IMPROVED METHOD FOR THE PREPARATION OF
LIPOSOME ENCAPSULATED VINCRISTINE FOR THERAPEUTIC USE
RELATED APPLICATIONS
This application claims priority to United States Provisional Application No.
61/728378, entitled "Improved Method for the Preparation of Liposome Encapsulated
Vincristine for Therapeutic Use", filed on November 20, 2012, the entirety of which is hereby
incorporated by reference.
BACKGROUND
Liposomes are well established nanoparticles that can enhance the efficacy of
therapeutically active drugs by improving the plasma distribution and pharmacokinetics of
the drugs over non-encapsulated forms (e.g., Weinstein, Liposomes: From Biophysics to
Therapeutics, (Ostro, M. J., ed.), Marcel Dekker, Inc., N.Y., pp. 277-338, (1987). For
example, Vincristine Sulfate Liposome Injection (VSLI) is a liposome formulation of the
anti-cancer therapeutic vincristine sulfate encapsulated in sphingomyelin-cholesterol
liposomes which provides greater efficacy than standard vincristine sulfate injection USP
(VSI). Clinical trials have also shown that VSLI facilitates dose intensification by
significantly extending vincristine's circulation half-life compared to non-encapsulated
vincristine. The liposome provides the mechanism for delayed drug release and the liposome
size allow the drug to accumulate in cancer tissues by extravasation (Webb et al., Cancer
Chemother. Pharmacol 42:461-470, 1998; Shan et al, Cancer Chemother. Pharmacol 58:245-
255, 2006). These features translate into improved clinical benefit over the standard VSI.
Encapsulation of vincristine sulfate into sphingomyelin-cholesterol liposomes is
typically achieved by using an acidic intraliposomal pH (e.g., pH of 4) and an exterior
medium at a neutral pH (e.g., pH of 7). This pH gradient allows the weakly basic vincristine
to diffuse into the liposome interior with high efficiency (Cullis et al., Trends in Biotech 9 :
268-272, 1991; Boman et al, Bioch Biophys Acta, 1152:253-258, 1993). In order for
vincristine to accumulate in the liposome interior with the transmembrane pH gradient, the
liposome membrane must become temporarily permeable to the steric bulk of vincristine.
Thus, unlike neutral or anionic drugs that often can be passively encapsulated into liposomes,
the temperature of the sphingomyelin-cholesterol liposome must be increased in order for the
transmembrane H gradient to function with vincristine. The liposome bilayer, which is an
orientation of interlocking sphingomyelin and cholesterol molecules, requires a unique
transient heat pattern to create thermotropic disorder transition states. These transition states
essentially abate the weak intermolecular bonding between the membrane lipids, creating
gaps in interlocking lipids and allow the liposome biolayer to become temporarily permeable.
The encapsulation process takes advantage of the spontaneous self reassembly of the
sphingomyelin-cholesterol lipids that occurs on cooling back to ambient temperature, which
restores the membrane integrity.
This heating profile for drug encapsulation must be balanced with the chemical
instability of vincristine to heat exposure (Vendrig et al., Internatl. J . of Pharmaceutics
50:189-196, 1989; Sethi et al, Cancer Res. 45:5386-5389, 1985). Vincristine is thermally
labile and readily degrades to N-desformylvincristine in the presence of elevated
temperatures. This formamide hydrolysis of vincristine is a well known degradation pathway
and affects the stability shelf life of vincristine sulfate injection (VLSI). For example, VLSI
solutions cannot be heat sterilized due to this heat lability and must be stored and shipped at
refrigerated temperature to realize extended stability.
Accordingly, at the present time Vincristine Sulfate Liposome Injection (VSLI) is
prepared from the individual components at a pharmacy according to the directions provided
on the FDA-approved label (www.accessdata.fda.gov; Reference ID: 317221 1, 2012). These
directions include a heating procedure that requires the use of a water bath in order to achieve
efficient encapsulation of vincristine in the sphingomyelin-cholesterol liposomes and
maintain chemical purity of vincristine. The excellent heat transfer properties of water allow
greater than 95% encapsulation of vincristine with no appreciable chemical degradation of
the drug.
Since VSLI is an injectable drug, the manufacture of the components and pharmacy
preparation are strictly regulated to maintain sterility. Accordingly, the use of an open water
bath during preparation of VSLI requires additional resources, planning, and equipment (e.g.,
floating ring), including an aseptic hood or "clean" room in order to maintain an aseptic
environment. In some pharmacies, the constitution of VSLI cannot be done due to the
restrictions on maintaining a sterile environment.
Accordingly, there remains a need for improved methods of preparing VSLI that can
be efficiently and reproducibly carried out without the additional resources and equipment
currently required.
SUMMARY OF THE INVENTION
The current invention is based, at least in part, on the development of a method for
preparing VSLI that circumvents the need for the use of a heated water bath during the
encapsulation process. Thus, the invention provides efficient, reproducible methods of
preparing VSLI which may be widely used with unexpected ease and reduced risk of
contamination.
In one aspect, the invention features a method of preparing a pharmaceutically
acceptable liquid composition comprising liposome-encapsulated vincristine which is free of
substantial degradation products, the method comprising the steps of (a) constituting in a
single vial (i) a first solution comprising vincristine sulfate at a concentration of about 1
mg/ml to about 5 mg/ml, wherein the first solution has a pH of about 3.5 to about 5.5; and (ii)
a second solution comprising sphingomyelin/cholesterol liposomes at a low pH; (b) raising
the pH of the constituting solution in the single vial to a pH of about 7.0 to 7.5; (c) heating
the single vial comprising the constituting solution in a dry heat block equilibrated at about
75°C for at least about 13 to about 18 minutes, wherein said heat block comprises one or
more bores about 1-5% larger than the average length or diameter of the single vial to
produce a solution comprising constituted liposome encapsulated vincristine; (d)
equilibrating the constituted solution to room temperature; (e) diluting a volume of the
constituted solution comprising a dose of liposome encapsulated vincristine for the patient of
about 1.5 to about 2.4 mg/m with a pharmaceutical diluent suitable for intravenous
administration, to produce the pharmaceutically acceptable liquid composition; and (f)
administering the pharmaceutically acceptable liquid composition to the patient, wherein the
constituted solution comprising liposome encapsulated vincristine comprises (i) less than
about 2.5% free vincristine; and (ii) less than about 1.5% N-desformylvincristine.
In some embodiments, the first solution comprising vincristine sulfate has pH of
about 4.5 to about 4.7. In one embodiment, the first solution further comprises mannitol at a
concentration of about 100-200 mg/ml.
In some embodiments, the pH of the second solution comprising the liposomes is
about 4.0. In one embodiment, the second solution further comprises a citrate buffer.
In some embodiments, the pH of the constituting solution is raised by the addition of a
third solution comprising a buffer at a pH of about 9.0. In one embodiment, the third solution
comprises sodium phosphate buffer.
In some embodiments, the constituting solution comprises a concentration ratio of
about 0.1/1.0 to about 0.2/2.0 vincristine sulfate to lipid.
In some embodiments, the concentration of vincristine sulfate in the constituted
solution is about 0.1 mg/mL to about 0.5 mg/mL. In some embodiments, the concentration of
vincristine sulfate in the constituted solution is about at about 0.15 mg/mL to about 0.2
mg/mL. In one embodiment, the concentration of vincristine sulfate in the constituted
solution is about 0.16 mg/mL.
In one embodiment, the first solution comprises vincristine sulfate USP (5 mg/5 mL),
which is equivalent to 4.5 mg/5 mL vincristine free base, and 500 mg/5 mL mannitol, the
second solution comprises sphingomyelin/cholesterol liposomes consisting of 73.5 mg/mL
sphingomyelin, 29.5 mg/mL cholesterol, 33.6 mg/mL citric acid, 35.4 mg/mL sodium citrate,
and the third solution comprises 355 mg/25 mL dibasic sodium phosphate and 225 mg/25 mL
sodium chloride.
In some embodiments, the ratio of sphingomyelin to cholesterol in the liposome is
between about 75/25 mol %/mol sphingomyelin/cholesterol to 30/50 mol %/mol %
sphingomyelin/cholesterol. In some embodiments, the liposomes comprise about 70/30 mol
%/mol sphingomyelin/cholesterol to 40/45 mol %/mol % sphingomyelin/cholesterol. In one
embodiment, the liposomes comprise approximately 55/45 mol %/mol %
sphingomyelin/cholesterol. In another embodiment, the liposomes comprising about 60/40
mol %/mol % sphingomyelin/cholesterol.
In some embodiments, the liposomes have a size range of about 0.05-0.5 microns. In
some embodiments, the liposomes have a mean diameter of about 50-200 nm. In one
embodiment, the liposomes have a mean diameter of about 90-125 nm.
In some embodiments, the constituting solution has a volume of between about 20-50
mL. In some embodiments, the constituting solution has a volume of between 30-35 mL.
In some embodiments, the heat block is equilibrated to 75±2°C for about 15 minutes
prior to insertion of the vial containing the constituting solution. In some embodiments, the
constituting solution is heated for about 13-15 minutes within the caliber bore of a dri-block
equilibrated at 75±2°C. In one embodiment, the constituting solution is heated for 14 minutes
± 30 seconds within the caliber bore of a dri-block equilibrated at 75±2°C.
In some embodiments, the bores in the heat block are less than about 3% larger than
the average length or diameter of the single vial containing the constituting solution. In some
embodiments, the single vial containing the constituting solution has a diameter between
about 35.8 to about 37.3 mm, and the caliber bores in the heat block are cylindrical with a
diameter between 37.2 to 37.8 mm in diameter.
In some embodiments, the constituted solution is equilibrated to room temperature for
at least about 30 minutes.
In some embodiments, the volume of the constituted solution comprising a dose of
liposome encapsulated vincristine for the patient of about 1.5 to about 2.4 mg/m is diluted
with standard pharmaceutical diluents suitable for intravenous administration, to produce the
pharmaceutically acceptable liquid composition. In some embodiments, the volume of the
patients calculated dose is removed from an infusion container and replaced with the
calculated volume of the constituted VSLI solution.
In some embodiments, the pharmaceutically acceptable liquid composition
comprising liposome-encapsulated vincristine is administered to the patient within no more
than 24 hours after constitution.
The VSLI produced according to the methods of the invention are typically
administered to a patient having cancer. In some embodiments, the cancer is lymphoma,
leukemia, myeloma, brain cancer or neuroblastoma.
In some embodiments, the pharmaceutically acceptable liquid composition
comprising liposome-encapsulated vincristine is administered by intravenous infusion over a
period of about 30 to 60 minutes. In some embodiments, the pharmaceutically acceptable
liquid composition comprising liposome-encapsulated vincristine is administered by
intravenous infusion once every 7-28 days. In one embodiment, the pharmaceutically
acceptable liquid composition comprising liposome-encapsulated vincristine is administered
by intravenous infusion once every 7 days.
BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a graph depicting the internal heating profile of a constituted solution
containing vincristine sulfate and sphingomyelin/cholesterol liposomes using a dry block and
water bath.
DETAILED DESCRIPTION
The present invention overcomes the deficiencies associated with the use of a water
bath during the currently used methods of preparing VLSI. Surprisingly, it was discovered
that the use of a heating block with a custom designed insert designed to conform to the
container used for constituting the VSLI provides the heat profile needed to achieve uniform
encapsulation of vincristine without significant degradation.
In addition, the improved ability of the methods of preparing VSLI described herein
to demonstrate parametric release is significant. Since the stability of VSLI warrants "just in
time" preparation, the constitution process must be highly efficient and reproducible by the
pharmacist. The pharmacist needs to know (i.e., parametrically) that the encapsulation has
been achieved by the heat induced process because it provides "a system of release that gives
the assurance that a product is of the intended quality based on the review of information
collected during the constitution process and on the compliance with specific GMP
requirements related to parametric release" (Annex 17 EU guidance).
The heating block procedure of the present invention provides a convenient and
compliant process to achieve constitution of VSLI with greater than 95% encapsulation
efficiency. Since it involves fewer steps, the probability of operational errors is decreased.
The process is overall more straightforward, takes less time, uses fewer resources, and is
convenient for routine pharmacy operation. Additionally, the individual preparing the VSLI
need not deal with potential microbial contamination from microbes growing in the water
bath or water vapor from the heated water bath.
Definitions
Unless specifically noted otherwise, all technical and scientific terms used herein have
the standard definitions commonly understood by one of ordinary skill in the art of
therapeutic and pharmaceutical science.
The singular form "a," "an," and "the" include plural reference unless the context
clearly dictates otherwise.
The terms "comprise" and comprising" are used in the inclusive, open sense, meaning
that additional elements may be included.
The term "about", particularly in reference to a given quantity or number, is meant to
encompass deviations of plus or minus five percent.
A "sterile" composition or container, as used herein, is free of viable microbes as
determined using the USP sterility test. (See, "The United States Pharmacopeial Convention:
2008) .
"Liposome" "vesicle" and "liposome vesicle" will be understood to indicate structures
having lipid-containing membranes enclosing an aqueous interior. The structures may have
one or more lipid membranes unless otherwise indicated, although generally the liposomes
will have only one membrane. Such single-layered liposomes are referred to herein as
"unilamellar". Multilayer liposomes are referred to herein as "multilamellar".
A "standard" therapeutic agent, or "free" therapeutic agent, refers to a therapeutic
agent that is not liposome-encapsulated. Usually, a drug is presumed to be "standard or "free"
unless specified otherwise. A standard vinca alkaloid in free form may still be present in
combination with other reagents, however, such as other chemotherapeutic compounds, a
pharmaceutical carrier, or complexing agents, i.e. as used herein the term only specifically
excludes lipid formulations of the vinca alkaloids.
The phrase "just in time" refers to the combining the separate components of a drug
product (e.g., VSLI) shortly (e.g., within 24 hours or less) before administration to the patient
in order to maintain the quality of the drug product (e.g., minimize degradation).
"Systemic delivery," as used herein, refers to delivery that leads to a broad biodistribution
of a compound within an organism. Systemic delivery means that a useful,
preferably therapeutic, amount of a compound is exposed to most parts of the body. To obtain
broad bio-distribution generally requires a route of introduction such that the compound is
not rapidly degraded or cleared (such as by first pass organs (liver, lung, etc.) or by rapid,
nonspecific cell binding) before reaching a disease site. Systemic delivery of liposomeencapsulated
vinca alkaloids is preferably obtained by intravenous delivery.
The phrase "therapeutically effective amount" refers to an amount of drug (e.g.,
VSLI) effective to treat a disease or disorder (e.g., cancer) in a mammal, for example,
resulting in stable disease, partial remission or complete remission of the cancerous state.
A "stable disease," as used herein, refers to a state wherein administration of the drug
(e.g., VSLI) causes cessation of the growth or prevalence of a tumor or cancer as measured
by standard clinical, radiological and/or biochemical means, although there is no regression
or decrease in the size or prevalence of the cancer.
A "Partial response" or "partial remission" refers to the amelioration of a cancerous
state, as measured by standard clinical, radiological and/or biochemical means, in response to
treatment. Typically, a "partial response" means that the size of a tumor or the level of a
cancer-indicating blood marker has decreased from a baseline level (e.g., 20%, 30%, 40%> or
50%) in response to treatment. For example, for treatment of blood cancers the responses
are assessed based on the international working group criteria (International Working Group
(IWS) criteria; BD Cheson et al, J Clin Oncol 15:4642-4649).
A "complete response" or "complete remission" means that a cancerous state, as
measured by, for example, tumor size and/or cancer marker levels, is undetectable following
treatment.
"Neurological toxicity" includes symptoms of neuropathy, such as hypoesthesia,
hyperesthesia, paresthesia, hyporeflexia, areflexia, neuralgia, jaw pain, decreased vibratory
sense, cranial neuropathy, ileus, burning sensation, arthralgia, myalgia, muscle spasm,
weakness, and/or orthostatic hyptension both before and during treatment. Orthostatic
hypotension may occur. A Neurological toxicity is assessed as being Grade 1 to Grade 3
based on the National Cancer Institute (NCI) Common Terminology Criteria for Adverse
Events (CTCAE) version 4.03 (http://ctep.cancer.gov/reporting/etc.html).
Vincristine Sulfate
Vincristine sulfate is a member of a vinca alkaloid family originally isolated from the
periwinkle plant {Catharanthus roseus). Vincristine Sulfate has cell-cycle specific anticancer
activity. The vinca alkaloid bind to tubulin, altering tubulin polymerization leading to
metaphase arrest, inhibition of cell mitosis, and cell death. As a cell cycle specific agent its'
therapeutic response is advanced by liposome encapsulation which maintains extended drug
levels. Prolonged exposure of cells to vincristine (and other cell cycle specific drugs) has
been shown to enhance in-vitro cytotoxicity of the drug (Bfurris et al, JNCI 84; 1816-1826,
1992; Georgiadis et al, Clin Cancer Res 3:449-454, 1997; Jackson and Bender, Cancer Res
39:4346-4349, 1979).
Vincristine sulfate is commonly isolated as a 1:1 sulfate salt. It is a hygroscopic, white
to slightly yellowish crystalline powder that is soluble in water. It has a molecular weight of
923.04 (salt form) / 824.98 (base form) and a molecular formula of C46H56N4O10 · H2SO4.
The chemical name for vincristine sulfate is 22-oxovincaleukoblastine and it has the
following chemical structure:
Vincristine sulfate is prescribed as vincristine sulfate injection USP (e.g., as a 1
mg/mL solution) and is also known as leurocristine sulfate, Kyocristine, vincosid, vincrex,
Oncovin, Vincasar PFS®, is commercially available from any of a number of sources.
Liposomes
The liposome carrier component of the present invention are comprised of
sphingomyelin and cholesterol liposomes injection (SCLI). The ratio of sphingomyelin to
cholesterol present in the liposome may vary, but generally is in the range of from 75/25 mol
%/mol sphingomyelin/cholesterol to 30/50 mol % mol % sphingomyelin/cholesterol. In one
embodiment, the liposome composition comprise about 70/30 mol % mol
sphingomyelin/cholesterol to 40/45 mol % mol % sphingomyelin/cholesterol. In another
embodiment, the liposome compositions comprise approximately 55/45 mol % mol %
sphingomyelin/cholesterol. In still another embodiment the liposome compositions comprise
about 60/40 mol % mol % sphingomyelin/cholesterol.
In certain embodiments, additional lipids may be present in the formulations, for
example, to prevent lipid oxidation or to attach ligands onto the liposome surface. Generally,
the inclusion of other lipids will result in a decrease in the sphingomyelin/cholesterol ratio.
The sphingomyelin/cholesterol liposomes used in the present invention can be
multilamellar or unilamellar. Suitable methods for preparing the liposomes include, but are
not limited to, sonication, extrusion, high pressure/homogenization, microfluidization,
detergent dialysis, calcium-induced fusion of small liposome vesicles, thin film
evaporization, and ether-infusion methods, all of which are well known in the art. For
example, a variety of methods are available for preparing liposomes as described in, e.g.,
Szoka, et al, Ann. Rev. Biophys. Bioeng., 9:467 (1980), U.S. Pat. Nos. 4,186,183, 4,217,344,
4,235,871, 4,261,975, 4,485,054, 4,501,728, 4,774,085, 4,837,028, 4,946,787, 5,543,152,
6,723,338, WO 91/17424, Deamer and Bangham, Biochim. Biophys. Acta, 443:629 634
(1976); Fraley, et al, Proc. Natl. Acad. Sci. USA, 76:3348 3352 (1979); Hope, et al,
Biochim. Biophys. Acta, 812:55 65 (1985); Mayer, et al, Biochim. Biophys. Acta, 858:161
168 (1986); Williams, et al, Proc. Natl. Acad. Sci., 85:242 246 (1988), the text Liposomes,
Marc J . Ostro, ed., Marcel Dekker, Inc., New York, 1983, Chapter 1, and Hope, et al, Chem.
Phys. Lip., 40:89 (1986), all of which are incorporated herein by reference.
Following liposome preparation, the liposomes can be sized to achieve the desired
particle size range using standard methods well-known in the art (e.g., see US 6,723,338).
Typically liposomes which can be used in the VSLI preparations described herein have a size
range of about 0.05-0.5 microns (50-500 nm), 0.2-0.4 microns (200-400 nm), about 0.1-0.4
microns (100-400 nm), about 0.05-0.2 (50-200 nm) or about 0.5 (500 nm) to about 0.15
microns(150 nm). In certain embodiments, the liposomes have a particle size having a mean
particle diameter of about 50 nm, about 60 nm, about 70 nm, about 80 nm, about 90 nm,
about 100 nm, about 105 nm, about 110 nm, about 115 nm, about 120 nm, about 130 nm,
about 140 nm, about 150 nm, about 160 nm, 170 nm, about 180 nm, about 190 nm, or about
200 nm. In one embodiment, the average particle size is between 90 and 125nm with the
preferred average particle size about 107.5 nm, where 25% of the particle size distribution is
not less than 70nm and where 90% of the distribution has a particle size of not more than 170
nm.
The sphingomyelin/cholesterol liposomes function as the liposome component used in
the VSLI preparations described herein and are manufactured so that the liposome interior
has a low pH. During the constitution process VSI, having a low pH, and SPLI, having a low
pH, are diluted in a buffer of a higher pH whereby the final pH of the external VSLI solution
is about physiologically neutral. The result is the creation of a pH gradient across the lipid
membrane in which the pH is lower in the interior core of the liposomes than the exterior
surrounding solution. Such gradients are achieved according to known methods (e.g., US
6,723,338). For example, gradients can be achieved by formulating the liposomes in the
presence of a buffer with a pH between about 2 and about 6, a pH between about 3 and about
5, and then subsequently transferring the liposomes to a higher pH, for example, of about 7.0
to about 7.5. In one embodiment, the liposomes have an interior pH of about 4.0. Any
number of dilution buffers can be used, such as sodium phosphate. In one embodiment the
buffer has a pH of 8-10, preferably 9.0, so that the final diluted external liposome solution
when mixed with VSI and SPLI will have a physiologic neutral pH.
Prior to use in the preparation of VSLI according to the methods described herein, the
SPLI liposomes can be stored at refrigerated conditions for substantial periods of time prior
to drug encapsulation and constitution of VSLI for administration to a patient. Alternatively,
the liposomes can be dehydrated, stored and then rehydrated prior to use in accordance with
well-known methods (See, e.g., US Patents 5,077,056 or 5,736,155).
VSLI Preparation
VSLI is prepared with strict aseptic techniques, for example, in a biological safety
cabinet or by established pharmacy safety procedures for the preparation of sterile injectable
formulations and hazardous drugs. Procedures for handling and disposal of anticancer drugs
must be strictly followed (NIOSH Alert: Preventing occupational exposure to antineoplastic
and other hazardous drugs in healthcare settings. 2004. U.S. Department of Health and
Human Services, Public Health Service, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No.
2004- 16; OSHA Technical Manual, TED 1-0.1 5A, Section VI: Chapter 2. Controlling
Occupational Exposure to Hazardous Drugs. OSHA, 1999; American Society of HealthSystem
Pharmacists. ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm. (2006) 63:1 172-1 193; Polovich M, White JM, Kelleher LO (eds.) 2005.
Chemotherapy and biotherapy guidelines and recommendations for practice (2nd. ed.)
Pittsburgh, PA: Oncology Nursing Society)
The process for preparing constituted VSLI includes the following general steps:
• A constituting solution is prepared by mixing in a sterile container a first solution of
vincristine sulfate containing between about 1 mg/mL, about 2 mg/mL or about 5
mg/mL in a buffer containing about 100 to about 200 mg/mL mannitol (other
pharmaceutically acceptable excipients in which vincristine sulfate remains stable can
also be used) at a pH of about 3.5 to about 5.5, or about 4.5 to about 4.7, with a
second solution of liposomes suspended in a buffer at low pH (e.g., about 4.0) at an
appropriate concentration ratio, for example, 0.1/1.0 to 0.2/1.0 (weight vincristine
sulfate to weight lipid).
• The pH of the constituting solution containing the vincristine sulfate and liposomes is
then raised to about 7.0 to about 7.5 to create a pH gradient. This can be
accomplished, for example, by the addition of a buffer (e.g., sodium phosphate) at a
higher pH (e.g., about 9.0).
• The constituting solution is then heated for at least about 13 to about 18 minutes in a
dry heat block equilibrated to about 75°C, which contains caliber wells less than about
5%, larger than the average length or diameter of the container containing the
constituting solution to produce the constituted product, VSLI.
• The heated, constituting solution comprising the constituted product is then allowed to
equilibrate for at least about 30 minutes, at least about 45 minutes or at least about 60
minutes to room temperature (15°C to 30°C,).
• A volume of the constituting solution corresponding to the dose of the constituted
VSLI to be administered to the patient is then admixed with a solution suitable for
intravenous administration to a final volume of about 100 mL.
In some embodiments, solutions of vincristine sulfate, liposomes and high pH buffer
are provided in three separate containers. In certain embodiments, the three solutions are
constituted into one sterile container with a capacity to contain the combined volume of the
solutions, for example, about 20-50 mL, about 25-40 mL, or about 30-35 mL.
In one embodiment, the separate components are provided as a kit including 3 or
more vials. At least one of the vials contains a vincristine solution containing, e.g., 1 mg/mL,
2 mg/mL, or 5 mg/mL vincristine sulfate in buffer containing, e.g., 100 or 200 mg/mL
mannitol (other excipients that are pharmaceutically acceptable, and in which vincristine
remains stable for extended periods, can also be used), and adjusted to pH 3.5 to 5.5, or
preferably pH 4.5 to pH 4.7. One of the vials contains a solution comprising sphingomyelin
and cholesterol liposomes suspended in a 300 mM citrate buffer at, e.g., pH 4.0. Another vial
or vials contains an alkaline phosphate buffer (e.g., pH 9.0) such as dibasic sodium
phosphate, 14.2 mg/ml (20 ml/vial).
In one embodiment, the ingredients for the constitution of VSLI are provided
separately in three vials containing (i) vincristine sulfate USP (5 mg/5 mL), which is
equivalent to 4.5 mg/5 mL vincristine free base, and 500 mg/5 mL mannitol; (ii)
sphingomyelin/cholesterol liposomes injection (SPLI) consisting of 73.5 mg/mL
sphingomyelin, 29.5 mg/mL cholesterol, 33.6 mg/mL citric acid, 35.4 mg/mL sodium citrate,
and not more than 0.1% ethanol; and (iii) Sodium phosphate injection (SPI) containing 355
mg/25 mL dibasic sodium phosphate and 225 mg/25 mL sodium chloride all prepared with
water for injection.
The containers used in the methods of the invention are sterile and composed of any
pharmaceutically acceptable substance (e.g., glass or plastic). There are a number of different
vial types and sized that are commercially marketed by a number of different manufacturers
(e.g., Wheaton Products, Thomas Scientific). In one embodiment, the components are
constituted in a sterile vial with an average diameter of about 36.5 mm, and an average range
of about 35.8 to about 37.3 mm.
Suitable dry block heaters, which provide a safe, dry, constant temperature source, are
commercially available from a number of sources (e.g, Bibby Scientific Ltd, V& P Scientific,
Inc., Fisher Scientific Inc., VWR Scientific, Thermolyne Inc.). Heat conductive inserts
having one or more calibrated bores adapted to receive the container of constituting solution
may be metal (e.g., anodized aluminum, copper) or other suitable heat conductive materials.
Inserts containing bores of openings of the appropriate size can be readily obtained (e.g.,
V&P Scientific, Inc.), or manufactured using standard methods. In certain embodiments, the
heat block contains openings that are between about 1-5%, or about 4.5%, 4.2%, 4.0%, 3.8%,
3.5%, 3.3%, 3.0%, 2.8%, 2.5%, 2.2%, 2.0%, 1.8%, 1.5%, 1.2% or 1.0% larger than the
average length or diameter of the container containing the constituting solution. In some
embodiments, the heat block contains cylindrical openings. In one embodiment, the openings
are between 37.2 to 37.8 mm in diameter, or between about 37.4 to 37.6 mm in diameter.
In some embodiments, the constituting solution is heated for about 13 minutes, about
14 minutes, about 15 minutes, about 16 minutes, about 17 minutes at about 75°C. In one
embodiment, the constituting solution is heated for about 14 minutes in at heat block
equilibrated at 75°C.
The constituted VSLI may be admixed with a pharmaceutically acceptable diluent
suitable for intravenous administration to the patient (e.g., dextrose, sodium chloride) which
may be provided, for example in a pre-filled, sterile container (glass bottle, plastic bottle or
plastic bag). In some embodiments, the volume of the patients calculated dose is removed
from an infusion bag and replaced with the calculated volume of the constituted VSLI
solution into an infusion bag, for example, where the final volume of the infusion container
will be 100 mL. In one embodiment, the pharmaceutically acceptable diluents is of 5%
Dextrose Injection or 0.9% Sodium Chloride Injection.
VSLI
The VSLI produced according to the methods described herein appears as a white to
off-white, translucent suspension, essentially free of visible foreign matter and aggregates.
Typically, greater than about 95%, about 96%>, about 97%, about 98%> or more of the
vincristine sulfate is encapsulated in the liposomes.
The VSLI produced according to the methods described herein contains total
impurities of less than about 4.0%, 3.5%, 3.4%, 3.2%, 3.1%> or 3.0%>. In some embodiments,
the VSLI contains less than about 2.0%, 1.8%, 1.7%, 1.6%, 1.5%, 1.4% or 1.3% Ndesformylvincristine.
The VSLI produced according to the methods described herein has an average in vitro
release rate (IVR) or in vivo release rate of at least about 75%, 76%, 77%, 78%, 79%, 80%,
81%, 82%, 83%, 84% or about 85% within 72 hours.
Assays for determining the level of vincristine encapsulation, the levels of impurities
and release rates of vincristine from liposomes are known in the art. See, for example, US
Patents 5543152 and 5837282; Zhigalstev et al. J . Controlled Release 104:103-1 11, 2005);
Puscalau et al. Am. J . Health-Syst. Pharm. 62:1606-1612, 2005).
Generally, the VSLI produced according to the methods described herein contains
vincristine sulfate at about 0.1 mg/mL to about 0.5 mg/mL. In certain embodiments, the
vincristine sulfate is present at about 0.15 mg/mL to about 0.2 mg/mL. In one embodiment,
the vincristine sulfate is present at about 0.16 mg/mL. In one embodiment, the VSLI contains
5 mg vincristine sulfate, 500 mg mannitol, 73.5 mg sphingomyelin, 29.5 mg cholesterol, 36
mg sodium citrate, 38 mg citric acid, 355 mg sodium phosphate, and 225 mg sodium
chloride.
Dosage and Administration
VSLI prepared according to the methods described herein can be used to treat any
type of cancer including primary, relapsed and refractory cancers. The patient or subject
treated with the VLSI may be a variety of animals, including humans, non-human primates,
avian species, equine species, canine species, feline species, bovine species, swine,
lagomorphs, rodents, and the like. In certain embodiments, the VSLI is used to treat cancers
of the blood and lymphatic systems including, but not limited to, lymphomas, leukemias and
myelomas. In certain embodiments, the VSLI is used to treat tumors including, but not
limited to neuroblastomas and brain cancers.
The VSLI can be used as a single agent or in combination with other
chemotherapeutic agents, such as cyclophosphamide, doxorubicin and/or prednisone. In one
embodiment, the VSLI is administered along with as cyclophosphamide, doxorubicin and
prednisone as a liposomal CHOP formulation ("lipo-CHOP). In another embodiment, the
VSLI is co-administered with at least one additional anti-tumor agent. In another
embodiment, the additional anti-tumor agent is an anti-tumor monoclonal antibody, such as
Oncoly™, Rituxan™, or Bexxar™. In another embodiment, the additional anti-tumor agent
is an antisense drugs or an anti-tumor vaccine. In another embodiment, the VSLI is co
administered with a prophylactic or therapeutic treatment for neurotoxicity, such as
gabapentin (Neurontin™).
Typically, the VSLI is prepared within about 24 hours of administration to the patient
and is stored at room temperature (15°C to 30°C,) or refrigerated (2-8°C).
The VSLI is administered to the patient systemically by intravenous delivery. In one
embodiment, the VSLI is administered by intravenous infusion over a period of, e.g., about
30 minutes, about 45 minutes, about 60 minutes, about 90 minutes or longer.
Typically, the VSLI is administered periodically, e.g., once every 7-28 days. In
certain embodiments, the VSLI is administered once every 3, 5, 7, 10, 14, 2 1 or 28 days. In
one embodiment, the VSLI is administered by intravenous infusion every 14 days. In another
embodiment, the VSLI is administered by intravenous infusion every 7 days. As used herein,
each administration of VSLI is considered one "course" of treatment.
The amount of VSLI administered per dose will depend on a number of factors, such
as the medical history of the patient, the use of other therapies, and the nature of the disease
(e.g., first line, relapsed or refractory cancer). Typically, the VSLI prepared according to the
methods described herein is administered at a dosage of about 1.4 to about 2.4 mg/m . In
certain embodiments, the VSLI is administered at a dose of about 1.5 mg/m , about 1.8
mg/m2, about 2.0 mg/m2, 2.1 mg/m2, 2.2 mg/m2, 2.3 mg/m2 or 2.4 mg/m2 (i.e., mg vincristine
per m body surface area). In one embodiment, the VSLI is administered at a dose of 2.25
mg/m by intravenous infusion over about 60 minutes once every 7 days.
In other embodiments, the dose of VSLI may be temporarily interrupted and/or
reduced during treatment. For example, in one embodiment, the dosage of VSLI
administered to a patient portraying a Grade 3 peripheral neuropathy or persistent Grade 2
peripheral neuropathy may be discontinued for up to about 7 days, and then reduced to a dose
of about 2mg/m upon recovery to Grade 1 or 2. In another embodiment, the dosage
administered to a patient portraying a persistent Grade 2 peripheral neuropathy, even after
receiving a reduced dose, may be discontinue for up to 7 days, and then reduced to dose of
1.825 mg/m2, or a dose of 1.5 mg/m2 .
The dosage of VSLI is determined by calculating the body surface area (BSA) of the
subject according to well-known methods. For example, according to Mosteller's formula in
which the BSA equals the square root of product of the weight of the subject in kg times the
height in cm divided by 3600. The "normal" BSA in humans is generally taken to be 1.7 m
but also depends on other factors including the age and gender of the individual. For
example:
2 • Average BSA for adult men: 1.9 m
• Average BSA for adult women: 1.6 m
• Average BSA for children (9 years): 1.07 m
• Average BSA for children (10 years): 1.14 m
• Average BSA for children (12-13 years): 1.33 m
(Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987;3 17: 1098)
EXAMPLES
Example 1
The temperature profile of the VSLI vial solution was investigated during the heating
with the dry block process and compared with that of the temperature profile observed when
heating with a water bath following the approved label instructions for Marqibo ® (FDA/cder
Reference ID: 317221 1, August 2012).
Equipment and Materials
• Marqibo® kit constituted VSLI, lot NT 268035 (contents of partially used vials
combined into one vial
• Techne Dri-block ® DB-3 heater equipped with 1.480" diameter well and thermometer
pocket (Bibby Scientific Limited).
• Digital thermometers ; accurate to ± 1°C in the range of 0°-100°C
• Isotemp 202 #00947 water bath (Fisher Scientific)
• Fluke 726 #914002 thermo-couple temperature calibrator (Fluke Corporation)
Procedure
Temperature profile measurements were generated by recording the solution
temperature inside the vial after being placed in the heating apparatus (i.e., dry block or water
bath). Time zero was the point where the vial was placed in the heating apparatus. The
following procedure was used:
1. The components, VSI and SCLI, were combined into a single SPI vial (Swiss
Precision Instruments, Inc.). A digital thermocouple was inserted through the septum
of the vial and held approximately 5 mm from the bottom surface of the vial and
positioned in the middle of the liquid solution.
2. The dry block heater was used with a block containing a 1.480 inch vial container
hole. The block temperature was monitored by placing a thermometer into the
block's thermometer hole, which is situated in proximity to the vial container hole.
The block heater was set to a temperature of 75°C and allowed to warm until the
block thermometer read 75 ± 2°C. The heated block was equilibrated for a minimum
of 15 minutes at 75 ± 2°C. The vial was then inserted into the well of the 75 ± 2°C
equilibrated block for 14 minutes ± 15 seconds, and then removed. The constituted
vial was allowed to come to ambient temperature by placing in ambient conditions for
about 60 minutes. The procedure was repeated twice using the same vial.
3. Vial internal liquid temperature, and block temperatures were recorded at 1 minute
intervals (or as noted) and tabulated in Table 1.
4. For comparison, the water bath was allowed to heat until the water temperature was
65 ± 5°C. The water bath was equilibrated for a minimum of 15 minutes. The vial
containing constituted VSLI was then inserted into the water bath for 10 minutes ± 1
minute, and then removed. The constituted vials were allowed to come to ambient
temperature.
5. Vial internal liquid temperature, time and water temperature were recorded and
tabulated in Table 1.
Results and Discussion
The temperature profile of heating the liquid contents of a constituted VSLI vial with
a dry block equilibrated at 75°± 2°C, demonstrate an even and gradual heating rate to 65°±
5°C. The results tabulated in Table 1 and Figure 1 show that the dry block heated the liquid
vial contents at a mean rate of 3.26°C/minute as compared to the water bath, which heated the
vial contents at a mean rate of 4.21°C/minute. The desired temperature of 65°± 5°C was
achieved in 14 minutes in the dry block compared to the water bath which took 10 minutes.
With both heating apparatuses, once the vial was removed from the heating source there was
gradual cooling. The temperature remained within 59-65°C for 3-4 minutes following
removal from the dry block and 1-2 minutes following removal from the water bath. With
both apparatuses, the vial was exposed to 50-65°C for at least 20 minutes with the dry block
and 15 minutes with the water bath. Following heating in either apparatus, the solutions
remained visually identical: a white to off-white, translucent suspension essentially free of
visible foreign matter and aggregates.
Table 1. Constitution Temperature Profile*
internal Temp HB = internal temperature of vial contents heated in the dry block
Internal TempWB= internal temperature of the vial contents heated in the water bath
NR= Not recorded
Conclusion
This study demonstrated that the dry block proved a suitable temperature heating
profile that allows the VSLI vials internal liquid temperature to achieve 65°± 5°C within 14
minutes, and provided a heating exposure in the 50-65°C range of 20 minutes. This
compares to the heating the vials in a water bath, which achieves an internal liquid
temperature of 65°± 5°C in 10 minutes, and an overall heating exposure in the 50-65°C range
of 15 minutes. The rate of heating for both methods was gradual and even. The dry block set
at 75°± 2°C produced a heating rate of 3.26°C per minute, and the water bath set at 65°± 5°C
produced a rate of 4.2 1°C per minute. The heating leveled off with the water bath, while the
rate of the heating in the dry block continued at a steady rate toward the 75°± 2°C set point.
Cooling to ambient temperature took about 60 minutes once the vials were removed from
either heating apparatus. These heating profiles suggest that the near quantitative
encapsulation of vincristine is a thermodynamic process which is dependent on the overall
exposure to temperatures that promote membrane encapsulation rather than the kinetics of
achieving those conditions.
In summary, the dry block and water bath can provide a thermodynamic profile that
allows encapsulation of vincristine into the sphingomyelin cholesterol liposomes for the
efficient preparation of VSLI.
Example 2
The levels of vincristine degradant products of VSLI constituted using a dry heat
block were investigated.
Equipment and Materials:
Techne DB-3 Dri-Block equipped with 1.480" diameter well and thermometer
pocket.
Thermometer with a diameter no greater than 7 mm, and accurate to ± 1°C in the
range ofO°-100°C.
Calibrated stopwatch or timer
Micrometer (0-2") or equivalent.
30 Marqibo® Kits, Lot # TTX061 1 (Talon Therapeutics, Inc.)
Procedure
Vials from 30 Marqibo ® kits having SPI vials with the maximum and minimum outer
diameters were used in the study. The diameter of the SPI vials was measured and recorded
to the nearest 0.001". Results are shown in Table 2.
Table 2. Vial Identification and SPI Vial Diameter
Two vials were selected for constitution. The vial having a diameter closest to or
equal to 1.41 inches ("vial 1"), the lower end of the allowed SPI vial diameter had a
measured diameter of 1.4305 inches. The vial having a diameter closest to or equal to 1.47
inches ("vial 2"), the upper end of the allowed SPI vial diameter, was measured to have a
diameter of 1.4545 inches.
The selected kits were constituted as described above and tested for Vincristine
Sulfate, Related Compounds and particle size and distribution following adapted Vincristine
sulfate injection USP methods.
The two study kits were constituted using the above instructions, except that instead
of the water bath, the Dri-Block heater was used with a block containing a 1.480 inch vial
container hole. The block temperature was monitored by placing a thermometer into the
block's thermometer hole which is situated in proximity to the vial container hole. The block
heater was set to a temperature of 75°C and allowed to heat until the block thermometer read
75 ± 2°C. The heated block was then equilibrated for a minimum of 15 minutes (time
recorded). The conditions are noted in Table 3. Each vial was then inserted into the 75 ± 2°C
heated block for 14 minutes ± 15 seconds (time recorded), and then removed and allowed to
come to ambient temperature by placing the vial in ambient conditions over about 60
minutes.
Time and block temperatures were recorded as indicated in Table 4 during
constitution. Analytical results were recorded in Tables 5, 6 and 7.
Table 3. Dry Block Temperature Equilibration
Table 4. Dry Block Constitution Parameters
Table 5. Total & Free Vincristine Results
The constitution of VSLI was achieved using constitution vials having a diameter of
1.4305 and 1.4545 inches using the Dri- Block heater. These represented vials closest to the
1.41 inch lower limit and 1.47 inch upper limits allowed for vial diameters. During the 14
minute incubation of the VSLI vials in the heating block, the block temperature dropped no
more than 1 degree due to temperature equilibration between the space gap between the block
well diameter and either diameter of vials. This kinetics of the heat transfer did not affect the
preparation of VSLI. After 14 minutes of exposure to the Dri-Block heat equilibrated at
75°C, the resulting constituted VSLI from both vials achieved greater than 97% vincristine
encapsulation . The incubation using the Dri-Block resulted in an encapsulation efficiency
averaging 2.175% free vincristine. No new or increased impurities were observed with the
Dri-Block heating profile. The principle degradant, N-desformylvincrisine, was observed at
an average of 1.33%, with no other impurity greater than 0.574%, and total impurities of no
more than 3.10%. The particle size distribution was consistent with VSLI specifications with
an average diameter of 107.5 nm diameter and mean D of 90.5 nm and D 0 of 138.5 nm,
VSLI prepared with Dri-Block heating released approximately 84 percent of the vincristine
by 72 hours by IVR analysis..
In conclusion, VSLI constituted using the dry block heater equilibrated at 75 ± 2°
with an incubation period of 14 minutes ± 15 seconds encapsulated greater than 99% of
vincristine in the sphingomyelin-cholesterol liposomes, and no anomalies were recorded
during this experiment. The data establish a dry block constitution temperature profile that
leads to a product that efficiently encapsulates vincristine and demonstrates that the dry block
heater can be substituted for a water bath in the constitution of VSLI.
Example 3
In this study the levels of vincristine degradant products were measured to provide a
range of constitution time using the dry block procedure.
Equipment and Materials
• Dri-Block® equipped with 1.476" (±0.004) diameter well and thermometer pocket.
• Thermometer with a diameter no greater than 7 mm, and accurate to ± 1°C in the
range ofO°-100°C.
• Calibrated stopwatch or timer
• Marqibo® Kits, Lot # TTX06 11 (Talon Therapeutics, Inc.)
Procedure
Three Marqibo® Kits were selected at random and constituted by heating in the dry
block at three different times (13, 14 and 15 minutes, respectively) at 75°C. The constituted
vials were tested for Total and Free Vincristine Sulfate, Related Compounds, particle size and
distribution using adapted vincristine sulfate Injection USP methods.
The study kits were constituted using the instructions as described above except that,
instead of a water bath, the Dri-Block® heater was used with a block containing a 1.476 inch
(±0.004") vial container hole. The block temperature was monitored by placing a
thermometer into the block's thermometer hole which is situated in proximity to the vial
container hole. The block was set to a temperature of 75°C and allowed to heat until the
thermometer in the block reads 75 ± 2°C. The heated block was then equilibrated for a
minimum of 15 minutes. The conditions were recorded in Table 9. Each vial was then
inserted into the 75 ± 2°C heated block for 13 minutes ± 15 seconds, 14 minutes ± 15
seconds, and 15 minutes ± 15 seconds, respectively. The vials were then removed and
placed at ambient temperature. The constituted vials were allowed to cool at ambient
temperature for at least 60 minutes prior to testing.
Time and block temperatures were recorded as indicated in Tables 9 and 10 during
constitution. Analytical results were recorded in Tables 11, 1 andl3.
Table 9a. Dry Block Temperature Equilibration (Vial 1)
Temperature at end of 15 minute equilibration period: 75.1°C
Table 10. Dry Block Constitution Parameters
Table 11. Total & Free Vincristine Results
Table 12. Related Compounds Results
Results and Discussion
One constituted kit each was placed in an equilibrated heat block at 75°C for 13, 14
and 15 minutes respectively. All the sample times produced encapsulated vincristine, and
there were no significant differences in test results noted between the three vials. Greater
than 97% vincristine encapsulation was observed with all three vials using the Dri-Block
resulting in an encapsulation efficiency with a maximum 2.3% free vincristine. No new or
increased impurities were observed with the Dri-Block heating profile. The principal
degradant, N-desformylvincrisine, was observed at a maximum of 1.5 1% with no other
impurity greater than 0.59% and total impurities of no more than 3.3%. The particle size
distribution was consistent with VSLI specifications with an average diameter of 107 nm
diameter and mean D of 90 nm and D 0 of 137 nm.
In conclusion, VSLI constituted with the substitution of the water bath with a Dri-
Block equilibrated at 75±2° C with an incubation period of 13 to15 minutes (±15 seconds)
encapsulated vincristine efficiently and no anomalies were recorded during the conduct of
the experiment. The data establishes a Dri-Block constitution temperature profile that leads to
efficient VSLI constitution and shows that the Dri-block heater can be substituted for a water
bath in the constitution of the VSLI.
It is understood that the examples and embodiments described herein are for
illustrative purposes only and that various modifications or changes in light thereof will be
suggested to persons skilled in the art and are to be included within the spirit and purview of
this application and scope of the appended claims. All publications, patents, and patent
applications cited herein are hereby incorporated by reference in their entirety for all
purposes.

CLAIMS
1. A method of preparing a pharmaceutically acceptable liquid composition comprising
liposome-encapsulated vincristine which is free of substantial degradation products, the
method comprising:
(a) Constituting in a single vial (i) a first solution comprising vincristine sulfate at a
concentration of about 1 mg/ml to about 5 mg/ml, wherein the first solution has a pH
of about 3.5 to about 5.5; and (ii) a second solution comprising
sphingomyelin/cholesterol liposomes at a low pH;
(b) raising the pH of the constituting solution in the single vial to a pH of about 7.0 to
7.5;
(c) heating the single vial comprising the constituting solution in a dry heat block
equilibrated at about 75°C for at least about 13 to about 18 minutes, wherein said heat
block comprises one or more bores about 1-5% larger than the average length or
diameter of the single vial to produce a solution comprising constituted liposome
encapsulated vincristine;
(d) equilibrating the constituted solution to room temperature;
(e) diluting a volume of the constituted solution comprising a dose of liposome
encapsulated vincristine for the patient of about 1.5 to about 2.4 mg/m with a
pharmaceutical diluent suitable for intravenous administration, to produce the
pharmaceutically acceptable liquid composition; and
(f) administering the pharmaceutically acceptable liquid composition to the patient,
wherein the constituted solution comprising liposome encapsulated vincristine comprises (i)
less than about 2.5% free vincristine; and (ii) less than about 1.5% N-desformylvincristine.
2. The method of claim 1, wherein the first solution comprising vincristine sulfate has
pH of about 4.5 to about 4.7.
3. The method of any of the preceding claims, wherein the first solution further
comprises mannitol at a concentration of about 100-200 mg/ml.
4. The method of any of the preceding claims, wherein the pH of the second solution
comprising the liposomes is about 4.0.
5. The method of claim any of the preceding claims, wherein the second solution further
comprises a citrate buffer.
6. The method of any of the preceding claims, wherein the pH of the constituting
solution is raised by the addition of a third solution comprising a buffer at a pH of about 9.0.
7. The method of claim 6, wherein the third solution comprises sodium phosphate
buffer.
8. The method of any of the preceding claims, wherein the constituting solution
comprises a concentration ration of about 0.1/1.0 to about 0.2/2.0 vincristine sulfate to lipid.
9. The method of any of the preceding claims, wherein the concentration of vincristine
sulfate in the constituted solution is about 0.1 mg/mL to about 0.5 mg/mL.
10. The method of any of the preceding claims, wherein the concentration of vincristine
sulfate in the constituted solution is about at about 0.15 mg/mL to about 0.2 mg/mL.
11. The method of any of the preceding claims, wherein the concentration of vincristine
sulfate in the constituted solution is about at about 0.16 mg/mL.
12. The method of claim 6, wherein the first solution comprises vincristine sulfate USP (5
mg/5 mL), which is equivalent to 4.5 mg/5 mL vincristine free base, and 500 mg/5 mL
mannitol, the second solution comprises sphingomyelin/cholesterol liposomes consisting of
73.5 mg/mL sphingomyelin, 29.5 mg/mL cholesterol, 33.6 mg/mL citric acid, 35.4 mg/mL
sodium citrate, and the third solution comprises 355 mg/25 mL dibasic sodium phosphate and
225 mg/25 mL sodium chloride.
13. The method of any of the preceding claims, wherein the ratio of sphingomyelin to
cholesterol in the liposome is between about 75/25 mol %/mol sphingomyelin/cholesterol to
30/50 mol %/mol % sphingomyelin/cholesterol.
14. The method of any of the preceding claims, wherein the liposomes comprise about
70/30 mol %/mol sphingomyelin/cholesterol to 40/45 mol %/mol %
sphingomyelin/ cholesterol
15. The method of any of the preceding claims, wherein the liposomes comprise
approximately 55/45 mol %/mol % sphingomyelin/cholesterol.
16. The method of claim 13, wherein the liposomes comprising about 60/40 mol %/mol
% sphingomyelin/cholesterol.
17. The method of any of the preceding claims, wherein the liposomes have a size range
of about 0.05-0.5 microns.
18. The method of any of the preceding claims, wherein the liposomes have a mean
diameter of about 50-200 nm.
19. The method of any of the preceding claims, wherein the liposomes have a mean
diameter of about 90-125 nm.
20. The method of any of the preceding claims, wherein the constituting solution has a
volume of between about 20-50 mL.
2 1. The method of any of the preceding claims, wherein the constituting solution has a
volume of between 30-35 mL.
22. The method of any of the preceding claims, wherein the heat block is equilibrated to
75±2°C for about 15 minutes
23. The method of any of the preceding claims, wherein the constituting solution is heated
for about 13-15 minutes within the caliber bore of a dri-block equilibrated at 75±2°C.
24. The method of any of the preceding claims, wherein the constituting solution is heated
for 14 minutes ± 30 seconds within the caliber bore of a dri-block equilibrated at 75±2°C.
25. The method of any of the preceding claims, wherein the bores in the heat block are
less than about 3% larger than the average length or diameter of the single vial containing the
constituting solution.
26. The method of any of the preceding claims, wherein the single vial containing the
constituting solution has a diameter between about 35.8 to about 37.3 mm.
27. The method of claim 26, wherein the caliber bores in the heat block are cylindrical
with a diameter between 37.2 to 37.8 mm in diameter.
28. The method of any of the preceding claims, wherein the constituted solution is
equilibrated to room temperature for at least about 30 minutes.
29. The method of any of the preceding claims, wherein a volume of the constituted
solution comprising a dose of liposome encapsulated vincristine for the patient of about 1.5 to
about 2.4 mg/m is diluted with standard pharmaceutical diluents suitable for intravenous
administration, to produce the pharmaceutically acceptable liquid composition.
30. The method of any of the preceding claims, wherein the volume of the patients
calculated dose is removed from an infusion container and replaced with the calculated
volume of the constituted VSLI solution.
31. The method of any of the preceding claims, wherein the pharmaceutically acceptable
liquid composition comprising liposome-encapsulated vincristine is administered to the
patient within about 24 hours after step (c).
32. The method of any of the preceding claims, wherein the patient has cancer.
33. The method of claim 32, wherein the cancer is selected from the group consisting of
lymphoma, leukemia, myeloma, brain cancer and neuroblastoma,.
34. The method of any of the preceding claims, wherein the pharmaceutically acceptable
liquid composition comprising liposome-encapsulated vincristine is administered by
intravenous infusion over a period of about 30 to 60 minutes.
35. The method of any of the preceding claims, wherein the pharmaceutically acceptable
liquid composition comprising liposome-encapsulated vincristine is administered by
intravenous infusion once every 7-28 days.
36. The method of any of the preceding claims, wherein the pharmaceutically acceptable
liquid composition comprising liposome-encapsulated vincristine is administered by
intravenous infusion once every 7 days.
37. A method of preparing a pharmaceutically acceptable liquid composition comprising
liposome-encapsulated vincristine which is free of substantial degradation products, the
method comprising:
(a) constituting in a single vial (i) a first solution comprising vincristine sulfate at a
concentration of about 1 mg/ml and mannitol at a concentration of about 100 mg/ml,
wherein the first solution has a pH of about 4.5 to about 4.7; (ii) a second solution
comprising liposomes with 60/40 mol% ml% sphingomyelin /cholesterol in a citrate
buffer at a pH of about 4.0; and (iii) a third solution comprising a sodium phosphate
buffer at a pH of about 9.0, wherein the final pH of the constituting solution is about
7.0 to about 7.6, and the concentration of vincristine sulfate is about 0.16 mg/ml;
(b) heating the single vial comprising the constituting solution in a dry heat block
equilibrated at 75°C ± 2°C for 14 minutes ± 30 seconds to produce a solution
comprising constituted liposome encapsulated vincristine, wherein the single vial has
a diameter between about 35.8 mm to about 37.3 mm, and the heat block comprises
one or more cylindrical bores with a diameter between about 37.2 mm to about 37.8
mm;
(d) equilibrating the constituted solution to room temperature for at least 30 minutes;
(e) diluting a volume of the constituted solution comprising the liposome
encapsulated vincristine with a pharmaceutical diluent to produce a pharmaceutically
acceptable liquid composition suitable for intravenous administration of vincristine at
a dosage of about 1.5 to about 2.4 mg/m , wherein the constituted solution comprising
liposome encapsulated vincristine comprises (i) less than about 2.5% free vincristine;
and (ii) less than about 1.5% N-desformylvincristine.