Methods for inhibiting tumor cell proliferation

MBHB CASE NO. 01-043-PCT METHODS FOR INHIBITING TUMOR CELL PROLIFERATIONCross ReferenceThis application claims priority to U. S. Provisional Patent Application Serial No.

60/287,760 filed May 1,2001.

Field of the InventionThis present invention relates to compositions and methods useful for the inhibition of tumor cell proliferation.

Background of the InventionDespite many years of promising new therapies, cancer remains a major cause of morbidity and mortality (Bailar et al., N. Engl. J. Med. 336: 1569-1574,1997). Typical therapeutic treatments may include surgery, radiation therapy, and/or chemotherapy. A variety of chemotherapeutic compounds have found widespread use in the clinical treatment of cancer and have proven to be indispensable in the effort to combat this disease.

Nevertheless, on an individual case basis, some cancers can respond differently to a given therapy making it difficult and costly to achieve an effective clinical treatment regimen.

Accordingly, there is a substantial need for new methods and active agents that are effective in inhibiting the growth of tumors.

Summary of the InventionThe present invention provides methods for inhibiting tumor cell proliferation by administering to a patient in need thereof an amount effective of angiotensinogen, angiotensin I (AI), AI analogues, AI fragments and analogues thereof, angiotensin II (AII), All analogues, All fragments or analogues thereof or All AT2 type 2 receptor agonists, either alone, combined, or in further combination with known therapeutic methods for inhibiting tumor cell proliferation, such as surgery, cytokine therapy, hormone therapy, and antihormone therapy. In a preferred embodiment, the tumor comprises an adenocarcinoma. In a further preferred embodiment, the tumor comprises an adenocarcinoma of ovarian, endometrial, uterine, or breast origin.

Detailed Description of the Preferred EmbodimentsUnless otherwise indicated, the term"angiotensin converting enzyme inhibitors"or "ACE inhibitors"includes any compound that inhibits the conversion of the decapeptide angiotensin I to angiotensin II, and include but are not limited to alacepril, alatriopril, altiopril calcium, ancovenin, benazepril, benazepril hydrochloride, benazeprilat, benzazepril, benzoylcaptopril, captopril, captopril-cysteine, captopril-glutathione, ceranapril, ceranopril, ceronapril, cilazapril, cilazaprilat, converstatin, delapril, delapril-diacid, enalapril, enalaprilat, enalkiren, enapril, epicaptopril, foroxymithine, fosfenopril, fosenopril, fosenopril sodium, fosinopril, fosinopril sodium, fosinoprilat, fosinoprilic acid, glycopril, hemorphin-4, idapril, imidapril, indolapril, indolaprilat, libenzapril,STDC0666 lisinopril, lyciumin A, lyciumin B, mixanpril, moexipril, moexiprilat, moveltipril, muracein A, muracein B, muracein C, pentopril, perindopril, perindoprilat, pivalopril, pivopril, quinapril, quinapril hydrochloride, quinaprilat, ramipril, ramiprilat, spirapril, spirapril hydrochloride, spiraprilat, spiropril, spiropril hydrochloride, temocapril, temocapril hydrochloride, teprotide, trandolapril, trandolaprilat, utibapril, zabicipril, zabiciprilat, zofenopril and zofenoprilat. (See for example Jackson, et al.,Renin and Angiotensin in Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th ed., eds. Hardman, et al. (McGraw Hill, 1996); and U. S.STDC0494 Patent No. 5,977,159.)Unless otherwise indicated, the term"active agents"as used herein refers to the group of compounds comprising angiotensinogen, angiotensin I (AI), AI analogues, AI fragments and analogues thereof, angiotensin II (AII), All analogues, All fragments or analogues thereof or All AT2 type 2 receptor agonists, either alone, combined, or in further combination with other compounds, for inhibiting tumor cell proliferation.

As used herein, the term"tumor"includes refers to tumor types including but not limited to carcinomas, which as used herein refers to tumors originating in the epithelial cells of an organ. In a preferred embodiment, the tumor type is an adenocarcinoma, which as used herein refers to a subclass of carcinomas that originate in a glandular portion of an organ. In a more preferred embodiment, the organ in which the adenocarcinoma originates is selected from the group consisting of ovarian, endometrial, uterine, and breast tissues, most preferably from endometrial or breast tissue.

While not being limited in any way by a mechanism of action of the active agents in inhibiting tumor cell proliferation, it is proposed that the active agents may be more active inhibiting proliferation of hormone-dependent tumors, including but not limited to those of ovarian, endometrial, uterine, and breast origin.

As used herein, the term"amount effective to inhibit tumor cell proliferation"is taken to mean an appropriate quantity of one or more active agents, that when administered to a subject in need thereof, results in a slowing or stopping of the rate of progression of tumor cell growth, and/or that decreases the size of a pre-existing tumor in a subject. The active agents thus act as chemotherapeutic agents for inhibiting tumor cell proliferation and tumor growth in a patient in need thereof, and thus further chemotherapeutic agents are not needed.

U. S. Patent No. 5,015,629 to DiZerega (the entire disclosure of which is hereby incorporated by reference) describes a method for increasing the rate of healing of wound tissue, comprising the application to such tissue of angiotensin II (AII) in an amount which is sufficient for said increase. The application of All to wound tissue significantly increases the rate of wound healing, leading to a more rapid re-epithelialization and tissue repair. The term All refers to an octapeptide present in humans and other species having the sequence AspArg-Val-Tyr-Ile-His-Pro-Phe [SEQ ID NO : 1].STDC0747 The biological formation of angiotensin is initiated by the action of renin on the plasma substrate angiotensinogen (CirculationResearch 60: 786-790 (1987); Clouston et al., Genomics 2: 240-248 (1988); Kageyama et al.,Biochemistry 23: 3603-3609; Ohkubo et al., Proc. Natl. Acad. Sci. 80: 2196-2200 (1983)); all references hereby incorporated in their entirety). The substance so formed is a decapeptide called angiotensin I (AI) which is converted to All by the converting enzyme angiotensinase which removes the C-terminal His-Leu residues from AI, Asp-Arg-Val-Tyr-Ile-His-Pro-PheHis-Leu [SEQ ID NO : 37]. All is a known pressor agent and is commercially available.

Studies have shown that All increases mitogenesis and chemotaxis in cultured cells that are involved in wound repair, and also increases their release of growth factors and extracellular matrices (diZerega, U. S. Patent No. 5,015,629; Dzau et. al., J. Mol. Cell.

Cardiol. 21: S7 (Supp III) 1989; Berk et. al., Hypertension 13: 305-14 (1989); Kawahara, et al., BBRC 150: 52-9 (1988); Naftilan, et al., J Clin. Invest. 83: 1419-23 (1989); Taubman et al., J. Biol. Chem. 264: 526-530 (1989); Nakahara, et al., BBRC 184: 811-8 (1992); Stouffer and Owens, Circ. Res. 70: 820 (1992); Wolf, et al., Am. J. Pathol. 140: 95-107 (1992); Bell and Madri, Am. J. Pathol. 137: 7-12 (1990)). In addition, All was shown to be angiogenic in rabbit corneal eye and chick chorioallantoic membrane models (Fernandez, et al., J. Lab.

Clin. Med. 105: 141 (1985); LeNoble, et al., Eur. J. Pharmacol. 195: 305-6 (1991)).

We have previously demonstrated that angiotensinogen, angiotensin I (AI), AI analogues, AI fragments and analogues thereof, angiotensin II (AII), All analogues, All fragments or analogues thereof ; All AT2 type 2 receptor agonists are effective in accelerating wound healing, the proliferation of certain cell types, and are effective when used as adjuncts to chemotherapy or radiation therapy to treat patients in need of such treatment. See, for example, co-pending U. S.STDC0784 Patent Application Serial Nos. 08/126,370, filed September 24, 1993; 09/208,337, filed December 9,1998; 09/108,478,09/434,746 filed November 5, 1999; 09/503,872, filed February 14,2000; 08/990,664, filed December 15,1997; 09/210,249, filedDecember 11,1998; 09/098,806, filed November 24,1998; 09/012,400, filed January 23, 1998; 09/264,563, filed March 8,1999; 09/287,674, filed April 7,1999; 09/307,940, filedMay 10,1999; 09/246,162, filed February 8,1999; 09/255,136, filed February 19,1999; 09/245,680, filed February 8,1999; 09/250,703, filed February 15,1999; 09/246,525, filedFebruary 8,1999; 09/266,293, filed March 11,1999; 09/332,582, filed June 14,1999; 09/373,962, filed August 13,1999; 09/352,191, filed July 12,1999; as well as issued U. S.

Patent Nos. 5,015,629; 5,629,292; 5,716,935; 5,834,432; 5,955,430; 6,096,709; 6,110,895; 6,165,978; and 6,177,407.

The effect of All on a given cell type has been hypothesized to be dependent, in part, upon the All receptor subtypes the cell expresses (Shanugam et al., Am. J. Physiol. 268: F922F930 (1995); Helin et al., Annals of Medicine 29: 23-29 (1997); Bedecs et al., Biochem J.

325: 449-454 (1997)). These studies have shown that All receptor subtype expression is a dynamic process that changes during development, at least in some cell types. All activity is typically modulated by either or both the AT1 and AT2 All receptors. However, All has recently been shown to stimulate proliferation of primary human keratinocytes via a nonAT1, non-AT2 receptor. (Steckelings et al., Biochem. Biophys. Res. Commun. 229: 329-333 (1996)). These results underscore the cell-type (ie: based on receptor expression) specific nature of All activity.

Many studies have focused upon AII (1-7) (All residues 1-7) (SEQ ID NO : 4) or other fragments of All to evaluate their activity. These studies suggest that the All fragment AII (1- 7) acts through one or more receptors that are distinct from the AT1 and AT2 receptors that modulate All activity. (Ferrario et al., J. Am. Soc. Nephrol. 9: 1716-1722 (1998); Iyer et al.,Hypertension 31: 699-705 (1998); Freeman et al., Hypertension 28: 104 (1996); Ambuhl et al., Brain Res. Bull. 35: 289 (1994)). Thus, AII (1-7) activity on a particular cell type cannot be predicted based solely on the effect of All on the same cell type. In fact, there is evidence that AII (1-7) often opposes the actions of All.STDC0469 (See, for example, Ferrario et al.,Hypertension 30: 535-541 (1997))AII (1-7) (SEQ ID NO : 4) has been shown to inhibit smooth muscle cell proliferation, and to reduce smooth muscle cell growth after vascular injury (Strawn et al., Hypertension 33: 207-211 (1999)). A (II), in contrast, is known to increase proliferation of smooth muscle cells (Mueck, et al., Int. J. Clin. Pharmacol. Ther., 37 (7): 365-6 (1999)).

The ACE inhibitor captopril has been shown to have antitumor activity in a xenograft mouse model of human renal cell carcinoma, although proliferation of renal carcinoma cells in vitro was not inhibited by captopril (Hii et al., Br. J. Cancer 77 (6): 880-83 (1998)). Similar in vitro studies have demonstrated that captopril can inhibit proliferation of human mammary ductal carcinoma cells (Small Jr., et al., Breast Cancer Res. Treat., 44 (3): 217-24 (1997)) as well as hamster pancreatic duct carcinoma cells (Reddy, et al., Proc. Soc. Exp. Biol. Med., 210 (3): 221-6 (1995)).

Clinical treatments employing All in combination with chemotherapeutic agents such as mitomycin C and 5-FU (5-fluorouracil), have been used against liver metastasis from gastric cancer, but were not effective in controlling recurrences of metastatic growth (Iwasaki et al., Gan To Kagaku Ryoho 22 (11): 1674-78 (1995); Iwasaki et al., Gan To Kagaku Ryoho 25 (9): 1412-15 (1998); Ohashi et al., Gan To Kagaku Ryoho 26 (12): 1777-80 (1999)). All has been shown to increase rat pituitary tumor cell proliferation in vitro (Kunert-Radek andPawlikowski, Biochem. Biophys. Res. Commun., 183 (1) : 27-30 (1992)).

Based on the above, there would be no expectation by one of skill in the art that the active agents of the present invention could be used to treat and prevent tumor cell proliferation.

A peptide agonist selective for the AT2 receptor (All has 100 times higher affinity forAT2 than AT1) is p-aminophenylalanine6-AII ["(p-NH2-Phe) 6-AII)"], Asp-Arg-Val-Tyr-IleXaa-Pro-Phe [SEQ ID NO. 36] wherein Xaa is p-NH2-Phe (Speth and Kim, BBRC 169: 9971006 (1990). This peptide gave binding characteristics comparable to AT2 antagonists in the experimental models tested (Catalioto, et al., Eur. J. Pharmacol. 256: 93-97 (1994); Bryson, et al., Eur. J. Pharmacol. 225: 119-127 (1992).

The effects of AII and All receptor antagonists have been examined in two experimental models of vascular injury and repair which suggest that both All receptor subtypes (AT1 and AT2) play a role in wound healing (Janiak et al., Hypertension 20: 737-45 (1992); Prescott, et al., Am. J. Pathol. 139: 1291-1296 (1991); Kauffman, et al., Life Sci.

49: 223-228 (1991); Viswanathan, et al., Peptides 13: 783-786 (1992); Kimura, et al., BBRC 187: 1083-1090 (1992)).

As hereinafter defined, a preferred class of AT2 agonists for use in accordance with the present invention comprises All analogues or active fragments thereof having p-NH2-Phe in a position corresponding to a position 6 of All. In addition to peptide agents, various nonpeptidic agents (e. g., peptidomimetics) having the requisite AT2 agonist activity are further contemplated for use in accordance with the present invention.

The active agents of particular interest in accordance with the present invention comprise a sequence of at least three contiguous amino acids of groups Rl-R8 in the sequence of general formula I R1-R2-R3-R4-R5-R6-R7-R8 wherein R'is selected from the group consisting of H, Asp, Glu, Asn, Acpc (1-aminocyclopentane carboxylic acid), Ala, Me2Gly, Pro, Bet, Glu (NH2), Gly,Asp (NH2) and Suc, R2 is is selected from the group consisting of Arg, Lys, Ala, Citron, Orn,Ser (Ac), Sar, D-Arg and D-Lys, R3 is selected from the group consisting of Val, Ala, Leu, norLeu, Ile, Gly,Lys, Pro, HydroxyPro, Aib, Acpc and Tyr;STDC0696 R4 is selected from the group consisting of Tyr, Tyr (P03) 2, Thr, Ser, homoSer, azaTyr, and Ala;R5 is selected from the group consisting of Ile, Ala, Leu, norLeu, Val and Gly; R6 is selected from the group consisting of His, Arg or 6-NH2-Phe ; R is selected from the group consisting of Pro or Ala; and R8 is selected from the group consisting of Phe, Phe (Br), Ile and Tyr, excluding sequences including R4 as a terminal Tyr group.

In alternate embodiments, the active agents comprise a sequence of at least four, five, six, or seven contiguous amino acids of groups Rl-R8 in the sequence of general formula I.

In a further alternative, the active agents consist of a sequence of at least four, five, six, or seven contiguous amino acids of groups R'-R in the sequence of general formula I.

Compounds falling within the category of AT2 agonists useful in the practice of the invention include the All analogues set forth above subject to the restriction that R6 is p-NH2- Phe.

Particularly preferred combinations for Rl and R2 are Asp-Arg, Asp-Lys, Glu-Arg andGlu-Lys. Particularly preferred embodiments of this class comprise the following amino acid sequences: All [SEQ ID NO : 1] ; AIII or AII (2-8), Arg-Val-Tyr-Ile-His-Pro-Phe [SEQ IDNO : 2]; AII (3-8), also known as desl-AIII or AIV, Val-Tyr-Ile-His-Pro-Phe [SEQ ID NO : 3] ;AII (1-7), Asp-Arg-Val-Tyr-Ile-His-Pro [SEQ ID NO : 4]; AII (2-7), Arg-Val-Tyr-Ile-His-Pro [SEQ ID NO : 5] ; AII (3-7), Val-Tyr-Ile-His-Pro [SEQ ID NO : 6]; AII (5-8), Ile-His-Pro-Phe [SEQ ID NO : 7]; AII (1-6), Asp-Arg-Val-Tyr-Ile-His [SEQ ID NO : 8]; AII (1-5), Asp-Arg-Val Tyr-Ile [SEQ ID NO : 9];STDC0565 AII (1-4), Asp-Arg-Val-Tyr [SEQ ID NO : 10]; and AII (1-3), AspArg-Val [SEQ ID NO : 11]. Other preferred embodiments include: Arg-norLeu-Tyr-Ile-HisPro-Phe [SEQ ID NO : 12] and Arg-Val-Tyr-norLeu-His-Pro-Phe [SEQ ID NO : 13]. Still another preferred embodiment encompassed within the scope of the invention is a peptide having the sequence Asp-Arg-Pro-Tyr-Ile-His-Pro-Phe [SEQ ID NO : 31]. AII (4-8), Tyr-Ile- His-Pro-Phe [SEQ ID NO : 15] was also tested and found not to be effective.

Another class of compounds of particular interest in accordance with the present invention are those of the general formula IIR2-R3-R4-R5-R6-R7-R8 in which R2 is selected from the group consisting of H, Arg, Lys, Ala, Orn,Citron, Ser (Ac), Sar, D-Arg and D-Lys;R3 is selected from the group consisting of Val, Ala, Leu, norLeu, Ile, Gly,Pro, Hydroxy-Pro, Aib, Acpc and Tyr;R4 is selected from the group consisting of Tyr, Tyr (P03) 2, Thr, Ser, homoSer, azaTyr, and Ala; Rs is selected from the group consisting of Ile, Ala, Leu, norLeu, Val andGly;R6 is His, Arg or 6-NH2-Phe ;STDC0149 R is Pro or Ala; and R8 is selected from the group consisting of Phe, Phe (Br), Ile and Tyr.

A particularly preferred subclass of the compounds of general formula II has the formula R'-R'-Tyr-R'-His-Pro-Phe [SEQ ID NO : 16] wherein R2, R3 and R are as previously defined. Particularly preferred compounds include peptides having the structures Arg-Val-Tyr-Gly-His-Pro-Phe [SEQ ID NO : 17] andArg-Val-Tyr-Ala-His-Pro-Phe [SEQ ID NO : 18]. The fragment AII (4-8) was ineffective in repeated tests; this is believed to be due to the exposed tyrosine on the N-terminus.

Other particularly preferred embodiments include: 1GD Ala4-AII (1-7) DRVAIHP SEQ ID NO : 38 2GD Pro3-AII (1-7) DRPYIHP SEQ ID NO : 39 5GD Lys3-AII (1-7) DRKYIHP SEQ ID NO : 40 9GD NorLeu-AII (1-7) DR (nor) YIHP SEQ ID NO : 41 GSD 28 Ile8-AII DRVYIHPI SEQ ID NO : 42Ala3aminoPhe6 AIII DRAYIF*PF SEQ ID NO : 43Ala3-AIII RVAIHPF SEQ ID NO : 44Gly'-AII GRVYIHPF SEQ ID NO : 45 NorLeu4-AIII--RVYnLHPF SEQ ID NO :STDC0844 46 Acpc3-AII DR (Acpc) YIHPF SEQ ID NO : 47 GSD 37B Orn2-AII D (Orn) VYIHPF SEQ ID NO : 48GSD38B Citrons-All D (Citron) VYIHPF SEQ ID NO : 49 3GD Pro3Ala4-AII (1-7) DRPAIHP SEQ ID NO : 50 8GD Hydroxy-Pro3-AII (1-7) DRP (OH) AIHP SEQ ID NO : 51 Thus, in further embodiments of the invention, the active agents comprise an amino acid sequence selected from the group consisting of any one of SEQ ID NOS: 1-51. In an further embodiment, the active agent does not consist of All (SEQ ID NO : 1). In a further embodiment, the active agent comprises the amino acid sequence of SEQ ID NO : 4 (AII (1- 7)).STDC0232 In a further embodiment, the active agent consists of the amino acid sequence of any ofSEQ ID NOS: 1-51. In a further preferred embodiment, the active agent consists of the amino acid of SEQ ID NO : 4.

In the above formulas, the standard three-letter abbreviations for amino acid residues are employed. In the absence of an indication to the contrary, the L-form of the amino acid is intended. Other residues are abbreviated as follows: TABLE 1Abbreviation for Amino AcidsEMI11.1 Me2Gly <SEP> N, <SEP> N-dimethylglycyl<tb> Bet <SEP> 1-carboxy-N, <SEP> N, <SEP> N-trimethylmethanaminium <SEP> hydroxide <SEP> inner<tb> <SEP> salt <SEP> (betaine)<tb> Suc <SEP> Succinyl<tb> Phe(Br)-bromo-L-henylalanyl<tb> azaTyr <SEP> aza-αSTDC0673'-homo-L-tyrosyl<tb> Acpc <SEP> 1-aminocyclopentane <SEP> carboxylic <SEP> acid<tb> Aib <SEP> 2-aminoisobutyric <SEP> acid<tb> Sar <SEP> N-methylglycyl <SEP> (sarcosine)<tb> Cit <SEP> Citron<tb> Om <SEP> Omithine<tb> It has been suggested that All and its analogues adopt either a gamma or a beta turn (Regoli, et al., Pharmacological Reviews 26: 69 (1974). In general, it is believed that neutral side chains in position R3, Rs and R7 may be involved in maintaining the appropriate distance between active groups in positions R4, R6 and R8 primarily responsible for binding to receptors and/or intrinsic activity.STDC0224 Hydrophobic side chains in positions R3, R and Rg may also play an important role in the whole conformation of the peptide and/or contribute to the formation of a hypothetical hydrophobic pocket.

Appropriate side chains on the amino acid in position R2 may contribute to affinity of the compounds for target receptors and/or play an important role in the conformation of the peptide. For this reason, Arg and Lys are particularly preferred as R2. Alternatively, R2 may be H, Ala, Orn, Citron, Ser (Ac), Sar, D-Arg, or D-Lys.

For purposes of the present invention, it is believed that R3 may be involved in the formation of linear or nonlinear hydrogen bonds with Rs (in the gamma turn model) or R6 (in the beta turn model). R3 would also participate in the first turn in a beta antiparallel structure (which has also been proposed as a possible structure). In contrast to other positions in general formula I, it appears that beta and gamma branching are equally effective in this position. Moreover, a single hydrogen bond may be sufficient to maintain a relatively stable conformation. Accordingly, R3 may suitably be selected from Lys, Val, Ala, Leu, norLeu, Ile, Gly, Pro, Hydroxy-Pro, Aib, Acpc and Tyr.

With respect to R4, conformational analyses have suggested that the side chain in this position (as well as in R3 and R5) contribute to a hydrophobic cluster believed to be essential for occupation and stimulation of receptors. Thus, R4 is preferably selected from Tyr, Thr,Tyr (P03) 2, homoSer, Ser and azaTyr. In this position, Tyr is particularly preferred as it may form a hydrogen bond with the receptor site capable of accepting a hydrogen from the phenolic hydroxyl (Regoli, et al. (1974), supra). It has also been found that R4 can be Ala.

In position R5, an amino acid with a P aliphatic or alicyclic chain is particularly desirable. Therefore, while Gly is suitable in position R5, it is preferred that the amino acid in this position be selected from Ile, Ala, Leu, norLeu, and Val.

In position R6, His, Arg or 6-NH2-Phe are preferred. The unique properties of the imidazole ring of histidine (e. g., ionization at physiological pH, ability to act as proton donor or acceptor, aromatic character) are believed to contribute to its particular utility as R6. For example, conformational models suggest that His may participate in hydrogen bond formation (in the beta model) or in the second turn of the antiparallel structure by influencing the orientation of R. Similarly, it is presently considered that R should be Pro or Ala in order to provide the most desirable orientation of R. In position R8,STDC0258 both a hydrophobic ring and an anionic carboxyl terminal appear to be particularly useful in binding of the analogues of interest to receptors; therefore, Tyr, Ile, Phe (Br), and especially Phe are preferred for purposes of the present invention.

Other active agents of particular interest include the following:TABLE 2Angiotensin II AnaloguesEMI13.1 <tb> All <SEP> Amino <SEP> Acid <SEP> Sequence <SEP> Sequence<tb> Analogue <SEP> Identifier<tb> Name<tb> Analogue <SEP> 1 <SEP> Asp-Arg-Val-Tyr-Val-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 19<tb> Analogue <SEP> 2 <SEP> Asn-Arg-Val-Tyr-Val-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 20<tb> Analogue <SEP> 3 <SEP> Ala-Pro-Gly-Asp-Arg-Ile-Tyr-Val-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 21<tb> Analogue <SEP> 4 <SEP> Glu-Arg-Val-Tyr-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 22<tb> Analogue <SEP> 5 <SEP> Asp-Lys-Val-Tyr-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 23<tb> Analogue <SEP> 6 <SEP> Asp-Arg-Ala-Tyr-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO:STDC0809 <SEP> 24<tb> Analogue <SEP> 7 <SEP> Asp-Arg-Val-Thr-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 25<tb> Analogue <SEP> 8 <SEP> Asp-Arg-Val-Tyr-Leu-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 26<tb> Analogue <SEP> 9 <SEP> Asp-Arg-Val-Tyr-Ile-Arg-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 27<tb> Analogue <SEP> 10 <SEP> Asp-Arg-Val-Tyr-Ile-His-Ala-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 28<tb> Analogue <SEP> 11 <SEP> Asp-Arg-Val-Tyr-Ile-His-Pro-Tyr <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 29<tb> Analogue <SEP> 12 <SEP> Pro-Arg-Val-Tyr-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 30<tb> Analogue <SEP> 13 <SEP> Asp-Arg-Pro-Tyr-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 31<tb> Analogue <SEP> 14 <SEP> Asp-Arg-Val-Tyr <SEP> (P03) <SEP> 2-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO:STDC0614 <SEP> 32<tb> Analogue <SEP> 15 <SEP> Asp-Arg-norLeu-Tyr-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 33<tb> Analogue <SEP> 16 <SEP> Asp-Arg-Val-Tyr-norLeu-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 34<tb> Analogue <SEP> 17 <SEP> Asp-Arg-Val-homoSer-Tyr-Ile-His-Pro-Phe <SEP> SEQ <SEP> ID <SEP> NO: <SEP> 35<tb> The polypeptides of the instant invention may be synthesized by any conventional method, including, but not limited to, those set forth in J. M. Stewart and J. D. Young, SolidPhase Peptide Synthesis, 2nd ed., Pierce Chemical Co., Rockford, 111. (1984) and J.

Meienhofer, Hormonal Proteins and Peptides, Vol. 2, Academic Press, New York, (1973) for solid phase synthesis and E. Schroder and K. Lubke, The Peptides, Vol. 1, Academic Press,New York, (1965) for solution synthesis. The disclosures of the foregoing treatises are incorporated by reference herein.

In general, these methods involve the sequential addition of protected amino acids to a growing peptide chain (U. S. Patent No. 5,693,616, herein incorporated by reference in its entirety). Normally, either the amino or carboxyl group of the first amino acid and any reactive side chain group are protected. This protected amino acid is then either attached to an inert solid support, or utilized in solution, and the next amino acid in the sequence, also suitably protected, is added under conditions amenable to formation of the amide linkage.

After all the desired amino acids have been linked in the proper sequence, protecting groups and any solid support are removed to afford the crude polypeptide. The polypeptide is desalted and purified, preferably chromatographically, to yield the final product.

Preferably, peptides are synthesized according to standard solid-phase methodologies, such as may be performed on an Applied Biosystems Model 430A peptide synthesizer (Applied Biosystems, Foster City, Calif.), according to manufacturer's instructions. Other methods of synthesizing peptides or peptidomimetics, either by solid phase methodologies or in liquid phase, are well known to those skilled in the art.

Alternatively, the peptides can be produced by standard molecular biological techniques.

One embodiment the present invention provides for pharmaceutical compositions comprising an effective amount of one or more of the active agents of the present invention to inhibit tumor cell proliferation, in combination with a pharmaceutically acceptable carrier.

In another embodiment, of the present invention provides for a method of inhibiting tumor cell proliferation by contacting tumor cells with an amount effective of one or more of the active agents of the present invention, or pharmaceutical compositions thereof, such that tumor cell proliferation is inhibited.

In yet another embodiment, the present invention provides methods for the inhibition of tumor cell proliferation by administering to a patient in need thereof an amount effective to inhibit tumor cell proliferation of one or more of the active agents or pharmaceutical compositions of the invention, either alone or in further combination with other compounds and methods effective for inhibiting tumor cell proliferation.

In each of these embodiments, it is preferred that the tumor comprises a carcinoma, more preferably an adenocarcinoma. In a more preferred embodiment, the organ in which the adenocarcinoma originates is selected from the group consisting of ovarian, endometrial, uterine, and breast tissues, most preferably from endometrial or breast tissue.

The active agents may be made up in a solid form (including granules, powders or suppositories) or in a liquid form (e. g., solutions, suspensions, or emulsions), and may be subjected to conventional pharmaceutical operations such as sterilization and/or may contain conventional adjuvants, such as stabilizers, wetting agents, emulsifiers, preservatives, cosolvents, suspending agents, viscosity enhancing agents, ionic strength and osmolality adjustors and other excipients in addition to buffering agents. Suitable water soluble preservatives which may be employed in the drug delivery vehicle include sodium bisulfite, sodium thiosulfate, ascorbate, benzalkonium chloride, chlorobutanol, thimerosal, phenylmercuric borate, parabens, benzyl alcohol, phenylethanol or antioxidants such as Vitamin E and tocopherol and chelators such as EDTA and EGTA.STDC0159 These agents may be present, generally, in amounts of about 0.001% to about 5% by weight and, preferably, in the amount of about 0.01 to about 2% by weight.

For administration, the active agents are ordinarily combined with one or more adjuvants appropriate for the indicated route of administration. The compounds may be admixed with lactose, sucrose, starch powder, cellulose esters of alkanoic acids, stearic acid, talc, magnesium stearate, magnesium oxide, sodium and calcium salts of phosphoric and sulphuric acids, acacia, gelatin, sodium alginate, polyvinylpyrrolidine, and/or polyvinyl alcohol, and tableted or encapsulated for conventional administration. Alternatively, the compounds of this invention may be dissolved in saline, water, polyethylene glycol, propylene glycol, carboxymethyl cellulose colloidal solutions, ethanol, corn oil, peanut oil, cottonseed oil, sesame oil, tragacanth gum, and/or various buffers. Other adjuvants and modes of administration are well known in the pharmaceutical art.STDC0174 The carrier or diluent may include time delay material, such as glyceryl monostearate or glyceryl distearate alone or with a wax, or other materials well known in the art.

A large variety of alternatives are known in the art as suitable for purposes of sustained release and are contemplated as within the scope of the present invention. Suitable delivery vehicles include, but are not limited to, the following: microcapsules or microspheres; liposomes and other lipid-based release systems; crystalloid and viscous instillates; absorbable and/or biodegradable mechanical barriers ; and polymeric delivery materials, such as polyethylene oxide/polypropylene oxide block copolymers (e. g. poloxamers), poly-orthoesters, cross-linked polyvinyl alcohol, polyanhydrides, polymethacrylate and polymethacryladmide hydrogels, anionic carbohydrate polymers, etc.

Useful delivery systems are well known in the art and are described in, e. g., U. S. Pat. No.

4,937,254, the entire disclosure of which is hereby incorporated by reference.

For use in treating or preventing tumor cell proliferation, the active agents may be administered by any suitable route, including local delivery, parentally, transdermally, or dermally in dosage unit formulations containing conventional pharmaceutically acceptable carriers, adjuvants, and vehicles. The term parenteral as used herein includes, subcutaneous, intravenous, intramuscular, intrasternal, intratendinous, intraspinal, intracranial, intrathoracic, infusion techniques or intraperitoneally.

Local delivery of the active agents of the invention can be by a variety of techniques that administer the agent at or near the site of neoplastic growth. Examples of site-specific or targeted local delivery techniques are not intended to be limiting but to be illustrative of the techniques available. Examples include local delivery catheters, such as an infusion catheter, an indwelling catheter, or a needle catheter, stets, synthetic grafts, adventitial wraps, shunts and stents or other implantable devices, site specific carriers, direct injection, or direct applications. (U. S. Patent 5,981,568, incorporated by reference herein in its entirety.)Local delivery by an implant describes the surgical placement of a matrix that contains the active agent into the tumor or immediate surrounding area.STDC0159 The implanted matrix can release the active agent by diffusion, chemical reaction, or solvent activators. See, for example, Lange, Science, 249,1527 (1990).

Another example is a delivery system in which a polymer that contains the active agent is injected into the area of the tumor in liquid form. The polymer then solidifies or cures to form an implant that is retained in situ. This technique is described in PCT WO 90/03768 (Donn, Apr. 19,1990), the disclosure of which is incorporated by reference herein.

For topical administration, the active agents may be formulated as is known in the art for direct application to a target area. Conventional forms for this purpose include wound dressings, coated bandages or other polymer coverings, ointments, lotions, pastes, jellies, sprays, and aerosols. The percent by weight of the active agent of the invention present in a topical formulation will depend on various factors, but generally will be from 0.005% to 95% of the total weight of the formulation, and typically 1-25% by weight.

The dosage regimen for treating or preventing tumor cell growth with the active agents is based on a variety of factors, including the age, weight, sex, medical condition of the individual, the severity of the condition, the route of administration, and the particular compound employed. Thus, the dosage regimen may vary widely, but can be determined by a physician. Dosage levels of the order of between 0.1 ng/kg and 10 mg/kg of the active agents per body weight are useful for all methods of use disclosed herein.

In a preferred method of treatment, an amount effective of the active agents or pharmaceutical compositions comprising the active agents to inhibit tumor cell proliferation is administered to a patient in need of such treatment as soon as possible following diagnosis of a tumorigenic growth.

In another aspect of the invention, pharmaceutical compositions are provided that comprise an amount effective to treat or prevent tumor cell proliferation of one or more of the active agents of the invention alone or in combination with other anti-tumor agents, including but not limited to angiotensin converting enzyme inhibitors and angiogenesis inhibitors.

The present invention, by providing methods for treating or preventing tumor cell proliferation is broadly useful to treat or inhibit tumor cell growth. It will be recognized that the active agents and dosage forms (both free and sustained release) of the invention are not restricted in use for therapy following other methods such as surgical excision. Thus, other aspects of the invention include therapeutic conjugates, dosage forms, and protocols useful in sustained therapeutic intervention for reducing, delaying, or eliminating further tumor cell growth.

EXAMPLE 1 : Human Tumor Cell Clonigenic Assay Samples 1-30 PURPOSE: The purpose this study is to evaluate the effect of an angiotensin peptide,AII (1-7) (SEQ ID NO : 4) on human tumor cell proliferation.

TEST SYSTEM:Species: Human, discarded primary tumorsParameters Measured: Tumor Cell ProliferationTest Article: AII (1-7), 0.1 ng/ml-10pg/ml (1.1 x 10-1 to 1.1 x 10-5 M)METHODSTumor Cell Preparation Primary and metastatic tumors obtained from the Department of Obstetrics andGynecology Pathology Section and the Surgical Pathology Division of Los Angeles County/University of Southern California were minced into pieces less than 2 mm in diameter in the presence of RPMI-1640 (Gibco, Grand Island, NTY) containing 15% heatinactivated fetal calf serum. Each gram of tumor tissue was treated with 10-20 mL of enzyme medium, consisting of Hanks'balanced salt solution with 0.03% DNAse (500 Kunitz units/mL; Sigma Chemical Co., St.STDC0051 Louis, MO) and 0.14% collagenase type I (Sigma).

Tumor fragments were stirred for 90 minutes at 37 C in the presence of 5% CO2. After enzymatic digestion, the free cells were decanted through 40-gauge mesh strainers and centrifuged at 200 x g for 10 minutes. The supernatant was removed and viable cells were resuspended in RPMI 1640. The cell number was determined using a hematocytometer and 0.04% trypan blue dye. The cells were then centrifuged and the pellet resuspended in RPMI 1640 at 5 x 105 cells/mL.

Tumor Cell CultureHuman cancer cells were obtained from operative specimens provided by the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, or the Department ofSurgical Pathology of Los Angeles County/University of Southern California School ofMedicine. Tumor cells were maintained in vitro in RPMI 1640 medium supplemented with 15% heat-inactivated fetal calf serum, 100 llg/mL streptomycin, fungizone 25 llg/mL, and 100 p/mL penicillin.

Clonigenic AssayCells were cultured on an underlayer of 0.5% agarose (Bethesda Research Labs,Bethesda, MD) prepared from a 3% stock of agarose with added penicillin (100 units/mL), streptomycin (100, ug/mL), and fungizone (1.25 g/mL) (GIBCO) as per a modification of an established procedure. The cloning efficiency of this assay varied depending upon the source of the tissue. One milliliter of this 0.5% agarose mixture was added to each 16 x 16-mm well of a 24-well plate and the plates were refrigerated for 10 minutes at 4 C. Cells were suspended in 0.6% agarose in RPMI-1640 supplemented with antibiotics and 15% fetal calf serum.STDC0223 One aliquot (0.5 mL) of cell suspension was added to each underlaver at a final concentration of 5 X 104 cells/well, and the plates were refrigerated 10 minutes at 4 C.

AII (1-7) (SEQ ID NO : 4) was added to samples as an overlayer in 300 L of RPMI1640 medium in concentrations from 0.1 ng to 10 pg/well. Positive controls were prepared as above, but the overlayer did not contain AII (1-7). Negative controls were prepared by omitting fetal calf serum from the cell suspension and AII (1-7) from the overlayer.STDC0508 After a 72-hour incubation at 37 C, 5 pCi of tritiated thymidine (specific activity 18.2 Ci/mmol; NewEngland Nuclear, Boston, MA) was layered over each well, and the plates were returned to the incubator for an additional 24 hours, incorporation of thymidine was terminated by transferring the agarose layers to 10-mL glass centrifuge tubes (Kimble, Division of Owens,IL) and boiling the tubes for 15 minutes in a water bath.STDC0850 The volume was brought to 8 mL, the tubes were centrifuged, and the pellets were washed with phosphate-buffered saline and then dissolved in 3 mL of 0.85 N KOH for 1 hour at 80 C. The tubes were cooled on ice and the hydrolysates were precipitated by adding 30 L of 1% human serum albumin (Sigma) and 2.4 mL of ice-cold trichloroacetic acid. After overnight storage at 4 C, precipitates were collected by centrifugation. Pellets were washed with 5% trichloroacetic acid, dissolved in 0.3 mL of 0.075 N KOH, and transferred to scintillation vials to which 5 mL of Liquiscint (National Diagnostics, Somerville, NJ) were added. Radioactivity per vial was measured in aNuclear-Chicago liquid scintillation counter.

RESULTSVarious tumor types were isolated directly from cancer patients have been obtained and assayed in this clonigenic system. The results are summarized in Table 3 below, and calculated IC50 data for samples in which AII (1-7) decreased proliferation (as well as some negative controls) are presented in Table 4.

Table 3. Effect of AII (1-7) on the Proliferation of Selected Human Primary TumorCells.EMI21.1 <tb>

Sample <SEP> Number <SEP> Effect <SEP> of <SEP> Diagnosis<tb> <SEP> AII <SEP> (1-7)<tb> Sample <SEP> 1 <SEP> No <SEP> Effect <SEP> Leiomyosarcoma<tb> Sample <SEP> 2 <SEP> Decreased <SEP> Ovarian <SEP> papillary <SEP> serous <SEP> carcinoma<tb> Sample <SEP> 3 <SEP> No <SEP> Effect <SEP> Ovarian <SEP> carcinoma-clear <SEP> cell<tb> Sample <SEP> 4 <SEP> Decreased <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 5 <SEP> Equivocal <SEP> Metastatic <SEP> uterine <SEP> carcinosarcoma <SEP> to <SEP> the<tb> <SEP> ovary<tb> Sample <SEP> 6 <SEP> No <SEP> Effect <SEP> Serous <SEP> tumor <SEP> of <SEP> low <SEP> malignant <SEP> potential<tb> Sample <SEP> 7 <SEP> Decreased <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 8 <SEP> Decreased <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 9 <SEP> Decreased <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 10

<SEP> No <SEP> Effect <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 11 <SEP> No <SEP> Effect <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 12 <SEP> No <SEP> Effect <SEP> Squamous <SEP> Cell <SEP> Carcinoma <SEP> of <SEP> the <SEP> Cervix,<tb> <SEP> gr <SEP> 3<tb> Sample <SEP> 13 <SEP> No <SEP> Effect <SEP> Metastatic <SEP> Ovarian <SEP> Papillary <SEP> Carcinoma<tb> <SEP> to <SEP> Omentum<tb> Sample <SEP> 14 <SEP> No <SEP> Growth <SEP> Squamous <SEP> Cell <SEP> Carcinoma <SEP> of <SEP> Lung<tb> Sample <SEP> 15 <SEP> No <SEP> Growth <SEP> Metastatic <SEP> Ovarian <SEP> Papillary <SEP> Carcinoma<tb> Sample <SEP> 16 <SEP> No <SEP> Effect <SEP> Ovarian <SEP> Cancer-High <SEP> Grade <SEP> Clear <SEP> Cell<tb> <SEP> Carcinoma<tb> EMI22.1 <tb> Sample <SEP> 17 <SEP> No <SEP> Effect <SEP> Uterine <SEP> Carcinosarcoma<tb> Sample <SEP> 18 <SEP> No <SEP>

Effect <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 19 <SEP> No <SEP> Effect <SEP> Recurrent <SEP> moderately <SEP> differentiated<tb> <SEP> colonic <SEP> adenocarcinoma<tb> Sample <SEP> 20 <SEP> Decreased <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 21 <SEP> No <SEP> Effect <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 22 <SEP> Decreased <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 23 <SEP> Decreased <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 24 <SEP> Decreased <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 25 <SEP> Decreased <SEP> Colon <SEP> adenocarcinoma<tb> Sample <SEP> 26 <SEP> Variable <SEP> Metastatic <SEP> colon <SEP> adenocarcinoma<tb> Sample <SEP> 27 <SEP> Decreased <SEP> Ovarian <SEP> adenocarcinoma<tb> Sample <SEP> 28 <SEP> Decreased <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 29 <SEP> No <SEP>

Effect <SEP> Invasive, <SEP> moderately <SEP> differentiated<tb> <SEP> adenocarcinoma <SEP> of <SEP> colon<tb> Sample <SEP> 30 <SEP> No <SEP> Effect <SEP> Cystic <SEP> poorly <SEP> differentiated <SEP> endometroid<tb> <SEP> carcinoma <SEP> of <SEP> ovary<tb> Sample <SEP> 31 <SEP> Decreased <SEP> Ovarian <SEP> Serous <SEP> papillary <SEP> carcinoma<tb> Sample <SEP> 32 <SEP> Decreased <SEP> Ovarian <SEP> adenocarcinoma<tb> Sample <SEP> 33 <SEP> No <SEP> Effect <SEP> Ovarian <SEP> adenocarcinoma<tb> Sample <SEP> 34 <SEP> No <SEP> Effect <SEP> Metastatic, <SEP> recurrent <SEP> moderately <SEP> to<tb> <SEP> poorly <SEP> differentiated <SEP> colonic<tb> <SEP> adenocarcinoma<tb> Sample <SEP> 35 <SEP> No <SEP> Growth <SEP> Colonic <SEP> adenocarcinoma, <SEP> Gr <SEP> 3-4,STDC0761<tb> <SEP> moderately <SEP> to <SEP> poorly <SEP> differentiated<tb> Sample <SEP> 36 <SEP> Decreased <SEP> Colonic <SEP> adenocarcinoma, <SEP> Gr <SEP> 3-4,<tb> <SEP> moderately <SEP> to <SEP> poorly <SEP> differentiated<tb> Sample <SEP> 37 <SEP> Decreased <SEP> Cervical <SEP> squamous <SEP> cell <SEP> carcinoma<tb> Table 4. IC50 Data EMI22.2 <tb> Sample <SEP> Number <SEP> IC50 <SEP> (ng/ml) <SEP> Diagnosis<tb> <SEP> of <SEP> AII <SEP> (1-7)<tb> Sample <SEP> 2 <SEP> 3. <SEP> 0 <SEP> Ovarian <SEP> papillary <SEP> serous <SEP> carcinoma<tb> Sample <SEP> 4 <SEP> 1. <SEP> 0 <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 7 <SEP> 2. <SEP> 73 <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 8 <SEP> 1.STDC0847 <SEP> 0 <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 9 <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 10 <SEP> No <SEP> Effect <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 11 <SEP> No <SEP> Effect <SEP> Endometrial <SEP> adenocarcinoma<tb> EMI23.1 <tb> Sample <SEP> 18 <SEP> No <SEP> Effect <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 20 <SEP> 0. <SEP> 3 <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 21 <SEP> No <SEP> Effect <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 22 <SEP> 0. <SEP> 1 <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 23 <SEP> 4. <SEP> 0 <SEP> Endometrial <SEP> adenocarcinoma<tb> Sample <SEP> 24 <SEP> 4. <SEP> 25 <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 25 <SEP> 4. <SEP> 75 <SEP> Colon <SEP> adenocarcinoma<tb> Sample <SEP> 27 <SEP> 3.STDC0732 <SEP> 6 <SEP> Ovarian <SEP> adenocarcinoma<tb> Sample <SEP> 28 <SEP> 2. <SEP> 97 <SEP> Breast <SEP> adenocarcinoma<tb> Sample <SEP> 31 <SEP> 2. <SEP> 34 <SEP> Ovarian <SEP> Serous <SEP> papillary <SEP> carcinoma<tb> Sample <SEP> 32 <SEP> 3. <SEP> 4 <SEP> Ovarian <SEP> adenocarcinoma<tb> Sample <SEP> 36 <SEP> 2.55 <SEP> Colonic <SEP> adenocarcinoma, <SEP> Gr <SEP> 3-4,<tb> <SEP> moderately <SEP> to <SEP> poorly <SEP> differentiated<tb> Sample <SEP> 37 <SEP> 2. <SEP> 73 <SEP> Cervical <SEP> squamous <SEP> cell <SEP> adenocarcinoma<tb> A statistical Chi Square analysis of the results reveals that AII (1-7) displays statistically significant tumor-type specificity:1) Uterine adenocarcinoma:STDC0174 5 decreased, 2 not affected (71.4% affected), remaining tumors not of this origin 11 decreased, 16 not affected (40.7% affected). p value: 0.306.

2) Breast infiltrating ductal adenocarcinoma: 4 decreased, 2 not affected (66.7% affected), remaining tumors not of this origin 12 decreased, 16 not affected (42% affected). p value: 0.5423) Uterine adenocarcinoma and breast infiltrating ductal adenocarcinoma: 9 decreased, 4 not affected (69.2% affected), remaining tumors not of this origin 7 decreased, 14 not affected (33.3% affected). p value: 0.0924) Uterine, ovarian and breast adenocarcinomas: 11 decreased (68.8%), 5 not affected (31.2%), remaining tumors not of this origin 5 decreased (27.8%), 13 not affected (72.2%) p value 0.0415) All adenocarcinoma: 14 decreased, 8 not affected (63.6% affected), remaining tumors not of this origin 2 decreased, 10 not affected (16.7% affected). p value: 0.024.