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Wo 2008/039482 A2 (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (43) International Publication Date (10) International Publication Number 3 April 2008 (03.04.2008) PCT WO 2008/039482 A2 (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/57 (2006.01) kind of national protection available): AE, AG, AL, AM, AT, AU, AZ, BA, BB, BG, BH, BR, BW, BY, BZ, CA, CH, (21) International Application Number: CN, CO, CR, CU, CZ, DE, DK, DM, DO, DZ, EC, EE, EG, PCT/US2007/020753 ES, FI, GB, GD, GE, GH, GM, GT, HN, HR, HU, ID, IL, (22) International Filing Date: IN, IS, JP, KE, KG, KM, KN, KP, KR, KZ, LA, LC, LK, 26 September 2007 (26.09.2007) LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PG, PH, PL, (25) Filing Language: English PT, RO, RS, RU, SC, SD, SE, SG, SK, SL, SM, SV, SY, (26) Publication Language: English TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW (30) Priority Data: 60/847,173 26 September 2006 (26.09.2006) US (84) Designated States (unless otherwise indicated, for every (71) Applicant (for all designated States except US): THE kind of regional protection available): ARIPO (BW, GH, REGENTS OF THE UNIVERSITY OF CALIFORNIA GM, KE, LS, MW, MZ, NA, SD, SL, SZ, TZ, UG, ZM, [US/US]; 1111 Franklin Street, Fifth Floor, Oakland, CA ZW), Eurasian (AM, AZ, BY, KG, KZ, MD, RU, TJ, TM), 94607-5200 (US). European (AT,BE, BG, CH, CY, CZ, DE, DK, EE, ES, FI, FR, GB, GR, HU, IE, IS, IT, LT,LU, LV,MC, MT, NL, PL, (72) Inventor; and PT, RO, SE, SI, SK, TR), OAPI (BF, BJ, CF, CG, CI, CM, (75) Inventor/Applicant (for US only): LEE, Eva, Y-H P. GA, GN, GQ, GW, ML, MR, NE, SN, TD, TG). [US/US]; 128 Sprague Hall, Irvine, CA 92697 (US). (74) Agents: DE BERG, Lisa, G. et al; Casimir Jones, S.C., Published: 101 Howard Street, Suite 350, San Francisco, CA 94105 — without international search report and to be republished (US). upon receipt of that report (54) Title: METHODS AND COMPOSITIONS FOR CANCER PREVENTION AND TREATMENT (57) Abstract: The present invention relates to methods and compositions for cancer prevention and treatment. In particular, the present invention provides methods and compositions for modulating, studying, preventing and treating progesterone receptor related carcinogenesis with anti-progesterones and anti-estrogens. METHODS AND COMPOSITIONS FOR CANCER PREVENTION AND TREATMENT This application claims priority to United States Provisional Application 60/847,173, filed on September 26, 2006. This application was made with government support under grant number CA049649 awarded by NCI and grant number DAMD 17-02-1 - 0694 awarded by the DOD. The government has certain rights in the invention. FIELD OF THE INVENTION The present invention relates to methods and compositions for cancer prevention and treatment hi particular, the present invention provides methods and compositions for modulating, studying, preventing and treating progesterone receptor related carcinogenesis with anti-progesterones and anti-estrogens. BACKGROUND OF THE INVENTION Breast cancer incidence in women has increased from one in 20 in 1960 to one in seven today. Every two minutes a woman in the United States is diagnosed with breast cancer. In 2005, it was estimated that about 212,000 new cases of invasive breast cancer would be diagnosed, along with 58,000 new cases of non-invasive breast cancer, and 40,000 women were expected to die from this disease. The exact cause of breast cancer is not known, however changes in certain genes make women more susceptible to breast cancer. Individuals with mutations in the breast cancer gene 1 (BRCAl) and gene 2 (BRCA2), for example, are predisposed to breast and ovarian cancers and run a high risk of having the disease. BRCAl participates in several cellular processes, but its function in suppressing carcinogenesis of ovarian hormone-sensitive tissues remains unclear. Historically, estrogen and the estrogen receptor and their function in breast cancer have attracted considerable attention. However, the underlying mechanisms of cancer are not fully understood. The current therapies for breast cancer include chemotherapy, radiation therapy, surgery to remove a woman's ovaries to decrease production of the hormones estrogen and progesterone, surgery to remove the tumors, and combinations thereof. What is needed are novel ways of studying, understanding, treating, and above all, preventing breast and other cancers. SUMMARY OF THE INVENTION The present invention relates to methods and compositions for cancer prevention and treatment. In particular, the present invention provides methods and compositions for modulating, studying, preventing and treating progesterone receptor related carcinogenesis with anti-progesterones and anti-estrogens. Mutations in BRCAl are associated with an increase in breast and ovarian cancer risks (Miki et al., 1994, Science 266:66). Reduced BRCAl expression due to promoter methylation is also found in sporadic breast and ovarian cancers (Thompson et al., 1995, Nat. Genet. 9:444). BRCAl maintains genome stability by participating in DNA damage repair, cell cycle checkpoint control and transcriptional regulation (Ting et al., 2004, DNA Repair 3:935; Turner et al., 2004, Nat. Rev. Cancer 4:814). The specific suppression of breast and ovarian carcinogenesis by the pleiotropic BRCAl tumor suppressor may be due to its regulatory roles over estrogen receptor α (ERa) and the progesterone receptor (PR) (Fan et al., 1999, Science 284:1354; Zheng et al., 2001, Proc. Natl. Acad. Sci. 98:9587; Razandi et al., 2004, MoI. Cell. Biol. 24:5900; Ma et al., 2006, MoI. Endocrinol. 20:14). ERa and PR play important roles in breast development (Henninghausen et al., 2005, Nat. Rev. MoI. Cell.Biol. 6:715; Li et al., 2004, Mech. Ageing Dev. 125:669). In ERa knockout mice, ductal elongation and pregnancy-induced proliferation of mammary gland are severely affected (Mallepell et al., 2006, Proc. Natl. Acad. Sci. 103:2196). In mice lacking PR-B, the long form of PR, ductal elongation is normal but pregnancy-induced ductal branching, and alveolar proliferation and differentiation are defective (Mulac- Jericevic et al., 2003, Proc. Natl. Acad. Sci. 100:9744). BRCAl modulates the activities of these nuclear hormone receptors through three distinct mechanisms: ligand-dependent, and - independent transcription activities of ERa and PR, as well as non-genomic function of ERa (Fan et al., 1999, Science 284:1354; Zheng et al., 2001, Proc. Natl. Acad. Sci. 98:9587; Razandi et al., 2004, MoI. Cell. Biol. 24:5900; Ma et al., 2006, MoI. Endocrinol. 20:14). The contribution of ER and PR in BRCAl -mediated carcinogenesis remains unclear, however. Progesterone and estrogen hormone replacement therapy in postmenopausal women is associated with higher proliferation index and significantly greater breast cancer risk (Million Women Study, 2003, Lancet 362:419; Rossouw et al., 2002, JAMA 288:321; Lee et al., 2006, Int. J. Cancer 118:1285). The two PR isoforms, PR-A and PR-B are generated through alternative promoter usage of a single gene (Li et al., 2004, Mech. Ageing Dev. 125:669). Introduction of extra PR-A transgene, the short form of PR in mice, leads to abnormal mammary development and ductal hyperplasia (Shyamala et al., 1998, Proc. Natl. Acad. Sci. 95:696). Immunostaining shows increased PR expression in normal mammary epithelial cells (MECs) of breast cancer patients carrying a germ line mutation of BRCAl (King et al., 2004, Cancer Res. 64:505 1). Normally, PR stability is regulated by proteosome; a progesterone receptor becomes polyubiquinated upon exposure to a ligand and is subsequently targeted for degradation by proteosome (Lange et al., 2000, Proc. Natl. Acad. Sci. 97:1032). The present invention demonstrates that progesterone receptor stability is related to breast cancer, and preventing and/or treating progesterone related breast cancer with anti- progesterones provides a molecular framework for the study and prevention of cancer in BRCAl carriers by using anti-progesterones as a chemopreventive strategy for PR related cancers. Anti-progesterones, such as pure progesterone receptor antagonists (PAs, typically associated with compounds that exhibit no agonistic effect on PR) or selective progesterone receptor modulators (SPRMs, typically associated with compounds that exhibit both antagonistic and agonist effects of PR) (hereinafter, PA and SPRM compounds will be referred to under the general acronym of "SPRM") are those compounds, drugs, or agents that modulate the activity of the progesterone receptor (Chabbert-buffet et al., 2005, Hum. Repro. Update 11:293-307, incorporated herein in its entirety). Although the SPRMs have no immediate structural relationship with progesterone, they are stereochemical^ similar to this hormone and interact with its receptors. The study of BRCAl mutations in vitro and in an in vivo mouse model described herein demonstrates the efficacy of using SPRMs to modulate tumorigenesis. Using mice models, it is shown that BRCAl/p53 defective mammary glands of nulliparous mice accumulate lateral branches and undergo extensive alveologenesis, a phenotype only seen during pregnancy in normal mice. The majority of BRCAl mediated tumors in humans harbor p53 mutations as well (Ting et al., 2004, DNA Repair 3:935; Turner et al., 2004, Nat. Rev. Cancer 4:814). Progesterone receptors, but not estrogen receptors, are over-expressed in MECs of conditional BRCAl/p53, but not p53 knockout mice; therefore, progesterone is a potent mitogen for BRCAl/p53 defective MECs specifically. Ligand-induced polyubiquitination and proteosome-mediated degradation of PRs are aberrant in breast epithelial cells with BRCAl knockdown, leading to stabilization and accumulation of PR. Treatment with the SPRM mifepristone prevents tumorigenesis in mice carrying mutated BRCAl/p53 alleles, thereby showing a critical role of PR in BRCAl mediated tumorigenesis.
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