Three metabolic pathways have been identified according to the possible metabolites. These pathways are the hydroxylation of the phenyl group (M35), the opening of the piperidine with a reduction of the primary alcohol (M34) and the oxidation to a carboxylic acid and epoxidation of the ethylene followed by a hydrolysis to the formation of dihydrodiol (PCI-45227). The latter metabolite presents also 15 times lower inhibitory activity against BTK. The metabolism of ibrutinib is mainly performed by CYP3A5 and CYP3A4. and in a minor extent it is seen to be performed by CYP2D6.[A7663]
Since 2014, Ibrutinib has been available as a new drug for the treatment of leukemic diseases. Ibrutinib (Imbruvica) is metabolized in the liver mainly by the isoenzyme CYP3A4 and to a minor extent by CYP2D6. Simultaneous application of Imbruvica and consumption of foods containing secondary metabolites strongly inhibiting the CYP3A4 isoform, could significantly influence the toxicity of this drug. This article references the respective foods.
In the prelicensure clinical trials of ibrutinib in patients with CLL and mantle cell lymphoma, the rates of serum enzyme elevations during therapy were 20% to 30% but were similar to comparator arms, and elevations were generally mild (less than 5 times ULN) and self limited. In multiple controlled trials there were no reports of clinically apparent liver injury or need for early discontinuation because of hepatotoxicity. The major toxicities of ibrutinib resembled those of the tyrosine kinase receptor inhibitors and included hemorrhage and myelosuppression. While ibrutinib depressed peripheral lymphocyte counts and caused both lymphopenia and neutropenia, it has little effect on serum immunoglobulin levels and was not associated with reactivation of tuberculosis or opportunistic infections in prelicensure studies. Nevertheless, with approval and more widespread use of ibrutinib, rare cases of acute liver injury including acute liver failure and severe instances of reactivation of hepatitis B have been reported. The latency to onset of liver injury varied from several weeks to 9 months. The pattern of injury was hepatocellular, but the course was atypical of an acute hepatitis-like injury and more similar to acute hepatic necrosis with early onset of hepatic failure.
In two open label clinical trials of acalabrutinib in patients with CLL and mantle cell lymphoma, serum aminotransferase elevations occurred in 19% to 23% of patients during therapy and rose to above 5 times ULN in 2% to 3%. These elevations were transient and resolved spontaneously. Among the 610 patients treated with acalabrutinib in these trials, there were no instances of clinically apparent liver injury attributed to its use, but there was a single instance of acute liver failure and death due to reactivation of hepatitis B. Similar cases of reactivation have been reported with ibrutinib, another small molecule inhibitor of Bruton's tyrosine kinase. Experience with acalabrutinib has been limited and the frequency of clinically apparent liver injury and reactivation of hepatitis B are not known.
Ibrutinib was not showed to present a mutagenic potential in bacterial assays, nor clastogenic in chromosome aberration assays in mammalian cells or in bone marrow micronucleus assays in mice. Carcinogenicity or effects on fertility have not been determined.[FDA label]
IDENTIFICATION AND USE: Ibrutinib is an oral tyrosine kinase inhibitor that irreversibly binds and inhibits tyrosine-protein kinase BTK (Bruton tyrosine kinase). BTK is important in the function of B-cell receptor signaling and therefore in the maintenance and expansion of various B-cell malignancies. Targeting BTK with ibrutinib is an effective strategy in treating these malignancies. Ibrutinib, marketed as Imbruvica, is indicated for the treatment of patients with mantle cell lymphoma (MCL) or chronic lymphocytic leukemia (CLL) who have received at least one prior therapy. It is also indicated for the treatment of patients with chronic lymphocytic leukemia (CLL) with 17p deletion and patients with Waldenstrom's macroglobulinemia (WM). HUMAN EXPOSURE AND TOXICITY: Studies in humans have shown that ibrutinib may enhance chemoimmunotherapy efficacy without additive toxicities. Ibrutinib is cytotoxic to malignant plasma cells from patients with multiple myeloma (MM) and furthermore treatment with ibrutinib significantly augments the cytotoxic activity of bortezomib and lenalidomide chemotherapies. Hypersensitivity reactions including anaphylactic shock (fatal), urticaria, and angioedema have been reported. The outcome of patients with MCL who experience disease progression following ibrutinib therapy is poor, with both low response rates to salvage therapy and short duration of responses. ibrutinib inhibited the proliferation and induced apoptosis of Germinal center B-cell like diffuse large B-cell lymphoma (GCB-DLBCL) cell lines through suppression of BCR signaling pathway and activation of caspase-3. Furthermore, the chemokines CCL3 and CCL4 production from tumor cells were also found to be attenuated by ibrutinib treatment. Different cell lines exhibited distinct sensitivity after ibrutinib treatment. Interestingly, the decreasing level of p-ERK after ibrutinib treatment, but not the basal expression level of Btk, correlated with different drug sensitivity. Ibrutinib could be a potentially useful therapy for GCB-DLBCL and the decreasing level of p-ERK could become a useful biomarker to predict related therapeutic response. Ibrutinib is well tolerated when added to R-CHOP (chemotherapy named after the initials of the drugs used: rituximab, cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine (Oncovin ), prednisolone), and could improve responses in patients with B-cell non-Hodgkin lymphoma. ANIMAL STUDIES: Ibrutinib caused malformations in rats at exposures 14 times those reported in patients with MCL and 20 times those reported in patients with CLL or WM, receiving the ibrutinib dose of 560 mg per day and 420 mg per day, respectively. Reduced fetal weights were observed at lower exposures.
/HUMAN EXPOSURE STUDIES/ We performed a prospective study of ibrutinib in 63 symptomatic patients with Waldenstrom's macroglobulinemia who had received at least one previous treatment, and we investigated the effect of MYD88 and CXCR4 mutations on outcomes. Ibrutinib at a daily dose of 420 mg was administered orally until disease progression or the development of unacceptable toxic effects. After the patients received ibrutinib, median serum IgM levels decreased from 3520 mg per deciliter to 880 mg per deciliter, median hemoglobin levels increased from 10.5 g per deciliter to 13.8 g per deciliter, and bone marrow involvement decreased from 60% to 25% (P<0.01 for all comparisons). The median time to at least a minor response was 4 weeks. The overall response rate was 90.5%, and the major response rate was 73.0%; these rates were highest among patients with MYD88(L265P)CXCR4(WT) (with WT indicating wild-type) (100% overall response rate and 91.2% major response rate), followed by patients with MYD88(L265P)CXCR4(WHIM) (85.7% and 61.9%, respectively) and patients with MYD88(WT)CXCR4(WT) (71.4% and 28.6%). The estimated 2-year progression-free and overall survival rates among all patients were 69.1% and 95.2%, respectively. Treatment-related toxic effects of grade 2 or higher included neutropenia (in 22% of the patients) and thrombocytopenia (in 14%), which were more common in heavily pretreated patients; postprocedural bleeding (in 3%); epistaxis associated with the use of fish-oil supplements (in 3%); and atrial fibrillation associated with a history of arrhythmia (5%). Ibrutinib was highly active, associated with durable responses, and safe in pretreated patients with Waldenstrom's macroglobulinemia. MYD88 and CXCR4 mutation status affected responses to this drug.
Ibrutinib is rapidly absorbed after oral administration and it presents a Cmax, tmax and AUC of approximately 35 ng/ml, 1-2 hour and 953 mg.h/ml respectively.[T148]
The cumulative excretion of ibrutinib in urine is of about 7.8% of the administered dose and most of this excretion is found during the first 24 hours after administration. In feces, the cumulative excretion accounts for 80% of the administered dose and the excretion occurs within 48 hours of the initial administration. The total excretion of ibrutinib during the first 168 hours after initial administration accounts for 88.5% of the administered dose.[A7663]
[EN] PROCESS FOR THE PREPARATION OF 1-[(3R)-3-[4-AMINO-3-(4-PHENOXYPHENVL)-1H- PVRAZOLO[3,4-D]PYRINIIDIN-1-Y1]-1-PIPERIDINVL]-2-PROPEN-1-ONE AND ITS POLYMORPHS THEREOF<br/>[FR] PROCÉDÉ DE PRÉPARATION DE 1-[(3R)-3-[4-AMINO-3-(4-PHÉNOXYPHÉNYL)-1H- PYRAZOLO[3,4-D]PYRINIIDIN-1-Y1]-1-PIPÉRIDINYL]-2-PROPÈN-1-ONE ET DE SES POLYMORPHES
申请人：MSN LABORATORIES PRIVATE LTD
公开号：WO2016170545A1
公开（公告）日：2016-10-27
The present invention relates to an improved process for the preparation of 1-[(3R)-3-[4-amino-3-(4-phenoxyphenyl)- 1 H-pyrazolo[3,4-d]pyrimidin- 1 -yl]- 1 -piperidin yl]-2-propen-1-one compound of formula- 1 and its polymorphs thereof, which is represented by the following structural formula:
[EN] COMBINATIONS OF INHIBITORS OF IRAK4 WITH INHIBITORS OF BTK<br/>[FR] COMBINAISONS D'INHIBITEURS DE L'IRAK4 À L'AIDE D'INHIBITEURS DE LA BTK
申请人：BAYER PHARMA AG
公开号：WO2016174183A1
公开（公告）日：2016-11-03
The present application relates to novel combinations of at least two components, component A and component B: · component A is an IRAK4-inhibiting compound of the formula (I) as defined herein, or a diastereomer, an enantiomer, a metabolite, a salt, a solvate or a solvate of a salt thereof; · component B is a BTK-inhibiting compound, or a pharmaceutically acceptable salt thereof; and, optionally, · one or more components C which are pharmaceutical products; in which one or two of the above-defined compounds A and B are optionally present in pharmaceutical formulations ready for simultaneous, separate or sequential administration, for treatment and/or prophylaxis of diseases, and to the use thereof for production of medicaments for treatment and/or prophylaxis of diseases, especially for treatment and/or prophylaxis of endometriosis, lymphoma, macular degeneration, COPD, neoplastic disorders and psoriasis.
[EN] COMBINATION OF CHIMERIC ANTIGEN RECEPTOR THERAPY AND AMINO PYRIMIDINE DERIVATIVES<br/>[FR] THÉRAPIE COMBINÉE PAR RÉCEPTEUR ANTIGÉNIQUE CHIMÉRIQUE ET DÉRIVÉS D'AMINO PYRIMIDINE
申请人：NOVARTIS AG
公开号：WO2016164580A1
公开（公告）日：2016-10-13
The invention provides compositions and methods for treating diseases associated with expression of CD19, e.g., by administering a recombinant T cell comprising the CD19 CAR as described herein, in combination with a BTK inhibitor, e.g., an amino pyrimidine derivative described herein. The invention also provides kits and compositions described herein.
[EN] PURINONE COMPOUNDS AS KINASE INHIBITORS<br/>[FR] COMPOSÉS PURINONES COMME INHIBITEURS DE KINASE
申请人：PHARMACYCLICS INC
公开号：WO2015002894A1
公开（公告）日：2015-01-08
Disclosed herein are compounds that form covalent bonds with Bruton's tyrosine kinase (Btk). Also described are irreversible inhibitors of Btk. In addition, reversible inhibitors of Btk are also described. Also disclosed are pharmaceutical compositions that include the compounds. Methods of using the Btk inhibitors are disclosed, alone or in combination with other therapeutic agents, for the treatment of autoimmune diseases or conditions, heteroimmune diseases or conditions, cancer, including lymphoma, and inflammatory diseases or conditions.
