1.54 mg/kg bw once a day and about 0.01 to 10, preferably 0.02 to 5.0 and more preferably 0.25 to 3.8 mg/kg bw, particularly 3.76 mg/kg bw per week. For applications in human medicine, the present pharmaceutical composition may be administered at a monthly dose of preferably about 40 mg/m2 up to about 3700 mg/m2, particularly up to about 1022 mg/m2 human body surface (bs), more preferably up to about 584 mg/m2 bs, even more preferably up to about 480 mg/m2 bs, and most preferably up to about 352 mg/m2 bs. In a preferred embodiment the present pharmaceutical composition is administered at a monthly dose of about 40 mg/m2 bs up to about 584 mg/m2 bs and more preferably of about 176 mg/m2 bs up to about 352 mg/m2 bs. On an average, a human patient has a body surface of about 1.84 m2. Thus, for an average person of 70 kg body weight and 172 cm height, preferred values for monthly doses, single doses etc. which have been indicated above in mg/kg body weight (bw) may be converted for human applications to corresponding values of in mg/m2 human body surface (bs) by multiplication with a species-specific factor according to known methods. The dose scheme can range from a plurality of times daily to a plurality of times during a month period, each of said times being separated by an interval of between days or weeks. The total treatment period is preferably at least one month. The pharmaceutical composition is also suitable for a long-term administration for at least 3 months, for at least 4 months, for at least 6 months or for at least 12 months and up to 6 months, up to 12 months, up to 18 months, up to 24 months or even longer. In a preferred embodiment the duration of the administration of the once or twice weekly dosing schedule is several weeks, preferably at least seven weeks. Even in prolonged treatment schedules, the drug resistances or detrimental side-effects like alopecia, nephropathy are rarely observed. Further, usually no premedication like corticosteroids or anti-histamines is required. The continued administration of lower doses once or twice weekly is at least as effective as the administration of a single high dose or frequent low dose administration interrupted by pause intervals. During the treatment interval the dose units and the dose intervals may remain constant. On the other hand, the dose units may be increased during the treatment interval, e.g. beginning with a starting dose and escalating in one or several steps to a consolidation dose, which may be 2, 3, 4 or even more times higher than the starting dose. Additionally or alternatively, the treatment interval between single doses may be altered, e.g. decreased or increased during the treatment period. The term "about" as used in the present specification describes a deviation from the given value of up to plus or minus 5%. The term "liposomal preparation" and "liposomes" are used synonymously throughout the present application. The liposomal preparation may be a component of a "pharmaceutical composition" and may be administered together with physiologically acceptable carriers such as a buffer. The term "liposomal paclitaxel" or "lipid complexed paclitaxel" refers to a liposomal preparation comprising paclitaxel encapsulated within liposomes. A specific liposomal paclitaxel formulation is EndoTAG®-1. EndoTAG®-1, sometimes also referred to as MBT-0206, is a liposomal preparation with a molar ratio of 50:47:3 mole % of DOTAP, DOPC and paclitaxel. EndoTAG®-1 is a registered trademark in Germany. The unit "mg/kg bw" refers to mg of liposomal paclitaxel per kg body weight. The unit "mg/m2 bs" or just "mg/m2" refers to mg liposomal paclitaxel per m2 human body surface (bs). Thus, the dose calculation refers only to the mass of the paclitaxel portion, not the lipid portion. The term "angiogenesis associated disease" or "angiogenic disease" refers to a disease which is dominated by the pathological growth of capillary blood vessels (Folkmann, J. and Klagsbrun, M. 1987, Angiogenic Factors. Science 235, 442-446). Examples of such a disease are e.g. diabetic retinopathy, chronic inflammatory diseases, rheumatoid arthritis, inflammation, dermatitis, psoriasis, stomach ulcers, tumor diseases such as hematogenous and solid tumors. The term "chemosensitizer" refers to a substance or drug, which makes it easier for chemotherapy to affect, particularly kill cancer cells. In a preferred embodiment, the cationic liposomal preparation of the present invention comprises at least one cationic lipid from about 30 mole % to about 99.9 mole %, preferably to about 98 mole % cationic lipid, paclitaxel in an amount of at least about 0.1 mole %, preferably of at least about 2 mole %; and at least one neutral and/or anionic lipid from about 0 mole % to about 70 mole % and is used for manufacturing a pharmaceutical composition for simultaneous, separate, or sequential combination therapy with a jointly effective dose of at least one further active agent and/or heat and/or radiation and/or cryotherapy. In a further preferred embodiment, the liposomal preparation comprises paclitaxel in an amount of about 0.1 mole %, particularly of about 2 mole %, to about 8 mole %, preferably in an amount of about 0.5 mole %, particularly of about 2 mole %, to about 5 mole %, more preferably in an amount of about 1 mole % to about 4 mole % and most preferably in an amount of about 2.5 mole % to about 3.5 mole %. The cationic liposomal preparation of the present invention comprises substantially no paclitaxel crystals. The liposomal preparation of the present invention is a cationic liposomal preparation which comprises cationic lipids in an amount of about 30 mole % to about 99.9 mole %, particularly to about 70 mole %, preferably from about 40 mole % to about 60 mole % and most preferably from about 45 mole %, to about 55 mole %. The liposomal preparation is characterized by having a positive zeta potential in about 0.05 M KCI solution at about pH 7.5 at room temperature. The preferred cationic lipids of the liposomal preparation have a positive net charge and are N-[1-(2,3-dioleoyloxy)propyl]-
FIG. 1: Cationic liposomal paclitaxel (EndoTAG®-1) in twice weekly dosing schedule. Schematic of the dose schedule for twice weekly application of liposomal paclitaxel. Cationic liposomal paclitaxel (EndoTAG®-1) is applied twice weekly (days 1, 4, 8, 11, 15, 18, 22, 25, 29, 32, 36, 39, 43, and 46) in three different doses: (low dose: 11 mg/m2 lipid complexed paclitaxel); (medium dose: 22 mg/m2 lipid complexed paclitaxel); (high dose: 44 mg/m2 lipid complexed paclitaxel).
FIG. 2: Cationic liposomal paclitaxel (EndoTAG®-1) in a pancreatic cancer study. Schematic of the dose schedule for twice weekly application of liposomal paclitaxel in combination with gemcitabine (Gemzar®) once weekly. The control group of patients receives 1: gemcitabine monotherapy. The other patients receive gemcitabine in combination with cationic liposomal paclitaxel (EndoTAG®-1) at three doses: 2: gemcitabine+EndoTAG®-1 (low dose: 11 mg/m2 lipid complexed paclitaxel); 3: gemcitabine+EndoTAG®-1 (medium dose: 22 mg/m2 lipid complexed paclitaxel); 4: gemcitabine+EndoTAG®-1 (high dose: 44 mg/m2 lipid complexed paclitaxel). Gemcitabine is applied at a dose of 1000 mg/m2 body surface once a week (Mon; =days 4, 11, 18, 25, 32, 39, and 46). Cationic liposomal paclitaxel (EndoTAG®-1) is applied twice weekly (days 1, 4, 8, 11, 15, 18, 22, 25, 29, 32, 36, 39, 43, and 46). The following examples should be illustrative only but are not meant to be limiting to the scope of the invention. Other generic and specific configurations will be apparent to those skilled in the art.
Example 1 Human Therapy Treatment Protocol This example is concerned with human treatment protocols using the formulations disclosed. Treatment will be of use preventing and/or treating various human diseases and disorders associated with enhanced angiogenic activity. It is considered to be particularly useful in anti-tumor therapy, for example, in treating patients with solid tumors and hematological malignancies or in therapy against a variety of chronic inflammatory diseases such as rheumatoid arthritis or psoriasis. A feature of the invention is that several classes of diseases and/or abnormalities may be treated by directly targeting angiogenic epithelial cells without directly targeting the tissue or cells involved in the abnormality, e.g. by inhibiting angiogenesis the blood supply to a tumor is cut off and the tumor is killed without directly targeting the tumor cells in any manner. Other classes of diseases and/or abnormalities may be treated by directly targeting angiogenic endothelial cells and by directly targeting the tissue or cells involved in the abnormality. In another application, drug resistant cells such as drug resistant cancer cells or highly proliferative synoviocytes in rheumatoid arthritis can be affected directly. The various elements of conducting a clinical trial, including patient treatment and monitoring, will be known to those skilled in the art in light of the present disclosure. For regulatory approval purposes, it is contemplated that patients chosen for a study are either anti-neoplastic treatment naive or would have failed to respond to at least one course of conventional therapy and would have objectively measurable disease as determined by physical examination, laboratory techniques, or radiographic procedures. Such patients would also have no history of clinically relevant cardiac or renal disease and any chemotherapy should be stopped at least 2 weeks before entry into the study. Prior to application, the formulation can be reconstituted in an aqueous solution in the event that the formulation was freeze dried. As outlined above, the required application volume is calculated from the patient's body weight and the dose schedule. The disclosed formulations may be administered over a short to medium infusion time. The infusion given at any dose level should be dependent upon the toxicity achieved after each. Thus, if Grade II toxicity was reached after any single infusion, or at a particular period of time for a steady rate infusion, further doses should be withheld or the steady rate infusion stopped unless toxicity improved. Increasing doses should be administered to groups of patients until approximately 60% of patients showed unacceptable Grade III or IV toxicity in any category. Doses that are ⅔ of this value would be defined as the safe dose. Physical examination, tumor measurements and laboratory tests should, of course, be performed before treatment and at intervals of about 3-4 weeks later. Laboratory tests should include complete blood cell counts, serum creatinine, creatine kinase, electrolytes, urea, nitrogen, SGOT, bilirubin, albumin and total serum protein. Clinical responses may be defined by acceptable measure or changes in laboratory values e.g. tumor markers. For example, a complete response may be defined by the disappearance of all measurable disease for at least a month, whereas a partial response may be defined by a 50% or greater reduction. All of the compositions and methods disclosed and claimed herein can be made and executed without undue experimentation in light of the present disclosure. While the compositions and methods of this invention have been described in terms of preferred embodiments, it will be apparent to those skilled in the art that variations may be applied to the composition, methods and in the steps or in the sequence of steps of the method described herein without departing from the concept, spirit and scope of the invention. More specifically, it will be apparent that certain agents which are both chemically and physiologically related may be substituted for the agents described herein while the same or similar results would be achieved. All such similar substitutes and modifications apparent to those skilled in the art are deemed to be within the spirit, scope and concept of the invention as defined by the appended claims. Some variation in dosage will necessarily occur depending on the condition of the subject being treated. The person responsible for administration will, in any event, determine the appropriate dose for the individual subject. Moreover, for human administration, preparations should meet sterility, pyrogenicity, general safety and purity standards as required by the FDA Office of Biologics standards. The present invention includes a method of delivery of a pharmaceutically effective amount of the inventive formulation of an active agent to a target site such as an angiogenic vascular target site of a subject in need thereof. A "subject in need thereof" refers to a mammal, e. g. a human. The route of administration preferably comprises peritoneal or parenteral administration. For use with the present invention the "pharmacologically effective amount" of a compound administered to a subject in need thereof will vary depending on a wide range of factors. The amount of the compound will depend upon the size, age, sex, weight, and condition of the patient, as well as the potency of the substance being administered. Having indicated that there is considerable variability in terms of dosing, it is believed that those skilled in the art can, using the present disclosure, readily determine appropriate dosing by first administering extremely small amounts and incrementally increasing the dose until the desired results are obtained. Although the amount of the dose will vary greatly based on factors as described above, in general, the present invention makes it possible to administer substantially smaller amounts of any substance as compared with delivery systems which only target the pathologic tissue, e. g. target the tumor cells themselves.
Example 2 Twice Weekly Administration Protocol for Cationic Liposomal Paclitaxel (FIG. 1) Indication: Pancreatic Cancer; adenocarcinoma of the pancreas Study Design: A controlled, -three armed, randomized, open label clinical phase II trial 1st line treatment with twice weekly administration of lipid complexed paclitaxel (EndoTAG®-1) in three dose levels compared with gemcitabine monotherapy in patients with measurable locally advanced and/or metastatic adenocarcinoma of the pancreas is performed. The four treatment arms consist of (see FIG. 1): Arm 1: Gemcitabine monotherapy (control group): 1000 mg/m2 (=25.67 mg/kg body weight) Arm 2: EndoTAG®-1 (low dose: 11 mg/m2 (=0.28 mg/kg body weight) lipid complexed paclitaxel) Arm 3: EndoTAG®-1 (medium dose: 22 mg/m2(=0.56 mg/kg body weight) lipid complexed paclitaxel) Arm 4: EndoTAG®-1 (high dose: 44 mg/m2 (=1.13 mg/kg body weight) lipid complexed paclitaxel) Patients with advanced and/or metastatic adenocarcinoma of the pancreas that are considered unresectable are eligible to enter the study after signing informed consent and having undergone baseline evaluation. Those patients meeting study eligibility criteria will either receive a standardized chemotherapy regime (i.e. gemcitabine) as a monotherapy or EndoTAG®-1 infusions. Seven weekly applications of gemcitabine will be administered in arm 1 (gemcitabine monotherapy control arm without EndoTAG®-1). In arms 2, 3 and 4 seven weeks of fourteen twice weekly applications of EndoTAG®-1 (days 1, 4, 8, 11, 15, 18, 22, 25, 29, 32, 36, 39, 43, and 46) are performed. In summary, one complete cycle of this new regimen comprises fourteen applications of EndoTAG®-1, which then consists of seven weeks (arms 2, 3, and 4).
Example 3 Combination Therapy of Cationic Liposomal Paclitaxel (EndoTAG®-1) Twice Weekly in Combination with Gemcitabine Once Weekly (FIG. 2) Study No. Indication CT4001 Pancreatic Cancer; adenocarcinoma of the pancreas Study Design CT 4001: A controlled, -four armed, randomized, open label clinical phase II trial 1st line combination treatment with weekly infusions of gemcitabine and twice weekly administration of lipid complexed paclitaxel (EndoTAG®-1) in three single dose levels compared with gemcitabine monotherapy in patients with measurable locally advanced and/or metastatic adenocarcinoma of the pancreas is performed. The four treatment arms consist of (see FIG. 2): Arm 1: Gemcitabine monotherapy (control group): 1000 mg/m2 (=25.67 mg/kg body weight) Arm 2: Gemcitabine+EndoTAG®-1 (low dose: 11 mg/m2 (=0.28 mg/kg body weight) lipid complexed paclitaxel) Arm 3: Gemcitabine+EndoTAG®-1 (medium dose: 22 mg/m2 (=0.56 mg/kg body weight) lipid complexed paclitaxel) Arm 4: Gemcitabine EndoTAG®-1 (high dose: 44 mg/m2 (=1.13 mg/kg body weight) lipid complexed paclitaxel) Patients with advanced and/or metastatic adenocarcinoma of the pancreas that are considered unresectable are eligible to enter the study after signing informed consent and having undergone baseline evaluation. Those patients meeting study eligibility criteria will either receive a standardized chemotherapy regime (i.e. gemcitabine) as a monotherapy or gemcitabine preceded by EndoTAG®-1 infusions. Seven weekly applications of gemcitabine will be administered in arm 1 (gemcitabine monotherapy control arm without EndoTAG®-1). In arms 2, 3, and 4 seven weeks of gemcitabine treatment (days 4, 11, 18, 25, 32, 39, and 46) will be combined with a total of fourteen twice weekly applications of EndoTAG®-1 (days 1, 4, 8, 11, 15, 18, 22, 25, 29, 32, 36, 39, 43, and 46). In summary, one complete cycle of this new regimen comprises seven applications of gemcitabine (all arms) and fourteen applications of EndoTAG®-1, which then consists of seven weeks (arms 2, 3, and 4). Conclusion Treatments with high doses of EndoTAG®-1 can be replaced by using low doses at a higher frequency. There is a correlation between treatment density (no. of treatments per week) and treatment efficacy. The optimised dosing regimen potentially reduces toxic side effects caused by high dose treatments and reduces physical burden of the patient, which leads to an improved quality of life.
Example 4 Treatment of Liver Cancer (Hepatocellular Carcinoma) Study Design: A controlled, two-armed, randomized, open label clinical phase II trial, comparing TACE therapy only to TACE (transarterial chemoembolization) therapy combined with once weekly administration of lipid complexed paclitaxel (EndoTAG®-1) is performed. The two treatment arms consist of: Arm 1: TACE therapy alone (control group); Arm 2: TACE therapy in combination with once weekly EndoTAG®-1 (44 mg/m2 lipid complexed paclitaxel). Patients with irresectable histological/cytological proven hepatocellular carcinoma (HCC) who have shown responsiveness to TACE therapy are eligible to enter the study after signing informed consent and having undergone baseline evaluation. Those patients meeting study elegibility criteria are randomized and either receive TACE therapy or TACE therapy in combination with a once a week administration of 44 mg/m2 EndoTAG®-1, an interim analysis determining progression or response based on DCE-MRI and MRI scans is performed. Progression-free-survival (PFS) is determined as the primary efficacy parameter in the study.
Claims 1. A method of treating a human subject suffering from cancer comprising administering to the human subject a pharmaceutical composition comprising a cationic liposomal formulation comprising: wherein the cationic liposomal formulation has a positive zeta potential in about 0.05 M KCI solution at about pH 7.5 at room temperature, wherein the composition is administered at a schedule of: wherein the pharmaceutical composition is administered at a dose of paclitaxel from about 0.05 mg/kg to about 1.88 mg/kg body weight (bw) of the subject, wherein a total monthly dose of paclitaxel administered is from about 0.1 mg/kg to about 15 mg/kg bw of the subject, and wherein the cancer is pancreatic cancer, liver cancer, prostate cancer, breast cancer, lung cancer, gastrointestinal cancer, or melanoma. at least one cationic lipid from about 30 mole % to about 99.9 mole %, paclitaxel in an amount of at least about 0.1 mole %, and optionally a neutral and/or anionic lipid, (i) once a week, (ii) twice a week, or (iii) a combination of (i) and (ii), 2. The method of claim 1, wherein the pharmaceutical composition is administered at a dose of paclitaxel from about 0.25 mg/kg to about 1.54 mg/kg bw of the subject, about 0.25 mg/kg to about 1.25 mg/kg bw of the subject, about 0.25 to about 1.13 mg/kg bw of the subject, about 0.28 to about 1.13 mg/kg bw of the subject, about 0.28 to about 0.94 mg/kg bw of the subject, or about 0.28 mg/kg bw to about 0.75 mg/kg bw of the subject. 3. The method of claim 1, wherein the pharmaceutical composition is administered at a dose of paclitaxel of about 0.28 mg/kg bw of the subject, about 0.56 mg/kg bw of the subject, about 1.13 mg/kg bw of the subject, or about 1.54 mg/kg bw of the subject. 4. The method of claim 1, wherein the total monthly dose is from about 1 mg/kg to about 15 mg/kg bw of the subject, about 0.5 mg/kg to about 7.5 mg/kg bw of the subject, about 1.1 mg/kg to about 6.2 mg/kg bw of the subject, about 1.1 mg/kg to about 4.5 mg/kg bw of the subject, about 2.2 mg/kg to about 6.2 mg/kg bw of the subject, or about 2.2 mg/kg to about 4.5 mg/kg bw of the subject. 5. The method of claim 1, wherein the pharmaceutical composition is administered at a schedule of once a week. 6. The method of claim 1, wherein the method further comprises administering to the human subject at least one further active agent and/or heat and/or radiation and/or cryotherapy. 7. The method of claim 6, wherein the pharmaceutical composition and the at least one further active agent and/or heat and/or radiation and/or cryotherapy are administered simultaneously, separately, or sequentially. 8. The method of claim 6, wherein the further active agent is a chemotherapeutic agent. 9. The method of claim 6, wherein the further active agent is an alkylating agent, a DNA topoisomerase inhibiting agent, a RNA/DNA antimetabolite, an anti-endothelial cell active agent, an anti-tumor active agent, an immunological active agent, or a chemosensitizer. 10. The method of claim 9, wherein the immunological active agent is a compound that reduces or eliminates a hypersensitivity reaction. 11. The method of claim 10, wherein the compound that reduces or eliminates a hypersensitivity reaction is ranitidine, dexamethasone, diphenhydramine, famotidine, hydrocortisone, clemastine, cimetidine, prednisolone, chlorphenamine, dimethindene maleate, or promethazine. 12. The method of claim 9, wherein the chemosensitizer is a cell cycle modulator, a substance that reverts drug resistance, and a vasoactive substance. 13. The method of claim 1, wherein the cationic liposomal formulation comprises paclitaxel in an amount of about 2 mole % to about 8 mole %. 14. The method of claim 13, wherein the cationic liposomal formulation comprises paclitaxel in an amount of about 2.5 mole % to about 3.5 mole %. 15. The method of claim 1, wherein the cationic liposomal formulation comprises 50:47:3 mole % of DOTAP, DOPC, and paclitaxel. 16. The method of claim 1, wherein the cationic liposomal formulation comprises liposomes having an average particle diameter from about 25 nm to about 500 nm, or about 100 nm to about 300 nm. 17. The method of claim 1, wherein the pharmaceutical composition is administered systemically. 18. The method of claim 7, wherein the further active agent is cisplatin, carboplatin, camptothecin, doxorubicin, 5-flurouracil, gemcitabine, thalidomide, discodermolide, laulimalide, isolaulimalide, eleutherobin, sarcodictyin A, or sarcodictyin B. 19. The method of claim 1, wherein the cationic lipid is selected from the group consisting of N-[1-(2,3-dioleoyloxy)propyl]-