WO2018195471A1 - Syk inhibitors in combination with hypomethylating agents - Google Patents

Syk inhibitors in combination with hypomethylating agents Download PDF

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Publication number
WO2018195471A1
WO2018195471A1 PCT/US2018/028636 US2018028636W WO2018195471A1 WO 2018195471 A1 WO2018195471 A1 WO 2018195471A1 US 2018028636 W US2018028636 W US 2018028636W WO 2018195471 A1 WO2018195471 A1 WO 2018195471A1
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Prior art keywords
pyrazin
methyl
pyrido
oxy
phenyl
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PCT/US2018/028636
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French (fr)
Inventor
Esteban M. Abella
Antonio Mario Querido Marcondes
Arati V. Rao
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Gilead Sciences, Inc.
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Publication of WO2018195471A1 publication Critical patent/WO2018195471A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/4985Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445Non condensed piperidines, e.g. piperocaine
    • A61K31/4523Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
    • A61K31/454Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. pimozide, domperidone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/70Carbohydrates; Sugars; Derivatives thereof
    • A61K31/7042Compounds having saccharide radicals and heterocyclic rings
    • A61K31/7052Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides
    • A61K31/706Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00Antineoplastic agents
    • A61P35/02Antineoplastic agents specific for leukemia

Definitions

  • the present disclosure relates to methods of treatment of diseases and disorders using combinations of hypomethylating agents and compounds that inhibit Spleen Tyrosine Kinase (SYK) activity.
  • SYK Spleen Tyrosine Kinase
  • HMAs hypomethylating agents
  • decitabine azacitidine
  • CMML chronic myelomonocytic leukaemia
  • MDS Myelodysplastic syndromes
  • AML acute myeloid leukemia
  • Lenalidomide is approved by the FDA for the treatment of patients with low or intermediate- 1 risk MDS with 5q-, with or without additional cytogenetic abnormalities.
  • Spleen Tyrosine Kinase is a member of the family of non-receptor tyrosine kinases, and is a regulator of early B-cell development as well as mature B-cell activation, signaling, and survival. SYK has roles in immunoreceptor- and integrin- mediated signaling in a variety of cell types, including B-cells, macrophages, monocytes, mast cells, eosinophils, basophils, neutrophils, dendritic cells, T-cells, natural killer cells, platelets, and osteoclasts. The inhibition of Syk activity can be useful for the treatment of cancers and inflammatory diseases.
  • a hypomethylating agent can be selected from 5-aza-2'-deoxycytidine (azacitidine) and 5-aza-2'-deoxycytidine (decitabine), or a pharmaceuticall acceptable salt thereof.
  • the myeloproliferative disorder is selected from myelodysplastic syndromes (MDS), acute myeloid leukemia (AML) and chronic myelomonocytic leukaemia (CMML).
  • MDS myelodysplastic syndromes
  • AML acute myeloid leukemia
  • CMML chronic myelomonocytic leukaemia
  • ALL acute lymphocytic leukemia
  • AML acute myeloid leukemia
  • CLL chronic lymphocytic leukemia
  • SLL small lymphocytic lymphoma
  • MPL myeloproliferative leukemia
  • MDS myelodysplastic syndrome
  • MPD myeloproliferative disease
  • CML chronic myeloid leukemia
  • MM multiple myeloma
  • NHL non-Hodgkin's lymphoma
  • MCL mantle cell lymphoma
  • follicular lymphoma Waldenstrom's macroglobulinemia
  • T-cell lymphoma B-cell lymphoma
  • DLBCL diffuse large B-cell lymphoma
  • pancreatic cancer bladder cancer, colorectal cancer, breast cancer, prostate cancer, renal cancer, hepatocellular cancer, lung cancer, ovarian cancer, cervical cancer, gastric cancer, esophageal cancer, head and neck
  • myeloproliferative disorders comprising the administration of an effective amount of lenalidomide or antithymocyte globulin, and a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof.
  • the myeloproliferative disorder is selected from MDS, AML and CMML.
  • the patient has received or is a candidate for receiving allogeneic stem cell transplantation wherein one or more hypomethylating agents is administered in combination with one or more SYK inhibitors.
  • the SYK inhibitor is selected from:
  • myelodysplastic syndrome is refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, or chronic myelomonocytic leukemia.
  • the myelodysplastic syndrome is Low-risk, Intermediate- 1, Intermediate-2 or High-risk in international prognostic scoring system (IPSS).
  • the myelodysplastic syndrome is primary or secondary to radiotherapy or chemotherapy.
  • the patient has a del(5q), in particular, Del5q31-33 abnormality.
  • the SYK inhibitor is administered prior to administering the hypomethylating agent. In some embodiments, the SYK inhibitor is administered after administering the hypomethylating agent. In some embodiments, the SYK inhibitor is administered concurrently with the hypomethylating agent.
  • the SYK inhibitor is administered prior to administering lenalidomide or antithymocyte globulin. In some embodiments, the SYK inhibitor is administered after administering lenalidomide or antithymocyte globulin. In some embodiments, the SYK inhibitor is administered concurrently with lenalidomide or antithymocyte globulin.
  • treatment is an approach for obtaining beneficial or desired results including clinical results.
  • beneficial or desired clinical results may include one or more of the following:
  • "delaying" the development of a disease or condition means to defer, hinder, slow, retard, stabilize, and/or postpone development of the disease or condition. This delay can be of varying lengths of time, depending on the history of the disease or condition, and/or subject being treated.
  • a method that "delays" development of a disease or condition is a method that reduces probability of disease or condition development in a given time frame and/or reduces the extent of the disease or condition in a given time frame, when compared to not using the method. Such comparisons are typically based on clinical studies, using a statistically significant number of subjects.
  • Disease or condition development can be detectable using standard methods, such as routine physical exams, mammography, imaging, or biopsy. Development may also refer to disease or condition progression that may be initially undetectable and includes occurrence, recurrence, and onset.
  • compositions and methods when used to define compositions and methods, shall mean excluding other elements of any essential significance to the compositions and methods for the intended use, but not excluding elements that do not materially affect the characteristic(s) of the compositions or methods.
  • Consisting of or its grammatic variants shall mean excluding elements not specifically recited. Embodiments defined by each of these transition terms are within the scope of this disclosure. For example, when a composition is described as comprising ingredients A, B and C, a composition consisting essentially of A, B and C, and a composition consisting of A, B and C are independently within the scope of this disclosure.
  • a pharmaceutically acceptable carrier includes reference to one and more than one pharmaceutically acceptable carriers.
  • the term "about” means within ⁇ 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%), 0.1%), or 0.05%) of a given value or range.
  • about means ⁇ 5% of a given value or range.
  • about means ⁇ 4% of a given value or range.
  • about means ⁇ 3% of a given value or range.
  • about means ⁇ 2% of a given value or range. In another embodiment, about means ⁇ 1%> of a given value or range. In another embodiment, about means ⁇ 0.5% of a given value or range. In another embodiment, about means ⁇ 0.05% of a given value or range.
  • the term "about x" includes the value "x.”
  • administer refers to introducing an agent into a patient.
  • a therapeutic amount can be administered.
  • administering when used in connection with a compound or composition (and grammatical equivalents) refer both to direct administration, which may be administration to a patient by a medical professional or by self-administration by the patient, and/or to indirect administration, which may be the act of prescribing a drug.
  • Alkyj encompasses straight chain and branched chain having the indicated number of carbon atoms, usually from 1 to 20 carbon atoms, for example 1 to 8 carbon atoms, such as 1 to 6 carbon atoms.
  • C J -C 6 alkyl encompasses both straight and branched chain alkyl of from 1 to 6 carbon atoms.
  • alkyl groups include methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, tert-butyl, pentyl, 2-pentyl, isopentyl, neopentyl, hexyi, 2-hexyl, 3-hexyl, 3-methyipentyl, and the like.
  • Alkyl en e is another subset of alkyl, referring to the same residues as alkyl, but having two points of attachment.
  • Alkylene groups will usually have from 2 to 20 carbon atoms, for example 2 to 8 carbon atoms, such as from 2 to 6 carbon atoms.
  • Co alkylene indicates a covending bond and Ci alkylene is a methylene group.
  • Ci alkylene is a methylene group.
  • alkyl residue having a specific number of carbons all geometric isomers having that number of carbons are intended to be encompassed; thus, for example, ''butyl” is meant to include n-butyl, sec-butyl, isobutyl and t-butyl; “propyl” includes n-propyl and isopropyl.
  • “Lower alkyl” refers to alkyl groups having 1 to 4 carbons.
  • Cycloalkyl indicates a saturated hydrocarbon ring group, having the specified number of carbon atoms, usually from 3 to 10 ring carbon atoms.
  • Examples of cy cloalkyl groups include cyclopropyl, cyclobutyl, cyclopentyi, and cyclohexyl as well as bridged and caged saturated ring groups such as norbomane.
  • Alkoxy refers to an alkyl group of the indicated number of carbon atoms attached through an oxygen bridge such as, for example, methoxy, ethoxy, propoxy, isopropoxy, n-butoxy, sec-butoxy, tert-butoxy, pentoxy, 2-pentyloxy, isopentoxy, neopentoxy, hexoxy, 2-hexoxy, 3-hexoxy, 3-methylpentoxy, and the like. Alkoxy groups will usually have from 1 to 6 carbon atoms attached through the oxygen bridge. "Lower alkoxy” refers to alkoxy groups having 1 to 4 carbons.
  • Acyl refers to the groups (alkyl)-C(O)-; (cycloalkyl)-C(Q)-; (aryl)-C(O)-; (heteroaryl)-C(O)-; and (heterocycloalkyl)-C(O)-, wherein the group is attached to the parent structure through the carbonyi functionality and wherein alkyl, cycloalkyl, aryl, heteroaryl, and heterocycloalkyl are as described herein.
  • Acyl groups have the indicated number of carbon atoms, with the carbon of the keto group being included in the numbered carbon atoms.
  • a C 2 acyl group is an acetyl group having the formula
  • a C l-Cealkoxy carbonyl group is an alkoxy group having from 1 to 6 carbon atoms attached through its oxygen to a carbonyl linker.
  • Amino refers to the group -NHz.
  • Aryl encompasses 6 to 14-membered carbocyclic aromatic rings, for example, benzene; bicyclic ring systems wherein at least one ring is carbocyclic and aromatic, for example, naphthalene, indane, and tetra!in; and tricyclic ring systems wherein at least one ring is carbocyclic and aromatic, for example, fluorene.
  • aryl includes phenyl fused to a 5 to 7-membered cycloalkyl ring. For such fused ring systems wherein only one of the rings is a carbocyclic aromatic ring, the point of attachment may be at the carbocyclic aromatic ring or the cycloalkyl ring.
  • Aryl does not encompass or overlap in any ⁇ way with heteroaryl, separately defined below. Hence, if one or more carbocyclic aromatic rings is fused with a heterocycloalkyl aromatic ring, the resulting ring system is heteroaryl, not aryl, as defined herein.
  • halo includes fluoro, chloro, bromo, and iodo, and the term
  • halogen includes fluorine, chlorine, bromine, and iodine.
  • Heteroaryl encompasses 5 to 14-membered aromatic, monocyclic rings containing one or more, for example, from 1 to 4, or In some embodiments, from 1 to 3, heteroatonis chosen from N, O, and S, with the remaining ring atoms being carbon; and bicyclic rings containing one or more, for example, from 1 to 4, or in some embodiments, from 1 to 3, ring heteroatoms chosen from N, O, and S, with the remaining ring atoms being carbon and wherein at least one heteroatom is present in an aromatic ring.
  • heteroaryl includes a 5- to 7-membered heterocycloalkyl, aromatic ring fused to a 5- to 7- membered cycloalkyl ring.
  • the point of attachment may be at the
  • heteroaromatic ring or the cycloalkyl ring When the total number of S and O atoms in the heteroaryl group exceeds I, those heteroatoms are not adjacent to one another. In some embodiments, the total number of S and O atoms in the heteroaryl group is not more than 2. In some embodiments, the total number of S and O atoms in the aromatic heterocycle is not more than 1. Examples of heteroary!
  • groups include, but are not limited to, (as numbered from the linkage position assigned priority 1), 2-pyridyl, 3-pyridyl, 4-pyridyl, 2,3-pyrazinyl, 3,4-pyrazinyl, 2,4-pyrimidinyl, 3,5-pyrimidinyl, 2,3-pyrazolinyl, 2,4-imidazolinyl, isoxazolinyl, oxazolinyl, thiazoiiny], thiadiazoiinyl, tetrazoiyl, thienyl, benzolhiophenyl, furanyl, benzofuranyi, benzoimidazolinyl, indoiinyl, pyridizinyl, triazolyl, quinolinyl, pyrazoiyl, and 5,6,7,8-tetrahydroisoquino3ine. Heteroary! does not encompass or overlap with ary! as defined above. Substitute
  • heteroaryloxy refers to the group -O-heteroaryl.
  • heterocycloalkyl is meant a single aliphatic ring, usually with 3 to 14 ring atoms, containing at least 2 carbon atoms in addition to 1-3 heteroatoms independently- selected from oxygen, sulfur, and nitrogen, as well as combinations comprising at least one of the foregoing heteroatoms.
  • Suitable heterocyc!oalkyl groups include, for example (as numbered from the linkage position assigned priority 1), 2-pyrrolinyl, 2,4-imidazolidinyl, 2,3-pyrazolidinyl, 2-piperidyl, 3-piperidyl, 4-piperdyi, and 2,5-piperzinyl. Morpholiny!
  • heterocycloalkyl also includes ring systems substituted with one or more oxo moieties, such as piperidinyl N-oxide,
  • Heterocycloalkyl also includes bicyclic ring systems wherein neither of the rings is aromatic and wherein at least one of the rings in the bicyclic ring system contains at least 2 carbon atoms in addition to 1-3 heteroatoms independently chosen from oxygen, sulfur, and nitrogen.
  • substituted means that any one or more hydrogens on the designated atom or group is replaced with a selection from the indicated group, provided that the designated atom's normal valence is not exceeded.
  • substituents and/or variables are permissible only if such combinations result in stable compounds or useful synthetic intermediates.
  • a stable compound or stable structure is meant to imply a compound that is sufficiently robust to survive isolation from a reaction mixture, and subsequent formulation as an agent having at least practical utility.
  • substituents are named into the core structure. For example, it is to be understood that when (cycloalkyl)alkyl is listed as a possible substituent, the point of attachment of this substituent to the core structure is in the alkyl portion.
  • substituted alkyl, cycloalkyl, aryl, heterocycloalkyl, and heteroaryl refer respectively to alkyl, cycloalkyl, aryl,
  • heterocycloalkyl and heteroaryl wherein one or more (such as up to 5, for example, up to 3) hydrogen atoms are replaced by a substituent independently chosen from -R a , -OR b , -0(Ci- C2 alkyl)0- (e.g., methylenedioxy-), -SR b , guanidine, guanidine wherein one or more of the guanidine hydrogens are replaced with a lower-alkyl group, -NR ⁇ , halo, cyano, oxo (as a substituent for heterocycloalkyl), nitro, -COR b , -C02R b , -CONR ⁇ , -OCOR b , -OCO2R 11 , -OCONR ⁇ , -NR c COR b , -NRTOiR 8 , -NR c CONR b R c , -SOR a , -SOaR 8
  • R a is chosen from optionally substituted C1-C6 alkyl, optionally substituted cycloalkyl, optionally substituted aryl, optionally substituted heterocycloalkyl, and optionally substituted heteroaryl;
  • R b is chosen from H, optionally substituted C1-C6 alkyl, optionally substituted cycloalkyl, optionally substituted aryl, optionally substituted heterocycloalkyl, and optionally substituted heteroaryl;
  • R c is chosen from hydrogen and optionally substituted C1-C4 alkyl
  • R b and R c and the nitrogen to which they are attached, form an optionally substituted heterocycloalkyl group
  • each optionally substituted group is unsubstituted or independently substituted with one or more, such as one, two, or three, substituents independently selected from C1-C4 alkyl, C3-C6 cycloalkyl, aryl, heteroaryl, aryl-Ci-C4 alkyl-, heteroaryl -C1-C4 alkyl-, C1-C4 haloalkyl-, -OC1-C4 alkyl, -OC1-C4 alkylphenyl, -C1-C4 alkyl-OH, -C1-C4 alkyl-0-C1-C4 alkyl, -OC1-C4 haloalkyl, halo, -OH, -NH2, -C1-C4 alkyl-NIfc, -N(C1-C 4 alkyl)(Ci-C 4 alkyl), -NH(Ci-C 4 alkyl), -N(Ci-C 4 al
  • substituted acyl refers to the groups (substituted alkyl)-C(O)-;
  • substituted alkoxy refers to alkoxy wherein the alkyl constituent is substituted (i.e., -0-(substituted alkyl)) wherein “substituted aikyi” is as described herein,
  • substituted alkoxycarbonyl refers to the group (substituted alkyl)-0- C(O)- wherein the group is attached to the parent staicture through the carbonyl functionality and wherein "substituted aikyi" is as described herein.
  • substituted heteroaryl oxy refers to heteroaryloxy wherein the aryl constituent is substituted (i .e., -0-(substituted heteroaryl)) wherein “substituted heteroaryl” is as described herein.
  • substituted cycioalkyloxy refers to cycloalkyloxy wherein the cvcloalkyl constituent is substituted (i .e., -0-(substituted cycloalkyl)) wherein “substituted cvcloalkyl” is as described herein.
  • substituted amino refers to the group -NHR d or -NR a R d where each R d is independently chosen from; hydroxy, optionally substituted alkyl, optionally substituted cycloalkyl, optionally substituted acyl, aminocarbonyl, optionally substituted aryl, optionally substituted heteroaryl, optionally substituted heterocycloalkyl,
  • alkoxycarbonyl, sulfinyl and sulfonyi provided that only one R d may be hydroxyl, and wherein substituted alkyl, cycloalkyl, aryl, heterocycloalkyl, and heteroaryl refer respectively to alkyl, cycloalkyl, aryl, heterocycloalkyl, and heteroaryl wherein one or more (such as up to 5, for example, up to 3) hydrogen atoms are replaced by a substituent independently selected from -R a , -OR b , -0(Ci-C2 alkyl)0- (e.g., methylenedioxy-), -SR b , guanidine, guanidine wherein one or more of the guanidine hydrogens are replaced with a lower-alkyl group, -NR b R c , halo, cyano, nitro, -COR b , -CO?.R b , -CONR b
  • substituted amino also refers to N-oxides of the groups -NHR d , and NR d R d each as described above.
  • N-oxides can be prepared by treatment of the corresponding amino group with, for example, hydrogen peroxide or m-chloroperoxybenzoic acid. The person skilled in the art is familiar with reaction conditions for carrying out the N-oxidation.
  • “Pharmaceutically acceptable” refers to a material that is not biologically or otherwise undesirable, e.g., the material may be incorporated into a pharmaceutical composition administered to a patient without causing any significant undesirable biological effects or interacting in a deleterious manner with any of the other components of the composition in which it is contained.
  • Pharmaceutically acceptable vehicles e.g., carriers, adjuvants, and/or other excipients
  • “Pharmaceutically acceptable salts” include, for example, salts with inorganic acids and salts with an organic acid.
  • Examples of salts may include hydrochlorate, phosphate, diphosphate, hydrobromate, sulfate, sulfinate, nitrate, malate, maleate, fumarate, tartrate, succinate, citrate, acetate, lactate, mesylate, p-toluenesulfonate, 2- hydroxy ethyl sulfonate, benzoate, salicylate, stearate, and alkanoate (such as acetate, HOOC- (CH2)n-COOH where n is 0-4).
  • alkanoate such as acetate, HOOC- (CH2)n-COOH where n is 0-4
  • the free base can be obtained by basifying a solution of the acid salt.
  • an addition salt particularly a pharmaceutically acceptable addition salt, may be produced by dissolving the free base in a suitable organic solvent and treating the solution with an acid, in accordance with conventional procedures for preparing acid addition salts from base compounds.
  • solvate refers to a crystal form with either a stoichiometric or non-stoichiometric amount of solvent incorporated into the crystal structure.
  • hydrate refers specifically to a crystal form with either a stoichiometric or non-stoichiometric amount of water incorporated into the crystal structure.
  • co-crystal refers to crystalline structure of a compound and one or more co-crystal formers connected through non-covalent interactions. Co-crystals may additionally be present in anhydrous, solvated or hydrated forms. In some embodiments, there is no hydrogen transfer between the compound and the co-crystal former in the crystalline structure.
  • Prodrugs means any compound which releases an active parent drug in vivo when such prodrug is administered to a patient.
  • Prodrugs may be prepared by modifying functional groups present in the compounds in such a way that the modifications are cleaved, either in routine manipulation or in vivo, to the parent compounds.
  • Examples of prodrugs include, but are not limited to esters (e.g., acetate, formate, and benzoate derivatives), amides, guanidines, carbamates (e.g., ⁇ , ⁇ -dimethylaminocarbonyl) of a hydroxy functional group in a compound, and the like.
  • Tautomer means compounds produced by the phenomenon wherein a proton of one atom of a molecule shifts to another atom.
  • the tautomers also refer to one of two or more structural isomers that exist in equilibrium and are readily converted from one isomeric form to another.
  • keto-enol tautomers such as acetone/propen- 2-ol, imine-enamine tautomers and the like
  • ring-chain tautomers such as glucose/2,3, 4,5,6- pentahydroxy-hexanal and the like
  • Certain compounds may have one or more tautomers and therefore include various isomers. All such isomeric forms of these compounds are expressly included in the present disclosure.
  • “Isomers” mean compounds having identical molecular formulae but differ in the nature or sequence of bonding of their atoms or in the arrangement of their atoms in space. “Stereoisomer” and “stereoisomers” refer to compounds that exist in different
  • stereoisomenc forms if they possess one or more asymmetric centers or a double bond with asymmetric substitution and, therefore, can be produced as individual stereoisomers or as mixtures.
  • Stereoisomers include enantiomers and diastereomers.
  • Stereoisomers that are not mirror images of one another are termed “diastereomers” and those that are non- superimposable mirror images of each other are termed “enantiomers.”
  • enantiomers stereoisomers that are not mirror images of one another
  • enantiomers those that are non- superimposable mirror images of each other.
  • An enantiomer can be characterized by the absolute configuration of its asymmetric center and is described by the R- and S-sequencing rules of Cahn and Prelog, or by the manner in which the molecule rotates the plane of polarized light and designated as dextrorotatory or levorotatory (i.e., as (+) or (-)-isomers respectively).
  • a chiral compound can exist as either individual enantiomer or as a mixture thereof.
  • a mixture containing equal proportions of the enantiomers is called a "racemic mixture.” Unless otherwise indicated, the description is intended to include individual stereoisomers as well as mixtures.
  • therapeutically effective amount refers to an amount that may be effective to elicit the desired biological or medical response, including the amount of a compound that, when administered to a subject for treating a disease, is sufficient to effect such treatment for the disease.
  • the effective amount may vary depending on the compound, the disease or condition being treated and its severity, the subject including the age, weight, etc., of the subject to be treated, and the manner of administering, which can readily be determined by one of ordinary skill in the art.
  • the effective amount can include a range of amounts.
  • a pharmaceutically effective amount includes amounts of an agent which are effective when combined with other agents.
  • patient refers to a mammal that is treated with a method as described herein, including but not limited to, a human, other primates, sports animals, animals of commercial interest such as cattle, farm animals such as horses, or pets such as dogs and cats.
  • the patient is a human.
  • provided herein are methods for treating a
  • myeloproliferative disorder comprising the administration of an effective amount of a hypomethylating agent and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof.
  • the hypomethylating agent can be selected from 5-aza-2'-deoxycytidine (azacitidine) and 5-aza-2'-deoxycytidine (decitabine), or a pharmaceutically acceptable salt thereof.
  • MDS myelodysplastic syndromes
  • hypomethylating agent and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof.
  • the hypomethylating agent can be selected from 5-aza-2'-deoxycytidine (azacitidine) and 5-aza-2'-deoxycytidine (decitabine), or a pharmaceutically acceptable salt thereof.
  • a method of treating a myeloproliferative disorder comprising administering to a patient in need thereof, a therapeutically effective amount of lenalidomide or a pharmaceutically acceptable salt thereof, and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor.
  • SYK spleen tyrosine kinase
  • provided herein are methods for treating
  • myeloproliferative disorders comprising the administration of an effective amount of antithymocyte globulin or a pharmaceutically acceptable salt thereof, and a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof.
  • SYK spleen tyrosine kinase
  • the myeloproliferative disorder is selected from MDS, A ML and CMML.
  • a method of treating Intermediate- 1 or Low risk myelodysplastic syndrome in a patient in need thereof comprising administering a therapeutically effective amount of a spleen tyrosine kinase inhibitor to said patient.
  • myelodysplastic syndrome is refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, or chronic myelomonocytic leukemia.
  • the myelodysplastic syndrome is Low-risk, Intermediate- 1, Intermediate-2 or High risk in international prognostic scoring system (IPSS).
  • the myelodysplastic syndrome is primary or secondary to radiotherapy or chemotherapy.
  • the patient has a del(5q), in particular, Del5q31-33 abnormality.
  • the patient has been previously treated or untreated for MDS.
  • the patient has a de novo MDS.
  • De novo MDS refers to an MDS that has arisen without an obvious or specific cause.
  • the patient has a secondary MDS.
  • Secondary MDS is an MDS that is found to have been caused by specific reasons and includes two general types: the first type is MDS that seems to have arisen from another bone marrow failure disorder or bone marrow cancer.
  • the second type of secondary MDS relates to cancer therapies for other cancers, including chemotherapy and radiation therapy, and is also referred to as treatment-related MDS or therapy-related MDS.
  • the patient has a de novo or secondary MDS of French- American- British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia).
  • myelodysplasia is associated with multilineage dysplasia.
  • myelodysplastic syndrome associated with an isolated del(5q), in particular, Del5q31-33 chromosome abnormality, or
  • SYK inhibitors can be used in the methods described herein.
  • R 1 is phenyl substituted with one or two groups chosen from
  • cycloalkyl optionally substituted with one or two groups chosen from hydroxy, lower alkoxy, and lower alkyl
  • heterocycloalkyl optionally substituted with one or two groups chosen from hydroxy, lower alkoxy, lower alkyl, lower alkyl substituted with hydroxy, optionally substituted amino, and oxo
  • R 6 and R 7 are independently selected from hydrogen, lower alkyl, lower alkyl substituted with hydroxy, lower alkyl substituted with optionally substituted amino, cycloalkyl, aryl, heteroaryl, and
  • heterocycloalkyl or R 6 and R 7 together with the nitrogen to which they are bound form a 3- to 7-membered heterocycloalkyl ring optionally substituted with one or two groups chosen from hydroxy, lower alkyl, and lower alkyl substituted with hydroxy,
  • R 6 and R 7 are independently selected from hydrogen, lower alkyl, lower alkyl substituted with hydroxy, lower alkyl substituted with optionally substituted amino, cycloalkyl, aryl, heteroaryl, and
  • heterocycloalkyl or R 6 and R 7 together with the nitrogen to which they are bound form a 3- to 7-membered heterocycloalkyl ring optionally substituted with one or two groups chosen from hydroxy, lower alkyl, and lower alkyl substituted with hydroxy, provided that at least one of R 6 and R 7 is not hydrogen,
  • lower alkoxy optionally substituted with one or two groups chosen from hydroxy, lower alkoxy, optionally substituted amino, carboxy, aminocarbonyl, and heterocycloalkyl,
  • lower alkyl optionally substituted with one or two groups chosen from hydroxy, lower alkoxy, halo, trifluoromethyl, optionally substituted amino, and heterocycloalkyl optionally substituted with lower alkyl; or wherein A is chosen from aryl, cycloalkyl and heterocycloalkyl groups, each of which groups having from 5 to 7 ring atoms including the atoms shared with the 6 membered aromatic ring and each of which groups being optionally substituted;
  • R 2 is chosen from optionally substituted aryl and optionally substituted heteroaiyl
  • R 3 is hydrogen
  • R 4 is hydrogen
  • R 5 is hydrogen
  • the '811 patent discloses the following SYK inhibitors: N-(3,4- dimethoxyphenyl)-6-(3-methylphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-(3-nitrophenyl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6- ⁇ 3-[(ethylamino)methyl]phenyl ⁇ imidazo[l,2-a]pyrazin-8-amine; N- (3,4-dimethoxyphenyl)-6-[3-(trifluoromethyl)phenyl]imidazo[l,2-a]pyrazin-8-amine; N- (3,4-dimethoxyphenyl)-6-(3-methoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-((3,4
  • the SYK inhibitor is Compound 1 having the formula:
  • the SYK inhibitor is a bis-mesylate salt of the above compound.
  • the SYK inhibitor is a SYK inhibitor disclosed in U.S. Patent No. 8,455,493, U.S. Patent Publication Nos. 20150038504, 20150038505,
  • the SYK inhibitor is a compound selected from:
  • the SYK inhibitor is a compound having the formula:
  • Fostamatinib R-406 or a pharmaceutically acceptable salt thereof.
  • Cyclobutanol l-[4-[5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4- b]pyrazin-7-yl]phenyl]-;
  • Ethanone l-[(2S)-2-[[[7-[4-(l-amino-2- methylpropyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-;
  • Benzeneethanol p,p-dimethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-;
  • Benzenemethanol a-(l-methylethyl)-4- [5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-;
  • Benzenemethanol a-(l,l-dimethylethyl)-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Cyclobutanecarbonitrile, l-[4-[5-[[(2S)-
  • Pyrido[3,4-b]pyrazine 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-7-[l- (tetrahydro-2H-pyran-4-yl)-lH-pyrazol-4-yl]-; Pyrido[3,4-b]pyrazine, 7-(4-methylphenyl)- 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4-b]pyrazine, 7-(4- chlorophenyl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4- b]pyrazine, 7-(l-methyl-lH-indol-5-yl)-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyljmethoxy
  • the SYK inhibitor, hypomethylating agent, lenalidomide or antithymocyte globulin may be administered using any suitable methods known in the art.
  • the compounds may be administered bucally, ophthalmically, orally, osmotically, parenterally (intramuscularly, intraperitoneally intrasternally, intravenously,
  • a SYK inhibitor may be administered with a
  • hypomethylating agent lenalidomide or antithymocyte globulin in a fixed dose
  • compositions or in separate pharmaceutical compositions, each of which can independently be administered bucally, ophthalmically, orally, osmotically, parenterally (intramuscularly, intraperitoneally intrasternally, intravenously, subcutaneously), rectally, topically, transdermally, or vaginally.
  • parenterally intramuscularly, intraperitoneally intrasternally, intravenously, subcutaneously
  • rectally topically, transdermally, or vaginally.
  • pharmaceutical compositions that contain one or more of the compounds of any of the formulae disclosed herein or a pharmaceutically acceptable salt, isomers, prodrug, or solvate thereof, and one or more pharmaceutically acceptable vehicles selected from carriers, adjuvants and excipients.
  • Suitable pharmaceutically acceptable vehicles may include, for example, inert solid diluents and fillers, diluents, including sterile aqueous solution and various organic solvents, permeation enhancers, solubilizers and adjuvants.
  • diluents including sterile aqueous solution and various organic solvents, permeation enhancers, solubilizers and adjuvants.
  • Such compositions are prepared in a manner well known in the pharmaceutical art. See, e.g., Remington's Pharmaceutical Sciences, Mace Publishing Co., Philadelphia, Pa. 17th Ed. (1985); and Modern
  • the pharmaceutical compositions may be administered in either single or multiple doses.
  • the pharmaceutical composition may be administered by various methods including, for example, rectal, buccal, intranasal and transdermal routes.
  • the pharmaceutical composition may be administered by intra-arterial injection, intravenously, intraperitoneally, parenterally, intramuscularly, subcutaneously, orally, topically, or as an inhalant.
  • the pharmaceutical composition is administered orally.
  • Oral administration may be another route for administration of the compounds described herein. Administration may be via, for example, capsule or enteric coated tablets.
  • the active ingredient is usually diluted by an excipient and/or enclosed within such a carrier that can be in the form of a capsule, sachet, paper or other container.
  • the excipient serves as a diluent, it can be in the form of a solid, semi-solid, or liquid material, which acts as a vehicle, carrier or medium for the active ingredient.
  • compositions can be in the form of tablets, pills, powders, lozenges, sachets, cachets, elixirs, suspensions, emulsions, solutions, syrups, aerosols (as a solid or in a liquid medium), ointments containing, for example, up to 10% by weight of the active compound, soft and hard gelatin capsules, sterile injectable solutions, and sterile packaged powders.
  • the pharmaceutical composition is in the form of tablets.
  • pharmaceutically acceptable carrier or “pharmaceutically acceptable excipient” includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents and the like.
  • the use of such media and agents for pharmaceutically active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions is contemplated. Supplementary active ingredients can also be incorporated into the compositions.
  • excipients include lactose, dextrose, sucrose, sorbitol, mannitol, starches, gum acacia, calcium phosphate, alginates, tragacanth, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone, cellulose, sterile water, syrup, and methyl cellulose.
  • the formulations can additionally include lubricating agents such as talc, magnesium stearate, and mineral oil; wetting agents; emulsifying and suspending agents; preserving agents such as methyl and propylhydroxy-benzoates; sweetening agents; and flavoring agents.
  • compositions that include at least one compound of any of the formulae described herein or a pharmaceutically acceptable salt, isomer, prodrug, or solvate thereof, can be formulated so as to provide quick, sustained or delayed release of the active ingredient after administration to the subject by employing procedures known in the art.
  • Controlled release drug delivery systems for oral administration include osmotic pump systems and dissolutional systems containing polymer-coated reservoirs or drug-polymer matrix formulations. Examples of controlled release systems are given in U.S. Patent Nos. 3,845,770; 4,326,525; 4,902,514; and 5,616,345.
  • Another formulation for use in the methods of the present application employs transdermal delivery devices ("patches").
  • transdermal patches may be used to provide continuous or discontinuous infusion of the compounds described herein in controlled amounts.
  • the construction and use of transdermal patches for the delivery of pharmaceutical agents is well known in the art. See, e.g., U.S. Patent Nos. 5,023,252, 4,992,445 and 5,001,139.
  • Such patches may be constructed for continuous, pulsatile, or on demand delivery of pharmaceutical agents.
  • the principal active ingredient may be mixed with a pharmaceutical excipient to form a solid preformulation composition containing a homogeneous mixture of a compound of any of the above formulae or a pharmaceutically acceptable salt, prodrug, or solvate thereof.
  • a pharmaceutical excipient When referring to these preformulation compositions as homogeneous, the active ingredient may be dispersed evenly throughout the composition so that the composition may be readily subdivided into equally effective unit dosage forms such as tablets, pills and capsules.
  • the tablets or pills of the compounds described herein may be coated or otherwise compounded to provide a dosage form affording the advantage of prolonged action, or to protect from the acid conditions of the stomach.
  • the tablet or pill can include an inner dosage and an outer dosage component, the latter being in the form of an envelope over the former.
  • the two components can be separated by an enteric layer that serves to resist disintegration in the stomach and permit the inner component to pass intact into the duodenum or to be delayed in release.
  • enteric layers or coatings such materials including a number of polymeric acids and mixtures of polymeric acids with such materials as shellac, cetyl alcohol, and cellulose acetate.
  • compositions for inhalation or insufflation may include solutions and suspensions in pharmaceutically acceptable, aqueous or organic solvents, or mixtures thereof, and powders.
  • the liquid or solid compositions may contain suitable
  • compositions are administered by the oral or nasal respiratory route for local or systemic effect.
  • compositions in pharmaceutically acceptable solvents may be nebulized by use of inert gases. Nebulized solutions may be inhaled directly from the nebulizing device or the nebulizing device may be attached to a facemask tent, or intermittent positive pressure breathing machine. Solution, suspension, or powder compositions may be administered, preferably orally or nasally, from devices that deliver the formulation in an appropriate manner.
  • the SYK inhibitor is administered prior to administering the hypomethylating agent. In some embodiments, the SYK inhibitor is administered after administering the hypomethylating agent. In some embodiments, the SYK inhibitor is administered concurrently with the hypomethylating agent.
  • the SYK inhibitor is administered prior to administering lenalidomide or antithymocyte globulin. In some embodiments, the SYK inhibitor is administered after administering lenalidomide or antithymocyte globulin. In some embodiments, the SYK inhibitor is administered concurrently with lenalidomide or antithymocyte globulin.
  • a dosage may be expressed as a number of milligrams of a compound of the formula per kilogram of the subject's body weight (mg/kg). Dosages of between about 0.01 and 200 mg/kg may be appropriate. In some embodiments, about 0.01 and 150 mg/kg may be appropriate. In other embodiments a dosage of between 0.05 and 100 mg/kg may be appropriate.
  • Normalizing according to the subject's body weight can be useful, for example, when adjusting dosages between subjects of widely disparate size, such as occurs when using the drug in both children and adult humans or when converting an effective dosage in a non-human subject such as dog to a dosage suitable for a human subject.
  • the daily dosage may also be described as a total amount of a compound of the formulae administered per dose or per day.
  • Daily dosage of a compound may be between about 1 mg and 2,000 mg, between about 1,000 to 2,000 mg/day, between about 1 to 1,000 mg/day, between about 1 to 500 mg/day, between about 100 to 150 mg/day, between about 1 to 100 mg/day, between about between about 1 to 50 mg/day, between about 50 to 100 mg/day, between about 100 to 125 mg/day, between about 100 to 150 mg/day, between about 100 to 175 mg/day, between about 100 to 200 mg/day, between about 100 to 225 mg/day, between about 100 to 250 mg/day, between about 100 to 350 mg/day, between about 100 to 400 mg/day, between about 100 to 450 mg/day, or between about 100 to 500 mg/day.
  • the total daily dosage for a human subject may be between 1 mg and 1,000 mg/day, between about 1 to 100 mg/day, between about 1 to 50 mg/day, between about 50 to 100 mg/day, between 50 to 300 mg/day, between 50 to 200 mg/day, between 75 to 200 mg/day, between 75 to 150 mg/day, between 100 to 200 mg/day, between about 200 to 300 mg/day, between about 300 to 400 mg/day, between about 400 to 500 mg/day, between about 100 to 150 mg/day, between about 150 to 200 mg/day, between about 200 to 250 mg/day, between about 75 to 150 mg/day, or between about 150 to 300 mg/day.
  • the daily dosage of a SYK inhibitor may be between about 1 mg and 2,000 mg, between about 1,000 to 2,000 mg/day, between about 1 to 1,000 mg/day, between about 1 to 500 mg/day, between about 100 to 150 mg/day, between about 1 to 100 mg/day, between about between about 1 to 50 mg/day, between about 50 to 100 mg/day, between about 100 to 125 mg/day, between about 100 to 150 mg/day, between about 100 to 175 mg/day, between about 100 to 200 mg/day, between about 100 to 225 mg/day, between about 100 to 250 mg/day, between about 100 to 350 mg/day, between about 100 to 400 mg/day, between about 100 to 450 mg/day, or between about 100 to 500 mg/day.
  • the daily dosage of a SYK inhibitor is about 400 mg/day.
  • the daily dosage of a SYK inhibitor is about 800 mg/day.
  • the daily dosage of a hypomethylating agent may be between about 1 mg and 2,000 mg, between about 1,000 to 2,000 mg/day, between about 1 to 1,000 mg/day, between about 1 to 500 mg/day, between about 1 to 100 mg/day, between about 1 to 90 mg/day, between about between about 1 to 80 mg/day, between about 1 to 70 mg/day, between about 1 to 60 mg/day, between about 1 to 50 mg/day, between about 1 to 40 mg/day, between about 1 to 30 mg/day, between about 1 to 20 mg/day, or between about 1 to 10 mg/day.
  • the daily dosage of decitabine may be between about 1 mg/day and 20 mg/day, such as about 20 mg/day.
  • the daily dosage of azacitidine for example, may be between about 10 and 100 mg/day, such as about 75 mg/day.
  • the daily dosage of lenalidomide may be between about 1 mg and 100 mg, between about 1 to 50 mg/day, between about 1 to 30 mg/day, between about 1 to 25 mg/day, or between about 2 to 25 mg/day.
  • the daily dosage of lenalidomide may be between about 1 mg/day and 20 mg/day, such as about 25, about 10, about 5 or about 2.5 mg/day.
  • lenalidomide is administered daily.
  • lenalidomide is administered on Days 1-21 of repeated 28-day cycles.
  • lenalidomide is administered orally at about 25 mg once daily orally on Days 1-21 of repeated 28-day cycles.
  • lenalidomide is administered
  • lenalidomide administered orally at about 10 mg once daily. In some embodiments, lenalidomide is administered orally at about 5 mg once daily. In some embodiments, lenalidomide is administered orally at about 2.5 mg once daily.
  • the daily dosage of antithymocyte globulin may be between about 1 mg and 2,000 mg, between about 1,000 to 2,000 mg/day, between about 1 to 1,000 mg/day, between about 1 to 500 mg/day, between about 10 to 400 mg/day, or between about 50 to 300 mg/day. In some embodiments, the daily dosage of antithymocyte globulin may be between about 0.1 to 10 mg/kg of body weight, between about 0.5 to 5 mg/kg of body weight, or between about 1 to 2 mg/kg of body weight.
  • the daily dosage of antithymocyte globulin may be about 0.5 mg/kg of body weight, about 1 mg/kg of body weight, about 1.5 mg/kg of body weight, about 2 mg/kg of body weight, about 2.5 mg/kg of body weight, or about 3 mg/kg of body weight.
  • antithymocyte globulin is administered consecutively for about 3 to 20 days.
  • antithymocyte globulin is administered consecutively for about 4 to 14 days.
  • antithymocyte globulin is administered consecutively for about 4 to 7 days.
  • antithymocyte globulin is administered intravenous at about 1.5 mg/kg of body weight daily for 4 to 7 days.
  • antithymocyte globulin is administered intravenous at about 1.5 mg/kg of body weight daily for 7 to 14 days.
  • the compounds of the present application or the compositions thereof may be administered once, twice, three, or four or more times daily, using any suitable mode described above.
  • the dose of a SYK inhibitor, or a pharmaceutically acceptable salt thereof is administered once daily.
  • the dose of a SYK inhibitor, or a pharmaceutically acceptable salt thereof is administered twice daily.
  • the dose of a hypomethaling agent, lenalidomide or antithymocyte globulin is administered once daily.
  • the dose of a hypomethaling agent, lenalidomide or antithymocyte globulin is administered twice daily.
  • a patient undergoing treatment with a SYK inhibitor and a hyopmethylating agent is further administered with one or more additional drugs selected from corticosteroids, glucocorticoids, mineralocorticoids, hydrocortisone, dexamethasone, cortisone, prednisone, prednisolone, methylprednisolone, dexamethasone, betamethasone, triamcinolone, beclometasone, fludrocortisone, fludrocortisone acetate, deoxycorticosterone, deoxycorticosterone acetate, or aldosterone.
  • additional drugs selected from corticosteroids, glucocorticoids, mineralocorticoids, hydrocortisone, dexamethasone, cortisone, prednisone, prednisolone, methylprednisolone, dexamethasone, betamethasone, triamcinolone, beclometasone,
  • the patient undergoing treatment with a method described herein is not being treated with a Bcl-2 inhibitor. In some embodiments, the patient undergoing treatment with a method described herein is not being treated with a vinca alkaloid.
  • SYK inhibitor as described herein
  • a hypomethylating agent lenalidomide or antithymocyte globulin, as described herein, in the treatment of a medical condition such as those described herein.
  • compositions comprising a SYK inhibitor, as described herein, and compositions comprising a
  • hypomethylating agent lenalidomide or antithymocyte globulin, as described herein, can be prepared and placed in an appropriate container, and labeled for treatment of an indicated condition. Accordingly, provided is also an article of manufacture, such as a container comprising a unit dosage form of a SYK inhibitor and a unit dosage form of a
  • the article of manufacture is a container comprising (i) a unit dosage form of a SYK inhibitor, as described herein, and one or more pharmaceutically acceptable carriers, adjuvants or excipients; and (ii) a unit dosage form of a hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, and one or more pharmaceutically acceptable carriers, adjuvants or excipients.
  • kits comprising unit dosage forms of a SYK inhibitor, as described herein, and compositions comprising a hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, and a package insert containing instructions for use of the composition in treatment of a medical condition.
  • the kits comprises (i) a unit dosage form of the SYK inhibitor, as described herein, and one or more pharmaceutically acceptable carriers, adjuvants or excipients; and (ii) a unit dosage form of a hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, and one or more pharmaceutically acceptable carriers, adjuvants or excipients.
  • the instructions for use in the kit may be for treating a cancer, including, for example, a hematologic malignancy, as further described herein.

Abstract

Provided herein are methods and compositions for treating myeloproliferative diseases and disorders. In some embodiments, the method comprises administering an effective amount of a spleen tyrosine kinase inhibitor and a hypomethylating agent, lenalidomide or antithymocyte globulin to a patient in need thereof.

Description

SYK INHIBITORS IN COMBINATION WITH HYPOMETHYLATING AGENTS
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Serial No. 62/488, 137, filed April 21, 2017, the disclosure of which is hereby incorporated herein by reference in its entirety.
FIELD
[0002] The present disclosure relates to methods of treatment of diseases and disorders using combinations of hypomethylating agents and compounds that inhibit Spleen Tyrosine Kinase (SYK) activity.
BACKGROUND
[0003] In recent years, new therapeutic strategies have been developed with the hypomethylating agents (HMAs), decitabine and azacitidine. (Santini et. al., Leukemia Research, 38 (12), 2014, 1381-1391). Currently azacitidine and decitabine are FDA approved for the treatment of myelodysplastic syndromes (MDS). Furthermore, decitabine is approved by the European Medicines Agency for MDS, multiple myeloma and mantle cell lymphoma, while azacitidine is approved for MDS, AML and chronic myelomonocytic leukaemia (CMML). Myelodysplastic syndromes (MDS) are a diverse group of myeloid neoplasms characterized by ineffective hematopoiesis resulting in peripheral blood cytopenias with a risk for transformation to acute myeloid leukemia (AML). Currently, supportive care with transfusions, hypomethylating and immunomodulatory agents remain the mainstay of therapy and allogeneic stem cell transplantation is the only curative therapy typically reserved for patients in high/INT-2 IPSS risk group. (Koreth J., Clin Oncol. 2013; 31(21): 2662-2670). Lenalidomide is approved by the FDA for the treatment of patients with low or intermediate- 1 risk MDS with 5q-, with or without additional cytogenetic abnormalities. Protein kinases, the largest family of human enzymes, encompass well over 500 proteins. Spleen Tyrosine Kinase (SYK) is a member of the family of non-receptor tyrosine kinases, and is a regulator of early B-cell development as well as mature B-cell activation, signaling, and survival. SYK has roles in immunoreceptor- and integrin- mediated signaling in a variety of cell types, including B-cells, macrophages, monocytes, mast cells, eosinophils, basophils, neutrophils, dendritic cells, T-cells, natural killer cells, platelets, and osteoclasts. The inhibition of Syk activity can be useful for the treatment of cancers and inflammatory diseases. U.S. Patents 8,455,493, 8,440,667, 9,376,441,
9,416,111, 9,353,066 and 9,376,418 disclose SYK inhibitors. Several SYK inhibitors are in advanced stages of clinical trials.
SUMMARY
[0004] Provided herein are methods for treating myeloproliferative disorders comprising the administration of an effective amount of a hypomethylating agent and a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof. The hypomethylating agent can be selected from 5-aza-2'-deoxycytidine (azacitidine) and 5-aza-2'-deoxycytidine (decitabine), or a pharmaceuticall acceptable salt thereof.
Figure imgf000003_0001
Azacitidine Decitabine
[0005] In some embodiments, the myeloproliferative disorder is selected from myelodysplastic syndromes (MDS), acute myeloid leukemia (AML) and chronic myelomonocytic leukaemia (CMML).
[0006] In some embodiments, provided herein are methods of treatment for
myelosuppression in a subject diagnosed with acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), myeloproliferative leukemia (MPL), myelodysplastic syndrome (MDS), myeloproliferative disease (MPD), chronic myeloid leukemia (CML), multiple myeloma (MM), non-Hodgkin's lymphoma (NHL), mantle cell lymphoma (MCL), follicular lymphoma, Waldenstrom's macroglobulinemia (WM), T-cell lymphoma, B-cell lymphoma, diffuse large B-cell lymphoma (DLBCL), pancreatic cancer, bladder cancer, colorectal cancer, breast cancer, prostate cancer, renal cancer, hepatocellular cancer, lung cancer, ovarian cancer, cervical cancer, gastric cancer, esophageal cancer, head and neck cancer, melanoma, neuroendocrine cancer, CNS cancer, brain cancer, bone cancer, soft tissue sarcoma, non-small cell lung cancer, small-cell lung cancer or colon cancer.
[0007] In some embodiments, provided herein are methods for treating
myeloproliferative disorders comprising the administration of an effective amount of lenalidomide or antithymocyte globulin, and a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof. In some embodiments, the myeloproliferative disorder is selected from MDS, AML and CMML. In some embodiments, the patient has received or is a candidate for receiving allogeneic stem cell transplantation wherein one or more hypomethylating agents is administered in combination with one or more SYK inhibitors.
[0008] In some embodiments, the SYK inhibitor is selected from:
Figure imgf000004_0001
Compound 1 Compound 2 Compound 3
Figure imgf000004_0002
Compound 4 Compound 5 Compound 6 or a pharmaceutically acceptable salt thereof. [0009] In some embodiments, myelodysplastic syndrome is refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, or chronic myelomonocytic leukemia. In some embodiments, the myelodysplastic syndrome is Low-risk, Intermediate- 1, Intermediate-2 or High-risk in international prognostic scoring system (IPSS). In some embodiments, the myelodysplastic syndrome is primary or secondary to radiotherapy or chemotherapy. In some embodiments, the patient has a del(5q), in particular, Del5q31-33 abnormality.
[0010] In some embodiments, the SYK inhibitor is administered prior to administering the hypomethylating agent. In some embodiments, the SYK inhibitor is administered after administering the hypomethylating agent. In some embodiments, the SYK inhibitor is administered concurrently with the hypomethylating agent.
[0011] In some embodiments, the SYK inhibitor is administered prior to administering lenalidomide or antithymocyte globulin. In some embodiments, the SYK inhibitor is administered after administering lenalidomide or antithymocyte globulin. In some embodiments, the SYK inhibitor is administered concurrently with lenalidomide or antithymocyte globulin.
DETAILED DESCRIPTION
[0012] As used herein, in some variations, "treatment" or "treating" is an approach for obtaining beneficial or desired results including clinical results. Beneficial or desired clinical results may include one or more of the following:
(i) inhibiting the disease or condition (e.g., decreasing one or more symptoms resulting from the disease or condition, and/or diminishing the extent of the disease or condition);
(ii) slowing or arresting the development of one or more clinical symptoms associated with the disease or condition (e.g., stabilizing the disease or condition, preventing or delaying the worsening or progression of the disease or condition, and/or preventing or delaying the spread (e.g., metastasis) of the disease or condition); and/or
(iii) relieving the disease, that is, causing the regression of clinical symptoms (e.g., ameliorating the disease state, providing partial or total remission of the disease or condition, enhancing effect of another medication, delaying the progression of the disease, increasing the quality of life, and/or prolonging survival).
[0013] In some variations, "delaying" the development of a disease or condition means to defer, hinder, slow, retard, stabilize, and/or postpone development of the disease or condition. This delay can be of varying lengths of time, depending on the history of the disease or condition, and/or subject being treated. For example, a method that "delays" development of a disease or condition is a method that reduces probability of disease or condition development in a given time frame and/or reduces the extent of the disease or condition in a given time frame, when compared to not using the method. Such comparisons are typically based on clinical studies, using a statistically significant number of subjects. Disease or condition development can be detectable using standard methods, such as routine physical exams, mammography, imaging, or biopsy. Development may also refer to disease or condition progression that may be initially undetectable and includes occurrence, recurrence, and onset.
[0014] By "optional" or "optionally" is meant that the subsequently described event or circumstance may or may not occur, and that the description includes instances where the event or circumstance occurs and instances in which it does not. For example, "optionally substituted alkyl" encompasses both "alkyl" and "substituted alkyl" as defined below. It will be understood by those skilled in the art, with respect to any group containing one or more substituents, that such groups are not intended to introduce any substitution or substitution patterns that are sterically impractical, synthetically non-feasible and/or inherently unstable.
[0015] The term "comprise" and variations thereof, such as, "comprises" and
"comprising" are to be construed in an open, inclusive sense, that is, as "including, but not limited to." "Consisting essentially of or its grammatic variants when used to define compositions and methods, shall mean excluding other elements of any essential significance to the compositions and methods for the intended use, but not excluding elements that do not materially affect the characteristic(s) of the compositions or methods. "Consisting of or its grammatic variants shall mean excluding elements not specifically recited. Embodiments defined by each of these transition terms are within the scope of this disclosure. For example, when a composition is described as comprising ingredients A, B and C, a composition consisting essentially of A, B and C, and a composition consisting of A, B and C are independently within the scope of this disclosure.
[0016] It is noted here that as used in this specification and the appended claims, the singular forms "a" "an" and "the" and the like include plural referents unless the context clearly dictates otherwise. For example, the term "a pharmaceutically acceptable carrier" includes reference to one and more than one pharmaceutically acceptable carriers.
[0017] The term "about" means within ± 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%), 0.1%), or 0.05%) of a given value or range. In one embodiment, about means ± 5% of a given value or range. In another embodiment, about means ± 4% of a given value or range. In another embodiment, about means ± 3% of a given value or range. In another
embodiment, about means ± 2% of a given value or range. In another embodiment, about means ± 1%> of a given value or range. In another embodiment, about means ± 0.5% of a given value or range. In another embodiment, about means ± 0.05% of a given value or range. The term "about x" includes the value "x."
[0018] The term "administration" refers to introducing an agent into a patient. A therapeutic amount can be administered. "Administration" and related terms "administer" and "administering," when used in connection with a compound or composition (and grammatical equivalents) refer both to direct administration, which may be administration to a patient by a medical professional or by self-administration by the patient, and/or to indirect administration, which may be the act of prescribing a drug.
[0019] "Alkyj" encompasses straight chain and branched chain having the indicated number of carbon atoms, usually from 1 to 20 carbon atoms, for example 1 to 8 carbon atoms, such as 1 to 6 carbon atoms. For example C J -C6 alkyl encompasses both straight and branched chain alkyl of from 1 to 6 carbon atoms. Examples of alkyl groups include methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, tert-butyl, pentyl, 2-pentyl, isopentyl, neopentyl, hexyi, 2-hexyl, 3-hexyl, 3-methyipentyl, and the like. Alkyl en e is another subset of alkyl, referring to the same residues as alkyl, but having two points of attachment. Alkylene groups will usually have from 2 to 20 carbon atoms, for example 2 to 8 carbon atoms, such as from 2 to 6 carbon atoms. For example, Co alkylene indicates a covaient bond and Ci alkylene is a methylene group. When an alkyl residue having a specific number of carbons is named, all geometric isomers having that number of carbons are intended to be encompassed; thus, for example, ''butyl" is meant to include n-butyl, sec-butyl, isobutyl and t-butyl; "propyl" includes n-propyl and isopropyl. "Lower alkyl" refers to alkyl groups having 1 to 4 carbons.
[0020] "Cycloalkyl" indicates a saturated hydrocarbon ring group, having the specified number of carbon atoms, usually from 3 to 10 ring carbon atoms. Examples of cy cloalkyl groups include cyclopropyl, cyclobutyl, cyclopentyi, and cyclohexyl as well as bridged and caged saturated ring groups such as norbomane.
[0021] "Alkoxy" refers to an alkyl group of the indicated number of carbon atoms attached through an oxygen bridge such as, for example, methoxy, ethoxy, propoxy, isopropoxy, n-butoxy, sec-butoxy, tert-butoxy, pentoxy, 2-pentyloxy, isopentoxy, neopentoxy, hexoxy, 2-hexoxy, 3-hexoxy, 3-methylpentoxy, and the like. Alkoxy groups will usually have from 1 to 6 carbon atoms attached through the oxygen bridge. "Lower alkoxy" refers to alkoxy groups having 1 to 4 carbons.
[0022] " Ammocarbony l" encompasses a group of the formula -(C=0)NRaRb where Ra and Rb are independently chosen from hydrogen and the optional substituents for
"substituted amino" described below.
[0023] "Acyl" refers to the groups (alkyl)-C(O)-; (cycloalkyl)-C(Q)-; (aryl)-C(O)-; (heteroaryl)-C(O)-; and (heterocycloalkyl)-C(O)-, wherein the group is attached to the parent structure through the carbonyi functionality and wherein alkyl, cycloalkyl, aryl, heteroaryl, and heterocycloalkyl are as described herein. Acyl groups have the indicated number of carbon atoms, with the carbon of the keto group being included in the numbered carbon atoms. For example a C2 acyl group is an acetyl group having the formula
CH3(C=0)-. [0024] "Alkoxycarbonyl" refers to an ester group of the formula (al koxy)(C=0)- attached through the carbonyl carbon wherein the alkoxy group has the indicated number of carbon atoms. Thus a C l-Cealkoxy carbonyl group is an alkoxy group having from 1 to 6 carbon atoms attached through its oxygen to a carbonyl linker.
[0025] "Amino" refers to the group -NHz.
[0026] "Aryl" encompasses 6 to 14-membered carbocyclic aromatic rings, for example, benzene; bicyclic ring systems wherein at least one ring is carbocyclic and aromatic, for example, naphthalene, indane, and tetra!in; and tricyclic ring systems wherein at least one ring is carbocyclic and aromatic, for example, fluorene. For example, aryl includes phenyl fused to a 5 to 7-membered cycloalkyl ring. For such fused ring systems wherein only one of the rings is a carbocyclic aromatic ring, the point of attachment may be at the carbocyclic aromatic ring or the cycloalkyl ring. Aryl, however, does not encompass or overlap in any¬ way with heteroaryl, separately defined below. Hence, if one or more carbocyclic aromatic rings is fused with a heterocycloalkyl aromatic ring, the resulting ring system is heteroaryl, not aryl, as defined herein.
[0027] The term "halo" includes fluoro, chloro, bromo, and iodo, and the term
"halogen" includes fluorine, chlorine, bromine, and iodine.
[0028] "Heteroaryl" encompasses 5 to 14-membered aromatic, monocyclic rings containing one or more, for example, from 1 to 4, or In some embodiments, from 1 to 3, heteroatonis chosen from N, O, and S, with the remaining ring atoms being carbon; and bicyclic rings containing one or more, for example, from 1 to 4, or in some embodiments, from 1 to 3, ring heteroatoms chosen from N, O, and S, with the remaining ring atoms being carbon and wherein at least one heteroatom is present in an aromatic ring. For example, heteroaryl includes a 5- to 7-membered heterocycloalkyl, aromatic ring fused to a 5- to 7- membered cycloalkyl ring. For such fused heteroaryl ring systems wherein only one of the rings contains one or more heteroatoms, the point of attachment may be at the
heteroaromatic ring or the cycloalkyl ring. When the total number of S and O atoms in the heteroaryl group exceeds I, those heteroatoms are not adjacent to one another. In some embodiments, the total number of S and O atoms in the heteroaryl group is not more than 2. In some embodiments, the total number of S and O atoms in the aromatic heterocycle is not more than 1. Examples of heteroary! groups include, but are not limited to, (as numbered from the linkage position assigned priority 1), 2-pyridyl, 3-pyridyl, 4-pyridyl, 2,3-pyrazinyl, 3,4-pyrazinyl, 2,4-pyrimidinyl, 3,5-pyrimidinyl, 2,3-pyrazolinyl, 2,4-imidazolinyl, isoxazolinyl, oxazolinyl, thiazoiiny], thiadiazoiinyl, tetrazoiyl, thienyl, benzolhiophenyl, furanyl, benzofuranyi, benzoimidazolinyl, indoiinyl, pyridizinyl, triazolyl, quinolinyl, pyrazoiyl, and 5,6,7,8-tetrahydroisoquino3ine. Heteroary! does not encompass or overlap with ary! as defined above. Substituted heteroary! also includes ring systems substituted with one or more oxide (-0") substituents, such as pyridiny! N-oxides.
[0029] The term "heteroaryloxy" refers to the group -O-heteroaryl.
[0030] By "heterocycloalkyl" is meant a single aliphatic ring, usually with 3 to 14 ring atoms, containing at least 2 carbon atoms in addition to 1-3 heteroatoms independently- selected from oxygen, sulfur, and nitrogen, as well as combinations comprising at least one of the foregoing heteroatoms. Suitable heterocyc!oalkyl groups include, for example (as numbered from the linkage position assigned priority 1), 2-pyrrolinyl, 2,4-imidazolidinyl, 2,3-pyrazolidinyl, 2-piperidyl, 3-piperidyl, 4-piperdyi, and 2,5-piperzinyl. Morpholiny! groups are also contemplated, including 2-morpholinyl and 3-morpholinyl (numbered wherein the oxygen is assigned priority 1). Substituted heterocycloalkyl also includes ring systems substituted with one or more oxo moieties, such as piperidinyl N-oxide,
morpholinyl-N-oxide, 1-oxo-l-thiomorpholinyl and 1, 1-dioxo-l-thiomorpholinyl.
[0031] "Heterocycloalkyl" also includes bicyclic ring systems wherein neither of the rings is aromatic and wherein at least one of the rings in the bicyclic ring system contains at least 2 carbon atoms in addition to 1-3 heteroatoms independently chosen from oxygen, sulfur, and nitrogen.
[0032] The term "substituted," as used herein, means that any one or more hydrogens on the designated atom or group is replaced with a selection from the indicated group, provided that the designated atom's normal valence is not exceeded. When a substituent is oxo (i.e., =0) then 2 hydrogens on the atom are replaced. Combinations of substituents and/or variables are permissible only if such combinations result in stable compounds or useful synthetic intermediates. A stable compound or stable structure is meant to imply a compound that is sufficiently robust to survive isolation from a reaction mixture, and subsequent formulation as an agent having at least practical utility. Unless otherwise specified, substituents are named into the core structure. For example, it is to be understood that when (cycloalkyl)alkyl is listed as a possible substituent, the point of attachment of this substituent to the core structure is in the alkyl portion.
[0033] The terms "substituted" alkyl, cycloalkyl, aryl, heterocycloalkyl, and heteroaryl, unless otherwise expressly defined, refer respectively to alkyl, cycloalkyl, aryl,
heterocycloalkyl, and heteroaryl wherein one or more (such as up to 5, for example, up to 3) hydrogen atoms are replaced by a substituent independently chosen from -Ra, -ORb, -0(Ci- C2 alkyl)0- (e.g., methylenedioxy-), -SRb, guanidine, guanidine wherein one or more of the guanidine hydrogens are replaced with a lower-alkyl group, -NR^, halo, cyano, oxo (as a substituent for heterocycloalkyl), nitro, -CORb, -C02Rb, -CONR^, -OCORb, -OCO2R11, -OCONR^, -NRcCORb, -NRTOiR8, -NRcCONRbRc, -SORa, -SOaR8, -SChNR^, and -NRcS02Ra,
where Rais chosen from optionally substituted C1-C6 alkyl, optionally substituted cycloalkyl, optionally substituted aryl, optionally substituted heterocycloalkyl, and optionally substituted heteroaryl;
Rbis chosen from H, optionally substituted C1-C6 alkyl, optionally substituted cycloalkyl, optionally substituted aryl, optionally substituted heterocycloalkyl, and optionally substituted heteroaryl; and
Rcis chosen from hydrogen and optionally substituted C1-C4 alkyl; or
Rb and Rc, and the nitrogen to which they are attached, form an optionally substituted heterocycloalkyl group; and
where each optionally substituted group is unsubstituted or independently substituted with one or more, such as one, two, or three, substituents independently selected from C1-C4 alkyl, C3-C6 cycloalkyl, aryl, heteroaryl, aryl-Ci-C4 alkyl-, heteroaryl -C1-C4 alkyl-, C1-C4 haloalkyl-, -OC1-C4 alkyl, -OC1-C4 alkylphenyl, -C1-C4 alkyl-OH, -C1-C4 alkyl-0-C1-C4 alkyl, -OC1-C4 haloalkyl, halo, -OH, -NH2, -C1-C4 alkyl-NIfc, -N(C1-C4 alkyl)(Ci-C4 alkyl), -NH(Ci-C4 alkyl), -N(Ci-C4 alkylXC1-C4 alkylphenyl), -NH(Ci-C4 alkylphenyl), cyano, nitro, oxo (as a substituted for heteroaryl), -CO2H, -C(0)OCi-C4 alkyl, -CON(Ci-C4
Figure imgf000012_0001
[0034] The term "substituted acyl" refers to the groups (substituted alkyl)-C(O)-;
(substituted cycloaikyi)-C(O)-, (substituted aryl)-C(O)-, (substituted heteroaryl)-C(O)-, and (substituted lieterocycioalkyl)-C(O)-, wherein the group is attached to the parent structure through the carbonyl functionality and wherein substituted alkyl, cvcloalkyl, ary!, heteroaryl, and heterocycloalkyl are as described herein.
[0035] The term "substituted alkoxy" refers to alkoxy wherein the alkyl constituent is substituted (i.e., -0-(substituted alkyl)) wherein "substituted aikyi" is as described herein,
[0036] The term "substituted alkoxycarbonyl" refers to the group (substituted alkyl)-0- C(O)- wherein the group is attached to the parent staicture through the carbonyl functionality and wherein "substituted aikyi" is as described herein.
[0037] The term "substituted heteroaryl oxy" refers to heteroaryloxy wherein the aryl constituent is substituted (i .e., -0-(substituted heteroaryl)) wherein "substituted heteroaryl" is as described herein.
[0038] The term "substituted cycioalkyloxy" refers to cycloalkyloxy wherein the cvcloalkyl constituent is substituted (i .e., -0-(substituted cycloalkyl)) wherein "substituted cvcloalkyl" is as described herein.
[0039] The term "substituted amino" refers to the group -NHRd or -NRaRd where each Rdis independently chosen from; hydroxy, optionally substituted alkyl, optionally substituted cycloalkyl, optionally substituted acyl, aminocarbonyl, optionally substituted aryl, optionally substituted heteroaryl, optionally substituted heterocycloalkyl,
alkoxycarbonyl, sulfinyl and sulfonyi, provided that only one Rd may be hydroxyl, and wherein substituted alkyl, cycloalkyl, aryl, heterocycloalkyl, and heteroaryl refer respectively to alkyl, cycloalkyl, aryl, heterocycloalkyl, and heteroaryl wherein one or more (such as up to 5, for example, up to 3) hydrogen atoms are replaced by a substituent independently selected from -Ra, -ORb, -0(Ci-C2 alkyl)0- (e.g., methylenedioxy-), -SRb, guanidine, guanidine wherein one or more of the guanidine hydrogens are replaced with a lower-alkyl group, -NRbRc, halo, cyano, nitro, -CORb, -CO?.Rb, -CONRbRc, -OCORb, -OC02Ra, -OCONRbRc, -NRcCORb, ~NRcCG?Ra, -NRcCO'NRbRc, -SORa, -S02Ra,
-S02NRbRc, and -NRcSO?.Ra, and wherein Ra, Rb and Rc are as defined herein.
[00401 The term "substituted amino" also refers to N-oxides of the groups -NHRd, and NRdRd each as described above. N-oxides can be prepared by treatment of the corresponding amino group with, for example, hydrogen peroxide or m-chloroperoxybenzoic acid. The person skilled in the art is familiar with reaction conditions for carrying out the N-oxidation.
[0041] "Pharmaceutically acceptable" refers to a material that is not biologically or otherwise undesirable, e.g., the material may be incorporated into a pharmaceutical composition administered to a patient without causing any significant undesirable biological effects or interacting in a deleterious manner with any of the other components of the composition in which it is contained. Pharmaceutically acceptable vehicles (e.g., carriers, adjuvants, and/or other excipients) have preferably met the required standards of
toxicological and manufacturing testing and/or are included on the Inactive Ingredient Guide prepared by the U.S. Food and Drug administration.
[0042] "Pharmaceutically acceptable salts" include, for example, salts with inorganic acids and salts with an organic acid. Examples of salts may include hydrochlorate, phosphate, diphosphate, hydrobromate, sulfate, sulfinate, nitrate, malate, maleate, fumarate, tartrate, succinate, citrate, acetate, lactate, mesylate, p-toluenesulfonate, 2- hydroxy ethyl sulfonate, benzoate, salicylate, stearate, and alkanoate (such as acetate, HOOC- (CH2)n-COOH where n is 0-4). In addition, if the compounds described herein are obtained as an acid addition salt, the free base can be obtained by basifying a solution of the acid salt. Conversely, if the product is a free base, an addition salt, particularly a pharmaceutically acceptable addition salt, may be produced by dissolving the free base in a suitable organic solvent and treating the solution with an acid, in accordance with conventional procedures for preparing acid addition salts from base compounds. Those skilled in the art will recognize various synthetic methodologies that may be used to prepare nontoxic
pharmaceutically acceptable addition salts.
[0043] Certain compounds can exist in unsolvated forms, including anhydrous forms, as well as solvated forms, including hydrated forms. As used herein, the term "solvate" refers to a crystal form with either a stoichiometric or non-stoichiometric amount of solvent incorporated into the crystal structure. Similarly, the term "hydrate" refers specifically to a crystal form with either a stoichiometric or non-stoichiometric amount of water incorporated into the crystal structure.
[0044] The term "co-crystal" refers to crystalline structure of a compound and one or more co-crystal formers connected through non-covalent interactions. Co-crystals may additionally be present in anhydrous, solvated or hydrated forms. In some embodiments, there is no hydrogen transfer between the compound and the co-crystal former in the crystalline structure.
[0045] "Prodrugs" means any compound which releases an active parent drug in vivo when such prodrug is administered to a patient. Prodrugs may be prepared by modifying functional groups present in the compounds in such a way that the modifications are cleaved, either in routine manipulation or in vivo, to the parent compounds. Examples of prodrugs include, but are not limited to esters (e.g., acetate, formate, and benzoate derivatives), amides, guanidines, carbamates (e.g., Ν,Ν-dimethylaminocarbonyl) of a hydroxy functional group in a compound, and the like.
[0046] "Tautomer" means compounds produced by the phenomenon wherein a proton of one atom of a molecule shifts to another atom. The tautomers also refer to one of two or more structural isomers that exist in equilibrium and are readily converted from one isomeric form to another. Examples of include keto-enol tautomers, such as acetone/propen- 2-ol, imine-enamine tautomers and the like, ring-chain tautomers, such as glucose/2,3, 4,5,6- pentahydroxy-hexanal and the like, the tautomeric forms of heteroaryl groups containing a -N=C(H)-NH- ring atom arrangement, such as pyrazoles, imidazoles, benzimidazoles, triazoles, and tetrazoles. Certain compounds may have one or more tautomers and therefore include various isomers. All such isomeric forms of these compounds are expressly included in the present disclosure.
[0047] "Isomers" mean compounds having identical molecular formulae but differ in the nature or sequence of bonding of their atoms or in the arrangement of their atoms in space. "Stereoisomer" and "stereoisomers" refer to compounds that exist in different
stereoisomenc forms if they possess one or more asymmetric centers or a double bond with asymmetric substitution and, therefore, can be produced as individual stereoisomers or as mixtures. Stereoisomers include enantiomers and diastereomers. Stereoisomers that are not mirror images of one another are termed "diastereomers" and those that are non- superimposable mirror images of each other are termed "enantiomers." When a compound has an asymmetric center, for example, it is bonded to four different groups, a pair of enantiomers is possible. An enantiomer can be characterized by the absolute configuration of its asymmetric center and is described by the R- and S-sequencing rules of Cahn and Prelog, or by the manner in which the molecule rotates the plane of polarized light and designated as dextrorotatory or levorotatory (i.e., as (+) or (-)-isomers respectively). A chiral compound can exist as either individual enantiomer or as a mixture thereof. A mixture containing equal proportions of the enantiomers is called a "racemic mixture." Unless otherwise indicated, the description is intended to include individual stereoisomers as well as mixtures.
[0048] The terms "effective amount", "pharmaceutically effective amount", and
"therapeutically effective amount" refer to an amount that may be effective to elicit the desired biological or medical response, including the amount of a compound that, when administered to a subject for treating a disease, is sufficient to effect such treatment for the disease. The effective amount may vary depending on the compound, the disease or condition being treated and its severity, the subject including the age, weight, etc., of the subject to be treated, and the manner of administering, which can readily be determined by one of ordinary skill in the art. The effective amount can include a range of amounts. A pharmaceutically effective amount includes amounts of an agent which are effective when combined with other agents. [0049] The term "patient" or "subject" refers to a mammal that is treated with a method as described herein, including but not limited to, a human, other primates, sports animals, animals of commercial interest such as cattle, farm animals such as horses, or pets such as dogs and cats. In some embodiments, the patient is a human.
[0050] In some embodiments, provided herein are methods for treating a
myeloproliferative disorder comprising the administration of an effective amount of a hypomethylating agent and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof. The hypomethylating agent can be selected from 5-aza-2'-deoxycytidine (azacitidine) and 5-aza-2'-deoxycytidine (decitabine), or a pharmaceutically acceptable salt thereof.
[0051] In some embodiments, provided herein are methods for treating myelodysplastic syndromes (MDS) comprising the administration of an effective amount of a
hypomethylating agent and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof. The hypomethylating agent can be selected from 5-aza-2'-deoxycytidine (azacitidine) and 5-aza-2'-deoxycytidine (decitabine), or a pharmaceutically acceptable salt thereof.
Figure imgf000016_0001
Decitabine
[0052] In some embodiments, provided is a method of treating a myeloproliferative disorder, comprising administering to a patient in need thereof, a therapeutically effective amount of lenalidomide or a pharmaceutically acceptable salt thereof, and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor.
[0053] In some embodiments, provided herein are methods for treating
myeloproliferative disorders comprising the administration of an effective amount of antithymocyte globulin or a pharmaceutically acceptable salt thereof, and a spleen tyrosine kinase (SYK) inhibitor to a patient in need thereof.
[0054] In some embodiments, the myeloproliferative disorder is selected from MDS, A ML and CMML.
[0055] In some embodiments, provided is a method of treating Intermediate- 1 or Low risk myelodysplastic syndrome in a patient in need thereof, comprising administering a therapeutically effective amount of a spleen tyrosine kinase inhibitor to said patient.
[0056] In some embodiments, myelodysplastic syndrome is refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, or chronic myelomonocytic leukemia. In some embodiments, the myelodysplastic syndrome is Low-risk, Intermediate- 1, Intermediate-2 or High risk in international prognostic scoring system (IPSS). In some embodiments, the myelodysplastic syndrome is primary or secondary to radiotherapy or chemotherapy. In some embodiments, the patient has a del(5q), in particular, Del5q31-33 abnormality.
[0057] In some embodiments, provided herein are methods of treatment for
myelosuppression in a subject diagnosed with ALL, AML, CLL, SLL, MPL, MDS, MPD, CML, MM, NHL, MCL, follicular lymphoma, WM, T-cell lymphoma, B-cell lymphoma, DLBCL, pancreatic cancer, bladder cancer, colorectal cancer, breast cancer, prostate cancer, renal cancer, hepatocellular cancer, lung cancer, ovarian cancer, cervical cancer, gastric cancer, esophageal cancer, head and neck cancer, melanoma, neuroendocrine cancer, CNS cancer, brain cancer, bone cancer, soft tissue sarcoma, non-small cell lung cancer, small-cell lung cancer and colon cancer.
[0058] In some embodiments, the patient has been previously treated or untreated for MDS. In some embodiments, the patient has a de novo MDS. De novo MDS refers to an MDS that has arisen without an obvious or specific cause. In some embodiments, the patient has a secondary MDS. Secondary MDS is an MDS that is found to have been caused by specific reasons and includes two general types: the first type is MDS that seems to have arisen from another bone marrow failure disorder or bone marrow cancer. The second type of secondary MDS relates to cancer therapies for other cancers, including chemotherapy and radiation therapy, and is also referred to as treatment-related MDS or therapy-related MDS. In some embodiments, the patient has a de novo or secondary MDS of French- American- British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia). In some embodiments, myelodysplasia is associated with multilineage dysplasia. In some embodiments, myelodysplastic syndrome associated with an isolated del(5q), in particular, Del5q31-33 chromosome abnormality, or
unclassifiable myelodysplastic syndrome.
Spleen Tyrosine Kinase (SYK) Inhibitors
[0059] In certain embodiments the following SYK inhibitors can be used in the methods described herein.
[0060] i. The following SYK inhibitors of Formula (I) are disclosed in U.S. Patent No. 9, 120,811, the contents of the '811 atent are incorporated by reference herein:
Figure imgf000018_0001
or a pharmaceutically acceptable salt thereof, wherein
R1 is phenyl substituted with one or two groups chosen from
halo,
hydroxy,
carboxy,
cycloalkyl optionally substituted with one or two groups chosen from hydroxy, lower alkoxy, and lower alkyl, heterocycloalkyl optionally substituted with one or two groups chosen from hydroxy, lower alkoxy, lower alkyl, lower alkyl substituted with hydroxy, optionally substituted amino, and oxo,
heteroaryl,
amino optionally substituted with one or two groups chosen from lower alkyl, lower alkyl substituted with halo, lower alkyl substituted with hydroxy, and lower alkyl substituted with lower alkoxy,
-C(0)NR6R7 wherein R6 and R7 are independently selected from hydrogen, lower alkyl, lower alkyl substituted with hydroxy, lower alkyl substituted with optionally substituted amino, cycloalkyl, aryl, heteroaryl, and
heterocycloalkyl, or R6 and R7 together with the nitrogen to which they are bound form a 3- to 7-membered heterocycloalkyl ring optionally substituted with one or two groups chosen from hydroxy, lower alkyl, and lower alkyl substituted with hydroxy,
-S(0)2NR6R7 wherein R6 and R7 are independently selected from hydrogen, lower alkyl, lower alkyl substituted with hydroxy, lower alkyl substituted with optionally substituted amino, cycloalkyl, aryl, heteroaryl, and
heterocycloalkyl, or R6 and R7 together with the nitrogen to which they are bound form a 3- to 7-membered heterocycloalkyl ring optionally substituted with one or two groups chosen from hydroxy, lower alkyl, and lower alkyl substituted with hydroxy, provided that at least one of R6 and R7 is not hydrogen,
lower alkoxy optionally substituted with one or two groups chosen from hydroxy, lower alkoxy, optionally substituted amino, carboxy, aminocarbonyl, and heterocycloalkyl,
heteroaryloxy, and
lower alkyl optionally substituted with one or two groups chosen from hydroxy, lower alkoxy, halo, trifluoromethyl, optionally substituted amino, and heterocycloalkyl optionally substituted with lower alkyl; or
Figure imgf000020_0001
wherein A is chosen from aryl, cycloalkyl and heterocycloalkyl groups, each of which groups having from 5 to 7 ring atoms including the atoms shared with the 6 membered aromatic ring and each of which groups being optionally substituted;
R2 is chosen from optionally substituted aryl and optionally substituted heteroaiyl;
R3 is hydrogen;
R4 is hydrogen; and
R5 is hydrogen.
[0061] The '811 patent discloses the following SYK inhibitors: N-(3,4- dimethoxyphenyl)-6-(3-methylphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-(3-nitrophenyl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-{3-[(ethylamino)methyl]phenyl}imidazo[l,2-a]pyrazin-8-amine; N- (3,4-dimethoxyphenyl)-6-[3-(trifluoromethyl)phenyl]imidazo[l,2-a]pyrazin-8-amine; N- (3,4-dimethoxyphenyl)-6-(3-methoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-(pyridin-4-yl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-(pyridin-3-yl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-phenylimidazo[l,2-a]pyrazin-8-amine; 3-{8-[(3,4- dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl }benzonitrile; N-(3 ,4- dimethoxyphenyl)-6-(4-fluorophenyl)imidazo[l,2-a]pyrazin-8-amine; 4-{8-[(3,4- dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}benzene-l -sulfonamide; N-(3,4- dimethoxyphenyl)-6-{4-[(ethylamino)methyl]phenyl}imidazo[l,2-a]pyrazin-8-amine; 6-(4- chlorophenyl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 6-(3- chlorophenyl)-N-(4-ethoxy-3-methoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-(4-methanesulfonylphenyl)imidazo[l,2-a]pyrazin-8-amine; 4-{8-[(3,4- dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl }benzonitrile; N-(3 ,4- dimethoxyphenyl)-6-(4-methylphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(4-ethoxy-3- methoxyphenyl)-6-(3-methylphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(4-ethoxy-3- methoxyphenyl)-6-(3-fluorophenyl)imidazo[l,2-a]pyrazin-8-amine; 6-(3,4-difluorophenyl)- N-(4-ethoxy-3-methoxyphenyl)imidazo[l,2-a]-pyrazin-8-amine; 6-(4-chloro-3- methylphenyl)-N-(4-ethoxy-3-methoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 3-{8-[(4- ethoxy-3-methoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}benzene-l -sulfonamide; N-(4- ethoxy-3-methoxyphenyl)-6-(3-methanesulfonylphenyl)imidazo[l,2-a]pyrazin-8-amine; N- (4-ethoxy-3-methoxyphenyl)-6-(4-fluoro-3-methylphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(4-ethoxy-3-methoxyphenyl)-6-(3-fluoro-4-methylphenyl)imidazo[l,2-a]pyrazin-8- amine; 6-(3-chloro-4-methylphenyl)-N-(4-ethoxy-3-methoxyphenyl)imidazo[l,2-a]pyrazin- 8-amine; N-(4-ethoxy-3-methoxyphenyl)-6-(2-fluoropyridin-4-yl)imidazo[l,2-a]pyrazin-8- amine; N-(4-ethoxy-3-methoxyphenyl)-6-(5-methylpyridin-3-yl)imidazo[l,2-a]pyrazin-8- amine; 6-(5-chloropyridin-3-yl)-N-(4-ethoxy-3-methoxyphenyl)imidazo[l,2-a]pyrazin-8- amine; N-(4-ethoxy-3-methoxyphenyl)-6-(pyrimidin-5-yl)imidazo[l,2-a]pyrazin-8-amine; l-{4-[(4-{8-[(4-ethoxy-3-methoxyphenyl)amino]imidazo[l,2-a]pyrazin-6- yl } phenyl)methyl]piperazin- 1 -yl } ethan- 1 -one; 1 - { 4- [(3 - { 8-[(3 ,4- dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl }phenyl)methyl]piperazin- 1 -yl } ethan- 1 - one; N-(3,4-dimethoxyphenyl)-6-[3-(piperazin-l-ylmethyl)phenyl]imidazo[l,2-a]pyrazin-8- amine; N-(3 ,4-dimethoxyphenyl)-6-[4-(piperazin- 1 -ylmethyl)phenyl]imidazo[ 1 ,2-a]pyrazin- 8-amine; 6-(2,3-dihydro-l,4-benzodioxin-6-yl)-N-(3,4-dimethoxyphenyl)imidazo[l,2- a]pyrazin-8-amine; N-(3-{8-[(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6- yl}phenyl)acetamide; 6-(3-aminophenyl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8- amine; N-(4-{8-[(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6- yl}phenyl)acetamide; N-(3,4-dimethoxyphenyl)-6-(thiophen-3-yl)imidazo[l,2-a]pyrazin-8- amine; N-(3,4-dimethoxyphenyl)-6-(lH-indazol-5-yl)imidazo[l,2-a]pyrazin-8-amine; N- (3,4-dimethoxyphenyl)-6-[4-(lH-imidazol-2-yl)phenyl]imidazo[l,2-a]pyrazin-8-amine; N- (3,4-dimethoxyphenyl)-6-(quinolin-6-yl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-amine; 6-{8-[(3,4- dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl } -3 ,4-dihydro-2H- 1 ,4-benzoxazin-3 - one; 6-(l,3-benzothiazol-5-yl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 6- (l,3-benzothiazol-6-yl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 6-{8- [(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}quinazolin-2-amine; N-(3,4- dimethoxyphenyl)-6-(thiophen-2-yl)imidazo[l,2-a]pyrazin-8-amine; 3-amino-5-{8-[(3,4- dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl } - 1 -methyl- 1 ,2-dihydropyridin-2-one; 6-{8-[(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}quinolin-2-amine; 6-(4- aminophenyl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 6-(lH-l,3- benzodiazol-5-yl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-[3-(lH-imidazol-5-yl)phenyl]imidazo[l,2-a]pyrazin-8-amine; 7-{8- [(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}-3,4-dihydro-2H-l,4-benzoxazin- 3-one; N-(4-ethoxy-3-methoxyphenyl)-6-(lH-indazol-5-yl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4-dimethoxyphenyl)-6-[4-(lH-imidazol-5-yl)phenyl]imidazo[l,2-a]pyrazin-8-amine; N-(4-ethoxy-3-methoxyphenyl)-6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-amine; 6-(l,3- benzothiazol-6-yl)-N-(4-ethoxy-3-methoxyphenyl)imidazo[l,2-a]-pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-[3-(l,3-thiazol-2-yl)phenyl]imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-(l-methyl-lH-l,3-benzodiazol-5-yl)imidazo[l,2-a]pyrazin-8-amine; 5- { 8-[(3 ,4-dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl } - 1 ,2-dihydropyridin-2-one; 6- (l,3-benzothiazol-5-yl)-N-(4-ethoxy-3-methoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; N- (3,4-dimethoxyphenyl)-6-[4-(l,3-oxazol-2-yl)phenyl]imidazo[l,2-a]pyrazin-8-amine; (3- {[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)methanol; 5-{8-[(3,4- dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}pyridin-2-amine; N-(3,4- dimethoxyphenyl)-6-[3-(l,3-oxazol-2-yl)phenyl]imidazo[l,2-a]pyrazin-8-amine; N-[6-(lH- indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]-3,4-dihydro-2H-l,4-benzoxazin-6-amine; l-(4- {[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)ethanol; N-(3,4- dimethoxyphenyl)-6-[4-(l,3-thiazol-2-yl)phenyl]imidazo[l,2-a]pyrazin-8-amine; (5-{[6- (lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}-2-methoxyphenyl)methanol; N-(3,4- dimethoxyphenyl)-6-(lH-indol-6-yl)imidazo[l,2-a]pyrazin-8-amine; N-(3,4- dimethoxyphenyl)-6-(l -methyl- 1H- 1 ,3 -benzodiazol-6-yl)imidazo[ 1 ,2-a]pyrazin-8-amine; N- (4-ethoxy-3-methoxyphenyl)-6-(l -methyl- lH-indazol-5-yl)imidazo[l,2-a]pyrazin-8-amine; N-(4-ethoxy-3-methoxyphenyl)-6-(l-methyl-lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8- amine; N-(3,4-dimethoxyphenyl)-6-(l -methyl- lH-indazol-5-yl)imidazo[l,2-a]pyrazin-8- amine; 6-(lH-l,2,3-benzotriazol-6-yl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8- amine; N-(3,4-dimethoxyphenyl)-6-{ lH-imidazo[4,5-b]pyridin-6-yl}imidazo[l,2-a]pyrazin- 8-amine; 6-(l,3-benzoxazol-5-yl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 6-(l,3-benzoxazol-6-yl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 6-{8- [(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}-4-methyl-3,4-dihydro-2H-l,4- benzoxazin-3-one; N-(3,4-dimethoxyphenyl)-6-(l -methyl- lH-indazol-6-yl)imidazo[l, 2- a] pyrazin-8-amine; N-(3,4-dimethoxyphenyl)-6-(lH-indol-5-yl)imidazo[l,2-a]pyrazin-8- amine; 6-{8-[(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}quinolin-3-amine; 2- (4-{[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)propan-2-ol; 5-{8-[(3,4- dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}-lH-indazol-3-amine; 6-{8-[(3,4- dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl } - 1H- 1 ,3 -benzo-diazol-2-amine; 6-{ 8- [(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}-2H,3H,4H-pyrido[3,2- b] [ 1 ,4]oxazin-3 -one; 6-{ 8-[(3 ,4-dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl } -2- methyl-3,4-dihydro-2H-l,4-benzoxazin-3-one; 6-{8-[(3,4- dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}-2,2-dimethyl-3,4-dihydro-2H-l,4- benzoxazin-3-one; 7-{8-[(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6- yl}quinolin-2-ol; 2-(4-{[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)-2- methylpropan- 1 -ol; 6- { 8-[(3 ,4-dimethoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl } - 1H- indazol-3 -amine; (4-{[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}-2- methoxyphenyl)methanol; 6-(2,3-dihydro-lH-indol-6-yl)-N-(3,4- dimethoxyphenyl)imidazo[l,2-a]pyrazi-n-8-amine; N-[6-(3-amino-lH-indazol-5- yl)imidazo[l,2-a]pyrazin-8-yl]-3,4-dihydro-2H-l,4-benzoxazin-6-amine; N-{4-[3- (dimethylamino)propoxy]-3-methoxyphenyl}-6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8- amine; 3-(4-{[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}-2-methoxyphen- oxy)propan-l-ol; 6-(lH-indazol-6-yl)-N-[4-methoxy-3-(pyrrolidin-l-yl)phenyl]imidazo[l,2- a]-pyrazin-8-amine; 5-{[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}-2,3- dihydro-lH-indol-2-one; 7-{8-[(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6- yl}quinoxalin-2-ol; 7-{8-[(3,4-dimethoxyphenyl)amino]imidazo[l,2-a]pyrazin-6-yl}- lH,2H,3H-pyrido[2,3-b][l,4]oxazin-2-one; N-[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8- yl]-4-methyl-3,4-dihydro-2H-l,4-benzoxazin-7-amine; N-(2-fluoro-4-methoxyphenyl)-6- (lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-amine; 6-(lH-indazol-6-yl)-N-[3-methoxy-4- (pyrrolidin- 1 -yl)phenyl]imidazo[ 1 ,2-a]pyrazin-8-amine; N-[6-( lH-indazol-6-yl)imidazo[ 1 ,2- a]pyrazin-8-yl]-2,3,4,5-tetrahydro-l,5-benzoxazepin-7-amine; l-(4-{[6-(3-amino-lH- indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)ethan-l-ol; 6-(3,4-dihydro-2H-l,4- benzoxazin-6-yl)-N-(3,4-dimethoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; N-[6-(lH- indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]-4-methyl-3,4-dihydro-2H-l,4-benzoxazin-6- amine; 6-{[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}-2,3-dihydro-lH-indol-2- one; N-(3,4-dimethoxyphenyl)-6-{ lH-pyrrolo[3,2-b]pyridin-6-yl}imidazo[l,2-a]pyrazin-8- amine; N-[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]-3,4-dihydro-2H-l,4-benzoxazin- 7-amine; 6- { 8-[(4-ethoxy-3 -methoxyphenyl)amino]imidazo[ 1 ,2-a]pyrazin-6-yl } - 1H- indazol-3 -amine; N-[6-(2-aminoquinazolin-6-yl)imidazo[l,2-a]pyrazin-8-yl]-4-methyl-3,4- dihydro-2H- 1 ,4-benzoxazin-6-amine; 2-methyl-2-(4- { [6-( 1 -methyl- 1H- 1 ,3 -benzodiazol-5- yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)propan-l-ol; 6-(3,4-dihydro-2H-l,4- benzoxazin-6-yl)-N-(4-ethoxy-3-methoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; N-[6-(2,3- dihydro-lH-indol-6-yl)imidazo[l,2-a]pyrazin-8-yl]-3,4-dihydro-2H-l,4-benzoxazin-6- amine; (2-methoxy-5-{[6-(l-methyl-lH-l,3-benzodiazol-6-yl)imidazo[l,2-a]pyrazin-8- yl]amino}phenyl)methanol; 6-(lH-indazol-6-yl)-N-{4-[2-methyl-l-(morholin-4-yl)propan- 2-yl]phenyl}imidazo[l,2-a]pyrazin-8-amine; N-[6-(lH-indol-6-yl)imidazo[l,2-a]pyrazin-8- yl]-3,4-dihydro-2H-l,4-benzoxazin-6-amine; 7-{8-[(4-methyl-3,4-dihydro-2H-l,4- benzoxazin-7-yl)amino]imidazo[l,2-a]pyrazin-6-yl}quinoxalin-2-ol; l-(4-{[6-(l,3- benzothiazol-5-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)ethan-l-ol; 6-(lH- 1,2,3- benzotnazol-6-yl)-N-[3-methoxy-4-(propan-2-yloxy)phenyl]imidazo[l,2-a]pyrazin-8-amine; 5-(8-{[3-methoxy-4-(pyrrolidin-l-yl)phenyl]amino}imidazo[l,2-a]pyrazin-6-yl)-lH- indazol-3 -amine; 2-(4-{[6-(2-aminoquinazolin-6-yl)imidazo[l,2-a]pyrazin-8- yl] amino } phenyl)- propan-2-ol ; 6-( 1 H-indazol-6-yl)-N-[3 -methoxy-4-(morpholin-4- yl)phenyl]imidazo[ 1 ,2-a]pyrazin-8-amine; 2-(4- { [6-( 1 ,3 -benzothiazol-5-yl)imidazo[ 1 ,2- a]pyrazin-8-yl]amino}phenyl)propan-2-ol; 6-(8-{[4-(2-hydroxypropan-2- yl)phenyl]amino}imidazo[l,2-a]pyrazin-6-yl)-3,4-dihydro-2H-l,4-benzoxazin-3-one; 6- (lH-indazol-6-yl)-N-(3-methoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 6-(lH-indazol-6- yl)-N-(4-methoxyphenyl)imidazo[l,2-a]pyrazin-8-amine; 2-(4- {[6-(l -methyl- 1H- 1,3- benzodiazol-5-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)propan-2-ol; 2-(4-{[6-(l- methyl-lH-l,3-benzodiazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)propan-2-ol; 1- (4-{[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}-2-methoxyphenyl)pipendin-4- ol; 6-(lH-indazol-6-yl)-N-[4-(pyrrolidin-l-yl)phenyl]imidazo[l,2-a]pyrazin-8-amine; l-(4- {[6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)pyrrolidin-3-ol; 2-(4-{[6- (4-methyl-3 ,4-dihydro-2H- 1 ,4-benzoxazin-7-yl)imidazo[ 1 ,2-a]pyrazin-8- yl]amino}phenyl)propan-2-ol; 2-(4-{[6-(3,4-dihydro-2H-l,4-benzoxazin-6-yl)imidazo[l,2- a]pyrazin-8-yl]amino}phenyl)propan-2-ol; 2-(4-{[6-(l,4-dimethyl-l,2,3,4- tetrahydroquinoxalin-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)propan-2-ol; l-(4-{[6- (lH-mdazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}-2-methoxyphenyl)azetidin-3-ol; 2-(4- {[6-(lH-indol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)propan-2-ol-2-(4-{[6-(3,4- dihydro-2H-l,4-benzoxazin-7-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)propan-2-ol; 2- (4-{[6-(4-methyl-3,4-dihydro-2H-l,4-benzoxazin-6-yl)imidazo[l,2-a]pyrazin-8- yl]amino}phenyl)propan-2-ol; 2-(4-{[6-(2,3-dimethyl-2H-indazol-5-yl)imidazo[l,2- a]pyrazin-8-yl]amino}phenyl)propan-2-ol; 2-(4-{[6-(3-methyl-lH-indazol-5-yl)imidazo[l,2- a]pyrazin-8-yl] amino } phenyl)propan-2-ol ; N- [3 -methoxy-4-(morpholin-4-yl)phenyl] -6-( 1 - methyl-lH-l,3-benzodiazol-6-yl)imidazo[l,2-a]pyrazin-8-amine; 6-(8-{[3-methoxy-4- (morpholin-4-yl)phenyl]amino}imidazo[l,2-a]pyrazin-6-yl)quinazolin-2-amine; l-(4-{[6- (lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)azetidin-3-ol; l-(4-{[6-(lH- indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}-2-methoxyphenyl)pyrrolidin-3-ol; 6-(3,4- dihydro-2H- 1 ,4-benzoxazin-6-yl)-N-[3 -methoxy-4-(morpholin-4-yl)phenyl]imidazo[ 1 ,2- a]pyrazin-8-amine; 6-(lH-indazol-6-yl)-N-[4-(2-methoxypropan-2-yl)phenyl]imidazo[l,2- a]pyrazin-8-amine; N-(4-ethoxy-3-methoxyphenyl)-6-(lH-indol-6-yl)imidazo[l,2- a]pyrazin-8-amine; N-[3-methoxy-4-(morpholin-4-yl)phenyl]-6-(l -methyl- lH-1, 3- benzodiazol-5-yl)imidazo[l,2-a]pyrazin-8-amine; N-[4-(4-ethylpiperazin-l-yl)-3- methoxyphenyl]-6-(lH-indazol-6-yl)imidazo[l,2-a]pyrazin-8-amine; and l-(4-{[6-(lH- indazol-6-yl)imidazo[l,2-a]pyrazin-8-yl]amino}phenyl)-3-methylpiperidin-3-ol, or a pharmaceutically acceptable salt thereof.
[0062] In one embodiment, the SYK inhibitor is Compound 1 having the formula:
Figure imgf000025_0001
(Compound 1) or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal,
pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof. In one embodiment, the SYK inhibitor is a bis-mesylate salt of the above compound. In one embodiment, the SYK inhibitor is a SYK inhibitor disclosed in U.S. Patent No. 8,455,493, U.S. Patent Publication Nos. 20150038504, 20150038505,
20150150881, the contents of which are incorporated by reference herein.
[0063] ii. The following SYK inhibitors are disclosed in U.S. Patent No. 9,290,505, the contents of which are incorporated by reference herein: 6-(6-amino-5-methylpyrazin-2-yl)- N-(4-(4-(oxetan-3-yl)piperazin-l-yl)phenyl)imidazo[l,2-a]pyrazin-8-amine; 6-(6- aminopyrazin-2-yl)-N-(4-(4-(oxetan-3 -yl)piperazin- 1 -yl)phenyl)imidazo[ 1 ,2-a]pyrazin-8- amine; (R)-(4-(4-((6-(6-aminopyrazin-2-yl)imidazo[l,2-a]pyrazin-8- yl)amino)phenyl)morpholin-2-yl)methanol; 6-(6-aminopyrazin-2-yl)-5-methyl-N-(4-(4- (oxetan-3 -yl)piperazin- 1 -yl)phenyl)imidazo[ 1 ,2-a]pyrazin-8-amine; 2-(5-((6-(6- aminopyrazin-2-yl)imidazo[ 1 ,2-a]pyrazin-8-yl)amino)-2-(4-(oxetan-3 -yl)piperazin- 1 - yl)phenoxy)ethanol; and 2-((4-(4-((6-(6-aminopyrazin-2-yl)imidazo[l,2-a]pyrazin-8- yl)amino)phenyl)piperazin-l-yl)methyl)propane-l,3-diol; 2-(5-((6-(6-amino-5- methylpyrazin-2-yl)imidazo[l,2-a]pyrazin-8-yl)amino)-2-(4-(oxetan-3-yl)piperazin-l- yl)phenoxy)ethanol, or a pharmaceutically acceptable salt thereof.
[0064] In one embodiment, the SYK inhibitor is a compound selected from:
Figure imgf000027_0001
acceptable salt, ester or derivative thereof.
[0065] iii. The following SYK inhibitors are disclosed in U.S. Patent Application No. 20110152273A1 : 6-((lR,2S)-2-aminocyclohexylamino)-7-fluoro-4-(l-methyl-lH-pyrazol- 4-yl)-lH-pyrrolo[3,4-c]pyridin-3(2H)-one; 6-((l S,2R)-2-aminocyclohexylamino)-7-fluoro- 4-(l-methyl-lH-pyrazol-4-yl)-lH-pyrrolo[3,4-c]pyridin-3(2H)-one; 6-((lR,25)-2- aminocyclohexylamino)-4-(l-(difluoromethyl)-lH-pyrazol-4-yl)-7-fluoro-lH-pyrrolo[3,4- c]pyridin-3(2H)-one; cis-6-(2-aminocyclohexylamino)-7-fluoro-4-(l -methyl- lH-pyrazol-4- yl)-lH-pyrrolo[3,4-c]pyridin-3(2H)-one; 6-((3R,4R)-3-aminotetrahydro-2H-pyran-4- ylamino)-4-(l-(difluoromethyl)-lH-pyrazol-4-yl)-7-fluoro-lH-pyrrolo[3,4-c]pyridin-3(2H)- one; and 6-((3R,4R)-3-aminotetrahydro-2H-pyran-4-ylamino)-7-fluoro-4-(3- methylisothiazol-5-yl)-lH-pyrrolo[3,4-c]pyridin-3(2H)-one, or a pharmaceutically acceptable salt thereof.
[0066] iv. The following SYK inhibitors are disclosed in U.S. Patent No. 9,376,441, the entire contents of which are incorporated by reference herein: (R)-4-((R)-l-((6-(3,4- dimethoxyphenyl)pyrazolo[ 1 , 5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -((6- (3,4-dimethoxyphenyl)-3-methylpyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3-methyl-6-(4-morpholinophenyl)pyrazolo[l,5-a]pyrazin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3-chloro-6-
(3,4dimethoxyphenyl)pyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l- ((6-(3,4-dimethoxyphenyl)-2-methylpyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2- one; (R)-4-((R)- 1 -((6-( 1 -(tert-butyl)- 1 H-pyrazol-4yl)-3 -methylpyrazolo[ 1 , 5 -a]pyrazin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(3,4-dimethoxyphenyl)pyrazolo[l,5- a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l((6-(3,4-dimethoxyphenyl)-3- methylpyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(l -(tert- butyl)- lH-pyrazol-4-yl)-3-methylpyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3-methyl-6-(4-morpholinophenyl)pyrazolo[l,5-a]pyrazin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3-chloro-6-(3,4- dimethoxyphenyl)pyrazolo[ 1 , 5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -((6- (3,4-dimethoxyphenyl)-2-methylpyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(3-methyl-6-(4-morpholinophenyl)pyrazolo[l,5-a]pyrazin-4-yl)- oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(l-tert-butyl-lH-pyrazol-4-yl)-3- methylpyrazolo[l,5-a]pyrazin-4-yloxy)ethyl)-l-((R)-l-(4-methoxyphenyl)ethyl)pyrrolidin- 2-one; (R)-4-((R)- 1 -(3 -chloro-6-(3 ,4dimethoxyphenyl)py razolo[ 1 , 5 -a]pyrazin-4- yloxy)ethyl)- 1 -((R)- 1 -(4-methoxyphenyl)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -(3 -chloro-6- (3,4-dimethoxyphenyl)pyrazolo[l,5-a]pyrazin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l- (6-(3,4-dimethoxyphenyl)-2-methylpyrazolo[l,5-a]pyrazin-4-yloxy)ethyl)-l-((R)-l-(4- methoxyphenyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(3,4-dimethoxyphenyl)-2- methylprazolo[l,5-a]pyrazin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(3-bromo-6-(3,4- dimethoxyphenyl)pyrazolo [ 1 , 5 -a]pyrazin-4-yloxy)ethyl)- 1 -((R)- 1 -(4- methoxyphenyl)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -(3 -bromo-6-(3 ,4- dimethoxyphenyl)pyrazolo[ 1 , 5-a]pyrazin-4-yloxy)ethyl)pyrrolidin-2-one; 4-(4-(4-((R)- 1 - ((R)-5-oxopyrrolidin-3-yl)ethoxy)pyrazolo[l,5-a]pyrazin-6yl)phenyl)piperazine-l- carboxylate; (R)-4-((R)- 1 -((6-(4-(piperazin- 1 -yl)phenyl)pyrazolo[ 1 , 5-a]pyrazin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -((6-(4-(4-acetylpiperazin- 1 - yl)phenyl)pyrazolo[ 1 , 5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -((6-(4-(4- (methylsulfonyl)piperazinl-yl)phenyl)pyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2- one; tert-butyl 4-(2-methoxy-4-(4-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)pyrazolo[l,5-a]- pyrazin-6-yl)phenyl)piperazine- 1 -carboxylate; (R)-4-((R)- 1 -((6-(3 -methoxy-4-(piperazin- 1 - yl)phenyl)prazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(4-(4- acetylpiperazin-l-yl)-3-methoxyphenyl)pyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2- one; (R)-4-((R)-l-((6-(3-methoxy-4-(4-(methylsulfonyl)piperazin-l-yl)phenyl)pyrazolo[l,5- a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; tert-butyl 4-(4(3-methyl-4-((R)-l-((R)-5- oxopyrrolidin-3-yl)ethoxy)pyrazolo[l,5-a]pyrazin-6-yl)phenyl)piperazine-l-carboxylate; (R)-4-((R)-l-((3-methyl-6-(4-(piperazin-l-yl)phenyl)pyrazolo[l,5-a]pyrazin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -((6-(4-(4-acetylpiperazin- 1 -yl)phenyl)- 3methylpyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3-methyl-6- (4-(4-(methylsulfonyl)piperazin- 1 -yl)phenyl)pyrazolo[ 1 , 5-a]pyrazin-4- yl)oxy)ethyl)pyrrolidin-2-one; tert-butyl 4-(2-methoxy-4-(3-methyl-4((R)-l-((R)-5- oxopyrrolidin-3-yl)ethoxy)pyrazolo[l,5-a]pyrazin-6-yl)phenyl)piperazine-l-carboxylate; (R)-4-((R)- 1 -((6-(3 -methoxy-4-(piperazin- 1 -yl)phenyl)-3 -methylprazolo[ 1 , 5 -a]pyrazin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -((6(4(4-acetylpiperazin- 1 -yl)-3 - methoxyphenyl)-3-methylprazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4- ((R)- 1 -((6-(3 -methoxy-4-(4-(m ethyl sulfonyl)piperazin- 1 -yl)phenyl)-3 -methylpyrazolo[ 1,5- a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(3-methoxy-4-(4-(oxetan-3- yl)piperazin-l-yl)phenyl)-3-methylpyrazolo[l,5-a]pyrazin-4-yl)oxy)ethyl)pyrrolidin-2-one; 6-chloro-4-((R)- 1 -((R)- 1 -((R)- 1 -(4-methoxyphenyl)ethyl)-5-oxopyrrolidin-3 - yl)ethoxy)pyrazolo[l,5-a]pyrazine-3-carbonitrile; 6-(3,4-dimethoxyphenyl)-4-((R)-l-((R)-5- oxopyrrolidin-3-yl)ethoxy)pyrazolo[l,5-a]pyrazine-3-carbonitrile; 6-(4-(4-acetylpiperazin- l-yl)phenyl)-4-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)pyrazolo[l,5-a]pyrazine-3- carbonitrile; 6-(4-(4-(methylsulfonyl)piperazin-l-yl)phenyl)-4-((R)-l-((R)-5-oxopyrroli- din-3-yl)ethoxy)pyrazolo[l,5-a]pyrazine-3-carbonitrile; 6-(4-(4-(oxetan-3-yl)piperazin-l- yl)phenyl)-4-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)pyrazolo[l,5-]pyrazine-3-carbonitrile; (R)-4-((R)-l-(6-(3,4-dimethoxyphenyl)-3-methyl-3H-imidazo[4,5-c]pyridin-4- yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(3,4-dimethoxyphenyl)-3-ethyl-3H- imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((S)-l-(6-(3,4- dimethoxyphenyl)-3-methyl-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)- 4-((R)-l-(3-cyclopropyl-6-(3,4-dimethoxyphenyl)-3H-imidazo[4,5-c]pyridin-4- yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(3-(difluoromethyl)-6-(3,4-dimethoxyphenyl)- 3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4((R)-l-(3-methyl-6-(3,4,5- trimethoxyphenyl)-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((6- (3,4-dimethoxyphenyl)-3-methyl-3H-imidazo[4,5-c]pyridin-4-yloxy)methyl)pyrrolidin-2- one; (R)-4-((R)-2-cyclopropyl-l-(6-(3,4-dimethoxyphenyl)-3-methyl-3H-imidazo[4,5- c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(3-methyl-6-(4-morpholinophenyl)- 3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(3- dimethoxyphenyl)-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l- (6-(3,4-dimethoxyphenyl)-3-isopropyl-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin- 2-one; 4-(3-methyl-4-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)-3H-imidazo[4,5-c]pyridin-6- yl)benzonitrile; (4R)-4-((lR)-l-(6-(3,4-dimethoxyphenyl)-2,3-dimethyl-3a,7a-dihydro-3H- imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(3,4- dimethoxyphenyl)-3-(2,2,2-trifluoroethyl)-3H-imidazo[4,5-c]pyridin-4- yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(3,4dimethoxyphenyl)-3-(oxetan-3-yl)-3H- imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(3-(2,2-difluoroethyl)-6- (3,4-dimethoxyphenyl)-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4- ((R)-l-(6-(3,4-dimethoxyphenyl)-3-(fluoromethyl)-3H-imidazo[4,5-c]pyridin-4- yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(3-fluoro-4-methoxyphenyl)-3-methyl-3H- imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; 2-methoxy-5-(3-methyl-4-((R)-5- oxopyrrolidin-3-yl)ethoxy)-3H-imidzo[4,5-c]pyridin-6-yl)benzonitrile-2-methoxy-5-(3- methyl-4-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)-3H-imidazo[4,5-c]pyridin-6- yl)benzonitrile; (R)-4-((R)-l-(3-methyl-6-phenyl-3H-imidazo[4,5-c]pyridin-4- yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(3-methyl-6-(3morpholinophenyl)-3H- imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(2-tert-butylthiazol- 4-yl)-3methyl-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(3- methyl-6-(pyrazolo[l,5-a]pyridin-3-yl)-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin- 2-one; (R)-4-((R)-l-(6-(2,2-difluorobenzo[d][l,3]dioxol-5-yl)-3-methyl-3H-imidazo[4,5- c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4((R)-l-(3-methyl-6-(4-methyl-3,4-dihydro- 2H-benzo[b][l,4]oxazin-6-yl)-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(3,4-dihydro-2H-benzo[b][l,4]oxazin-6-yl)-3-methyl-3H-imidazo[4,5- c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(2-tert-butylthiazol-5-yl)-3- methyl-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6- cyclohexenyl-3-methyl-3H-imidazo[4,5-c]pyridin-4-yloxy)ethyl)pyrrolidin-2-one; 4-(3- methyl-4-((R)-l-((R)-5-oxopyiTolidin-3-yl)ethoxy)-3H-imidazo[4,5-c]-pyridin-6-yl)pyridin- 2(lH)-one; 7-(3-methyl-4-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)-3H-imidazo[4,5- c]pyridin-6-yl)-3,4-dihydrobenzo[f][l,4]oxazepin-5(2H)-one; (R)-4-((R)-l-(3methyl-6-(4- methyl-3,4-dihydro-2H-benzo[b][l,4]oxazin-7-yl)-3H-imidazo[4,5-c]pyridin-4- yloxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(benzo[d]thiazol-5-yl)-3-methyl-3H- imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3-methyl-6-(2- methylbenzo[d]thiazol-5-yl)-3H-imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3-methyl-6-methyl-lH-indazol-5-yl)-3H-imidazo[4,5-c]pyridin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3-methyl-6-(l-methyl-lH-indazol-6-yl)-3H- imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(l,3-dimethyl-lH- indazol-5-yl)-3-H-imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3- methyl-6-(4-(4-(methylsulfonyl)piperazin-l-yl)phenyl)-3H-imidazo[4,5-c]pyridin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(3,4-dimethoxyphenyl)3-methyl-3H- imidazo[4,5-c]pyridin-4-yl)oxy)propyl)pyrrolidin-2-one; (R)-4-((S)-l-((6-(3,4- dimethoxyphenyl)-3-methyl-3H-imidazo[4,5-c]pyridin-4-yl)oxy)-2,2,2- trifluoroethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -((3 -methyl-6-(4-(4-(oxetan-3 -yl)piperazin- 1 - yl)phenyl)-3H-imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(4- (4-acetylpiperazin-l-yl)phenyl)-3methyl-3H-imidazo[4,5-c]pyridin-4- yl)oxy)ethyl)pyrrolidin-2-one; (R)-7-((R)-l-((3-(difluoromethyl)-6-(3,4-dimethoxyphenyl)- 3H-imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)-5-azaspiro[2,4]heptan-4-one; N,N-dimethyl-4-(3- methyl-4-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)-3H-imidazo[4,5-c]pyridin-6- yl)benzenesulfonamide; (R)-4-((R)-l-((3-(difluoromethyl)-6-(3,4-dimethoxyphenyl)-2- methyl-3H-imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((3- cyclopropyl-6-(3,4-dimethoxyphenyl)-2-methyl-3H-imidazo[4,5-c]pyridin-4- yl)oxy)ethyl)pyrrolidin-2-one; and (R)-4-((R)-l-((6-(3,4-dimethoxyphenyl)-3-isopropyl-2- methyl-3H-imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(tert- butyl)-lH-pyrazol-4-yl)-l-methyl-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4((R)-l-((l-methyl-5-(6-(trifluoromethyl)pyridin-2-yl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(6-methoxypyridin-2-yl)-l-methyl-lH- benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(5,6-dimethoxypyridin- 2-yl)-l,2-dimethyl-lH-benzo[d]-imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5- (5,6-dimethoxypyridin-2-yl)-l -methyl- lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2- one; (R)-4-((R)-l-((5-(3,4-dimethoxyphenyl)-l-methyl-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(6-aminopyridin-2-yl)-l-cyclopropyl-lH- benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(5-(4- morpholinopiperidin-l-yl)pyridin-2-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2- one; (R)-4-((R)- 1 -( 1 -cyclopropyl-5-(5-(4-(oxetan-3 -yl)piperidin- 1 -yl)pyridin-2-yl)- 1H- benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (4R)-4-((lR)-l-((5-(5-(6-oxa-3- azabicyclo[3.1.1 ]heptan-3 -yl)pyridin-2-yl)- 1 -cyclopropyl- lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -(( 1 -cyclopropyl-5-( 1 -methyl- lH-pyrazol-4-yl)- lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(l- (oxetan-3-yl)-lH-pyrazol-4-yl)-lH-benzo-[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)- 4-((R)- 1 -((5-( 1 -(tert-butyl)- lH-pyrazol-4-yl)- 1 -cyclopropyl- lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(l-(pyridin-4-yl)-lH-pyrazol-
4- yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-
5- (l-(l-hydroxy-2-methylpropan-2-yl)-lH-pyrazol-4-yl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -(( 1 -cyclopropyl-5-( 1 -(2 -hydroxy -2- methylpropyl)-lH-pyrazol-4-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)- 4-((R)- 1 -(( 1 -cy clopropyl-5 -( 1 -(1 -(oxetan-3 -yl)piperidin-4-yl)- 1 H-pyrazol-4-yl)- 1 H- benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(3- fluoro-4-(4-(oxetan-3-yl)piperazin-l-yl)phenyl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; 5-(l-cyclopropyl-7-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)- lH-benzo[d]imidazol-5-yl)-2-(4-(oxetan-3 -yl)piperazin- 1 -yl)benzonitrile; (R)-4-((R)- 1 -(( 1 - cyclopropyl-5-(5-(4-(oxetan-3-yl)piperazin-lyl)pyridin-2-yl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)4-((R)-l-((lcyclopropyl-5-(3,4-dihydro-2H-pyrido[3,2- b][l,4]oxazin-6-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l- cyclopropyl-5-(3,4-dihydro-2H-benzo[b][l,4]oxazin-6-yl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(6-(4-(oxetan-3-yl)piperazin- 1 -yl)pyridazin-3 -yl)- lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 - ((l-cyclopropyl-5-(3,3-dimethylindolin-6-yl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(pyrimidin-4-yl)-lH- benzo[d]imidazol-7-yl)-oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-phenyl- lH-henzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5- (pyrazin-2-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l- cyclopropyl-5-(pyridin-2-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4- ((R)- 1 -(( 1 -cyclopropyl-5-( 1 -methyl- 1 ,2,3 ,4-tetrahydroquinoxalin-6-yl)- 1H- benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(l- methyl-l-H-indazol-5-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4- ((R)-l-((l-cyclopropyl-5-(4-(difluoromethoxy)-3-methoxyphenyl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -(( 1 -cyclopropyl-5-(thiazol-2-yl)- 1H- benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(2-(2- hydroxypropan-2-yl)thiazol-5-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -(( 1 -cy clopropyl-5-(2-methylthiazol-4-yl)- lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(l-(tetrahydro-2H-pyran-4- yl)-lH-pyrazol-5-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l- ((l-cyclopropyl-5-(4,5-dimethylthiazol-2-yl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(4-(tert-butyl)thiazol-2-yl)-l-cyclopropyl- lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(2- (tetrahydro-2H-pyran-4-yl)thiazol-5-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2- one; (R)-4-((R)-l-((l-cyclopropyl-5-(l,5-dimethyl-lH-pyrazol-3-yl)-lH-benzo[d]imidazol- 7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(l,2-dimethyl-lH- imidazol-4-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l- cyclopropyl-5-(5-methyl-l,3,4-thiadiazol-2-yl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 ((5-(l -(tert-butyl)- lH-pyrazol-3 -yl)-l - cyclopropyl- lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -(( 1 - cyclopropyl-5-(2-methyl-lH-imidazol-5-yl)-lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(5-methylthiazol-2-yl)-lH- benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((l-cyclopropyl-5-(l- methyl-lH-pyrazol-3-yl)-lH-benzo[d]imidazol-7-yl)oxy)ethyl)pyrrolidin-2-one; and (R)-4- ((R)- 1 -(( 1 -cyclopropyl-5-(2-methyl-2H- 1 ,2,3 ,-triazol-4-yl)- lH-benzo[d]imidazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(l-cyclobutyl-lH-pyrazol-4- yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(l-(2,2-difluoroethyl)- lH-pyrazol-4-yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((-5-(l- isopropyl-lH-pyrazol-4-yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l- ((5-(l-(tert-butyl)-lH-pyrazol-4-yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4- ((R)-l-((5-(l-ethyl-lH-pyrazol-3-yl)benzol[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)- 4-((R)- 1 -((5-( 1 -(tert-butyl)- lH-pyrazol-4-yl)-2-methylbenzo[d]thiazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)- 1 -((5-( 1 -isopropyl- lH-pyrazol-3 - yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(l-(tetrahydro-2H- pyran-4-yl)-lH-pyrazol-4-yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l- ((5-(5-morpholinopyridin-2-yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; tert-butyl 4- (6-(7-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)benzo[d]thiazol-5-yl)pyridin-3-yl)piperazine- 1 -carboxylate; (R)-4-((R)- 1 -((5-(5-(4-(oxetan-3 -yl)piperazin- 1 -yl)pyridin-2- yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(5-(4-acetylpiperazin- l-yl)pyridin-2-yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(5-(4- (tetrahydro-2H-pyran-4-yl)piperazin-l-yl)pyridin-2-yl)benzo[d]thiazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(5,6-dimethoxypyridin-2- yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5-(4-(4-(oxetan-3- yl)piperazin-l-yl)phenyl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5- (4-morpholinophenyl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5- (3,4-dimethoxyphenyl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((5- (3,4-dimethoxyphenyl)-2-methylbenzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; tert-butyl 4-(4-(7-((R)-l-((R)-5-oxopyrrolidin-3-yl)ethoxy)benzo[d]thiazol-5-yl)phenyl)piperazine-l- carboxylate; (R)-4-((R)-l-([4,5'-bibenzo[d]thiazol]-7'-yloxy)ethyl)pyrrolidin-2-one, (S)-4- ((S)-l-((5-(2-(tert-butyl)thiazol-5-yl)benzo[d]thiazol-7-yl)oxy)ethyl)pyrrolidin-2-one; and (R)-4-((R)-l-((5-(l-methyl-lH-thieno[3,2-c]pyrazol-5-yl)benzo[d]thiazol-7- yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-(6-(benzo[d]thiazol-4-yl)-3-methyl-3H- imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; (R)-4-((R)-l-((6-(benzo[d]thiazol-5- yl)-3-methyl-3H-imidazo[4,5-c]pyridin-4-yl)oxy)ethyl)pyrrolidin-2-one; and (R)-4-((R)-l- ((3-methyl-6-(2-methylbenzo[d]thiazol-5-yl)-3H-imidazo[4,5-c]pyridin-4- yl)oxy)ethyl)pyrrolidin-2-one, or a pharmaceutically acceptable salt thereof.
[0067] v. The following SYK inhibitors are disclosed in U.S. Patent No. 9,359,375: 4- ((lR,2S)-2-aminocyclohexylamino)-2-(m-tolylamino)benzamide; 4-((lR,2S)-2- aminocyclohexylamino)-2-(l -methyl- lH-indol-4-ylamino)benzamide; 4-((lR,2S)-2- aminocyclohexylamino)-2-(4-fluorophenylamino)benzamide; 4-((lR,2S)-2- aminocyclohexylamino)-2-(3,5-dimethylphenylamino)benzamide; 2-(3-(2H-l,2,3-triazol-2- yl)phenylamino)-4-((lR,2S)-2-aminocyclohexylamino)benzamide; 4-((lR,2S)-2- aminocyclohexylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; 4-((lR,2S)-2- aminocyclohexylamino)-2-(3-phenylisoxazol-5-ylamino)benzamide; 4-((lR,2S)-2- aminocyclohexylamino)-2-(l -methyl- lH-pyrazol-4-ylamino)benzamide; (R)-4-(l-amino-4- methyl-l-oxopentan-2-ylamino)-2-(3-methylisothiazol-5-yl-amino)benzamide; (R)-4-(l- amino-l-oxopropan-2-ylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l- amino-3-methyl-l-oxobutan-2-ylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; (R)- 4-(l-amino-4-methyl-l-oxopentan-2-ylamino)-2-(5-methylisoxazol-3-ylamino)benzamide; (R)-4-(l-amino-4-methyl-l-oxopentan-2-ylamino)-2-(3-methylisoxazol-5- ylamino)benzamide; (R)-4-(l-amino-l-oxo-3-phenylpropan-2-ylamino)-2-(3- methylisothiazol-5-yl-amino)benzamide; (R)-4-(l-amino-3-(benzyloxy)-l-oxopropan-2- ylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l-amino-3 -hydroxy- 1- oxopropan-2-ylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l-amino-3- cyclohexyl-l-oxopropan-2-ylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(2- amino-2-oxo-l-phenylethylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l- amino-4-methyl-l-oxopentan-2-ylamino)-2-fluoro-6-(3-methylisothiazol-5- ylamino)benzamide; (R)-4-(l-amino-4-methyl-l-oxopentan-2-ylamino)-5-fluoro-2-(3- methylisothiazol-5-ylamino)benzamide; 4-((lR,2S)-2-aminocyclohexylamino)-5-fluoro-2- (3-methylisothiazol-5-ylamino)benzamide; (R)-4-(2-amino-l-cyclohexyl-2-oxoethylamino)- 2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l-amino-4-methyl-l-oxopentan-2- ylamino)-3-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l -amino- l-oxo-3 - phenylpropan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l- amino-3-cyclopropyl-l-oxopropan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5- ylamino)benzamide; (R)-4-(l -amino- l-oxobutan-2-ylamino)-5-fluoro-2-(3- methylisothiazol-5-ylamino)benzamide; (R)-4-(l-amino-3-(4-fluorophenyl)-l-oxopropan-2- ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l-amino-3-(4- hydroxyphenyl)-l-oxopropan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5- ylamino)benzamide; (R)-4-(2-amino-3-methoxypropylamino)-2-(3-methylisothiazol-5- ylamino)benzamide; (S)-4-(2-aminobutylamino)-2-(3-methylisothiazol-5- ylamino)benzamide; (S)-4-(2-aminopropylamino)-2-(3-methylisothiazol-5- ylamino)benzamide; (S)-4-(2-amino-4-methylpentylamino)-2-(3-methylisothiazol-5- ylamino)benzamide; (R)-4-(l -amino- l-oxobutan-2-ylamino)-2-(3-methylisothiazol-5- ylamino)benzamide; (R)-4-(l -amino- l-oxobutan-2-ylamino)-2-(3-methylisothiazol-5- ylamino)benzamide; (R)-4-(l-amino-3-cyclopropyl-l-oxopropan-2-ylamino)-2-(3- methylisothiazol-5-ylamino)benzamide; (R)-4-(l-amino-3-(4-methoxyphenyl)-l-oxopropan- 2-ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l-amino-3-(3- fluorophenyl)-l-oxopropan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5- ylamino)benzamide; (R)-4-(l-amino-l-oxo-3-(pyridin-4-yepropan-2-ylamino)-5-fluoro-2- (3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l -amino- l-oxo-3 -(pyridin-3-yl)propan-2- ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l-amino-3-methoxy- l-oxopropan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; 6-(cis-2- aminocyclohexylamino)-4-(3-toluidino)nicotinamide; 6-(cyclopentylamino)-4-(4- morpholinophenylamino)nicotinamide; 4-(4-carbamoylphenylamino)-6- (cyclopentylamino)nicotinamide; 4-((lR,2S)-2-aminocyclohexylamino)-5-fluoro-2-(3- phenylisoxazol-5-ylamino)benzamide; 4-((lR,2S)-2-aminocyclohexylamino)-2-(3- methylisoxazol-5-ylamino)benzamide; 4-((lR,2S)-2-aminocyclohexylamino)-5-fluoro-2-(3- methylisoxazol-5-ylamino)benzamide; (R)-4-(l-amino-3-(2-fluorophenyl)-l-oxopropan-2- ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; 4-(3-(2H-l,2,3-triazol-2- yl)phenylamino)-6-((lR,2S)-2-aminocyclohexylamino)nicotinamide; 6-((lR,2S)-2- aminocyclohexylamino)-4-(3-methylisothiazol-5-ylamino)nicotinamide; (R)-4-(2-amino-l- cyclopropyl-2-oxoethylamino)-5-fluoro-2-(3-methyl-isothiazol-5-ylamino)benzamide; 2-(3- methylisothiazol-5-ylamino)-4-(2-oxoazepan-3-ylamino)benzamide; (R)-4-(l-amino-3-(lH- indol-3-yl)-l-oxopropan-2-ylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l- amino-l-oxo-3-(pyridin-2-yl)propan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5- ylamino)benzamide; 4-(l-amino-4,4,4-trifluoro-l-oxobutan-2-ylamino)-5-fluoro-2-(3- methylisothiazol-5-ylamino)benzamide; (R)-4-(l -amino- l-oxo-3 -(thiophen-2-yl)propan-2- ylamino)-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4-(l -amino- l-oxo-3 -(4-(pyridin- 4-yl)phenyl)propan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; (R)- 4-(3 -(4-( lH-imidazol- 1 -yl)phenyl)- 1 -amino- 1 -oxopropan-2-ylamino)-5-fluoro-2-(3 - methylisothiazol-5-ylamino)benzamide; (R)-4-( 1 -amino- 1 -oxo-3 -(4-(2-oxopyridin- 1 (2H)- yl)phenyl)propan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4- ( 1 -amino-3 -(4-(methyl sulfonyl)phenyl)- 1 -oxopropan-2-ylamino)-5 -fluoro-2-(3 - methylisothiazol-5-ylamino)benzamide; (R)-4-(l -amino- 1 -oxo-3 -(4-(pyridin-3- yl)phenyl)propan-2-ylamino)-5-fluoro-2-(3-methylisothiazol-5-ylamino)benzamide; (R)-4- (l-amino-3-cyclopropyl-l-oxopropan-2-ylamino)-5-fluoro-2-(3-phenylisoxazol-5- ylamino)benzamide; 6-((lR,2S)-2-aminocyclohexylamino)-4-(pyrazolo[l,5-a]pyridin-3- ylamino)nicotinamide; and 6-((lR,2S)-2-aminocyclohexylamino)-4-(thieno[2,3-b]pyridin-3- ylamino)nicotinamide, or a pharmaceutically acceptable salt thereof.
[0068] In one embodiment, the SYK inhibitor is a compound having the formula:
Figure imgf000037_0001
or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal, pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
[0069] vi. The following SYK inhibitors are disclosed in U.S. Patent No 7,435,814 and
8 227,455:
Figure imgf000037_0002
Fostamatinib R-406
Figure imgf000038_0001
, or a pharmaceutically acceptable salt thereof.
[0070] vii. The following SYK inhibitor is disclosed in U.S. Patent No 8,470,835:
Figure imgf000038_0002
armaceutically acceptable salt thereof.
[0071] viii. The following SYK inhibitor (CC-509) is disclosed in Ferguson et. al. (PLOS t No 8,470,835:
Figure imgf000038_0003
or a pharmaceutically acceptable salt thereof.
[0072] ix. Pyridopyrazine SYK inhibitors are disclosed in U.S. Patent Publication Nos. 20160002221 and 20150307491, the contents of which are incorporated by reference herein. The following SYK inhibitors are disclosed in the '221 and '491 publications:
4- morpholinecarboxylic acid, 2-[[[7-[4-(l-acetyl-3-azetidinyl)phenyl]pyrido[3,4-b]pyrazin-
5- yl]oxy]methyl]-l, l-dimethylethyl ester, (2S)-; 4-morpholinecarboxylic acid, 2-[[[7-[4-(3- azetidinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, 1, 1-dimethylethyl ester, (2S)-; Carbamic acid, N-[[(2S)-2-[[[7-(3,4-dimethoxyphenyl)pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]sulfonyl]- 1,1-dimethylethyl ester; 4-morpholinesulfonyl isocyanate, 2-[[[7-(3,4-dimethoxyphenyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Pyrido[3,4-b]pyrazine, 5-[(2S)-2-morpholinylmethoxy]-7-[4-(tetrahydro-2H-pyran-4- yl)phenyl]-; Ethanone, l-[4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; 2-Pyrrolidinone, 4-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-l-[(l S)-l-phenylethyl]-, (4S)-; Pyrido[3,4-b]pyrazine, 7-(3,4-dimethoxyphenyl)-5-[(2S)-2-morpholinylmethoxy]-; 4- Morpholinecarboxylic acid, 2-[[[7-(3,4-dimethoxyphenyl)pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, 1, 1-dimethylethyl ester, (2S)-; 4-morpholineethanamine, 2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; lH-Isoindole- l,3(2H)-dione, 2-[2-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]ethyl]-; Benzenamine, 4-[5-[[(2S)-4-(ethenylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-N,N-dimethyl-; benzenamine, N,N- dimethyl-4-[5-[(2S)-2-morpholinylmethoxy]pyrido[3,4-b]pyrazin-7-yl]-; 4- Morpholinecarboxylic acid, 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, 1, 1-dimethylethyl ester, (2S)-; 1-Propanone, 3-chloro-l-[(2S)-2-[[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Pyrido[3,4- b]pyrazine, 5-[(2S)-2-morpholinylmethoxy]-7-[4-(4-morpholinyl)phenyl]-; 4- Morpholinecarboxylic acid, 2-[[[7-[4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, 1, 1-dimethylethyl ester, (2S)-; Benzoic acid, 4-[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]-; Benzoic acid, 4-[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]-, methyl ester; Cyclohexanone, 4-[[7- [4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]-; 3-Morpholinone, 6-[[[7-[4-(l- hydroxy-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-methyl-, (6S)-; Benzeneacetonitrile, a,a-dimethyl-4-[5-[[(2S)-4-methyl-5-oxo-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; 3-morphoolinone, 4-methyl-6-[[[7-[4-[l- (methylsulfonyl)-4-piperidinyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (6S)-; 3- Morpholinone, 6-[[[7-(3,4-dimethoxyphenyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- methyl-, (6S)-; 3-morphoolinone, 4-methyl-6-[[[7-[4-(4-methyl-l- piperazinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (6S)-; 3-Morpholinone, 4- methyl-6-[[[7-[4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (6S)-; 4- Morpholinecarboxamide, 2-[[[7-[4-(l-acetyl-3-azetidinyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; Ethanone, l-[(2S)-2-[[[7-[4-(l-acetyl-3- azetidinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 4- Morpholinesulfonamide, 2-[[[7-[4-(l-cyanocyclobutyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; 4-Morpholinesulfonamide, 2-[[[7-[4-(l- cyanocyclopropyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinesulfonamide, 2-[[[7-(3,4-dimethoxyphenyl)pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; Pyrido[3,4-b]pyrazine, 7-[4-(l-methylethenyl)phenyl]-5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]-; 2-Pyrrolidinone, 4-[[[7-[4-[l-(methylsulfonyl)-
4- piperidinyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (4S)-; 4- Morpholinecarboxamide, 2-[[[7-(lH-indazol-5-yl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-[4-(tetrahydro-2H-pyran-4-yl)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Benzenemethanol, a-methyl-4-[5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4- b]pyrazine, 7-[4-(4-morpholinyl)phenyl]-5-[(3R)-3-pyrrolidinyloxy]-; 2-Pyrrolidinone, 4- [[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (4R)-; 2- Pyrrolidinone, 4-[[[7-[4-(dimethylamino)-3-methylphenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (4S)-; 2-Pyrrolidinone, 4-[[[7-[4-(4-methyl-l- piperazinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (4S)-; 2-Pyrrolidinone, 4-[[[7- [3-methyl-4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (4S)-; 2- Pyrrolidinone, 4-[[[7-[4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (4S)-; 2-Pyrrolidinone, 4-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (4S)-; Methanone, l-azetidinyl[(2S)-2-[[[7-[4-
(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-[methyl(l-methylethyl)amino]phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-; 4-Morpholinecarboxamide, 2-[[[7-(3,4-dihydro-l,l- dimethyl-lH-2-benzopyran-6-yl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinecarboxamide, 2-[[[7-(l,3-dihydro-l,l-dimethyl-5-isobenzofuranyl)pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4-morphoolinecarboxamide, 2-[[[7-[4-(l- cyanocyclobutyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinecarboxamide, 2-[[[7-[4-(l-ethyl-l-hydroxypropyl)phenyl]pyrido[3,4-b]pyrazin-
5- yl]oxy]methyl]-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-[4-(l- cyanocyclopropyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinecarboxamide, 2-[[[7-[4-(l,l-dimethylethyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-[4-(l-cyano-l- methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinecarboxamide, 2-[(l S)-l-[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]ethyl]-, (2S)-; 4-morphoolinecarboxamide, 2-[(lR)-l-[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]ethyl]-, (2S)-; 4- Morpholinecarboxamide, 2-[[[7-(2,3-dihydro-l-methyl-lH-indol-5-yl)pyrido[3,4-b]pyrazin- 5-yl]oxy]methyl]-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-(l,2,3,4-tetrahydro-l-methyl-6- quinolinyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4-Morpholinecarboxamide, 2- [[[7-[4-(dimethylamino)-3-fluorophenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinecarboxamide, 2-[[[7-[4-(l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; 4-morphoolinecarboxamide, 2-[[[7-[3-chloro-4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinecarboxamide, 2-[[[7-[4-(dimethylamino)-3-methylphenyl]pyrido[3,4-b]pyrazin- 5-yl]oxy]methyl]-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-(3,4- dimethoxyphenyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Methanone, [(2S)-2-[[[7- [4-(methylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl][(3S)-l- methyl-3-pyrrolidinyl]-; Sulfamide, N'-[2-[(2S)-2-[[[7-[4-
(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]ethyl]-N,N- dimethyl-; Urea, N'-[2-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]ethyl]-N,N-dimethyl-; Methanesulfonamide, N-[2-[(2S)-2- [[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]ethyl]-; Acetamide, N-[2-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]ethyl]-; Acetonitnle, 2-[[2-[[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]sulfonyl]ethyl]methylamino]-; 3-Pyrrolidinol, l-[2-[[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]sulfonyl]ethyl]-, (3 S)-; 3-Pyrrolidinol, l-[2-[[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]sulfonyl]ethyl]-, (3R)-; Benzenamine, N,N-dimethyl-4-[5-[[(2S)-4-[[2-(2- methyl-lH-imidazol-l-yl)ethyl]sulfonyl]-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7- yl]-; 2H-Pyran-4-ol, tetrahydro-4-[4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; Acetamide, N-[l -methyl- 1-[4-[5- [[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]ethyl]-; 4-Morpholinesulfonamide, 2-[[[7-[4-(l-hydroxycyclobutyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; Pyrido[3,4-b]pyrazine, 7-(3,4-dihydro-l, l-dimethyl-lH-2- benzopyran-6-yl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Ethanone, 1-[(2S)- 2-[[[7-(3,4-dihydro-l, l-dimethyl-lH-2-benzopyran-6-yl)pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-; Pyrido[3,4-b]pyrazine, 7-(l,3-dihydro-l,l-dimethyl-5- isobenzofuranyl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Ethanone, 1-[(2S)- 2-[[[7-(l,3-dihydro-l,l-dimethyl-5-isobenzofuranyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]- 4-morpholinyl]-; Cyclobutanecarbonitrile, l-[4-[5-[[(2S)-4-acetyl-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; 4-Morpholinesulfonamide, 2- [[[7-[4-(l-ethyl-l-hydroxypropyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Cyclopropanecarbonitrile, l-[4-[5-[[(2S)-4-acetyl-2-morpholinyl]methoxy]pyrido[3,4- b]pyrazin-7-yl]phenyl]-; 4-Morpholinesulfonamide, 2-[[[7-[4-(tetrahydro-2H-pyran-4- yl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4-Morpholinesulfonamide, 2-[[[7- [4-(l, l-dimethylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Pyrido[3,4- b]pyrazine, 7-[4-(l,l-dimethylethyl)phenyl]-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyljmethoxy]-; Ethanone, l-[(2S)-2-[[[7-[4-(l, l-dimethylethyl)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 4-morphoolinesulfonamide, 2-[[[7-[4-(l-cyano- l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-N-methyl-, (2S)-; 4- Morpholinesulfonamide, 2-[[[7-[4-(l-cyano-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; 4-morphoolinesulfonamide, 2-[(l S)-l-[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]ethyl]-, (2S)-; 4- Morpholinesulfonamide, 2-[(lR)-l-[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]ethyl]-, (2S)-; Benzenamine, N,N-dimethyl-4-[5-[(l S)-l-[(2S)-4-(methylsulfonyl)-2- morpholinyl]ethoxy]pyrido[3,4-b]pyrazin-7-yl]-; 4-morphoolinecarboxamide, 2-[(l S)-l-[[7- [4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]ethyl]-N-methyl-, (2S)-;
Ethanone, l-[(2S)-2-[(l S)-l-[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]ethyl]-4-morpholinyl]-; Benzenamine, N,N-dimethyl-4-[5-[(lR)-l-[(2S)-4- (methylsulfonyl)-2-morpholinyl]ethoxy]pyrido[3,4-b]pyrazin-7-yl]-; 4- Morpholinecarboxamide, 2-[(lR)-l-[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]ethyl]-N-methyl-, (2S)-; Ethanone, l-[(2S)-2-[(lR)-l-[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]ethyl]-4-morpholinyl]-; 4- Morpholinesulfonamide, 2-[[[7-(2,3-dihydro-l-methyl-lH-indol-5-yl)pyrido[3,4-b]pyrazin- 5-yl]oxy]methyl]-, (2S)-; 4-morphoolinesulfonamide, 2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-N-methyl-, (2S)-; 4- Morpholinesulfonamide, 2-[[[7-(l,2,3,4-tetrahydro-l-methyl-6-quinolinyl)pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]-7-(l,2,3,4-tetrahydro-l-methyl-6-quinolinyl)-; 1-Propanone, 1-[(2S)- 2-[[[7-[4-(dimethylamino)-3-methylphenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; 1-Propanone, l-[(2S)-2-[[[7-[4-(dimethylamino)-3-methylphenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-2-hydroxy-, (2S)-; 1-Propanone, l-[(2S)-2-[[[7- [4-(dimethylamino)-3-methylphenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-2-hydroxy-, (2R)-; 1-Propanone, l-[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 1- Propanone, l-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-2-hydroxy-, (2S)-; 1-Propanone, l-[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-2-hydroxy-, (2R)-; Ethanone, 2-hydroxy-l-[(2S)-2-[[[7-[4-(l-methylethyl)phenyl]pyrido[3,4-b]pyrazin- 5-yl]oxy]methyl]-4-morpholinyl]-; 4-Morpholinesulfonamide, 2-[[[7-[4-(l- methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinecarboxamide, 2-[[[7-[4-(dimethylamino)-3-fluorophenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-N-methyl-, (2S)-; Pyrido[3,4-b]pyrazine, 7-[4-(l-methylethyl)phenyl]-5- [[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; 4-Morpholinecarboxamide, N-methyl- 2-[[[7-[4-(l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Ethanone, l-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-2-hydroxy-; 1-Propanone, l-[(2S)-2-[[[7-[4-
(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-2,2- difluoro-; 4-Morpholinecarboxamide, 2-[[[7-[3-chloro-4-(dimethylamino)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-N-methyl-, (2S)-; 4-morphoolinecarboxamide, 2-[[[7-[4- (dimethylamino)-3-methylphenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-N-methyl-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-N,N-dimethyl-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-(3,4- dimethoxyphenyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-N-methyl-, (2S)-; 4- Morpholinecarboxamide, 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-N-methyl-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholineethanesulfonamide, 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-N-methyl-, (2S)-; 4-Morpholinepropanamide, 2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-N-methyl-, (2S)-; 4- Morpholineacetamide, 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-N-methyl-, (2S)-; Acetamide, 2-[[(2S)-2-[[[7-[4-
(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morholinyl]sulfonyl]-N- methyl-; Methanone, cyclopentyl[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Cyclopropanecarbonitrile, l-[[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]carbonyl]-; Methanone, (2,2-difluorocyclopropyl)[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Methanone, [(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl][(3S)- tetrahydro-3-furanyl]-; Benzenamine, N,N-dimethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Benzenamine, 4-[5-[[(2S)-4-[[(3- fluorophenyl)methyl]sulfonyl]-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-N,N- dimethyl-; Benzenamine, N,N-dimethyl-4-[5-[[(2S)-4-(3-pyridinylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Benzenamine, 4-[5-[[(2S)-4- (cyclohexylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-N,N-dimethyl-; Benzenamine, 4-[5-[[(2S)-4-(cyclopropylsulfonyl)-2-moq)holinyl]methoxy]pyrido[3,4- b]pyrazin-7-yl]-N,N-dimethyl-; Benzenamine, N,N-dimethyl-4-[5-[[(2S)-4-[(l- methylethyl)sulfonyl]-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Benzenamine, 4-[5-[[(2S)-4-(ethylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-N,N- dimethyl-; Methanone, [(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl](l -methyl- lH-pyrazol-4-yl)-; Methanone, [(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-lH- imidazol-2-yl-; 1-Propanone, l-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-3-(lH-imidazol-l-yl)-; Ethanone, l-[(2S)-2- [[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-2- (lH-imidazol-5-yl)-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(cyclopropylsulfonyl)-2- morpholinyl]methoxy]-7-[4-(4-morpholinyl)phenyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-[(l- methylethyl)sulfonyl]-2-morpholinyl]methoxy]-7-[4-(4-morpholinyl)phenyl]-; 4- Morpholinepentanenitrile, 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-.delta.-oxo-, (2S)-; Ethanone, l-[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-2-(3- pyridinyl)-; 1-Propanone, l-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-3-(3-pyridinyl)-; Methanone, [(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-3-pyridinyl- ; 4-morphoolinebutanenitrile, 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-. gamma. -oxo-, (2S)-; 4-morphoolinepropanenitrile, 2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-P-oxo-, (2S)-; Methanone, [(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl](cis-4-hydroxycyclohexyl)-; Methanone, [(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl](trans-4- hydroxycyclohexyl)-; Methanone, [(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl](tetrahydro-2H-pyran-4-yl)-; Methanone, [(2S)- 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl][(3R)-tetrahydro-3-furanyl]-; Methanone, (3,3-difluorocyclobutyl)[(2S)-2-[[[7- [4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-;
Ethanone, 2-cyclopropyl-l-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-; Methanone, cyclopropyl[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 1- Propanone, l-[(2S)-2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-2-methyl-; Ethanone, l-[(2S)-2-[[[7-[4- (dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-;
Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-[(2-methoxyethyl)sulfonyl]-2-morpholinyl]methoxy]-7- [4-(4-morpholinyl)phenyl]-; Ethanamine, N,N-dimethyl-2-[[(2S)-2-[[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]sulfonyl]-; 4- Morpholinesulfonamide, 2-[[[7-[4-(4-methyl-l-piperazinyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; 4-Morpholinecarboxamide, 2-[[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinesulfonamide, 2-[[[7-[4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; Ethanone, 2,2-difluoro-l-[(2S)-2-[[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 1-Propanone,
3- (dimethylamino)-l-[(2S)-2-[[[7-[4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-; Ethanamine, 2-[2-methoxy-4-[5-[[(2S)-4-(methylsulfonyl)- 2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenoxy]-N,N-dimethyl-; Pyrido[3,4- b]pyrazine, 7-[4-[l-(2-methoxyethyl)-4-piperidinyl]phenyl]-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyljmethoxy]-; 1-Piperidineethanol, 4-[4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-
4- (methylsulfonyl)-2-morpholinyl]methoxy]-7-[4-[l-(methylsulfonyl)-4- piperidinyl]phenyl]-; Ethanone, l-[(2S)-2-[[[7-(4-fluoro-3,4-dihydro-l,l-dimethyl-lH-2- benzopyran-6-yl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Pyrido[3,4- b]pyrazine, 7-(4-fluoro-3,4-dihydro-l, l-dimethyl-lH-2-benzopyran-6-yl)-5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]-; Ethanone, l-[3-methyl-3-[4-[5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-l-azetidinyl]-; Benzeneacetic acid, a,a-dimethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4-b]pyrazine, 7-[4-(3-methyl-3- oxetanyl)phenyl]-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; 4- Morpholinecarboxamide, 2-[[[7-[4-(l-hydroxycyclobutyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; Ethanone, l-[(2S)-2-[[[7-[4-(l- hydroxycyclobutyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-;
Cyclobutanol, l-[4-[5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4- b]pyrazin-7-yl]phenyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(l-amino-2- methylpropyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-;
Benzeneethanol, p,p-dimethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Benzenemethanol, a-(l-methylethyl)-4- [5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-;
Ethanone, l-[(2S)-2-[[[7-[4-(l-hydroxy-2-methylpropyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(l-hydroxy-2,2- dimethylpropyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-;
Benzenemethanol, a-(l,l-dimethylethyl)-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Cyclobutanecarbonitrile, l-[4-[5-[[(2S)-
4- (methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(l-methoxyethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; Benzenemethanol, a,a-diethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Ethanone, l-[(2S)-2-[[[7-[4-[2-hydroxy- l-(hydroxymethyl)-l-methylethyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; Cyclopropanecarbonitrile, l-[4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; Benzeneethanol, a,a-dimethyl-4- [5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-;
Benzeneethanamine, N,N-dimethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Ethanone, l-[(2S)-2-[[[7-[4-[l- (dimethylamino)ethyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(l-ethyl-l-hydroxypropyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(l-methoxy-l- methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Pyrido[3,4- b]pyrazine, 7-[4-(l-methoxy-l-methylethyl)phenyl]-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]-; Ethanone, l-[(2S)-2-[[[7-[4-(2-amino-l,l- dimethylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 4- morphoolinecarboxamide, 2-[[[7-[4-(l-hydroxy-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-
5- yl]oxy]methyl]-, (2S)-; Ethanone, l-[(2S)-2-[[[7-[4-(l-hydroxy-l- methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 4- morphoolinecarboxamide, 2-[[[7-[4-(l-hydroxy-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin- 5-yl]oxy]methyl]-N-methyl-, (2S)-; 4-Morpholinesulfonamide, 2-[[[7-[4-(l-hydroxy-l- methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- morphoolinesulfonamide, 2-[[[7-[4-(l-hydroxy-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin- 5-yl]oxy]methyl]-N-methyl-, (2S)-; Acetamide, N-methyl-N-[[4-[5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]methyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)-2-moq)holinyl]methoxy]-7-[4-(4- morpholinylmethyl)phenyl]-; Ethanone, l-[(2S)-2-[[[7-[4-
[(dimethylamino)methyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 4- Morpholinecarboxamide, 2-[[[7-[4-(l-cyano-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-N-methyl-, (2S)-; Benzeneacetonitrile, 4-[5-[[(2S)-4-acetyl-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-a,a-dimethyl-; Ethanone, l-[(2S)-2-[[[7- [4-(l-amino-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Benzenemethanamine, a, a-dimethyl-4- [5 -[ [(2 S)-4-(methyl sulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Benzeneacetamide, a,a-dimethyl-4-[5- [[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4- b]pyrazine, 7-[4-(l,l-difluoroethyl)phenyl]-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyljmethoxy]-; 4-Morpholinecarboxamide, 2-[[[7-(4-ethylphenyl)pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-N-methyl-, (2S)-; 4-morphoolinesulfonamide, 2-[[[7-[4- (dimethylamino)-3-methylphenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-N-methyl-, (2S)-; 4-Morpholinesulfonamide, 2-[[[7-(3,4-dimethoxyphenyl)pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-N-methyl-, (2S)-; Benzenemethanol, a,a-dimethyl-4-[5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; 2-Pyridinamine, N,N-dimethyl-5-[5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin- 7-yl]-; Pyrido[3,4-b]pyrazine, 7-(2,3-dihydro-l-methyl-lH-indol-5-yl)-5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]-; Benzeneacetonitrile, a,a-dimethyl-4-[5-[[(2S)-
4- (methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; 4- Morpholinecarboxamide, 2-[[[7-(lH-indazol-5-yl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-N- methyl-, (2S)-; Pyrido[3,4-b]pyrazine, 7-(lH-indazol-5-yl)-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyljmethoxy]-; Ethanone, l-[(2S)-2-[[[7-(2,3-dihydro-l -methyl- lH-indol-5- yl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 4-Morpholinesulfonamide, 2- [[[7-[4-(dimethylamino)-3-methylphenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Ethanone, l-[(2S)-2-[[[7-[3-methyl-4-(4-methyl-l-piperazinyl)phenyl]pyrido[3,4-b]pyrazin-
5- yl]oxy]methyl]-4-n^holinyl]-; Ethanone, l-[(2S)-2-[[[7-(l,2,3,4-tetrahydro-l-methyl-6- quinolinyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2- [[[7-[3-methyl-4-(l-piperazinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; 4-Morpholinesulfonamide, 2-[[[7-[4-(dimethylamino)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-, (2S)-; Ethanone, l-[(2S)-2-[[[7-[6-(dimethylamino)-5-methyl- 3-pyridinyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 2H-Indol-2-one, 5-[5- [[(2S)-4-acetyl-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-l,3-dihydro-l-methyl-; Ethanone, l-[(2S)-2-[[[7-[4-(4-piperidinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(dimethylamino)-3,5- dimethylphenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, 1-[(2S)- 2-[[[7-[4-(l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(dimethylamino)-3-methylphenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-methoxy-3-(l- methylethoxy)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, 1- [(2S)-2-[[[7-(3,4-dihydro-4-methyl-2H-l,4-benzoxazin-7-yl)pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-n^holinyl]-; Ethanone, l-[(2S)-2-[[[7-[3-methoxy-4-(l- methylethoxy)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, 1- [(2S)-2-[[[7-[3-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-(3-methoxyphenyl)pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-n^holinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-[(l- methylethyl)amino]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-;
Ethanone, l-[(2S)-2-[[[7-[3-chloro-4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(dimethylamino)-3- fluorophenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2- [[[7-(3,5-dimethoxyphenyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-moq)holinyl]-;
Benzenamine, N,N,2-trimethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Ethanone, l-[(2S)-2-[[[7-(3,4- dimethoxyphenyl)pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, 1- [(2S)-2-[[[7-[4-(diethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; Ethanamine, N,N-dimethyl-2-[3-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenoxy]-; Acetamide, N-methyl-2-[4-[5- [[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenoxy]-; Ethanone, l-[4-[4-[5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4- b]pyrazin-7-yl]phenyl]-l-piperazinyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)- 2-morpholinyl]methoxy]-7-(3,4,5-trimethoxyphenyl)-; Pyrido[3,4-b]pyrazine, 7-(l-methyl- lH-indol-6-yl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Benzenamine, N,N- diethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Ethanone, l-[(2S)-2-[[[7-[4-[(2-methoxyethyl)amino]phenyl]pyrido[3,4-b]pyrazin-5- yl]°xy]methyl]-4-morpholinyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]-7-(6-quinolinyl)-; Pyrido[3,4-b]pyrazine, 7-(l,3-benzodioxol-5-yl)- 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4-b]pyrazine, 7-(2,3- dihydro-l,4-benzodioxin-6-yl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-;
Benzenamine, 2-chloro-N,N-dimethyl-4- [5 - [ [(2 S)-4-(methyl sulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4-b]pyrazine, 7-(l-methyl-lH- indazol-5-yl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Ethanone, l-[(2S)-2- [[[7-[4-(dimethylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-2,2- difluoro-; 4-Morpholinesulfonamide, N,N-dimethyl-2-[[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinesulfonamide, N-methyl-2-[[[7-[4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5- yl]oxy]methyl]-, (2S)-; Ethanone, l-[4-[4-[5-[[(2S)-4-acetyl-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-l-piperidinyl]-; Benzenamine, 2- fluoro-N,N-dimethyl-4-[5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4- b]pyrazin-7-yl]-; Benzenamine, 2-fluoro-N-methyl-4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Methanone, [(2S)-2-[[[7-[4- (methylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl][(2R)- tetrahydro-2-furanyl]-; Methanone, [(2S)-2-[[[7-[4-(methylamino)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl][(3S)-tetrahydro-3-furanyl]-; Ethanone, 1-[(2S)- 2-[[[7-[4-[4-(2 -hydroxy ethyl)-l-piperazinyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]- 4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-(4-methoxy-l-piperidinyl)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4- (methylamino)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Pyrido[3,4- b]pyrazine, 7-(l-methyl-lH-pyrazol-4-yl)-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]-; Benzonitrile, 4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4-b]pyrazine, 7-(4- fluorophenyl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4-b]pyrazine, 7-(3,4-dimethoxyphenyl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-;
Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-7-[l- (tetrahydro-2H-pyran-4-yl)-lH-pyrazol-4-yl]-; Pyrido[3,4-b]pyrazine, 7-(4-methylphenyl)- 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4-b]pyrazine, 7-(4- chlorophenyl)-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4- b]pyrazine, 7-(l-methyl-lH-indol-5-yl)-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyljmethoxy]-; Pyrido[3,4-b]pyrazine, 7-(4-methoxyphenyl)-5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]-7-[4-(l-pyrrolidinyl)phenyl]-; Benzenamine, N- methyl-4-[5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4-b]pyrazine, 7-(3-fluoro-4-methoxyphenyl)-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyljmethoxy]-; Pyrido[3,4-b]pyrazine, 7-[4-(difluoromethoxy)phenyl]-5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]-; Ethanone, l-[4-[4-[5-[[(2S)-4-(methylsulfonyl)- 2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-l-piperidinyl]-; Ethanone, 1- [(2S)-2-[[[7-[4-(dimethylamino)-3-fluorophenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-2,2-difluoro-; Pyrido[3,4-b]pyrazine, 7-[4-(4-methoxy-l -piped dinyl)phenyl]- 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; 4-Morpholinesulfonamide, 2-[[[7-[4- (l-pyrrolidinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 4- Morpholinesulfonamide, 2-[[[7-[4-(4,4-difluoro-l-piperidinyl)phenyl]pyrido[3,4-b]pyrazin- 5-yl]oxy]methyl]-, (2S)-; 4-morphoolinesulfonamide, 2-[[[7-[4-(l- piperidinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-, (2S)-; 1-Piperazineethanol, 4- [4-[5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-7-[4-[4- (methylsulfonyl)-l-piperazinyl]phenyl]-; Ethanone, l-[(2S)-2-[[[7-[4-[4-(ethylsulfonyl)-l- piperazinyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, 1- [(2S)-2-[[[7-[4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; Ethanone, l-[(2S)-2-[[[7-[4-[l-(ethylsulfonyl)-4- piperidinyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; 4- Piperidinemethanol, a,a-dimethyl-l-[4-[5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)- 4-(methylsulfonyl)-2-morpholinyl]methoxy]-7-[4-(l-piperidinyl)phenyl]-; Pyrido[3,4- b]pyrazine, 7-[4-(4,4-difluoro-l -piped dinyl)phenyl]-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyljmethoxy]-; Pyrido[3,4-b]pyrazine, 7-[4-[(2R,6S)-2,6-dimethyl-4- morpholinyl]phenyl]-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4- b]pyrazine, 7-[4-(2-methyl-4-morpholinyl)phenyl]-5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]-; Ethanone, l-[(2S)-2-[[[7-[4-(4-ethyl-l- piperazinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-2,2-difluoro-; Ethanone, 2,2-difluoro-l-[(2S)-2-[[[7-[4-(4-methyl-l-piperazinyl)phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Ethanone, 2,2-difluoro-l-[(2S)-2-[[[7-[3- fluoro-4-(4-morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-morpholinyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-7-[4-(l- piperazinyl)phenyl]-; Pyrido[3,4-b]pyrazine, 7-[4-(4-methyl-l-piperazinyl)phenyl]-5-[[(2S)- 4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]-7-[4-(4-morpholinyl)phenyl]-; Pyrido[3,4- b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-7-[4-(tetrahydro-2H- pyran-4-yl)phenyl]-; Pyrido[3,4-b]pyrazine, 5-[[(2S)-4-(methylsulfonyl)-2- morpholinyl]methoxy]-7-[4-(4-piperidinyl)phenyl]-; Ethanone, 2,2-difluoro-l-[(2S)-2-[[[7- [4-(tetrahydro-2H-pyran-4-yl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; Pyrido[3,4-b]pyrazine, 7-[4-(l-methyl-4-piperidinyl)phenyl]-5-[[(2S)-4- (methylsulfonyl)-2-morpholinyl]methoxy]-; Pyrido[3,4-b]pyrazine, 7-[3-fluoro-4-(4- morpholinyl)phenyl]-5-[[(2S)-4-(methylsulfonyl)-2-morpholinyl]methoxy]-; Ethanone, 2,2- difluoro-l-[(2S)-2-[[[7-[4-(l-piperazinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4- morpholinyl]-; 3-morphoolinone, 2-[[[7-[4-[l-(methylsulfonyl)-4- piperidinyl]phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-; 3-Μοφηο1ίηοηε, 2-[[[7-[4-(l- hydroxy-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-; 3-morphoolinone, 2- [[[7-[4-(l-hydroxy-l-methylethyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-4-methyl-; 3-morphoolinone, 4-methyl-2-[[[7-[4-[l-(methylsulfonyl)-4-piperidinyl]phenyl]pyrido[3,4- b]pyrazin-5-yl]oxy]methyl]-; 2-Piperidinone, 5-[[[7-[4-(4-methyl-l- piperazinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-; 2-Piperidinone, 5-[[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]methyl]-; Benzamide, 4-[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]-; Pyrido[3,4-b]pyrazine, 7-[4-[(2R,6S)- 2,6-dimethyl-4-morpholinyl]phenyl]-5-[[(3R)-tetrahydro-3-furanyl]oxy]-; 4- Piperidinemethanol, a,a-dimethyl-l-[4-[5-[[(3R)-tetrahydro-3-furanyl]oxy]pyrido[3,4- b]pyrazin-7-yl]phenyl]-; 1-Piperidineethanol, 4-[4-[5-[[(3R)-tetrahydro-3- furanyl]oxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-; Pyrido[3,4-b]pyrazine, 5-[[(3R)-tetrahydro- 3-furanyl]oxy]-7-[4-(tetrahydro-2H-pyran-4-yl)phenyl]-; Pyrido[3,4-b]pyrazine, 7-[3- methyl-4-[4-(methylsulfonyl)-l-piperazinyl]phenyl]-5-[[(3R)-tetrahydro-3-furanyl]oxy]-; Ethanone, l-[4-[2-methyl-4-[5-[[(3R)-tetrahydro-3-furanyl]oxy]pyrido[3,4-b]pyrazin-7- yl]phenyl]-l-piperazinyl]-; Pyrido[3,4-b]pyrazine, 7-[3-chloro-4-(4-morpholinyl)phenyl]-5- [[(3R)-tetrahydro-3-furanyl]oxy]-; Pyrido[3,4-b]pyrazine, 7-[3-fluoro-4-(4- morpholinyl)phenyl]-5-[[(3R)-tetrahydro-3-furanyl]oxy]-; Pyrido[3,4-b]pyrazine, 7-[3- methyl-4-(4-morpholinyl)phenyl]-5-[[(3R)-tetrahydro-3-furanyl]oxy]-; Ethanone, l-[4-[4- [5-[[(3R)-tetrahydro-2H-pyran-3-yl]oxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-l-piperidinyl]-; Pyrido[3,4-b]pyrazine, 7-[4-(4-piperidinyl)phenyl]-5-[[(3R)-tetrahydro-3-furanyl]oxy]-; Pyrido[3,4-b]pyrazine, 7-[4-[l-(methylsulfonyl)-4-piperidinyl]phenyl]-5-[[(3R)-tetrahydro- 2H-pyran-3-yl]oxy]-; Pyrido[3,4-b]pyrazine, 7-[4-[4-(methylsulfonyl)-l- piperazinyl]phenyl]-5-[[(3R)-tetrahydro-2H-pyran-3-yl]oxy]-; Ethanone, l-[4-[4-[5-[[(3R)- tetrahydro-2H-pyran-3-yl]oxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-l-piperazinyl]-;
Pyrido[3,4-b]pyrazine, 7-[4-[l-(methylsulfonyl)-4-piperidinyl]phenyl]-5-[(tetrahydro-2- furanyl)methoxy]-; Pyrido[3,4-b]pyrazine, 7-[4-[l-(methylsulfonyl)-4-piperidinyl]phenyl]- 5-[(tetrahydro-2H-pyran-2-yl)methoxy]-; Benzenamine, N,N-dimethyl-4-[5-[(tetrahydro-2- furanyl)methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Benzenamine, N,N-dimethyl-4-[5- [(tetrahydro-2H-pyran-2-yl)methoxy]pyrido[3,4-b]pyrazin-7-yl]-; Ethanone, l-[4-[4-[5- [[(3R)-tetrahydro-3-furanyl]oxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-l-piperidinyl]-;
Benzenamine, N,N,2-trimethyl-4-[5-[[(3R)-tetrahydro-3-furanyl]oxy]pyrido[3,4-b]pyrazin- 7-yl]-; Benzenamine, 2-chloro-N,N-dimethyl-4-[5-[[(3R)-tetrahydro-3- furanyl]oxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4-b]pyrazine, 7-[4-[4-(methylsulfonyl)-l- piperazinyl]phenyl]-5-[[(3R)-tetrahydro-3-furanyl]oxy]-; Ethanone, l-[4-[4-[5-[[(3R)- tetrahydro-3-furanyl]oxy]pyrido[3,4-b]pyrazin-7-yl]phenyl]-l-piperazinyl]-; Benzenamine, N,N-diethyl-4-[5-[[(3R)-tetrahydro-3-furanyl]oxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4- b]pyrazine, 7-(3,4-dimethoxyphenyl)-5-[[(3R)-tetrahydro-3-furanyl]oxy]-; Pyrido[3,4- b]pyrazine, 7-[4-(4-morpholinyl)phenyl]-5-[[(3R)-tetrahydro-3-furanyl]oxy]-; Benzenamine, N,N-dimethyl-4-[5-[(tetrahydro-2H-pyran-3-yl)oxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4- b]pyrazine, 7-[4-(4-methyl-l-piperazinyl)phenyl]-5-[[(3R)-tetrahydro-3-furanyl]oxy]-;
Pyrido[3,4-b]pyrazine, 7-[4-[l-(methylsulfonyl)-4-piperidinyl]phenyl]-5-[[(3R)-tetrahydro- 3-furanyl]oxy]-; Benzenamine, N,N-dimethyl-4-[5-[[(3R)-tetrahydro-3- furanyl]oxy]pyrido[3,4-b]pyrazin-7-yl]-; Benzenamine, N,N-dimethyl-4-[5-[(tetrahydro-2H- pyran-4-yl)oxy]pyrido[3,4-b]pyrazin-7-yl]-; Benzenamine, N,N-dimethyl-4-[5-[[(3S)- tetrahydro-3-furanyl]oxy]pyrido[3,4-b]pyrazin-7-yl]-; Pyrido[3,4-b]pyrazine, 7-[4-(4- morpholinyl)phenyl]-5-[2-(lH-pyrazol-4-yl)ethoxy]-; Cyclohexanol, 4-[[7-[4-(4- morpholinyl)phenyl]pyrido[3,4-b]pyrazin-5-yl]oxy]-, or a pharmaceutically acceptable salt thereof.
[0073] x. Benzamide and nicotinamde SYK inhibitors are disclosed in U.S. Patent Publication No. 20150038492, the contents of which are incorporated by reference herein.
[0074] xi. The SYK inhibitors disclosed in the following patents or patent publications can be utilized: U.S. Patent Nos. 9,416, 111; 9,334,278; 8,299,056; 9,290,490; 8,470,835; 20160185744; 20160130659; 20160058758; 20160045508; 20160052930; 20160031894; 20160002221.
Pharmaceutical Compositions and Administration
[0075] The SYK inhibitor, hypomethylating agent, lenalidomide or antithymocyte globulin may be administered using any suitable methods known in the art. For example, the compounds may be administered bucally, ophthalmically, orally, osmotically, parenterally (intramuscularly, intraperitoneally intrasternally, intravenously,
subcutaneously), rectally, topically, transdermally, or vaginally.
[0076] Compounds provided herein are usually administered in the form of
pharmaceutical compositions. A SYK inhibitor may be administered with a
hypomethylating agent, lenalidomide or antithymocyte globulin in a fixed dose
pharmaceutical composition or in separate pharmaceutical compositions, each of which can independently be administered bucally, ophthalmically, orally, osmotically, parenterally (intramuscularly, intraperitoneally intrasternally, intravenously, subcutaneously), rectally, topically, transdermally, or vaginally. Thus, provided herein are also pharmaceutical compositions that contain one or more of the compounds of any of the formulae disclosed herein or a pharmaceutically acceptable salt, isomers, prodrug, or solvate thereof, and one or more pharmaceutically acceptable vehicles selected from carriers, adjuvants and excipients. Suitable pharmaceutically acceptable vehicles may include, for example, inert solid diluents and fillers, diluents, including sterile aqueous solution and various organic solvents, permeation enhancers, solubilizers and adjuvants. Such compositions are prepared in a manner well known in the pharmaceutical art. See, e.g., Remington's Pharmaceutical Sciences, Mace Publishing Co., Philadelphia, Pa. 17th Ed. (1985); and Modern
Pharmaceutics, Marcel Dekker, Inc. 3rd Ed. (G.S. Banker & C.T. Rhodes, Eds.).
[0077] The pharmaceutical compositions may be administered in either single or multiple doses. The pharmaceutical composition may be administered by various methods including, for example, rectal, buccal, intranasal and transdermal routes. In certain embodiments, the pharmaceutical composition may be administered by intra-arterial injection, intravenously, intraperitoneally, parenterally, intramuscularly, subcutaneously, orally, topically, or as an inhalant. In some embodiments, the pharmaceutical composition is administered orally.
[0078] One mode for administration is parenteral, for example, by injection. The forms in which the pharmaceutical compositions described herein may be incorporated for administration by injection include, for example, aqueous or oil suspensions, or emulsions, with sesame oil, corn oil, cottonseed oil, or peanut oil, as well as elixirs, mannitol, dextrose, or a sterile aqueous solution, and similar pharmaceutical vehicles.
[0079] Oral administration may be another route for administration of the compounds described herein. Administration may be via, for example, capsule or enteric coated tablets. In making the pharmaceutical compositions that include at least one compound of any of the formulae described herein or a pharmaceutically acceptable salt, prodaig, or solvate thereof, the active ingredient is usually diluted by an excipient and/or enclosed within such a carrier that can be in the form of a capsule, sachet, paper or other container. When the excipient serves as a diluent, it can be in the form of a solid, semi-solid, or liquid material, which acts as a vehicle, carrier or medium for the active ingredient. Thus, the compositions can be in the form of tablets, pills, powders, lozenges, sachets, cachets, elixirs, suspensions, emulsions, solutions, syrups, aerosols (as a solid or in a liquid medium), ointments containing, for example, up to 10% by weight of the active compound, soft and hard gelatin capsules, sterile injectable solutions, and sterile packaged powders. In certain embodiments, the pharmaceutical composition is in the form of tablets.
[0080] As used herein, "pharmaceutically acceptable carrier" or "pharmaceutically acceptable excipient" includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents and the like. The use of such media and agents for pharmaceutically active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions is contemplated. Supplementary active ingredients can also be incorporated into the compositions.
[0081] Some examples of suitable excipients include lactose, dextrose, sucrose, sorbitol, mannitol, starches, gum acacia, calcium phosphate, alginates, tragacanth, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone, cellulose, sterile water, syrup, and methyl cellulose. The formulations can additionally include lubricating agents such as talc, magnesium stearate, and mineral oil; wetting agents; emulsifying and suspending agents; preserving agents such as methyl and propylhydroxy-benzoates; sweetening agents; and flavoring agents.
[0082] The compositions that include at least one compound of any of the formulae described herein or a pharmaceutically acceptable salt, isomer, prodrug, or solvate thereof, can be formulated so as to provide quick, sustained or delayed release of the active ingredient after administration to the subject by employing procedures known in the art. Controlled release drug delivery systems for oral administration include osmotic pump systems and dissolutional systems containing polymer-coated reservoirs or drug-polymer matrix formulations. Examples of controlled release systems are given in U.S. Patent Nos. 3,845,770; 4,326,525; 4,902,514; and 5,616,345. Another formulation for use in the methods of the present application employs transdermal delivery devices ("patches"). Such transdermal patches may be used to provide continuous or discontinuous infusion of the compounds described herein in controlled amounts. The construction and use of transdermal patches for the delivery of pharmaceutical agents is well known in the art. See, e.g., U.S. Patent Nos. 5,023,252, 4,992,445 and 5,001,139. Such patches may be constructed for continuous, pulsatile, or on demand delivery of pharmaceutical agents.
[0083] For preparing solid compositions such as tablets, the principal active ingredient may be mixed with a pharmaceutical excipient to form a solid preformulation composition containing a homogeneous mixture of a compound of any of the above formulae or a pharmaceutically acceptable salt, prodrug, or solvate thereof. When referring to these preformulation compositions as homogeneous, the active ingredient may be dispersed evenly throughout the composition so that the composition may be readily subdivided into equally effective unit dosage forms such as tablets, pills and capsules.
[0084] The tablets or pills of the compounds described herein may be coated or otherwise compounded to provide a dosage form affording the advantage of prolonged action, or to protect from the acid conditions of the stomach. For example, the tablet or pill can include an inner dosage and an outer dosage component, the latter being in the form of an envelope over the former. The two components can be separated by an enteric layer that serves to resist disintegration in the stomach and permit the inner component to pass intact into the duodenum or to be delayed in release. A variety of materials can be used for such enteric layers or coatings, such materials including a number of polymeric acids and mixtures of polymeric acids with such materials as shellac, cetyl alcohol, and cellulose acetate.
[0085] Compositions for inhalation or insufflation may include solutions and suspensions in pharmaceutically acceptable, aqueous or organic solvents, or mixtures thereof, and powders. The liquid or solid compositions may contain suitable
pharmaceutically acceptable excipients as described supra. In some embodiments, the compositions are administered by the oral or nasal respiratory route for local or systemic effect. In other embodiments, compositions in pharmaceutically acceptable solvents may be nebulized by use of inert gases. Nebulized solutions may be inhaled directly from the nebulizing device or the nebulizing device may be attached to a facemask tent, or intermittent positive pressure breathing machine. Solution, suspension, or powder compositions may be administered, preferably orally or nasally, from devices that deliver the formulation in an appropriate manner.
[0086] In some embodiments, the SYK inhibitor is administered prior to administering the hypomethylating agent. In some embodiments, the SYK inhibitor is administered after administering the hypomethylating agent. In some embodiments, the SYK inhibitor is administered concurrently with the hypomethylating agent.
[0087] In some embodiments, the SYK inhibitor is administered prior to administering lenalidomide or antithymocyte globulin. In some embodiments, the SYK inhibitor is administered after administering lenalidomide or antithymocyte globulin. In some embodiments, the SYK inhibitor is administered concurrently with lenalidomide or antithymocyte globulin.
Dosing Regimen
[0088] The specific dose level of compounds described herein for any particular subject can depend upon a variety of factors including, for example, the activity of the specific compound employed, the age, body weight, general health, sex, diet, time of administration, route of administration, and rate of excretion, drug combination and the severity of the particular disease in the subject undergoing therapy. For example, a dosage may be expressed as a number of milligrams of a compound of the formula per kilogram of the subject's body weight (mg/kg). Dosages of between about 0.01 and 200 mg/kg may be appropriate. In some embodiments, about 0.01 and 150 mg/kg may be appropriate. In other embodiments a dosage of between 0.05 and 100 mg/kg may be appropriate. Normalizing according to the subject's body weight can be useful, for example, when adjusting dosages between subjects of widely disparate size, such as occurs when using the drug in both children and adult humans or when converting an effective dosage in a non-human subject such as dog to a dosage suitable for a human subject.
[0089] The daily dosage may also be described as a total amount of a compound of the formulae administered per dose or per day. Daily dosage of a compound may be between about 1 mg and 2,000 mg, between about 1,000 to 2,000 mg/day, between about 1 to 1,000 mg/day, between about 1 to 500 mg/day, between about 100 to 150 mg/day, between about 1 to 100 mg/day, between about between about 1 to 50 mg/day, between about 50 to 100 mg/day, between about 100 to 125 mg/day, between about 100 to 150 mg/day, between about 100 to 175 mg/day, between about 100 to 200 mg/day, between about 100 to 225 mg/day, between about 100 to 250 mg/day, between about 100 to 350 mg/day, between about 100 to 400 mg/day, between about 100 to 450 mg/day, or between about 100 to 500 mg/day.
[0090] When administered orally, the total daily dosage for a human subject may be between 1 mg and 1,000 mg/day, between about 1 to 100 mg/day, between about 1 to 50 mg/day, between about 50 to 100 mg/day, between 50 to 300 mg/day, between 50 to 200 mg/day, between 75 to 200 mg/day, between 75 to 150 mg/day, between 100 to 200 mg/day, between about 200 to 300 mg/day, between about 300 to 400 mg/day, between about 400 to 500 mg/day, between about 100 to 150 mg/day, between about 150 to 200 mg/day, between about 200 to 250 mg/day, between about 75 to 150 mg/day, or between about 150 to 300 mg/day.
[0091] In some embodiments, the daily dosage of a SYK inhibitor may be between about 1 mg and 2,000 mg, between about 1,000 to 2,000 mg/day, between about 1 to 1,000 mg/day, between about 1 to 500 mg/day, between about 100 to 150 mg/day, between about 1 to 100 mg/day, between about between about 1 to 50 mg/day, between about 50 to 100 mg/day, between about 100 to 125 mg/day, between about 100 to 150 mg/day, between about 100 to 175 mg/day, between about 100 to 200 mg/day, between about 100 to 225 mg/day, between about 100 to 250 mg/day, between about 100 to 350 mg/day, between about 100 to 400 mg/day, between about 100 to 450 mg/day, or between about 100 to 500 mg/day. In an embodiment, the daily dosage of a SYK inhibitor is about 400 mg/day. In an embodiment, the daily dosage of a SYK inhibitor is about 800 mg/day.
[0092] In some embodiments, the daily dosage of a hypomethylating agent may be between about 1 mg and 2,000 mg, between about 1,000 to 2,000 mg/day, between about 1 to 1,000 mg/day, between about 1 to 500 mg/day, between about 1 to 100 mg/day, between about 1 to 90 mg/day, between about between about 1 to 80 mg/day, between about 1 to 70 mg/day, between about 1 to 60 mg/day, between about 1 to 50 mg/day, between about 1 to 40 mg/day, between about 1 to 30 mg/day, between about 1 to 20 mg/day, or between about 1 to 10 mg/day. For example, the daily dosage of decitabine may be between about 1 mg/day and 20 mg/day, such as about 20 mg/day. The daily dosage of azacitidine, for example, may be between about 10 and 100 mg/day, such as about 75 mg/day.
[0093] In some embodiments, the daily dosage of lenalidomide may be between about 1 mg and 100 mg, between about 1 to 50 mg/day, between about 1 to 30 mg/day, between about 1 to 25 mg/day, or between about 2 to 25 mg/day. For example, the daily dosage of lenalidomide may be between about 1 mg/day and 20 mg/day, such as about 25, about 10, about 5 or about 2.5 mg/day. In some embodiments, lenalidomide is administered daily. In some embodiments, lenalidomide is administered on Days 1-21 of repeated 28-day cycles. In some embodiments, lenalidomide is administered orally at about 25 mg once daily orally on Days 1-21 of repeated 28-day cycles. In some embodiments, lenalidomide is
administered orally at about 10 mg once daily. In some embodiments, lenalidomide is administered orally at about 5 mg once daily. In some embodiments, lenalidomide is administered orally at about 2.5 mg once daily.
[0094] In some embodiments, the daily dosage of antithymocyte globulin may be between about 1 mg and 2,000 mg, between about 1,000 to 2,000 mg/day, between about 1 to 1,000 mg/day, between about 1 to 500 mg/day, between about 10 to 400 mg/day, or between about 50 to 300 mg/day. In some embodiments, the daily dosage of antithymocyte globulin may be between about 0.1 to 10 mg/kg of body weight, between about 0.5 to 5 mg/kg of body weight, or between about 1 to 2 mg/kg of body weight. The daily dosage of antithymocyte globulin, for example, may be about 0.5 mg/kg of body weight, about 1 mg/kg of body weight, about 1.5 mg/kg of body weight, about 2 mg/kg of body weight, about 2.5 mg/kg of body weight, or about 3 mg/kg of body weight. In some embodiments, antithymocyte globulin is administered consecutively for about 3 to 20 days. In some embodiments, antithymocyte globulin is administered consecutively for about 4 to 14 days. In some embodiments, antithymocyte globulin is administered consecutively for about 4 to 7 days. In some embodiments, antithymocyte globulin is administered intravenous at about 1.5 mg/kg of body weight daily for 4 to 7 days. In some embodiments, antithymocyte globulin is administered intravenous at about 1.5 mg/kg of body weight daily for 7 to 14 days.
[0095] The compounds of the present application or the compositions thereof may be administered once, twice, three, or four or more times daily, using any suitable mode described above. In some embodiments, the dose of a SYK inhibitor, or a pharmaceutically acceptable salt thereof, is administered once daily. In some embodiments, the dose of a SYK inhibitor, or a pharmaceutically acceptable salt thereof, is administered twice daily. In some embodiments, the dose of a hypomethaling agent, lenalidomide or antithymocyte globulin is administered once daily. In some embodiments, the dose of a hypomethaling agent, lenalidomide or antithymocyte globulin is administered twice daily.
[0096] In some embodiments, a patient undergoing treatment with a SYK inhibitor and a hyopmethylating agent is further administered with one or more additional drugs selected from corticosteroids, glucocorticoids, mineralocorticoids, hydrocortisone, dexamethasone, cortisone, prednisone, prednisolone, methylprednisolone, dexamethasone, betamethasone, triamcinolone, beclometasone, fludrocortisone, fludrocortisone acetate, deoxycorticosterone, deoxycorticosterone acetate, or aldosterone.
[0097] In some embodiments, the patient undergoing treatment with a method described herein is not being treated with a Bcl-2 inhibitor. In some embodiments, the patient undergoing treatment with a method described herein is not being treated with a vinca alkaloid.
Articles of Manufacture and Kits
[0098] Also provided is use of the combination of SYK inhibitor, as described herein, and a hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, in the treatment of a medical condition such as those described herein.
[0099] Compositions (including, for example, formulations and unit dosages) comprising a SYK inhibitor, as described herein, and compositions comprising a
hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, can be prepared and placed in an appropriate container, and labeled for treatment of an indicated condition. Accordingly, provided is also an article of manufacture, such as a container comprising a unit dosage form of a SYK inhibitor and a unit dosage form of a
hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, and a label containing instructions for use of the compounds. In some embodiments, the article of manufacture is a container comprising (i) a unit dosage form of a SYK inhibitor, as described herein, and one or more pharmaceutically acceptable carriers, adjuvants or excipients; and (ii) a unit dosage form of a hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, and one or more pharmaceutically acceptable carriers, adjuvants or excipients.
[00100] Also provided are kits comprising unit dosage forms of a SYK inhibitor, as described herein, and compositions comprising a hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, and a package insert containing instructions for use of the composition in treatment of a medical condition. In some embodiments, the kits comprises (i) a unit dosage form of the SYK inhibitor, as described herein, and one or more pharmaceutically acceptable carriers, adjuvants or excipients; and (ii) a unit dosage form of a hypomethylating agent, lenalidomide or antithymocyte globulin, as described herein, and one or more pharmaceutically acceptable carriers, adjuvants or excipients.
[00101] The instructions for use in the kit may be for treating a cancer, including, for example, a hematologic malignancy, as further described herein.
[00102] Throughout this specification, various patents, patent applications and other types of publications (e.g., journal articles) are referenced. The disclosure of all patents, patent applications, and publications cited herein are hereby incorporated by reference in their entirety for all purposes.

Claims

CLAIMS What is claimed is:
1. A method of treating a myeloproliferative disorder, comprising administering to a patient in need thereof, a therapeutically effective amount of a hypomethylating agent and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor.
2. The method according to claim 1 wherein said hypomethylating agent is selected from 5- aza-2'-deoxycytidine (azacitidine) and 5-aza-2'-deoxycytidine (decitabine):
Figure imgf000063_0001
Azacitidine Decitabine or a pharmaceutically acceptable salt thereof.
3. The method according to claim 1 or 2 wherein said SYK inhibitor is Compound 1 having the formula:
Figure imgf000063_0002
Compound 1 or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal,
pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
4. The method according to claim 1 or 2 wherein said SYK inhibitor is a bis-mesylate salt of Compound 1 :
Figure imgf000064_0001
Compound 1, or a hydrate thereof.
5. The method according to claim 1 or 2 wherein said SYK inhibitor is a compound of formula:
Figure imgf000064_0002
or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal,
pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
6. The method according to any one of claims 1-5 wherein said myeloproliferative disorder is myelodysplastic syndrome (MDS).
7. The method according to claim 6 wherein said myelodysplastic syndrome is refractory anemia or refractory anemia with ringed sideroblasts.
8. The method according to claim 6 wherein said myelodysplastic syndrome is refractory anemia with excess blasts.
9. The method according to claim 6 wherein said myelodysplastic syndrome is refractory anemia with excess blasts in transformation.
10. The method according to claim 6 wherein said myelodysplastic syndrome is chronic myelomonocytic leukemia.
11. The method according to claim 6 wherein said myelodysplastic syndrome has
Intermediate-2 or High risk in international prognostic scoring system (TPSS).
12. The method according to claim 6 wherein said myelodysplastic syndrome is primary or secondary to radiotherapy or chemotherapy.
13. The method according to claim 6 wherein said myelodysplastic syndrome is associated with multilineage dysplasia.
14. The method according to claim 6 wherein said myelodysplastic syndrome is associated with an isolated Del5q31-33 chromosome abnormality.
15. The method according to claim 6 wherein said myelodysplastic syndrome is associated with unclassifiable myelodysplastic syndrome.
16. The method according to claim 6 wherein said patient has a Del5q31-33 abnormality.
17. The method according to claim 6 wherein said patient has been previously treated MDS.
18. The method according to claim 6 wherein said patient has de novo or secondary MDS.
19. The method according to claim 6 wherein said myelodysplastic syndrome is
Intermediate- 1 or Low risk in international prognostic scoring system (IPSS).
20. The method according to any one of claims 1-5 wherein said myeloproliferative disorder is selected from ALL, AML, CLL, SLL, MPL, MDS, MPD, CML, MM, NHL, MCL, follicular lymphoma, WM, T-cell lymphoma, B-cell lymphoma, DLBCL, pancreatic cancer, bladder cancer, colorectal cancer, breast cancer, prostate cancer, renal cancer, hepatocellular cancer, lung cancer, ovarian cancer, cervical cancer, gastric cancer, esophageal cancer, head and neck cancer, melanoma, neuroendocrine cancer, CNS cancer, brain cancer, bone cancer, soft tissue sarcoma, non-small cell lung cancer, small-cell lung cancer and colon cancer.
21. The method according to any one of claims 1-5 wherein said myeloproliferative disorder is selected from MDS, AML and CMML.
22. The method according to any one of claims 1-21 wherein said patient is a candidate for allogeneic stem cell transplantation.
23. The method according to any one of claims 1-21 wherein said patient is undergoing allogeneic stem cell transplantation.
24. The method according to any one claims 1-21 wherein said patient has received allogeneic stem cell transplantation.
25. A method of treating Intermediate- 1 or Low risk myelodysplastic syndrome in a patient in need thereof, comprising administering a therapeutically effective amount of a spleen tyrosine kinase inhibitor to said patient.
26. The method according to claim 25 wherein said spleen tyrosine kinase inhibitor is Compound 1 :
Figure imgf000066_0001
Compound 1, or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal,
pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
27. The method according to claim 25, wherein said spleen tyrosine kinase inhibitor is a bis-mesylate salt of Compound 1 :
Figure imgf000067_0001
Compound 1, or a hydrate thereof.
28. The method according to claim 25 wherein said spleen tyrosine kinase inhibitor is a compound of formula:
Figure imgf000067_0002
or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal, pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
29. A method of treating a myeloproliferative disorder, comprising administering to a patient in need thereof, a therapeutically effective amount of lenalidomide or a pharmaceutically acceptable salt thereof, and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor.
30. The method according to claim 29 wherein said SYK inhibitor is Compound 1 having the formula:
Figure imgf000068_0001
Compound 1 or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal,
pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
31. The method according to claim 29 wherein said SYK inhibitor is a bis-mesylate salt of Compound 1 :
Figure imgf000068_0002
Compound 1, or a hydrate thereof.
32. The method according to claim 29 wherein said SYK inhibitor is a compound of formula:
Figure imgf000069_0001
or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal,
pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
33. The method according to any one of claims 29-32 wherein said myeloproliferative disorder is myelodysplastic syndrome.
34. The method according to claim 33 wherein said myelodysplastic syndrome is refractory anemia or refractory anemia with ringed sideroblasts.
35. The method according to claim 33 wherein said myelodysplastic syndrome is refractory anemia with excess blasts.
36. The method according to claim 33 wherein said myelodysplastic syndrome is refractory anemia with excess blasts in transformation.
37. The method according to claim 33 wherein said myelodysplastic syndrome is chronic myelomonocytic leukemia.
38. The method according to claim 33 wherein said myelodysplastic syndrome has Intermediate-2 or High risk in international prognostic scoring system (TPSS).
39. The method according to claim 33 wherein said myelodysplastic syndrome is primary or secondary to radiotherapy or chemotherapy.
40. The method according to claim 33 wherein said myelodysplastic syndrome is associated with multilineage dysplasia.
41. The method according to claim 33 wherein said myelodysplastic syndrome is associated with an isolated Del5q31-33 chromosome abnormality.
42. The method according to claim 33 wherein said myelodysplastic syndrome is associated with unclassifiable myelodysplastic syndrome.
43. The method according to claim 33 wherein said patient has a Del5q31-33 abnormality.
44. The method according to claim 33 wherein said patient has been previously treated MDS.
45. The method according to claim 33 wherein said patient has de novo or secondary MDS.
46. The method according to claim 33 wherein said myelodysplastic syndrome is
Intermediate- 1 or Low risk in international prognostic scoring system (IPSS).
47. The method according to any one of claims 29-32 wherein said myeloproliferative disorder is selected from ALL, AML, CLL, SLL, MPL, MDS, MPD, CML, MM, NHL, MCL, follicular lymphoma, WM, T-cell lymphoma, B-cell lymphoma, DLBCL, pancreatic cancer, bladder cancer, colorectal cancer, breast cancer, prostate cancer, renal cancer, hepatocellular cancer, lung cancer, ovarian cancer, cervical cancer, gastric cancer, esophageal cancer, head and neck cancer, melanoma, neuroendocrine cancer, CNS cancer, brain cancer, bone cancer, soft tissue sarcoma, non-small cell lung cancer, small-cell lung cancer and colon cancer.
48. The method according to any one of claims 29-32 wherein said myeloproliferative disorder is selected from MDS, AML and CMML.
49. The method according to any one of claims 29-48 wherein said patient is a candidate for allogeneic stem cell transplantation.
50. The method according to any one of claims 29-48 wherein said patient is undergoing allogeneic stem cell transplantation.
51. The method according to any one of claims 29-48 wherein said patient has received allogeneic stem cell transplantation.
52. A pharmaceutical composition comprising a therapeutically effective amount of a hypomethylating agent, or a pharmaceutically acceptable salt thereof, and a therapeutically effective amount of a spleen tyrosine kinase inhibitor, or a pharmaceutically acceptable salt thereof.
53. The pharmaceutical composition according to claim 52 wherein said hypomethylating agent is selected from 5-aza-2'-deoxycytidine (azacitidine) and 5-aza-2'-deoxycytidine (decitabine):
Figure imgf000071_0001
Azacitidine Decitabine or a pharmaceutically acceptable salt thereof.
54. The pharmaceutical composition according to claim 52 or 53 wherein said SYK inhibitor is Compound 1 having the formula:
Figure imgf000071_0002
Compound 1 or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal,
pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
55. The pharmaceutical composition according to claim 52 or 53 wherein said SYK inhibitor is a bis-mesylate salt of Compound 1 :
Figure imgf000072_0001
Compound 1, or a hydrate thereof.
56. The pharmaceutical composition according to claim 52 or 53 wherein said SYK inhibitor is a compound of formula:
Figure imgf000072_0002
or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal, pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
57. A pharmaceutical composition comprising a therapeutically effective amount of lenalidomide or a pharmaceutically acceptable salt thereof, and a therapeutically effective amount of a spleen tyrosine kinase (SYK) inhibitor, or a pharmaceutically acceptable salt thereof.
58. The pharmaceutical composition according to claim 57 wherein said SYK inhibitor is Compound 1 having the formula:
Figure imgf000073_0001
Compound 1 or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal,
pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
59. The pharmaceutical composition according to claim 57 wherein said SYK inhibitor is a bis-mesylate salt of Compound 1 :
Figure imgf000073_0002
Compound 1, or a hydrate thereof.
60. The pharmaceutical composition according to claim 57 wherein said SYK inhibitor is a compound of formula:
Figure imgf000074_0001
or a pharmaceutically acceptable salt, pharmaceutically acceptable co-crystal, pharmaceutically acceptable ester, stereoisomer, mixture of stereoisomers, or tautomer thereof.
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