(12) United States Patent (10) Patent No.: US 7,780,978 B2 Maurer Et Al

Home , Lysophosphatidylcholine, Miproxifene, Miproxifene phosphate

USOO7780978B2

(12) United States Patent (10) Patent No.: US 7,780,978 B2 Maurer et al. (45) Date of Patent: * Aug. 24, 2010

(54) ORAL PHARMACEUTICAL COMPOSITIONS (58) Field of Classification Search ...... 424/439; AND METHODS OF USING THE SAME 514/449, 613; 426/72 See application file for complete search history. (75) Inventors: Barry J. Maurer, Sylmar, CA (US); Charles Patrick Reynolds,s s Shermans (56)56 Refeeees Citede Oaks, CA (US); David W. Yesair, U.S. PATENT DOCUMENTS Byfield, MA (US); Robert Travis 4,665,098 A * 5/1987 Gibbs et al...... 514,613 McKee, Jacksonville, FL (US); Stephen 4,874,795 A * 10/1989 Yesair ...... 514,725 W. Burgess, Chelsea, AL (US); Walter 5,891,466 A 4, 1999 Yesair A. Shaw, Birmingham, AL (US) 6,207,194 B1* 3/2001 Glahn ...... 424/489 6,225.325 B1* 5/2001 Jacob ...... 514/328 (73) Assignee: Childrens Hospital Los Angeles, Los 6.254.853 B1 72001 Hendler et al...... 424/45 Angeles, CA (US) 2002/0156023 A1* 10/2002 Walling et al...... 514/27 FOREIGN PATENT DOCUMENTS (*) Notice: Subject to any disclaimer, the term of this patent is extended or adjusted under 35 WO WOO3,O31593 A2 4, 2003 U.S.C. 154(b) by 1315 days. OTHER PUBLICATIONS is- Lepage et al. “Effect of an organized lipid matrix on lipid absorption This patent is Subject to a terminal dis and clinical outcomes inpatients with cystic fibrosis'. The Journal of Ca10. Pediatrics 141(2):178-185 (2002). Supplementary European Search Report corresponding to European (21) Appl. No.: 11/170,561 Patent Application No. 04706566.9 dated Apr. 22, 2010. (22) Filed: Jun. 29, 2005 * cited by examiner O O Primary Examiner Blessing MFubara (65) Prior Publication Data (74) Attorney, Agent, or Firm Myers Bigel Sibley & US 2006/OOO8508 A1 Jan. 12, 2006 Sajovec, PA Related U.S. Application Data (57) ABSTRACT (63) Continuation-in-part of application No. 10/767.352, The present invention provides an edible composition for oral filed on Jan. 30, 2004. delivery of an active agent such as paclitaxel or a retinide. The (60) Provisional application No. 60/444,530, filed on Jan. composition comprises, in the form of a dry flowable powder: 31, 2003. (a) an active agent such as a retinide; (b) lipid matrix compo sition; (c) optionally sweetener; (d) flour. Compositions of the (51)51) Int. Cl. invention mavy be administered pperse or mixed with a solid or A6 IK 47/00 (2006.01) liquid food carrier, for directoral consumption by a Subject or A6 IK3I/I6 (2006.01) administration through a feeding tube. A2.3L I/308 (2006.01) (52) U.S. Cl...... 424/439: 514/613; 426/72 19 Claims, 2 Drawing Sheets

4-HPR Levels in Mice Following Oral Treatment with LXS-HPR vs Capsule Formulation 120 mg/kg/day

LYN-X 5.57 LYM-X 5.58 LYM-X 5.60 20 LYNX 5.59 Capsule Lot R-6124 LYM-X 5.60 G1 (Slim-Fast) E LYM-X 5.60 G2 (D. Water)

o U.S. Patent Aug. 24, 2010 Sheet 1 of 2 US 7,780,978 B2

FIGURE 1 4-HPR Levels in Mice Following Oral Treatment with LXS-HPR vs Capsule Formulation 120 mg/kg/day

LYM-X 5.57 LYM-X 5.58 as LYM-X 5.60 LYN-X 5.59 Capsule Lot #R-6124 LYM-X 5.60 G1 (Slim-Fast) a LYM-X 5.60 G2 (D. Water)

FIGURE 2 4-HPR Levels in Mice Following Oral Treatment with LXS-HPR vs Capsule Formulation SO 250 mg/kg/day ims G1 - LYM-X 5.60 in SlinFast 50 G2 - LYM-X 5.60 in Water sess 4-H PR Capsule in SlimFast 40

10 U.S. Patent Aug. 24, 2010 Sheet 2 of 2 US 7,780,978 B2

FIGURE 3 4-HPR Levels in Mice Following Oral Treatment with LXS-HPR vs Capsule Formulation 560 mg/kg/day 60 LYM-X 5.57 LYM-X 5.58 50 s LYM-X 5.60 LYM-X 5.59 40 Capsule Lot #R-6124

0 US 7,780,978 B2 1. 2 ORAL PHARMACEUTICAL COMPOSITIONS Further, an improved oral formulation would facilitate the AND METHODS OF USING THE SAME combination of 4-HPR with ceramide modulating agents in the outpatient setting. RELATED APPLICATIONS Formulations of fenretinide suitable for high dose parenteral delivery are described in PCT Application WO This application is a continuation-in-part of U.S. patent 02/05869 to Gupta et al. application Ser. No. 10/767,352, filed Jan. 30, 2004, which in Formulations offenretinide suitable for oral delivery are turn claims the benefit of provisional application Ser. No. described in U.S. Pat. No. 5,972,911 and U.S. Pat. No. 4,874, 60/444,530, filed Jan. 31, 2003, the disclosures of both of 795. which are incorporated by reference herein in their entirety. 10 SUMMARY OF THE INVENTION RELATED APPLICATION INFORMATION The present invention provides an edible composition for Statement of Government Support oral delivery of an active agent such as a retinide. The com 15 position comprises or consists essentially of in the form of a This invention was made with Government support under dry flowable powder: grant number CA081403, CA082830, and CA100895 from (a) an active agent Such as a retinide (including a single the National Cancer Institute. The Government has certain active agent, or two or more active agents in combina rights to this invention. tion), preferably in an amount by weight of from 1 to 10 or 20 percent; FIELD OF THE INVENTION (b) lipid matrix composition, preferably in an amount by weight of from 5 to 40 percent (the composition prefer The present invention concerns pharmaceutical composi ably being one comprising or consisting essentially of at tions for oral delivery of a retinide such as fenretinide. least one fatty acid, at least one monoglyceride, and 25 lysophosphatidylcholine, and the lipid matrix composi BACKGROUND OF THE INVENTION tion preferably containing not more than 7 or 8 moles water per mole of lipid matrix): Fenretinide IHPR; all-trans-N-(4-hydroxyphenyl)retina (c) optionally Sweetener, which when present may be mide: CAS Registry number 65646-68-6 is a synthetic ret included in an amount by of from 1 to 30 percent; inoic acid derivative having the structure: 30 (d) flour, preferably in an amount of from 20 to 80 percent by weight; and (e) optionally humectant, in an amount by weight of from O 0 or 1 to 16 percent. In one preferred embodiment, the lipid matrix composition N1 N1 N1 N. N-( )—o 35 may comprise (i) at least one non-esterified fatty acid (e.g., one having 14 to 22 carbonatoms), (ii) at least one monoglyc eride which is a monoester of glycerol and a fatty acid (e.g., the fatty acid having 14 to 22 carbon atoms), and (iii) lyso Fenretinide is minimally soluble in aqueous solution. U.S. 40 phosphatidylcholine (e.g., one in which in which the fatty Pat. No. 4,665,098 by Gibbs describes an oral pharmaceutical acid moiety has 14 to 22 carbon atoms). The fatty acids and composition of fenretinide as useful for the treatment of monoglycerides may together comprise from 60 or 70 mole breast and bladder cancer. However, the bioavailability of this percent to 99 mole percent of the lipid matrix composition. oral fenretinide composition is limited and greater anticancer The molar ratio of the fatty acids to the monoglycerides may effects might be obtained if fenretinide could be delivered 45 be from 4:1 or 2:1 to 1:2 or 1:4. The lysophosphatidylcholine intravenously to achieve higher drug plasma levels. Hence, may comprise from 1 mole percent to 30 or 40 mole percent there currently remains a need for new pharmacological com of the lipid matrix composition. positions of fenretinide, especially for oral administration As discussed in greater detail below, compositions of the which provide for both satisfactory solubility, and plasma and invention may be packaged in bulk or unit dosage form. tissue bioavailability, especially in patient populations gen 50 Compositions of the invention may be administered perse or erally less tolerant of capsule, tablet, or other non-chewable mixed with a solid or liquid food carrier, for direct oral con or non-imbibible drug delivery vectors. Sumption by a subject or administration through a feeding Intravenous formulations of 4-HPR have recently been tube. developed that obtain significantly higher 4-HPR plasma (30 Thus, a further aspect of the present invention is a method 120 uM) and tissue levels in rodent and canine animal models 55 of treating a disorder Such as a proliferative disease in a than the current oral capsule formulation while retaining Subject in need thereof, comprising feeding or administering minimal systemic toxicity (results not shown). However, this the Subject a composition as described above in an amount formulation is intended for use in the inpatient setting in effective to treat that disorder (such as a proliferative disease). conjunction with intravenous Safingol (used as a ceramide A still further aspect of the present invention is the use of an metabolism modulator). Thus, there remains a need for an 60 active agent as described herein for the preparation of a com improved oral formulation of 4-HPR for outpatient use, such position as described herein. as in maintenance therapy during states of minimal residual In particular embodiments of the foregoing, at least two disease, or in the palliative care setting, that is easier to active agents are included in the composition. In some administer and that has improved bioavailability. Such a for embodiments the first active agent is a retinide (e.g., fenre mulation would be particularly advantageous for Small chil 65 tinide) and the second active agent is a glucosylceramide dren and elderly adults in which compliance with the sched synthase inhibitor (e.g., 1-phenyl-2-palmitoylamino-3-mor ules of the current oral capsular 4-HPR is problematical. pholino-1-propanol (PPMP)). US 7,780,978 B2 3 4 PCT Application WO 03/031593 describes acidified, pro DETAILED DESCRIPTION OF THE PREFERRED tonated aqueous, predominantly inverse hexagonal phase EMBODIMENTS LYM-X-SORBTM compositions containing proteins, sugars and starches as a nutritional Supplement but does not suggest The present invention is explained in greater detail below. the use or formulation of non-acidic, minimally hdyrated, 5 Applicants specifically intend that all United States patents predominantly lamellar phase LYM-X-SORBTM composi cited herein be incorporated herein by reference in their tions containing proteins, Sugars and/or starches for admin entirety. istering active agents such as fenretinide. The foregoing and other objects and aspects of the present 1. Active Agents. invention are explained in greater detail in the drawings 10 While the present invention is initially concerned with the herein and the specification set forth above. delivery of retinides, a variety of different active agents can be used in carrying out the present invention. Examples of active BRIEF DESCRIPTION OF DRAWINGS agents that can be incorporated into the compositions and formulations of the present invention include, but are not FIG. 1. Comparison of 4-HPR in LXS matrix vs Capsule 15 limited to, paclitaxel, insulin, histrelin, Bestradiol, nifedipin Formulation at 120 mg/kg/day. Cohorts of five mice were analogues, hydrochlorothiazide, McN-5703, capsaicin, dilt feed with 120 mg/kg/day of 4-HPR formulated in various iaZen, renin inhibitors, hydrocortisone, cromolyn, pramox LXS compositions, or 4-HPR expressed from capsules, ine, buprenorphine, progesterone, cyclosporin A, metronida mixed with mouse chow or Slim-Fast(R), divided BID, x4.5 Zole, and gentamicin. Retinides, particularly fenretinide, are days. Animals were sacrificed 3 hrs after the last dose and currently preferred. Thus active agents are, in preferred 4-HPR levels in plasma and tissues were assayed by HPLC. embodiments, antineoplastic agents, as discussed further Results showed that certain LXS formulations obtained below. higher levels than the 4-HPR capsule formulation. PLASMA: Retinides. Retinides used for carrying out the present G1 vs capsule, P=0.006; LYM-X 5.59 vs capsule, P=0.06; invention are, in general, ceramide-generating retinoids or LIVER: G1 vs capsule, P=0.013: LYM-X 5.59 vs capsule, 25 retinoic acid derivatives. Such compounds include those P=0.045; LUNGS: G1 vs capsule, P=0.028: G2 vs capsule, described in U.S. Pat. No. 4,190,594 to Gander (the disclo P=0.05; KIDNEY: G1 vs capsule, P=0.007; LYM-X 5.59 vs Sures of all patent references cited herein are incorporated capsule, P=0.06; BRAIN: G1 vs capsule, P=0.01: LYM-X herein by reference). Ceramide-generating retinoids include 5.58 vs capsule, P=0.02. Statistical analysis by Students all trans-retinoic acid (ATRA) and retinoic acid derivatives, t-test. Columns, in each set of columns, in sequence from left 30 including but not limited to: to right, represent LYM-X 5.57, LYM-X 5.58, LYM-X 5.60, (A) esters of all-trans-retinoic acid having the following LYM-X5.59, Capsule Lot #R-6124, LYM-X5.60 G1 (SLIM formula: FASTTM), and LYM-X 5.60 G2 (DI Water). FIG.2. Comparison of 4-HPR in LXSTM matrix vs Capsule Formulation at 250 mg/kg/day. Cohorts of five mice were 35 gavaged with 250 mg/kg/day of 4-HPR in LXS formulation LYM-X 5.60 in Slim-Fast(R) or in water, or 4-HPR expressed N1N1 N1 N. OX from capsules and mixed in Slim-Fast(R), divided BID, x4.5 days. Animals were sacrificed 3 hrs after the last dose and 4-HPR levels in plasma and tissues were assayed by HPLC. 40 Results showed that LXS formulations, especially in Slim Fast(R), obtained significantly higher levels than the 4-HPR capsule formulation except in brain tissue. PLASMA: G1 vs wherein X is a member selected from the group consisting of capsule, P=0.006; G2 vs capsule, P=0.008: LIVER: G1 vs capsule, P=0.001; G2 vs capsule, P=0.01: LUNGS: G1 vs 45 O O capsule, P=0.05; G2 vs capsule, P=0.035; KIDNEY: G1 vs capsule, P=0.013: G2 vs capsule, P=0.22; BRAIN: G1 vs capsule, P=0.187: G2 vs capsule, P=0.11. Statistical analysis by Student's t-test. PLEASE NOTE CHANGE OF SCALE. -N -) Columns, in each set of columns, in sequence from left to 50 right, represent LYM-X 5.60 GI (SLIMFASTTM), LYM-X O O 5.60 G2 (DI Water), and 4-HPR Capsule in SLIMFASTTM FIG.3. Comparison of 4-HPR in LXSTM matrix vs Capsule Formulation at 560 mg/kg/day. In a pilot experiment, single 2-cyclohexylethyl: 10-carbomethoxydecyl: 4-hydroxybutyl: mice were gavaged with 560 mg/kg/day of 4-HPR formulated 55 been: mixed m- and p-vinylbenzyl, and 4-bromoben in various LXS compositions or 4-HPR expressed from 4-HPR capsules, divided BID, x4.5 days. Animals were sac (B) esters of all-trans-retinoic acid having the following rificed 3 hrs after the last dose and 4-HPR levels in plasma and formula: tissues were assayed by HPLC. Results showed that all LXS formulations apparently obtained much higher levels than the 60 capsule formulation in plasma and liver and lung tissues, and LYM-X 5.60 exceeded capsule levels in kidney tissue. 4-HPR levels achieved in brain tissue using compositions LYM-X 5.59 and LYM-X 5.60 were about double that obtained using the capsule formulation. Columns, in each set of columns, in 65 sequence from left to right, represent LYM-X 5.57, LYM-X 5.58, LYM-X 5.60, LYM-X 5.59, and Capsule Lot #R-6124. US 7,780,978 B2 5 6 wherein Y is a member selected from the group consisting of Additional retinoic acid derivatives that can be used to cholesteryloxy; phenyl: 4-bromophenyl: 4-methoxyphenyl: carry out the present invention include C-Glycoside analogs 4-nitrophenyl: 4-hydroxyphenyl: 4-methylphenyl, 4-cy of N-(4-hydroxyphenyl)retinamide-O-glucuronide. Such anophenyl: 4-ethoxyphenyl, 4-acetoxyphenyl: 2-naphthyl; 4-biphenyl; 2.5-dimethoxyphenyl; 2,4-dichlorophenyl; 2.4- compounds and their preparation are known and described in dimethylphenyl: 3,4-diacetoxyphenyl: 3,4,5-trimethoxyphe U.S. Pat. Nos. 5,663,377 and 5,599.953, both to Curley et al., nyl; and 2,4,6-trimethylphenyl; and the disclosures of which are incorporated by reference herein (C) amides of all-trans-retinoic acid having the following in their entirety. Such compounds may have the general for formula: mula:

R OH O OH N1N1 N1 N. N (CH2) OH

where R is COOH, CHOH, or H, and n is 0 or 1. Specific examples of Such compounds include: 4-(retina mido)phenyl-C-glucuronide, 4-(retinamido)phenyl-C-glu 25 coside: 4-(retinamido)phenyl-C-Xyloside: 4-(retinamido) N1 N1 n1 N1 NZ benzyl-C-glucuronide, 4-(retinamido)benzyl-C-glucoside; 4-(retinamido)benzyl-C-Xyloside: 1-(B-D-glucopyranosyl) retinamide; and 1-(D-glucopyranosyluronosyl) retinamide.

30 A. Glucosylceramide synthesis and 1-acylceramide Syn wherein Z is a member selected from the group consisting of thesis inhibitors. The composition may also include a glyco n-propylamino; tert-butylamino; 1,1,3,3-tetramethylbuty sylceramide synthesis and/or a 1-acylceramide synthesis lamino: 1-morpholino: 4-hydroxyphenylamino: 4-car bomethoxy-2-hydroxyphenylamino; beta-(3,4-dimethox inhibitor as an active agent. In one embodiments such com yphenyl)-ethylamino: 2-benzothiazolylamino: 1-imidazolyl; pounds are preferably included in combination with a retinide 1-(2-nicotinoylhydrazolyl): 1-benzotriazolyl: 1-(1,2,4-triaz 35 as discussed above. By “and/or is meant that either of two olyl); drugs with a selective activity for one or the other enzyme may be administered singly or in combination, or a single drug active in inhibiting both enzymes may be given.

40 Examples of Such compounds include, but are not limited to, NH-N compounds having the formula:

CH3(CH2) 45

HNS ; and si-n- - 50 OH where R is an aromatic ring Such as phenyl, a cyclohexyl group, or an alpiphatic group having 10 to 15 carbon atoms, Particularly preferred is all-trans-N-(4-hydroxyphenyl)reti 55 namide, also called fenretinide, which has CAS registry num R is an amine group such as a morpholino group; and n is an ber 65646-68-6, and has the structure: integer of from 4 to 18 (including functional homologues, isomers and pharmaceutically acceptable salts thereof. Pref O erably, n is 4, 6, 8, 10, 12 or 14, and the Denantiomers of such compounds are preferred. In another embodiment the threo n1 N1 N1 ns N-()-on enantiomers of Such compounds are preferred. In another embodiment, the D, threo enantiomer of such compounds are preferred. Such compounds are known and are disclosed, for example, in U.S. Pat. No. 5,302,609 to Shayman and Radin; The foregoing compounds can be prepared in accordance 65 U.S. Pat. No. 5,041,441 to Radin et al.; and U.S. Pat. No. with known techniques. See, e.g., U.S. Pat. No. 4,190,594 to 5,707,649 to Inokuchi et al. Specific examples of glucosyl Gander et al.; U.S. Pat. No. 4,665,098 to Gibbs. ceramide synthase inhibitors include: US 7,780,978 B2 7 8 1-phenyl-2-acylamino-3-morpholino-1-propanol in which camycin, Asahi Chemical PL-AC, stearate; Takeda TAC-788, n is 6 to 12: thioguanine, tiazofurin, Erbamont TIF, trimetrexate, tyrosine 1-phenyl-2-decanoylamino-3-morpholino-1-propanol kinase inhibitors, tyrosine protein kinase inhibitors, Taiho (PDMP); UFT, toremifene, and uricytin. 1-phenyl-2-palmitoylamino-3-morpholino-1-propanol 5 A second family of antineoplastic agents which may be (PPMP); and used in combination with the present invention consists of Tamoxifen, including tamoxifen citrate. alkylating-type antineoplastic agents. The alkylating agents Additional active agents. Still more active agents (particu are believed to act by alkylating and cross-linking guanine larly including antineoplastics agents) that may be used in the and possibly other bases in DNA, arresting cell division. present invention include, but are not limited to, those 10 Typical alkylating agents include nitrogen mustards, ethyl described in U.S. Pat. No. 6,858,598 (Searle) eneimine compounds, alkyl Sulfates, cisplatin, and various The phrase “antineoplastic agents' includes agents that nitrosoureas. Suitable alkylating-type antineoplastic agents exert antineoplastic effects, i.e., prevent the development, that may be used in the present invention include, but are not maturation, or spread of neoplastic cells, directly on the limited to, Shionogi 254-S, aldo-phosphamide analogues, tumor cell, e.g., by cytostatic or cytocidal effects, and not 15 altretamine, anaxirone, Boehringer Mannheim BBR-2207. indirectly through mechanisms such as biological response bestrabucil, budotitane, Wakunaga CA-102, carboplatin, car modification. There are large numbers of antineoplastic mustine (BiCNU), Chinoin-139, Chinoin-153, chlorambucil, agents available in commercial use, in clinical evaluation and cisplatin, cyclophosphamide, American Cyanamid in pre-clinical development, which could be included in the CL-286558, Sanofi CY-233, cyplatate, dacarbazine, Degussa present invention for treatment of neoplasia by combination D-19-384, Sumimoto DACHP(Myr)2, diphenylspiromus drug chemotherapy. For convenience of discussion, antine tine, diplatinum cytostatic, Erba distamycin derivatives, oplastic agents are classified into the following classes, Sub Chugai DWA-2114R, ITI E09, elmustine, Erbamont FCE types and species: ACE inhibitors, alkylating agents, angio 24517 estramustine phosphate sodium, etoposide phosphate, genesis inhibitors, angiostatin, anthracyclines/DNA fotemustine, Unimed G-6-M. Chinoin GYKI-17230, hepsul intercalators, anti-cancer antibiotics or antibiotic-type 25 fam, ifosfamide, iproplatin, lomustine, mafosfamide, mito agents, antimetabolites, antimetastatic compounds, asparagi lactol, mycophenolate, Nippon Kayaku NK-121, NCI NSC nases, bisphosphonates, c0MP phosphodiesterase inhibitors, 264395, NCI NSC-342215, oxaliplatin, Upjohn PCNU, calcium carbonate, cyclooxygenase-2 inhibitors DHA prednimustine, Proter PTT-119, ranimustine, semustine, derivatives, DNA topoisomerase, endostatin, epipodophylo SmithKline SK&F-101772, thiotepa, Yakult Honsha SN-22, toxins, genistein, hormonal anticancer agents, hydrophilic 30 spiromustine, Tanabe Seiyaku TA-077, tauromustine, temo bile acids (URSO), immunomodulators or immunological Zolomide, teroxirone, tetraplatin and trimelamol. agents, integrin antagonists interferon antagonists or agents, A third family of antineoplastic agents which may be used MMP inhibitors, miscellaneous antineoplastic agents, mono in combination with the present invention consists of antibi clonal antibodies, nitrosoureas, NSAIDs, ornithine decar otic-type antineoplastic agents. Suitable antibiotic-type anti boxylase inhibitors, pBATTs, radio/chemo sensitizers/pro 35 neoplastic agents that may be used in the present invention tectors, retinoids selective inhibitors of proliferation and include, but are not limited to Taiho. 4181-A, aclarubicin, migration of endothelial cells, selenium, Stromelysin inhibi actinomycin D, actinoplanone, Erbamont ADR-456, aeropl tors, taxanes, vaccines, and Vinca alkaloids. ysinin derivative, Ajinomoto AN-201-II, Ajinomoto AN-3, The major categories that some preferred antineoplastic Nippon Soda anisomycins, anthracycline, azino-mycin-A, agents fall into include antimetabolite agents, alkylating 40 bisucaberin, Bristol-Myers BL-6859, Bristol-Myers BMY agents, antibiotic-type agents, hormonal anticancer agents, 25067, Bristol-Myers BMY-25551, Bristol-Myers BMY immunological agents, interferon-type agents, and a category 26605, Bristol-Myers BMY-27557, Bristol-Myers BMY of miscellaneous antineoplastic agents. Some antineoplastic 28438, bleomycin sulfate, bryostatin-1, Taiho C-1027, agents operate through multiple or unknown mechanisms and calichemycin, chromoximycin, dactinomycin, daunorubicin, can thus be classified into more than one category. 45 Kyowa Hakko DC-102, Kyowa Hakko DC-79, Kyowa Hakko A first family of antineoplastic agents which may be used DC-88A, Kyowa Hakko DC89-A1, Kyowa Hakko DC92-B, in combination with the present invention consists of antime ditrisarubicin B, Shionogi DOB-41, doxorubicin, doxorubi tabolite-type antineoplastic agents. Antimetabolites are typi cin-fibrinogen; elsamicin-A, epirubicin, erbstatin, esorubi cally reversible or irreversible enzyme inhibitors, or com cin, esperamicin-A1, esperamicin-A1b, Erbamont FCE pounds that otherwise interfere with the replication, 50 21954, Fujisawa FK-973, fostriecin, Fujisawa FR-900482, translation or transcription of nucleic acids. Suitable antime glidobactin, gregatin-A, grincamycin, herbimycin, idarubi tabolite antineoplastic agents that may be used in the present cin, illudins, kaZusamycin, kesarirhodins, Kyowa Hakko invention include, but are not limited to acanthifolic acid, KM-5539, Kirin Brewery KRN-8602, Kyowa Hakko aminothiadiazole, anastrozole, bicalutamide, brequinar KT-5432, Kyowa Hakko KT-5594, Kyowa Hakko KT-6149, sodium, capecitabine, carmofur, Ciba-Geigy CGP-30694, 55 American Cyanamid LL-D49194, Meiji Seika ME 2303, cladribine, cyclopentyl cytosine, cytarabine phosphate Stear menogaril, mitomycin, mitoxantrone, SmithKline M-TAG, ate, cytarabine conjugates, cytarabine ocfosfate, Lilly neoenactin Nippon Kayaku NK-313, Nippon Kayaku NKT DATHF, Merrel Dow DDFC, dezaguanine, dideoxycytidine, 01, SRI International NSC-357704, oxalysine, oxaunomycin, dideoxyguanosine, didox, Yoshitomi DMDC, doxifluridine, peplomycin, pilatin, pirarubicin, porothramycin, pyrindamy Wellcome EHNA, Merck & Co. EX-015, fazarabine, finas 60 cin A, Tobishi RA-I, rapamycin, rhizoxin, rodorubicin, Siba teride, floxuridine, fludarabine phosphate, N-(2-furanidyl)- nomicin, siwenmycin, Sumitomo SM-5887, Snow Brand 5-fluorouracil, Daiichi Seiyaku FO-152, fluorouracil (5-FU), SN-706, Snow Brand SN-07, Sorangicin-A, sparsomycin, SS 5-FU-fibrinogen, isopropyl pyrrolizine, Lilly LY-188011, Pharmaceutical SS-21020, SS Pharmaceutical SS-7313B, SS Lilly LY-264618, methobenzaprim, methotrexate, Wellcome Pharmaceutical SS-9816B, Steffimycin B, Taiho. 4181-2, tali MZPES, nafarelin, norspermidine, nolvadex, NCI NSC 65 somycin, Takeda TAN-868A, terpentecin, thrazine, tric 127716, NCI NSC-264880, NCI NSC-39661, NCI NSC rozarin A, Upjohn U-73975, Kyowa Hakko UCN-10028A, 612567. Warner-Lambert PALA, pentostatin, piritrexim, pli Fujisawa WF-3405, YoshitomiY-25024 and Zorubicin. US 7,780,978 B2 10 A fourth family of antineoplastic agents which may be used neoplaston A5, antineoplaston AS2-1, Henkel APD, in combination with the present invention consists of Syn aphidicolinglycinate, asparaginase, Avarol, baccharin, batra thetic nucleosides. Several synthetic nucleosides have been cylin, benfluron, benzotript, Ipsen-Beaufour BIM-23015, identified that exhibit anticancer activity. A well known bisantrene, Bristo-Myers BMY-40481, Vestarboron-10, bro nucleoside derivative with strong anticancer activity is 5 mofosfamide, Wellcome BW-502, Wellcome BW-773, cal 5-fluorouracil (5-FU).5-Fluorouracil has been used clinically cium carbonate, Calcet, Calci-Chew, Calci-Mix, Roxane cal in the treatment of malignant tumors, including, for example, cium carbonate tablets, caracemide, carmethizole carcinomas, sarcomas, skin cancer, cancer of the digestive hydrochloride, Ajinomoto CDAF, chlorsulfaquinoxalone, organs, and breast cancer. Derivatives of 5-fluorouracil with Chemes CHX-2053, Chemex CHX-100, Warner-Lambert anti-cancer activity have been described in U.S. Pat. No. 10 CI-921, Warner-Lambert CI-937, Warner-Lambert CI-941, 4,336,381. Warner-Lambert CI-958, clanfenur, claviridenone, ICN com U.S. Pat. No. 4,000.137 discloses that the peroxidate oxi pound 1259, ICN compound 4711, Contracan, Cell Pathways dation product of inosine, adenosine, or cytidine with metha CP-461, Yakult Honsha CPT-11, crisinatol, curaderm, nol or ethanol has activity against lymphocytic leukemia. cytochalasin B, cytarabine, cytocytin, Merz D-609, DABIS Cytosine arabinoside (also referred to as Cytarabin, araC, and 15 maleate, dacarbazine, datelliptinium, DFMO, didemnin-B, Cytosar) is a nucleoside analog of deoxycytidine that was first dihaematoporphyrin ether, dihydrolenperone dinaline, dista synthesized in 1950 and introduced into clinical medicine in mycin, Toyo Pharmar DM-341, Toyo Pharmar DM-75, Dai 1963.5-AZacytidine is a cytidine analog that is primarily used chi Seiyaku DN-9693, docetaxel, Encore Pharmaceuticals in the treatment of acute myelocytic leukemia and myelod E7869, elliprabin, elliptinium acetate, Tsumura EPMTC, ysplastic syndrome. 2-Fluoroadenosine-5'-phosphate (Flu ergotamine, etoposide, etretinate, Eulexin. RTM., Cell Path dara, also referred to as FaraA) is one of the most active agents ways Exisulind. RTM. (sulindac sulphone or CP-246), fenre in the treatment of chronic lymphocytic leukemia. tinide, Merck Research Labs Finasteride, Florical, Fujisawa A fifth family of antineoplastic agents which may be used FR-57704, gallium nitrate, gemcitabine, genkwadaphnin, in combination with the present invention consists of hor Gerimed, Chugai GLA-43, Glaxo GR-631 78, grifolan NMF monal agents. Suitable hormonal-type antineoplastic agents 25 5N, hexadecylphosphocholine, Green Cross HO-221, homo that may be used in the present invention include, but are not harringtonine, hydroxyurea, BTG ICRF-187, ilmofosine, limited to Abarelix; Abbott A-84861; Abiraterone acetate; irinotecan, isoglutamine, isotretinoin, Otsuka JI-36, Ramot Aminoglutethimide; anastrozole: Asta Medica AN-207; K-477, ketoconazole, Otsuak K-76COONa, Kureha Chemi Antide; Chugai AG-041R; AVorelin; aseranox: Sensus cal K-AM, MECT Corp KI-81 10, American Cyanamid B2036-PEG; Bicalutamide; buserelin; BTG CB-7598, BTG 30 L-623, leucovorin, levamisole, leukoregulin, lonidamine, CB-7630; Casodex; cetrolix; clastroban; clodronate diso Lundbeck LU-23-112, Lilly LY-186641, Materna, NCI (US) dium: Cosudex: Rotta Research CR-1505; cytadren; crinone: MAP, marycin, Merrel Dow MDL-27048, Medco MEDR deslorelin; droloxifene; dutasteride; Elimina; Laval Univer 340, megestrol, merbarone, merocyanine derivatives, methy sity EM-800; Laval University EM-652; epitiostanol; epris lanilinoacridine, Molecular Genetics MGI-136, minactivin, teride; Mediolanum EP-23904; EntreMed 2-ME: exemes 35 mitonafide, mitoquidone, Monocal, mopidamol, motretinide, tane; fadrozole; finasteride; flutamide; formestane; Zenyaku Kogyo MST-16, Mylanta, N-(retinoyl)amino acids, Pharmacia & Upjohn FCE-24304; ganirelix; goserelin; Shire Nilandron; Nisshin Flour Milling N-021, N-acylated-dehy gonadorelin agonist; Glaxo Wellcome GW-5638; Hoechst droalanines, nafazatrom, Taisho NCU-190, Nephro-Calci Marion Roussel Hoe-766; NCI hCG, idoxifene; isocordoin; tablets, nocodazole derivative, Normosang, NCI NSC Zeneca ICI-182780; Zeneca ICI-118630; Tulane University 40 145813, NCI NSC-361456, NCI NSC-604782, NCI NSC JO15X; Schering Ag J96: ketanserin; lanreotide; Milkhaus 95580, octreotide, Ono ONO-112, oduizanocine, Akzo Org LDI-200; letrozol; leuprolide; leuprorelin; liarozole; lisuride 10172, paclitaxel, pancratistatin, pazelliptine, Warner hydrogen maleate; loxiglumide; mepitioStane; Leuprorelin; Lambert PD-11 1707, Warner-Lambert PD-115934, Warner Ligand Pharmaceuticals LG-1127; LG-1447; LG-2293; Lambert PD-131141, Pierre Fabre PE-1001, ICRT peptide D, LG-2527; LG-2716; Bone Care International LR-103: Lilly 45 piroXantrone, polyhaematoporphyrin, polypreic acid, Efamol LY-326315; Lilly LY-353381-HC1; Lilly LY-326391; Lilly porphyrin, probimane, procarbazine, proglumide, Invitron LY-353381; Lilly LY-357489; miproxifene phosphate: Orion protease nexin I, Tobishi RA-700, razoxane, retinoids, Pharma MPV-2213ad; Tulane University MZ-4-71; nafare Encore Pharmaceuticals R-flurbiprofen, Sandostatin: Sap lin; nilutamide; Snow Brand NKS01; octreotide; Azko Nobel poro Breweries RBS, restrictin-P retelliptine, retinoic acid, ORG-31710; Azko Nobel ORG-31806; orimeten; orimetene: 50 Rhone-Poulenc RP-49532, Rhone-Poulenc RP-56976, orimetine; ormeloxifene; osaterone; Smithkline Beecham Scherring-Plough SC-57050, Scherring-Plough SC-57068, SKB-105657; Tokyo University OSW-1: Peptech PTL selenium(selenite and selenomethionine), SmithKline 03001: Pharmacia & Upjohn PNU-156765; quinagolide: SK&F-104864, Sumitomo SM-108, Kuraray SMANCS, ramorelix; Raloxifene; statin; Sandostatin LAR; Shionogi SeaPharm SP-10094, spatol, spirocyclopropane derivatives, S-10364; Novartis SMT-487; somavert; somatostatin; tamox 55 spirogermanium, Unimed, SS Pharmaceutical SS-554, stry ifen; tamoxifen methiodide; teverelix toremifene; triptorelin; poldinone, Stypoldione. Suntory SUN 0237, Suntory SUN TT-232; vapreotide; Vorozole:Yamanouchi YM-116; Yaman 2071, Sugen SU-101, Sugen SU-5416, Sugen SU-6668, ouchi YM-511; Yamanouchi YM-55208; Yamanouchi Sulindac, Sulindac Sulfone; Superoxide dismutase, Toyama YM-53789; Schering AG ZK-1911703: Schering AG T-506, Toyama T-680, taxol, Teijin TEI-0303, teniposide, ZK-230211; and Zeneca ZD-182780. 60 thaliblastine, Eastman Kodak TJB-29, tocotrienol, Topostin, A sixth family of antineoplastic agents which may be used Teijin TT-82, Kyowa Hakko UCN-01, Kyowa Hakko UCN in combination with the present invention consists of a mis 1028, ukrain, Eastman Kodak USB-006, vinblastine sulfate, cellaneous family of antineoplastic agents including, but not Vincristine, Vindesine, vinestramide, Vinorelbine, Vintriptol, limited to alpha-carotene, alpha-difluoromethyl-arginine, Vinzolidine, withanolides, Yamanouchi YM-534, Zileuton, acitretin, Biotec AD-5, Kyorin AHC-52, alstonine, amona 65 urSodeoxycholic acid, and Zanosar. fide, amphethinile, amsacrine, Angiostat, ankinomycin, anti Still more preferred antineoplastic agents include: anastro neoplaston A10, antineoplaston A2, antineoplaston A3, anti Zole, calcium carbonate, capecitabine, carboplatin, cisplatin, US 7,780,978 B2 11 12 Cell Pathways CP-461, cyclophosphamide, docetaxel, doxo may be in the form of colloidal particles. Where minimally rubicin, etoposide, ExisulindR, fluorouracil (5-FU), flu aqueous the compositions may further comprise (d) bicarbon oxymestrine, gemcitabine, goserelin, irinotecan, ketocona ate (e.g., wherein the concentration of the lysophosphatidyl Zole, letroZol, leucovorin, levamisole, megestrol, choline is at least 0.1 mM in the minimally aqueous environ mitoxantrone, paclitaxel, raloxifene, retinoic acid, tamox ment and the molar ratio of the bicarbonate to the ifen, thiotepa, topotecan, toremifene, Vinorelbine, vinblas lysophosphatidylcholine is greater than 1:1, greater than 1.4: tine, Vincristine, selenium (selenomethionine), urSodeoxy 1, or greater than 7:1), and optionally may further comprise cholic acid, Sulindac sulfone and eflornithine (DFMO). (e) bile salts such as Sodium taurocholate (e.g., wherein the Antineoplastic agents' as used herein includes com molar ratio of the bile salts to the lysophosphatidylcholine pounds that, while not active as antineoplastic agents when 10 may be at least 10:1). administered by themselves, enhance the activity of another A particularly preferred composition for combination with active agent when administered in combination with that the active agentis LYM-X-SORBTM drug matrix composition other active agent (that is "enhancers' or "enhancers of anti (see, e.g., G. Lepage, D. Yesair et al., J. Pediatrics 141, 178 neoplastic agents'). Examples include inhibitors of the P-gly 185 (2002)), available from BioMolecular Products, Inc., 136 coprotein (MDR1 drug efflux protein (or “multiple drug resis 15 Main Street, Byfield, Mass. 01922 USA (telephone 978-462 tance inhibitors'), such as cyclosporine or PSC833, 2244) or Avanti Polar Lipids, Inc., 700 Industrial Park Drive, combined with a drug that is a Substrate of the p-glycoprotein Alabaster, Ala. 35007 USA (telephone 205-663-24924; fax pump. Such as doxorubicin or Vincristine. Such compounds 205-663-0756) in a non-acidified and non-protonated and are kown and described in, for example, U.S. Pat. Nos. 6,210, non-aqueous lipid matrix form (e.g., minimally hydrated) of 917: 5416,091; 5,300,282; 5,124,339; 5,124,338; and 5,114, predominantly lamellar phase and with minimal hexagonal or 951. inverse hexagonal phase. 2. Lipid Matrix Compositions. The active agent (e.g. a retinide Such as fenretinide) may be Lipid matrix compositions that may be used to carry out the readily combined with the lipid matrix composition in any present invention generally comprise a combination of lyso Suitable amount, generally in a mole ratio of retinide: lipid phosphatidylcholine, monoglyceride, and fatty acid. Without 25 matrix composition of from about 0.2:1 to about 2:1, more wishing to be bound to any particular theory of the invention, particularly about 0.4:1 to 1.5:1, and still more particularly it is believed that the lipid matrix composition is non-liposo about 0.6:1 to 1:1. The amount of active agent(s) in the com mal (e.g., in a lamellar phase, and non- or minimally-hexago position may also be expressed as an amount by weight of the nal phase and/or inverse hexagonal phase) and forms an orga 30 edible powder formulation, as further explained below. nized lipid matrix of lysophosphatidylcholine, Where two active agents are included, the combining step monoglyceride and fatty acid that enfolds the active agent in can be carried out by combining a first and second active acyl-constituents of the lipid matrix monomer backbones for agent with the non-acidic lipid matrix composition to form absorption in the proximal intestine, with the monomers the viscous fluid. In the alternative, a first active agent can be forming chylomicron-like elements that enter systemic circu 35 combined with a first non-acidic lipid matrix composition as lation via the thoracic duct. described herein; a second active agent combined with a Lipid matrix compositions suitable for use in carrying out second non-acidic lipid matrix composition as described the present invention are known and described in, for herein (which may be the same as or different from the first); example, U.S. Pat. No. 4,874,795: U.S. Pat. No. 5,891,466: and the two precursors so formed then combined with one U.S. Pat. No. 5,972,911; U.S. Pat. No. 6,426,069; and PCT another to form the viscous fluid. Application WO 03/031593, the disclosures of which appli 40 cant specifically intends be incorporated by reference herein While lipid matrix compositions as described above are in their entirety. In one embodiment useful for carrying out preferred for carrying out the present invention, the invention the present invention, the lipid matrix composition com can also be carried out with liposome compositions. Lipo prises: Somes Suitable for use in the composition of the present (a) at least one non-esterified fatty acid having 14 to 18, or 45 invention include those composed primarily of vesicle-form 14 to 22, carbon atoms (e.g., palmitoleic, oleic, linoleic, ing lipids, as exemplified by the phospholipids. The lipo or linolenic fatty acids); Somes can also include other lipids incorporated into the lipid (b) at least one monoglyceride which is a monoester of bilayers, with the hydrophobic moiety in contact with the glycerol and a fatty acid having 14 to 18, or 14 to 22, interior, hydrophobic region of the bilayer membrane, and the carbon atoms (e.g., palmitoleic, oleic, linoleic, or lino 50 head group moiety oriented toward the exterior, polar Surface lenic fatty acids); and of the bilayer membrane. The vesicle-forming lipids are pref (c) lysophosphatidylcholine in which the fatty acid moiety erably ones having two hydrocarbon chains, typically acyl has 14 to 18, or 14 to 22, carbonatoms (e.g., in which the chains, and a head group, either polar or nonpolar. There are fatty acid moiety is a palmitoleic, oleic, linoleic, or lino a variety of synthetic vesicle-forming lipids and naturally 55 occurring vesicle-forming lipids, including the phospholip lenic fatty acid). ids. Such as phosphatidylcholine, phosphatidylethanolamine, In general, the fatty acids and monoglycerides together may phosphatidic acid, phosphatidylinositol, and sphingomyelin, comprise from about 70 mole percent to about 99 mole per where the two hydrocarbon chains are typically between cent of the lipid matrix composition, the molar ratio of the about 14-22 carbonatoms in length, and have varying degrees fatty acids to the monoglycerides may be from about 2:1 to 60 of unsaturation. The above-described lipids and phospholip about 1:2, and the lysophosphatidylcholine may comprises ids whose acyl chains have varying degrees of saturation can from about 1 mole percent to about 30 mole percent of the be obtained commercially or prepared according to published lipid matrix composition. methods. Other suitable lipids include glycolipids and sterols The lipid matrix compositions may be nonaqueous or mini such as cholesterol. see, e.g., U.S. Pat. No. 6,355.268; see also mally hydrated (e.g., containing less than 5, 6, 7 or 8, and 65 U.S. Pat. Nos. 6,673.364; 6,660,525; and 5,773,027 (the dis preferably not more than 1, 2, 3 or 4, Moles of water per mole closures of which applicants specifically intend be incorpo of lipid matrix composition). The lipid matrix composition rated herein by reference). US 7,780,978 B2 13 14 3. Edible Powder Formulations. as acetaldehyde, herbs, spices, mocha, butternut, rum, hazel In a preferred embodiment of the invention, the mixture or nut, horchata, dulche de leche, etc., as well as mixtures of complex of active agent (such as retinide) and lipid matrix these flavors. See, e.g., U.S. Pat. No. 6,207,206. composition is mixed with additional ingredients to form a Compositions of the invention can be made by, first, com free-flowing, edible powder of Solid particulate matter (e.g., bining an active agent (such as a retinide) with a lipid matrix as opposed to a liquid). Such additional ingredients include composition as described above. The lipid matrix composi Sweeteners, flours, humectants, etc. In general, such a com tion is preferably non-acidic or basic, and preferably contains position may comprise or consist essentially of less than 7 or 8 moles of water (and more preferably not more (a) from about 1 or 2 up to about 4, 6 or 10 percent by than 3 moles of water) per mole of lipid matrix. The combin weight of active agent (such as retinide) (including a 10 ing step may be carried out by heating the lipid matrix com single active agent, or two or more active agents in position to form a soft or viscious or oily composition and combination); then stirring or mixing the active agent therein to form a soft (b) from about 5 or 10 up to about 30 or 40 percent by or viscous or oily product. The Viscous/oily product is then weight of lipid matrix composition as described above; mixed with flour and optionally sweetener (and other optional (c) optionally, but in some embodiments preferably, from 15 ingredients as desired), with the mixing being carried out with about 1, 2, 5 or 10 up to about to 30 or 40 percent by Sufficient shear stress (e.g., by stirring or blowing) to produce weight of Sweetener (lower amounts being possible by a flowable powder composition as described herein. For inclusion of high intensity Sweeteners as discussed example, mixing can be carried out by pouring the flour (and below); optionally Sweetener) into the viscous/oily product with con (d) from about 20, 30 or 40 up to about 60, 70 or 80 percent current stirring in a food processor, blender, commercial by weight flour; and mixer or blender, or the like. The speed of the mixing appa (e) optionally, from 0 or 1 up to about 10, 16 or 20 percent ratus can be varied as desired throughout the process: e.g., by weight of a humectant (as needed or desired depend with mixing being carried out at a lower speed to initially ing upon choice of Sweetener and other ingredients). combine the ingredients, and then the speed increased as Additional optional ingredients may include Small 25 desired to produce the flowable powder composition amounts of salt, colorants, preservatives, stabilizers, antimi described herein. crobials, anti-caking additives, etc., as is conventional in the The flowable powder may be packaged in bulk or unit dose art. containers such as packets or sealed cups for Subsequent use, In one embodiment, where the active ingredients are fen with unit dose containers preferably containing from 1 to 10 retinide and PPMP in combination, the active ingredients are 30 or 20 grams of the flowable powder. included in the combination at a weight ratio range of 20:1 to The flowable powder may be consumed or administered 1:4 (fenretinide:PPMP) and more preferably at a weight ratio perse to a subject. The flowable powder may, if desired, be range of 10:1 to 1:2 (fenretinide: PPMP). caked or baked into a formed food product such as a cookie, Sweeteners that may be used in preparing formulations of wafer, or bar for Subsequent consumption by a Subject. The the invention include, but are not limited to, Sugars such as 35 flowable powder may, if desired, be mixed with another liq Sucrose, dextrose, fructose, maltodextrin, glucose, tagatose, uid, Solid, or semi-solid food or nutritional Supplement for lactose, invert Sugar, maltose, etc., as well as high intensity administration to a patient (examples including but not lim Sweeteners such as Sucralose, sodium cyclamate, Sodium sac ited to oatmeal or other grain meals, pudding, ice creams, charin, aspartame, etc. All Such Sweeteners may be used alone sorbet, apple sauce, liquid Soy-based nutritional Supplement or in combination with one another. 40 compositions such as SLIM-FASTTM and fruit juice). Prefer Any edible fine dry powder produced by grinding a nut, ably the foods or compositions with which the powder is cereal grain or other source of plant starch or carbohydrate mixed do not contain lipid-matrix destabilizing agents such may be used as the flour in the present invention. Suitable as milk fat (e.g., replacing milk fats with Soy fats). flours include but are not limited to rice flour, potato flour, 4. Treatment and Administration. corn flour, masa corn flour, tapioca flour, buckwheat flour, 45 wheat flour, oat flour, bean flour, barley flour rye flour, millet The present compositions and formulations can be admin flour, sorghum flour, chestnut flour, and mixtures thereof. The istered for the treatment of hyperproliferative disorders such flour may optionally have additional ingredients such as pre as tumors, cancers, and neoplastic disorders, as well as pre servatives and flowing agents included therein. malignant and non-neoplastic or non-malignant hyperprolif Humectants may optionally be included in the composition 50 erative disorders or for the treatment of other medical condi where necessary or desired to, among other things, lower the tions in need of treatment, such as hypertension, infection, at of the composition. Examples of humectants include, but inflammation, graft versus host disease, etc. are not limited to, corn syrup, high fructose corn syrup, poly Subjects to be treated by the compositions, formulations hydric alcohols (e.g., Sorbitol, glycerol. Xylitol and the like), and methods described herein are, in general, mammalian polydextrose, combinations thereof, etc. In some embodi 55 Subjects, including both human Subjects and animal Subjects ments, the compositions have an wateractivity (or “a) less Such as dogs, cats, horses, etc. for veterinary purposes. The than 0.85 (to reduce pathogen growth therein); in some Subjects are, in some embodiments, infant, juvenile, or geri embodiments the compositions have an at less than 0.65 (to atric Subjects. reduce growth of osmotolerant yeasts and molds therein). Examples of tumors, cancers, and neoplastic tissue that can Flavorants that may optionally be included in the compo 60 be treated by the present invention include but are not limited sition include, but are not limited to: almond nut, amaraetto, to malignant disorders such as breast cancers; osteosarcomas; anisette, banana, tapioca, brandy, cappuccino, mint, cinna angiosarcomas; fibrosarcomas and other sarcomas; leuke mon, cinnamon almond, creme de menthe, orange, pepper mias; lymphomas; sinus tumors; ovarian, uretal, bladder, mint Stick, pistachio, licorise, apple, chamomile, cinnamon prostate and other genitourinary cancers; colon, esophageal spice, creme, Vanilla, french Vanilla, lemon, macadamia nut, 65 and stomach cancers and other gastrointestinal cancers; lung orange, orange leaf, peach, Strawberry, grape, raspberry, cancers; myelomas; pancreatic cancers; liver cancers; kidney cherry, coffee, chocolate and the like, aroma enhancers such cancers; endocrine cancers; skin cancers; and brain or central US 7,780,978 B2 15 16 and peripheral nervous (CNS) system tumors, malignant or The present invention is explained further in the non-lim benign, including gliomas and neuroblastomas. iting Examples set forth below. Examples of premalignant and non-neoplastic or non-ma lignant hyperproliferative disorders include but are not lim EXAMPLE 1. ited to myelodysplastic disorders; cervical carcinoma-in-situ; familial intestinal polyposes such as Gardner syndrome; oral Oral Compositions of 4-HPR leukoplakias; histiocytoses; keloids; hemangiomas; hyper proliferative arterial Stenosis, inflammatory arthritis; hyper The actual dose of 4-HPR to be delivered to patients will keratoses and papulosquamous eruptions including arthritis. 10 ultimately define the resulting mixture Volume, once it is Also included are viral induced hyperproliferative diseases determined. These arbitrary values present 4-HPR doses of such as warts and EBV induced disease (i.e., infectious 0.5 to 2.5 grams per mixture volume. mononucleosis), Scarformation, and the like. The methods of A concentrated LXS-HPR mixture would be >1000 mg treatment disclosed herein may be employed with any subject 15 HPR per 10 cc. As awkward as this may be for typical dosage known or Suspected of carrying or at risk of developing a calculations, we usually describe drug-LXS ratios in terms hyperproliferative disorder as defined herein. of moles. This is because our prior work Suggests that 1 mole As used herein, “treatment of a hyperproliferative disor of drug Successfully interacts within the inclusion space of 1 der refers to methods of killing, inhibiting or slowing the growth or increase in size of a body or population of hyper mole of LXS. So, if we use a mole ratio of 0.8 (0.8 moles of proliferative cells or tumor or cancerous growth, reducing drug per mole of LXS), the maximum concentrated dosage hyperproliferative cell numbers, or preventing spread to other would be 397*0.8/2429, or 131 mg HPR per gram of LXS. anatomic sites, as well as reducing the size of a hyperprolif In reading Table 1, then, with a mole ratio of 0.8, 2.5g of erative growth or numbers of hyperproliferative cells. As used 4-HPR would complex with 19.09 g LXS with a resulting herein, “treatment' is not necessarily meant to imply cure or 25 total volume of 17.18 ml, or approximately 1400 mg per 10 complete abolition of hyperproliferative growths. As used cc. The calculations for lower mole ratios are included. herein, a treatment effective amount is an amount effective to Preferably, the LXS composition (in the form of an oil) is result in the killing, the slowing of the rate of growth of mixed with 4-HPR first. Once dissolved in the oil, a small hyperproliferative cells, the decrease in size of a body of 30 initial amount of basic water (such as containing the bicar hyperproliferative cells, and/or the reduction in number of bonate of soda) is mixed in to the composition to soften the hyperproliferative cells. composition to a foam. The resulting foam may then be mixed The therapeutically effective dosage of any one active with a suspension agent (e.g., SLIMFASTTM soy beverage or agent, the use of which is in the scope of present invention, will vary somewhat from compound to compound patient to 35 more water) via probe Sonication. Alternatively, the compo patient, and will depend upon factors such as the condition of sition containing 4-HPR or other medicinal agent in the LXS the patient and the route of delivery. Such dosages can be can be compounded directly with edible food compositions or determined in accordance with routine pharmacological pro excipients. cedures known to those skilled in the art, particularly in light 40 of the disclosure provided herein. For fenretinide, a dose to EXAMPLE 2 achieve a plasma level of about 1 uM to 10 or 50 uM, or greater, is employed (e.g., an oral dose of 10 or 20 to 500 or Improved Bioavailability of Oral 4-HPR Using LYM-X-SORBTM Lipid Matrix 1000 mg offenretinide). 45 Feeding of the compositions of the invention may be car ried out by any of a variety of procedures. The subject may be LYM-X-SORBTM (Lymphatic Xenobiotic Absorbability) fed the composition orally and directly. The composition may lipid matrix (also referred to as LXSTM herein) is a patented be diluted or combined in a food or beverage prior to feeding and proprietary technology of LYM-DRUG PRODUCTS, to a Subject. 50 LLC and BioMolecular Products, Inc., Byfield, Mass., useful for increasing the oral bioavailability of water insoluble com The feeding may be carried out by feeding the subject pounds. LXSTM is a non-liposomal, lipid-based, drug delivery through a gastric, jejunal, naso-gastric or nasal-jejunal feed system composed of FDA-accepted GRAS (Generally ing tube, in which case feeding preferably involves (i) com Regarded As Safe) lipids (lysophosphatidylcholine (LPC), bining the dry powder with a preferably non-lipid matrix 55 destabilizing liquid (e.g., one substantially free of milk fat) to monoglycerides (MG), and fatty acids (FA)). LXSTM acts as a produce a liquid composition, and then (ii) delivering the “lipid-fingered glove' which wraps around the drug of inter liquid composition to the Subject through the feeding tube. estina 1:1 molar ratio. In the presence of sodium bicarbonate Particularly suitable subjects for administering or feeding and bile salts, the LXS/drug matrix forms <10 nm size par the compositions described herein are infant, juvenile or geri 60 ticles that are readily absorbed. Neither the LXSTM monomer, atric Subjects. nor the LXS/drug matrix, damage intestinal villae. LXSTM The compositions described herein may be used in combi has been demonstrated safe in a one-year double blind oral nation therapies, such as described in B. Maurer et al., U.S. feeding trial in Cystic Fibrosis (CF) children (Lepage, et al. J Pat. No. 6,368,831, or B. Maurer et al., U.S. Pat. No. 6,352, 65 Pediatr. 114:178-185, 2002.) Diverse, minimally-soluble, 844, the disclosures of which are incorporated by reference drugs have been shown to be compatible with LXSTM, includ herein in their entirety. ing 4-HPR (U.S. Pat. No. 4,874,795). US 7,780,978 B2 17 18 LYM-X 5.60=1:3:3; and TABLE 1. G1, G2=LYM-X 5.60 in water or SLIMFASTTM soy bev erage The LYMX-X-5.59 composition is currently pre 4-HPR:LXS Mixture Concentrations ferred.

Wt wt Corresponding Mixture EXAMPLE 3 4-HPR:LXS 4-HPR LXS Volume Mole Ratio (g) (g) (cc) Powder Formulation Process O.6O OSO S.09 4.58 OO 10.18 9.16 10 A 1:0.8 Moleratio combination of LYM-X-SORBTM drug SO 15.27 3.75 matrix compostition was combined with fenretinide in accor 2.OO 20.36 8.33 dance with known techniques and as described in Example 1 2.50 25.45 22.91 above in a 1:0.8 Moleratio to forman LXS/4-HPR complex. O.65 OSO 4.70 4.23 The lipid matrix is not acidified or significantly hydrated to OO 9.40 8.46 15 form a protonated aqueous lipid matrix of predominantly SO 4.10 2.69 2.OO 8.8O 6.92 hexagonal or inverse hexagonal phase. Rather, the lipid 2.50 23.50 21.15 matrix is basic, minimally-hydrated, and of predominantly O.70 OSO 4.36 3.93 lamellar phase. The LXS/4-HPR is blended to an oil and OO 8.73 7.85 stored at -20°C. The oil is -88.8% (wt) LXS and 11.2% (wt) SO 3.09 1.78 4-HPR (1:0.8 mole ratio). 2.OO 7.45 5.71 A food processor is used for the blending to a powder but 2.50 21.82 9.64 this may be replaced by a much larger reactor vessel with 0.75 OSO 4.07 3.67 internal chopper blades or other mixing device to process OO 8.15 7.33 multiple kilos simultaneously. Either way, the flour and Sugar SO 2.22 1.OO 2.OO 6.29 4.66 25 are loaded into the blending vessel and mixed for ~1 minute 2.50 20.36 8.33 or more at room temperature. The LXS/4-HPR is then loaded O.8O OSO 3.82 3.44 at ambient temperature as a semi-solid to the flour/Sugar. OO 7.64 6.87 Allowing the LXS/4-HPR to warm to room temperature for SO 1.45 O.31 ~1 hour prior to loading provides a thick material capable of 2.OO 5.27 3.75 30 scooping in Solid pieces similar to butter. The combination is 2.50 9.09 7.18 then mixed at room temperature via the blending device (on high) for -2-3 minutes or until no solid LXS/4-HPR is noted. The resulting powder is bright yellow and free flowing with In beagle dogs, LXSTM increased the peak plasma concentra mild agglomerations that are easily broken apart upon exami 35 nation. This material is discharged and weighed into the tion of 200 mg doses of 4-HPR by 5-fold, and increased mean respective containers. Constituent ranges are: area under the curve (AUC) by 4.2-fold compared to the 53.5% (wt) wheat flour, current oral capsular formulation (of Gibbs)(U.S. Pat. No. 19.6% (wt) granulated Sugar, 4,665,098). In single-dose experiments in healthy human vol 23.8% (wt) LXS and unteers, plasma concentrations equivalent to those obtained 40 3.1% (wt) 4-HPR. using the current capsular 4-HPR formulation were achieved These weights, to date, have not had much discrepancy so using /s the 4-HPR dose in a LXSTM formulation. These the ranges are relatively tight (+1%) but in some preferred results suggested that a liquid formulation of 4-HPR with embodiments the final product may comprise at least 22-27% increased bioavailability might be possible using LXSTM total lipid and 2.5-3.5% 4-HPR. technology. 45 Salt and bicarbonate may be added in limited amounts (preferably not more than about 1%). Corn syrup may be To test this hypothesis, we had various LXSTM composi added up to 15%, but in combination with 15% LXS the tions of 4-HPR prepared that varied in the LPC:MG:FA ratios mixture becomes too thick for powder work. of the LXSTM matrix. We then feed mice with equal doses of The foregoing is illustrative of the present invention, and is 4-HPR in the LXSTM compositions, or expressed as a slurry 50 not to be construed as limiting thereof. The invention is from the current oral 4-HPR capsules. Steady state plasma defined by the following claims, with equivalents of the and tissue levels of 4-HPR were assayed after animal sacri claims to be included therein. fice. The results demonstrated that 4-HPR plasma and tissue That which is claimed is: levels were dose-dependent, and that certain LXSTM formu 55 1. An edible composition for oral delivery of an active lations obtained significantly higher steady-state 4-HPR agent, said composition comprising, in the form of a dry plasma and tissues than those achieved by the current capsu flowable powder: lar formulation, especially at higher doses (FIGS. 1, 2, and 3). (a) from 1 to 20 percent by weight of a retinide; All animals completed the experiments. No obvious toxicities (b) from 5 to 40 percent by weight of non-acidic lipid were observed. In FIG. 1: 60 matrix composition, said matrix composition compris LYM-X 5.57=1:2:4 lysophosphatidylcholine:monoglycer ing at least one fatty acid, at least one monoglyceride, ides:fatty acid (LPC:MG:FA): and lysophosphatidylcholine, and said lipid matrix com position containing not more than 4 moles water per LYM-X 5.58=1:4:2: mole of lipid matrix: LYM-X 5.59=1:4:2 with some base (bicarb) added during 65 (c) from 1 to 30 percent by weight of Sweetener; processing in an amount Sufficient to soften the oily (d) from 20 to 80 percent by weight flour; and mixture to a foam as discussed above; (e) from 0 to 16 percent by weight of a humectant. US 7,780,978 B2 19 20 2. The composition of claim 1, said lipid matrix composi 12. The composition of claim 11, wherein said retinide is tion comprising (i) at least one non-esterified fatty acid hav fenretinide and said glucosylceramide synthase inhibitor is ing 14 to 22, carbon atoms (ii) at least one monoglyceride 1-phenyl-2-palmitoylamino-3 -morpholino-1-propanol which is a monoester of glycerol and a fatty acid having 14 to (PPMP). 22 carbon atoms, and (iii) lysophosphatidylcholine in which 5 13. A method of making a composition of claim 1, com the fatty acid moiety has 14 to 22 carbon atoms, wherein said prising the steps of: fatty acids and monoglycerides together comprise from 70 combining at least one active agent with a non-acidic lipid mole percent to 99 mole percent of said lipid matrix compo matrix composition, said matrix composition compris sition, the molar ratio of said fatty acids to the monoglycer ing at least one fatty acid, at least one monoglyceride, ides is from 2:1 to 1:2, and said lysophosphatidylcholine 10 and lysophosphatidylcholine, and said lipid matrix com comprises from 1 mole percent to 30 mole percent of said position containing not more than 4 moles water per lipid matrix composition. mole of lipid matrix to form a viscous fluid; and then 3. The composition of claim 1, wherein said sweetener is mixing said viscous fluid with sweetener and flour with selected from the group consisting of Sucrose, dextrose, fruc sufficient shear stress to produce a flowable powder tose, maltodextrin, glucose, tagatose, lactose, invert Sugar, 15 composition according to claim 1. maltose, Sucralose, sodium cyclamate, Sodium saccharin, and 14. The method of claim 13, wherein said retinide is fen aspartame. retinide. 4. The composition of claim 1, said flour selected from the 15. The method of claim 13, wherein said method further group consisting of rice flour, potato flour, corn flour, masa comprises combining a glucosylceramide synthase inhibitor corn flour, tapioca flour, buckwheat flour, wheat flour, oat with the non-acidic lipid matrix composition. flour, bean flour, barley flour, rye flour, millet flour, sorghum 16. The method of claim 15, wherein said retinide is fen flour, chestnut flour, and mixtures thereof. retinide and said glucosylceramide synthase inhibitor is 5. The composition of claim 1, said composition having a 1-phenyl-2-palmitoylamino-3 -morpholino-1-propanol water activity (a)less than 0.85. (PPMP). 25 17. The method of claim 15, wherein said combining step 6. The composition of claim 1, wherein said humectant is is carried out by combining a retinide and a glucosylceramide included in said composition in an amount of at least 1% by synthase inhibitor with said non-acidic lipid matrix compo weight and is selected from the group consisting of corn sition to form said viscous fluid. syrup, high fructose corn syrup, polyhydric alcohols, poly 18. The method of claim 13, wherein said combining step dextrose, combinations thereof, and combinations thereof. 30 is carried out by: 7. The composition of claim 1, said lipid matrix composi combining a retinide with a non-acidic lipid matrix com tion further comprising water in an amount not greater 3 position, said matrix composition comprising at least moles water per mole lipid matrix. one fatty acid, at least one monoglyceride, and lysophos 8. The composition of claim 1, wherein said composition phatidylcholine, and said first lipid matrix composition comprises: 35 containing not more than 4 moles water per mole of lipid (a) from 2 to 6 percent by weight of a retinide; matrix to form a first precursor fluid; combining a glucosylceramide synthase inhibitor with a (b) from 10 to 30 percent by weight of said lipid matrix second non-acidic lipid matrix composition, said matrix composition; composition comprising at least one fatty acid, at least (c) from 5 to 30 percent by weight of said sweetener; and 40 one monoglyceride, and lysophosphatidylcholine, and (d) from 30 to 60 percent by weight flour. said lipid matrix composition containing not more than 9. A mixed food composition comprising the composition 4 moles water per mole of lipid matrix to form a second of claim 1 in combination with a food carrier. precursor fluid; and then 10. The mixed food composition of claim 9, wherein said combining said first precursor fluid and said second pre food carrier is selected from the group consisting of liquid 45 cursor fluid to form said viscous fluid. Soy-based nutritional Supplement, oatmeal, pudding, ice 19. The method of claim 18, wherein said retinide is fen creams, Sorbet, apple sauce, and fruit juice. retinide and said glucosylceramide synthase inhibitor is 11. The composition of claim 1, wherein said composition 1-phenyl-2-palmitoylamino-3-morpholino-1-propanol further comprises from 1 to 20 percent by weight of a gluco (PPMP). Sylceramide synthase inhibitor. UNITED STATES PATENT AND TRADEMARK OFFICE CERTIFICATE OF CORRECTION

PATENT NO. : 7,780,978 B2 Page 1 of 1 APPLICATIONNO. : 11/170561 DATED : August 24, 2010 INVENTOR(S) : Maurer et al. It is certified that error appears in the above-identified patent and that said Letters Patent is hereby corrected as shown below:

Column 20, Claim 13, Line 7: Please correct “combining at lease one active agent with to read -- combining a retinide with --

Signed and Sealed this Twenty-third Day of November, 2010

David J. Kappos Director of the United States Patent and Trademark Office UNITED STATES PATENT AND TRADEMARK OFFICE CERTIFICATE OF CORRECTION PATENT NO. : 7,780,978 B2 Page 1 of 1 APPLICATIONNO. : 11/170561 DATED : August 24, 2010 INVENTOR(S) : Maurer et al. It is certified that error appears in the above-identified patent and that said Letters Patent is hereby corrected as shown below:

On Title Page: Item (63) Related U.S. Application Data: Please correct “Jan. 30, 2004 to read -- Jan. 29, 2004 --

Column 1, Line 7: Please correct “Jan. 30, 2004 to read -- Jan. 29, 2004 --

Signed and Sealed this Third Day of May, 2011

David J. Kappos Director of the United States Patent and Trademark Office