Use of ATR inhibitors in combination with antiandrogen agent
Combining ATR inhibitors with antiandrogen agents targets cancer cells with overexpressed androgen receptors, enhancing treatment efficacy by selectively inducing cell death and increasing progression-free survival.
Patent Information
- Application Number
- PCT/EP2025/061816
- Authority / Receiving Office
- WO · WO
- Patent Type
- Applications
- Current Assignee / Owner
- Priority Date
- 2024-05-03
- Filing Date
- 2025-04-30
- Publication Date
- 2025-11-06
AI Technical Summary
Cancer cells with high replication stress due to oncogenic mutations or DNA damage are highly dependent on the ATR kinase for survival, making them vulnerable to targeted inhibition, while current treatments lack effective strategies to selectively target these cells.
Combining an ATR inhibitor with an antiandrogen agent to treat cancers with overexpressed androgen receptors, where the ATR inhibitor is administered either before, after, or concurrently with the antiandrogen agent, and at subtherapeutic dosages to enhance treatment efficacy.
The combination therapy increases progression-free survival in cancer patients by selectively targeting and inducing cell death in cancer cells with overexpressed androgen receptors, providing a therapeutic window over healthy cells.
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Abstract
Description
[0001] 1 P38863-WO USE OF ATR INHIBITORS IN COMBINATION WITH ANTIANDROGEN 5 AGENT FIELD OF THE DISCLOSURE The disclosure relates to combinations of at least one ataxia-telangiectasia and RAD- 3-related protein kinase (ATR) inhibitor, pharmaceutically acceptable salts thereof, or 10 pharmaceutical compositions containing the same, and at least one agent for the treatment of metastatic castration-resistant prostate cancer (mCRPC) such as an Antiandrogen Agent (AA), pharmaceutically acceptable salts thereof, or pharmaceutical compositions containing the same, and their use in the treatment of a disease or condition, such as a cancer. 15 BACKGROUND DNA damage occurs continually in cells as a result of environmental insults including ultraviolet radiation, X-rays, and endogenous stress factors, such as reactive oxygen and hydrolysis of bases. Cancer cells are subject to a higher rate of DNA damage inherently induced by higher rates of DNA replication in these cells. Several DNA damage response 20 (DDR) pathways have evolved in a highly coordinated manner to help repair DNA damage and to act as a cellular checkpoint to stop the replication of cells with damaged DNA, allowing for repair functions to occur before the damaged DNA is passed on to daughter cells. Each of the identified DNA repair pathways sense and repair distinct but overlapping types of DNA damage. 25 One major DDR protein that acts as a key cell cycle checkpoint is the ataxia telangiectasia mutated and rad3-related (ATR) kinase, related to the family of phosphoinositide 3-kinase-related protein kinases (PIKKs). ATR is activated by single stranded (ss) DNA lesions caused by stalled replication forks or during nucleotide excision repair but is also activated by double strand breaks following DNA end resection during 30 homologous recombination. ATR is recruited to sites of DNA damage by binding to the RPA protein that coats ssDNA along with an accessory factor called ATR-interacting protein (ATRIP). The ATR / ATRIP complex is then activated by recruitment of additional factors in the 9-1-1 complex (RAD 9, RAD1, and HUS1) which subsequently recruits the TOPBP1 protein and represents critical steps for activation of the downstream phosphorylation cascade 2 that results in cell cycle arrest. The primary target for ATR kinase is CHK1, which when phosphorylated, targets both cdc25 proteins and Wee1 resulting in inhibition of cyclin- dependent kinase activity and cell cycle arrest in S-phase or in G2 / M. ATR has been identified as an important cancer target since it is essential for dividing 5 cells. ATR deficient mice are embryonic lethal, however, adult mice with conditional ATR knocked out are viable with effects on rapidly proliferating tissues and stem cell populations. Mouse embryonic stem cells lacking ATR will only divide for 1-2 doublings and then die, suggesting that ATR is required for the maintenance of dividing cells. Interestingly, mice harboring hypomorphic ATR mutations that reduce expression of ATR to 10% of normal 10 levels showed reduced H-rasG12D-induced tumor growth with minimal effects on proliferating normal cells, e.g., the bone marrow or intestinal epithelial cells. Cancer cells that have high levels of replication stress due to oncogenic mutations, dysfunctional G1 / S checkpoint control (e.g., loss of p53 function), defects in other DNA repair pathways (e.g., ATM) or that are subject to the effects of DNA damaging agents, e.g., radiation therapy or 15 chemotherapeutic agents, are therefore more dependent on ATR for DNA repair and survival. Together, these results highlight a rationale for the selective sensitivity of proliferating tumor cells to ATR inhibition and the potential for a therapeutic window over healthy proliferating cells. Anti-androgen agents (“AA”) are also known as androgen receptor blockers and 20 androgen receptor antagonists. Upon administration an AA targets and binds to the androgen receptors on prostate cancer. Androgen receptors are expressed on the membrane of prostatic epithelial cells and overexpressed on prostate tumor cells. Several AA have been approved, are in clinical trials or are undergoing pre-clinical development, for treatment of prostate cancer such as flutamide, bicalutamide, nilutamide, 25 enzalutamide, apalutamide, and darolutamide. SUMMARY One aspect of the disclosure provides a combination of at least one ATR inhibitor, or a pharmaceutically acceptable salt thereof, and at least one antiandrogen agent (“AA”), or a 30 pharmaceutically acceptable salt thereof, and use thereof in the treatment of cancers or for inducing cell death in cancer cells. The cancers included herein may have an over-expression of androgen receptors on their cell membranes. In another aspect, the disclosure provides a method of treating a cancer in a subject, the method comprising administering to the subject in need thereof a therapeutically effective 3 amount of a combination of an ATR inhibitor and AA, where the cancers included herein can have an over-expression of androgen receptors on their cell membranes. In yet another aspect, the disclosure provides a method of treating a cancer in a subject, the method comprising: 5 (i) identifying a subject having a cancer having an over-expression of androgen receptors on its cell membrane; and (ii) administering to the subject a therapeutically effective amount of a combination of an ATR inhibitor and AA. In some embodiments, the ATR inhibitor is administered before the AA (e.g., within 1 10 week, within 6 days, within 5 days, within 4 days, within 3 days, within 2 days, within 1 day, or within 12 hours). In some embodiments, the ATR inhibitor is administered after the AA (e.g., within 1 week, within 6 days, within 5 days, within 4 days, within 3 days, within 2 days, within 1 day, or within 12 hours). In some embodiments, the ATR inhibitor is co- administered with the AA. In some embodiments, the ATR inhibitor is administered 15 intermittently (e.g., 1 day / week, 2 days / week, or 3 days / week). In some embodiments, the AA is administered daily, 1 day / week, 2 days / week, 3 days / week, or 4 days / week. In some embodiments, the AA is administered 1 day / week, 2 days / week, 3 days / week, or 4 days / week. In some embodiments, the AA is administered on a continuous daily basis. In some embodiments, the therapeutically effective amount of the ATR inhibitor in the 20 combination is a subtherapeutic regimen of the ATR inhibitor. In some embodiments, the subtherapeutic regimen comprises a starting dosage of the ATR inhibitor that is at least 50% less than the lowest standard starting dosage that is used for a monotherapy. In some embodiments, the subtherapeutic regimen comprises a maintenance dosage of the ATR inhibitor that is at least 50% less than the lowest standard maintenance dosage that is used for 25 a monotherapy. In some embodiments, the maintenance dosage comprises a first reduced dosage. In some embodiments, the maintenance dosage of the ATR inhibitor comprises a second reduced dosage. In some embodiments, the maintenance dosage comprises a third reduced dosage. In some embodiments, the route of administration of either or both the ATR inhibitor and the AA is an oral administration. 30 In still another aspect, the disclosure provides a method of inducing cell death in an aberrant cancer cell where the cancer has an over-expression of androgen receptors on its cell membrane, the method comprising contacting the cell with an effective amount of a combination of an ATR inhibitor and an AA, the effective amounts being sufficient to induce cell death in the aberrant cancer cell. 4 In still another aspect, the disclosure provides a method of treating a cancer in a subject, the method comprising the steps of: (i) identifying the cancer as having an over-expression of androgen receptors on their cell membranes.; and 5 (ii) administering to the subject in need thereof a therapeutically effective amount of an ATR inhibitor and a therapeutically effective amount of an AA that is Formula (I), a pharmaceutically acceptable salt thereof, or a combination thereof. Definitions The term "co-administration," "administration with," "administration in combination 10 with," or the like, as used herein, encompass administration of the selected therapeutic agents to a single patient, and are intended to include treatment regimens in which the agents are administered by the same or different route of administration or at the same or different time. The term "progression-free survival (PFS)" means time from initiation of therapy to first evidence of disease progression or death due to any cause, whichever occurs first. For the 15 purpose of the clinical trial described in the example, PFS is defined as the time from randomization of study population to the first documented progressive disease or death due to any cause. In some embodiments, administration of an ATR inhibitor and an AA provides an increase in the progression-free survival of a human subject with cancer compared to a human subject who is administered an ATR inhibitor alone. The increase in the progression-free 20 survival refers to an increase in PFS in cancer patients (e.g., without limitations, patients with advanced solid tumors) treated with an ATR inhibitor and an AA relative to PFS in cancer patients treated with an ATR inhibitor only. In some embodiments, the increase in progression-free survival is about 1 month, about 2 months, about 3 months, about 4 months, about 5 months, about 6 months, about 7 months, about 8 months, about 9 months, about 10 25 months, about 11 months, about 12 months, about 13 months, about 14 months, about 15 months, about 16 months, about 17 months, about 18 months, about 19 months, about 20 months, about 21 months, about 22 months, about 23 months, about 24 months, about 25 months, about 26 months, about 27 months, about 28 months, about 29 months, about 30 months, about 31 months, about 32 months, about 33 months, about 34 months, about 35 30 months, about 36 months, or greater than 36 months increased over that of a subject administered an ATR inhibitor alone. For the methods disclosed herein, subjects can be ones who have been previously treated with 1 to 3 (or greater) lines of therapy. A line of therapy is defined as one or more cycles of a planned treatment program, which may be one or more planned cycles of single- 5 agent therapy or a combination therapy, or a sequence of treatments administered in a planned manner. A new line of therapy begins when a planned course of therapy is modified to include other treatment agents due to lack of adequate response, disease progression, relapse, or toxicity. Previous lines of treatment include, but are not limited to, therapy comprising an 5 ATR inhibitor (e.g., without limitations, Camonsertib), an antibody therapy, stem cell transplant, or any combination thereof. In some cases, the subject had previously been administered an ATR inhibitor (e.g., without limitations, Camonsertib) either alone or in combination with other cancer treatments (e.g., an antibody therapy). The term "aberrant," as used herein, refers to different from normal. When used to 10 describe enzymatic activity, aberrant refers to activity that is greater or less than a normal control or the average of normal non-diseased control samples. Aberrant activity may refer to an amount of activity that results in a disease, where returning the aberrant activity to a normal or non-disease-associated amount (e.g. by administering a compound or using a method as described herein), results in reduction of the disease or one or more disease 15 symptoms. The aberrant activity can be measured by measuring the modification of a substrate of the enzyme in question; a difference of greater or equal to a 2-fold change in activity could be considered as aberrant. Aberrant activity could also refer to an increased dependence on a particular signaling pathway as a result of a deficiency in a separate complementary pathway. 20 The term “acyl,” as used herein, represents a group –C(=O)–R, where R is alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, or heterocyclyl. Acyl may be optionally substituted as described herein for each respective R group. The term “alkanoyl,” as used herein, represents a hydrogen or an alkyl group that is attached to the parent molecular group through a carbonyl group and is exemplified by formyl 25 (i.e., a carboxyaldehyde group), acetyl, propionyl, butyryl, and iso-butyryl. Unsubstituted alkanoyl groups contain from 1 to 7 carbons. The alkanoyl group may be unsubstituted of substituted (e.g., optionally substituted C1-7 alkanoyl) as described herein for alkyl group. The ending “-oyl” may be added to another group defined herein, e.g., aryl, cycloalkyl, and heterocyclyl, to define “aryloyl,” “cycloalkanoyl,” and “(heterocyclyl)oyl.” These groups 30 represent a carbonyl group substituted by aryl, cycloalkyl, or heterocyclyl, respectively. Each of “aryloyl,” “cycloalkanoyl,” and “(heterocyclyl)oyl” may be optionally substituted as defined for “aryl,” “cycloalkyl,” or “heterocyclyl,” respectively. The term “alkenyl,” as used herein, represents acyclic monovalent straight or branched chain hydrocarbon groups of containing one, two, or three carbon-carbon double bonds. Non- 6 limiting examples of the alkenyl groups include ethenyl, prop-1-enyl, prop-2-enyl, 1- methylethenyl, but-1-enyl, but-2-enyl, but-3-enyl, 1-methylprop-1-enyl, 2-methylprop-1-enyl, and 1-methylprop-2-enyl. Alkenyl groups may be optionally substituted as defined herein for alkyl. 5 The term “alkoxy,” as used herein, represents a chemical substituent of formula –OR, where R is a C1-6 alkyl group, unless otherwise specified. In some embodiments, the alkyl group can be further substituted as defined herein. The term “alkoxy” can be combined with other terms defined herein, e.g., aryl, cycloalkyl, or heterocyclyl, to define an “aryl alkoxy,” “cycloalkyl alkoxy,” and “(heterocyclyl)alkoxy” groups. These groups represent an alkoxy 10 that is substituted by aryl, cycloalkyl, or heterocyclyl, respectively. Each of “aryl alkoxy,” “cycloalkyl alkoxy,” and “(heterocyclyl)alkoxy” may optionally substituted as defined herein for each individual portion. The term “alkoxyalkyl,” as used herein, represents a chemical substituent of formula – L–O–R, where L is C1-6alkylene, and R is C1-6alkyl. An optionally substituted alkoxyalkyl is 15 an alkoxyalkyl that is optionally substituted as described herein for alkyl. The term “alkyl,” as used herein, refers to an acyclic straight or branched chain saturated hydrocarbon group, which, when unsubstituted, has from 1 to 12 carbons, unless otherwise specified. In certain preferred embodiments, unsubstituted alkyl has from 1 to 6 carbons. Alkyl groups are exemplified by methyl; ethyl; n- and iso-propyl; n-, sec-, iso- and 20 tert-butyl; neopentyl, and the like, and may be optionally substituted, valency permitting, with one, two, three, or, in the case of alkyl groups of two carbons or more, four or more substituents independently selected from the group consisting of: amino; aryl; aryloxy; azido; cycloalkyl; cycloalkoxy; cycloalkenyl; cycloalkynyl; halo; heterocyclyl; (heterocyclyl)oxy; heteroaryl; hydroxy; nitro; thiol; silyl; cyano; alkylsulfonyl; alkylsulfinyl; alkylsulfenyl; =O; 25 =S; -SO2R, where R is amino or cycloalkyl; =NR’, where R’ is H, alkyl, aryl, or heterocyclyl. Each of the substituents may itself be unsubstituted or, valency permitting, substituted with unsubstituted substituent(s) defined herein for each respective group. The term “alkylene,” as used herein, refers to a divalent alkyl group. An optionally substituted alkylene is an alkylene that is optionally substituted as described herein for alkyl. 30 The term “alkylamino,” as used herein, refers to a group having the formula –N(RN1)2or –NHRN1, in which RN1is alkyl, as defined herein. The alkyl portion of alkylamino can be optionally substituted as defined for alkyl. Each optional substituent on the substituted alkylamino may itself be unsubstituted or, valency permitting, substituted with unsubstituted substituent(s) defined herein for each respective group. 7 The term “alkylsulfenyl,” as used herein, represents a group of formula –S–(alkyl). Alkylsulfenyl may be optionally substituted as defined for alkyl. The term “alkylsulfinyl,” as used herein, represents a group of formula –S(O)–(alkyl). Alkylsulfinyl may be optionally substituted as defined for alkyl. 5 The term “alkylsulfonyl,” as used herein, represents a group of formula –S(O)2– (alkyl). Alkylsulfonyl may be optionally substituted as defined for alkyl. The term “alkynyl,” as used herein, represents monovalent straight or branched chain hydrocarbon groups of from two to six carbon atoms containing at least one carbon-carbon triple bond and is exemplified by ethynyl, 1-propynyl, and the like. The alkynyl groups may 10 be unsubstituted or substituted (e.g., optionally substituted alkynyl) as defined for alkyl. The term “amino,” as used herein, represents –N(RN1)2, where, if amino is unsubstituted, both RN1are H; or, if amino is substituted, each RN1is independently H, -OH, - NO2, -N(RN2)2, -SO2ORN2, -SO2RN2, -SORN2, -COORN2, an N-protecting group, alkyl, alkenyl, alkynyl, alkoxy, aryl, arylalkyl, aryloxy, cycloalkyl, cycloalkenyl, heteroalkyl, or 15 heterocyclyl, provided that at least one RN1is not H, and where each RN2is independently H, alkyl, or aryl. Each of the substituents may itself be unsubstituted or substituted with unsubstituted substituent(s) defined herein for each respective group. In some embodiments, amino is unsubstituted amino (i.e., -NH2) or substituted amino (e.g., NHRN1), where RN1is independently -OH, SO2ORN2, -SO2RN2, -SORN2, -COORN2, optionally substituted alkyl, or 20 optionally substituted aryl, and each RN2can be optionally substituted alkyl or optionally substituted aryl. In some embodiments, substituted amino may be alkylamino, in which the alkyl groups are optionally substituted as described herein for alkyl. In some embodiments, an amino group is –NHRN1, in which RN1is optionally substituted alkyl. The term “androgen receptor”, as used herein, is also known as NR3C4 (nuclear 25 receptor subfamily 3, group C, member 4) is a nuclear receptor that is activated by binding any of the androgenic hormones, including testosterone and dihydrotestosterone, in the cytoplasm and then translocating into the nucleus. The androgen receptor is a DNA-binding transcription factor that regulates gene expression and androgen regulated genes are critical for the development and maintenance of the male sexual phenotype. 30 The term “aryl,” as used herein, represents a mono-, bicyclic, or multicyclic carbocyclic ring system having one or two aromatic rings. Aryl group may include from 6 to 10 carbon atoms. All atoms within an unsubstituted carbocyclic aryl group are carbon atoms. Non-limiting examples of carbocyclic aryl groups include phenyl, naphthyl, 1,2- dihydronaphthyl, 1,2,3,4-tetrahydronaphthyl, fluorenyl, indanyl, indenyl, etc. The aryl group 8 may be unsubstituted or substituted with one, two, three, four, or five substituents independently selected from the group consisting of: alkyl; alkenyl; alkynyl; alkoxy; alkylsulfinyl; alkylsulfenyl; alkylsulfonyl; amino; aryl; aryloxy; azido; cycloalkyl; cycloalkoxy; cycloalkenyl; cycloalkynyl; halo; heteroalkyl; heterocyclyl; (heterocyclyl)oxy; 5 hydroxy; nitro; thiol; silyl; and cyano. Each of the substituents may itself be unsubstituted or substituted with unsubstituted substituent(s) defined herein for each respective group. The term “aryl alkyl,” as used herein, represents an alkyl group substituted with an aryl group. The aryl and alkyl portions may be optionally substituted as the individual groups as described herein. 10 The term “arylene,” as used herein, refers to a divalent aryl group. An optionally substituted arylene is an arylene that is optionally substituted as described herein for aryl. The term “aryloxy,” as used herein, represents a chemical substituent of formula –OR, where R is an aryl group, unless otherwise specified. In optionally substituted aryloxy, the aryl group is optionally substituted as described herein for aryl. 15 The term “ATR kinase,” as used herein, refers to Ataxia-telangiectasia and RAD-3- related protein kinase. The term “azido,” as used herein, represents an -N3group. The term “Camonsertib,” “RP-3500,” or “compound 121,” as used herein, refer to a potent and selective inhibitor of ATR. Camonsertib has been a potential candidate for the 20 treatment of specific cancers. See, for instance, NCT04497116. Camonsertib has the following structure: Camonsertib The term “carbocyclic,” as used herein, represents an optionally substituted C3-16 monocyclic, bicyclic, or tricyclic structure in which the rings, which may be aromatic or non- 25 aromatic, are formed by carbon atoms. Carbocyclic structures include cycloalkyl, cycloalkenyl, cycloalkynyl, and certain aryl groups. The term “carbonyl,” as used herein, represents a –C(O)– group. The term “cyano,” as used herein, represents –CN group. 9 The term “cycloalkenyl,” as used herein, refers to a non-aromatic carbocyclic group having at least one double bond in the ring and from three to ten carbons (e.g., a C3-10 cycloalkenyl), unless otherwise specified. Non-limiting examples of cycloalkenyl include cycloprop-1-enyl, cycloprop-2-enyl, cyclobut-1-enyl, cyclobut-1-enyl, cyclobut-2-enyl, 5 cyclopent-1-enyl, cyclopent-2-enyl, cyclopent-3-enyl, norbornen-1-yl, norbornen-2-yl, norbornen-5-yl, and norbornen-7-yl. The cycloalkenyl group may be unsubstituted or substituted (e.g., optionally substituted cycloalkenyl) as described for cycloalkyl. The term “cycloalkenyl alkyl,” as used herein, represents an alkyl group substituted with a cycloalkenyl group, each as defined herein. The cycloalkenyl and alkyl portions may 10 be substituted as the individual groups defined herein. The term “cycloalkoxy,” as used herein, represents a chemical substituent of formula – OR, where R is cycloalkyl group, unless otherwise specified. In some embodiments, the cycloalkyl group can be further substituted as defined herein. The term “cycloalkyl,” as used herein, refers to a cyclic alkyl group having from three 15 to ten carbons (e.g., a C3-C10 cycloalkyl), unless otherwise specified. Cycloalkyl groups may be monocyclic or bicyclic. Bicyclic cycloalkyl groups may be of bicyclo[p.q.0]alkyl type, in which each of p and q is, independently, 1, 2, 3, 4, 5, 6, or 7, provided that the sum of p and q is 2, 3, 4, 5, 6, 7, or 8. Alternatively, bicyclic cycloalkyl groups may include bridged cycloalkyl structures, e.g., bicyclo[p.q.r]alkyl, in which r is 1, 2, or 3, each of p and q is, 20 independently, 1, 2, 3, 4, 5, or 6, provided that the sum of p, q, and r is 3, 4, 5, 6, 7, or 8. The cycloalkyl group may be a spirocyclic group, e.g., spiro[p.q]alkyl, in which each of p and q is, independently, 2, 3, 4, 5, 6, or 7, provided that the sum of p and q is 4, 5, 6, 7, 8, or 9. Non- limiting examples of cycloalkyl include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, 1-bicyclo[2.2.1.]heptyl, 2-bicyclo[2.2.1.]heptyl, 5-bicyclo[2.2.1.]heptyl, 7- 25 bicyclo[2.2.1.]heptyl, and decalinyl. The cycloalkyl group may be unsubstituted or substituted (e.g., optionally substituted cycloalkyl) with one, two, three, four, or five substituents independently selected from the group consisting of: alkyl; alkenyl; alkynyl; alkoxy; alkylsulfinyl; alkylsulfenyl; alkylsulfonyl; amino; aryl; aryloxy; azido; cycloalkyl; cycloalkoxy; cycloalkenyl; cycloalkynyl; halo; heteroalkyl; heterocyclyl; (heterocyclyl)oxy; 30 heteroaryl; hydroxy; nitro; thiol; silyl; cyano; =O; =S; -SO2R, where R is amino or cycloalkyl; =NR’, where R’ is H, alkyl, aryl, or heterocyclyl; or –CON(RA)2, where each RAis independently H or alkyl, or both RA, together with the atom to which they are attached, combine to form heterocyclyl. Each of the substituents may itself be unsubstituted or substituted with unsubstituted substituent(s) defined herein for each respective group. 10 The term “cycloalkyl alkyl,” as used herein, represents an alkyl group substituted with a cycloalkyl group, each as defined herein. The cycloalkyl and alkyl portions may be optionally substituted as the individual groups described herein. The term “cycloalkylene,” as used herein, represents a divalent cycloalkyl group. An 5 optionally substituted cycloalkylene is a cycloalkylene that is optionally substituted as described herein for cycloalkyl. The term “cycloalkynyl,” as used herein, refers to a monovalent carbocyclic group having one or two carbon-carbon triple bonds and having from eight to twelve carbons, unless otherwise specified. Cycloalkynyl may include one transannular bond or bridge. Non- 10 limiting examples of cycloalkynyl include cyclooctynyl, cyclononynyl, cyclodecynyl, and cyclodecadiynyl. The cycloalkynyl group may be unsubstituted or substituted (e.g., optionally substituted cycloalkynyl) as defined for cycloalkyl. The terms “darolutamide” or NUBEQA®as used herein, refer to a potent and selective AA. Darolutamide is indicated for the treatment of metastatic hormone-sensitive prostate 15 cancer (mHSPC) and non-metastatic castration-resistant prostate cancer (nmCRPC). See https: / / www.nubequahcp.com. Darolutamide is a third-generation nonsteroidal antiandrogen that acts as a competitive silent antagonist of the androgen receptor. Darolutamide has the following structure: 20"Disease" or "condition" refer to a state of being or health status of a patient or subject capable of being treated with the compounds or methods provided herein. The term “halo,” as used herein, represents a halogen selected from bromine, chlorine, iodine, and fluorine. The term “heteroalkyl,” as used herein refers to an alkyl, alkenyl, or alkynyl group 25 interrupted once by one or two heteroatoms; twice, each time, independently, by one or two heteroatoms; three times, each time, independently, by one or two heteroatoms; or four times, each time, independently, by one or two heteroatoms. Each heteroatom is, independently, O, N, or S. In some embodiments, the heteroatom is O or N. None of the heteroalkyl groups 11 includes two contiguous oxygen or sulfur atoms. The heteroalkyl group may be unsubstituted or substituted (e.g., optionally substituted heteroalkyl). When heteroalkyl is substituted and the substituent is bonded to the heteroatom, the substituent is selected according to the nature and valency of the heteratom. Thus, the substituent bonded to the heteroatom, valency 5 permitting, is selected from the group consisting of =O, -N(RN2)2, -SO2ORN3, -SO2RN2, - SORN3, -COORN3, an N protecting group, alkyl, alkenyl, alkynyl, aryl, cycloalkyl, cycloalkenyl, cycloalkynyl, heterocyclyl, or cyano, where each RN2is independently H, alkyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, or heterocyclyl, and each RN3is independently alkyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, or heterocyclyl. Each of these substituents 10 may itself be unsubstituted or substituted with unsubstituted substituent(s) defined herein for each respective group. When heteroalkyl is substituted and the substituent is bonded to carbon, the substituent is selected from those described for alkyl, provided that the substituent on the carbon atom bonded to the heteroatom is not Cl, Br, or I. It is understood that carbon atoms are found at the termini of a heteroalkyl group. 15 The term “heteroaryl alkyl,” as used herein, represents an alkyl group substituted with a heteroaryl group, each as defined herein. The heteroaryl and alkyl portions may be optionally substituted as the individual groups described herein. The term “heteroarylene,” as used herein, represents a divalent heteroaryl. An optionally substituted heteroarylene is a heteroarylene that is optionally substituted as 20 described herein for heteroaryl. The term “heteroaryloxy,” as used herein, refers to a structure –OR, in which R is heteroaryl. Heteroaryloxy can be optionally substituted as defined for heterocyclyl. The term “heterocyclyl,” as used herein, represents a monocyclic, bicyclic, tricyclic, or tetracyclic ring system having fused, bridging, and / or spiro 3-, 4-, 5-, 6-, 7-, or 8-membered 25 rings, unless otherwise specified, containing one, two, three, or four heteroatoms independently selected from the group consisting of nitrogen, oxygen, and sulfur. In some embodiments, “heterocyclyl” is a monocyclic, bicyclic, tricyclic, or tetracyclic ring system having fused or bridging 5-, 6-, 7-, or 8-membered rings, unless otherwise specified, containing one, two, three, or four heteroatoms independently selected from the group 30 consisting of nitrogen, oxygen, and sulfur. Heterocyclyl can be aromatic or non-aromatic. Non-aromatic 5-membered heterocyclyl has zero or one double bonds, non-aromatic 6- and 7- membered heterocyclyl groups have zero to two double bonds, and non-aromatic 8-membered heterocyclyl groups have zero to two double bonds and / or zero or one carbon-carbon triple bond. Heterocyclyl groups include from 1 to 16 carbon atoms unless otherwise specified. 12 Certain heterocyclyl groups may include up to 9 carbon atoms. Non-aromatic heterocyclyl groups include pyrrolinyl, pyrrolidinyl, pyrazolinyl, pyrazolidinyl, imidazolinyl, imidazolidinyl, piperidinyl, homopiperidinyl, piperazinyl, pyridazinyl, oxazolidinyl, isoxazolidiniyl, morpholinyl, thiomorpholinyl, thiazolidinyl, isothiazolidinyl, thiazolidinyl, 5 tetrahydrofuranyl, dihydrofuranyl, tetrahydrothienyl, dihydrothienyl, dihydroindolyl, tetrahydroquinolyl, tetrahydroisoquinolyl, pyranyl, dihydropyranyl, dithiazolyl, etc. If the heterocyclic ring system has at least one aromatic resonance structure or at least one aromatic tautomer, such structure is an aromatic heterocyclyl (i.e., heteroaryl). Non-limiting examples of heteroaryl groups include benzimidazolyl, benzofuryl, benzothiazolyl, benzothienyl, 10 benzoxazolyl, furyl, imidazolyl, indolyl, isoindazolyl, isoquinolinyl, isothiazolyl, isothiazolyl, isoxazolyl, oxadiazolyl, oxazolyl, purinyl, pyrrolyl, pyridinyl, pyrazinyl, pyrimidinyl, qunazolinyl, quinolinyl, thiadiazolyl (e.g., 1,3,4-thiadiazole), thiazolyl, thienyl, triazolyl, tetrazolyl, etc. The term “heterocyclyl” also represents a heterocyclic compound having a bridged multicyclic structure in which one or more carbons and / or heteroatoms bridges two 15 non-adjacent members of a monocyclic ring, e.g., 8-oxabicyclo[3,2,1]octane, quinuclidine, tropanes, or diaza-bicyclo[2.2.2]octane. The term “heterocyclyl” includes bicyclic, tricyclic, and tetracyclic groups in which any of the above heterocyclic rings is fused to one, two, or three carbocyclic rings, e.g., an aryl ring, a cyclohexane ring, a cyclohexene ring, a cyclopentane ring, a cyclopentene ring, or another monocyclic heterocyclic ring. Examples of20 fused heterocyclyls include 1,2,3,5,8,8a-hexahydroindolizine; 2,3-dihydrobenzofuran; 2,3- dihydroindole; and 2,3-dihydrobenzothiophene. The heterocyclyl group may be unsubstituted or substituted with one, two, three, four, five, or six substituents independently selected from the group consisting of: alkyl; alkenyl; alkynyl; alkoxy; alkylsulfinyl; alkylsulfenyl; alkylsulfonyl; amino; aryl; aryloxy; azido; cycloalkyl; cycloalkoxy; cycloalkenyl; 25 cycloalkynyl; halo; heteroalkyl; heterocyclyl; (heterocyclyl)oxy; hydroxy; nitro; thiol; silyl; cyano; =O; =S; =NR’, where R’ is H, alkyl, aryl, or heterocyclyl. Each of the substituents may itself be unsubstituted or substituted with unsubstituted substituent(s) defined herein for each respective group. The term “heterocyclyl alkyl,” as used herein, represents an alkyl group substituted 30 with a heterocyclyl group, each as defined herein. The heterocyclyl and alkyl portions may be optionally substituted as the individual groups described herein. The term “heterocyclylene,” as used herein, represents a divalent heterocyclyl. An optionally substituted heterocyclylene is a heterocyclylene that is optionally substituted as described herein for heterocyclyl. 13 The term “(heterocyclyl)oxy,” as used herein, represents a chemical substituent of formula –OR, where R is a heterocyclyl group, unless otherwise specified. (Heterocyclyl)oxy can be optionally substituted in a manner described for heterocyclyl. The terms “hydroxyl” and “hydroxy,” as used interchangeably herein, represent an - 5 OH group. The term “isotopically enriched,” as used herein, refers to the pharmaceutically active agent with the isotopic content for one isotope at a predetermined position within a molecule that is at least 100 times greater than the natural abundance of this isotope. For example, a composition that is isotopically enriched for deuterium includes an active agent with at least 10 one hydrogen atom position having at least 100 times greater abundance of deuterium than the natural abundance of deuterium. Preferably, an isotopic enrichment for deuterium is at least 1000 times greater than the natural abundance of deuterium. More preferably, an isotopic enrichment for deuterium is at least 4000 times greater (e.g., at least 4750 times greater, e.g., up to 5000 times greater) than the natural abundance of deuterium. 15 The term “nitro,” as used herein, represents an -NO2 group. The term “oxo,” as used herein, represents a divalent oxygen atom (e.g., the structure of oxo may be shown as =O). The term “Ph,” as used herein, represents phenyl. The term “pharmaceutical composition,” as used herein, represents a composition 20 containing a compound described herein, formulated with a pharmaceutically acceptable excipient, and manufactured or sold with the approval of a governmental regulatory agency as part of a therapeutic regimen for the treatment of disease in a mammal. Pharmaceutical compositions can be formulated, for example, for oral administration in unit dosage form (e.g., a tablet, capsule, caplet, gelcap, or syrup); for topical administration (e.g., as a cream, 25 gel, lotion, or ointment); for intravenous administration (e.g., as a sterile solution free of particulate emboli and in a solvent system suitable for intravenous use); or in any other formulation described herein. The term “pharmaceutically acceptable excipient” or “pharmaceutically acceptable carrier,” as used interchangeably herein, refers to any ingredient other than the compounds 30 described herein (e.g., a vehicle capable of suspending or dissolving the active compound) and having the properties of being nontoxic and non-inflammatory in a patient. Excipients may include, for example: antiadherents, antioxidants, binders, coatings, compression aids, disintegrants, dyes (colors), emollients, emulsifiers, fillers (diluents), film formers or coatings, flavors, fragrances, glidants (flow enhancers), lubricants, preservatives, printing inks, 14 sorbents, suspending or dispersing agents, sweeteners, or waters of hydration. Exemplary excipients include, but are not limited to: butylated hydroxytoluene (BHT), calcium carbonate, calcium phosphate (dibasic), calcium stearate, croscarmellose, crosslinked polyvinyl pyrrolidone, citric acid, crospovidone, cysteine, ethylcellulose, gelatin, 5 hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose, magnesium stearate, maltitol, mannitol, methionine, methylcellulose, methyl paraben, microcrystalline cellulose, polyethylene glycol, polyvinyl pyrrolidone, povidone, pregelatinized starch, propyl paraben, retinyl palmitate, shellac, silicon dioxide, sodium carboxymethyl cellulose, sodium citrate, sodium starch glycolate, sorbitol, starch (corn), stearic acid, stearic acid, sucrose, talc, 10 titanium dioxide, vitamin A, vitamin E, vitamin C, and xylitol. The term “pharmaceutically acceptable salt,” as use herein, represents those salts which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of humans and animals without undue toxicity, irritation, allergic response and the like and are commensurate with a reasonable benefit / risk ratio. Pharmaceutically acceptable salts 15 are well known in the art. For example, pharmaceutically acceptable salts are described in: Berge et al., J. Pharmaceutical Sciences 66:1-19, 1977 and in Pharmaceutical Salts: Properties, Selection, and Use, (Eds. P.H. Stahl and C.G. Wermuth), Wiley-VCH, 2008. The salts can be prepared in situ during the final isolation and purification of the compounds described herein or separately by reacting the free base group with a suitable organic acid. 20 Representative acid addition salts include acetate, adipate, alginate, ascorbate, aspartate, benzenesulfonate, benzoate, bisulfate, borate, butyrate, camphorate, camphorsulfonate, citrate, cyclopentanepropionate, digluconate, dodecylsulfate, ethanesulfonate, fumarate, glucoheptonate, glycerophosphate, hemisulfate, heptonate, hexanoate, hydrobromide, hydrochloride, hydrogen sulfate, hydroiodide, 2-hydroxy-ethanesulfonate, lactobionate,25 lactate, laurate, lauryl sulfate, malate, maleate, malonate, methanesulfonate, 2- naphthalenesulfonate, nicotinate, nitrate, oleate, oxalate, palmitate, pamoate, pectinate, persulfate, 3-phenylpropionate, phosphate, picrate, pivalate, propionate, stearate, succinate, sulfate, tartrate, thiocyanate, toluenesulfonate, undecanoate, valerate salts, and the like. Representative alkali or alkaline earth metal salts include sodium, lithium, potassium, 30 calcium, magnesium, and the like, as well as nontoxic ammonium, quaternary ammonium, and amine cations, including, but not limited to ammonium, tetramethylammonium, tetraethylammonium, methylamine, dimethylamine, trimethylamine, triethylamine, ethylamine, and the like. In some embodiments, the pharmaceutically acceptable salt is a hydrogen sulfate salt. 15 The term “tautomer” refers to structural isomers that readily interconvert, often by relocation of a proton. Tautomers are distinct chemical species that can be identified by differing spectroscopic characteristics, but generally cannot be isolated individually. Non- limiting examples of tautomers include ketone - enol, enamine - imine, amide - imidic acid, 5 nitroso - oxime, ketene – ynol, and amino acid – ammonium carboxylate. The term “therapeutically effective amount,” as used herein, means the amount of a compound or a pharmaceutically acceptable salt thereof that, in a combination of an ATR inhibitor and AA, is sufficient to treat cancer. A therapeutically effective amount of an ATR inhibitor may be a subtherapeutic regimen. 10 The term “subject,” as used herein, represents a human or non-human animal (e.g., a mammal) that is suffering from, or is at risk of, disease or condition, as determined by a qualified professional (e.g., a doctor or a nurse practitioner) with or without known in the art laboratory test(s) of sample(s) from the subject. Preferably, the subject is a human. Non- limiting examples of diseases and conditions include diseases having the symptom of cell 15 hyperproliferation, e.g., a cancer. The term “subtherapeutic regimen,” as used herein, refers to a dosing regimen that is at least 5% less (e.g., at least 10%, 20%, 50%, 80%, 90%, or even 95%) than the lowest standard recommended dosing regimen of a particular compound formulated for a given route of administration for treatment of cancer. A subtherapeutic regimen of a compound may be 20 therapeutically ineffective for the compound in a monotherapy regimen. In the methods of the disclosure, a therapeutically effective amount of an ATR inhibitor is preferably a subtherapeutic regimen (e.g., a regimen that is therapeutically ineffective for the ATR inhibitor in a monotherapy regimen). A subtherapeutic regimen of an ATR inhibitor that is formulated for oral administration may differ from a subtherapeutic regimen of the same 25 agent formulated for intratumoral administration. A subtherapeutic regimen may include a “subtherapeutic starting regimen” and a “subtherapeutic maintenance regimen.” A “subtherapeutic starting regimen” of a compound (e.g., an ATR inhibitor) is lower than the lowest standard starting dosage of the same compound (e.g., an ATR inhibitor). Similarly, a “subtherapeutic maintenance regimen” of a compound (e.g., an ATR inhibitor) is lower than 30 the lowest standard maintenance regimen of the same compound (e.g., an ATR inhibitor). Typically, the subtherapeutic regimen is at least 1% of the lowest standard therapeutic regimen. “Treatment” and "treating," as used herein, refer to the medical management of a subject with the intent to improve, ameliorate, stabilize, prevent, or cure a disease or 16 condition. This term includes active treatment (treatment directed to improve the disease or condition); causal treatment (treatment directed to the cause of the associated disease or condition); palliative treatment (treatment designed for the relief of symptoms of the disease or condition); preventative treatment (treatment directed to minimizing or partially or 5 completely inhibiting the development of the associated disease or condition); and supportive treatment (treatment employed to supplement another therapy). A disease or condition may be a cancer. Non-limiting examples of cancers include, e.g., renal cell carcinoma, mature B- cell neoplasms, endometrial cancer, ovarian cancer, colorectal cancer, skin cancer (non- melanoma), small bowel cancer, non-small cell lung cancer, melanoma, bladder cancer, 10 pancreatic cancer, head and neck cancer, mesothelioma, glioma, prostate cancer, breast cancer, and esophagogastric cancer. If any publication incorporated herein by reference contains a definition not consistent with a definition presented herein, the latter definition prevails. 15 DETAILED DESCRIPTION In general, the disclosure relates to a combination of an ATR inhibitor, or a pharmaceutically acceptable salt thereof, and an antiandrogen agent (“AA”), or a pharmaceutically acceptable salt thereof, and use thereof for the treatment of cancers or for inducing cell death in cancer cells. The cancers included herein have an over-expression of 20 androgen receptors on their cell membranes. Without intending to be bound by theory, it is believed that an ATR inhibitor, which inhibits the DDR of a target cell, and an AA, which blocks the androgen receptors of a target cell, act synergistically to induce cell death in cancer cells having an over-expression of androgen receptors on their cell membranes. Advantageously, an ATR inhibitor and an AA 25 may act synergistically to induce cell death in cancer cells. Advantageously, combination cancer therapies including an ATR inhibitor and an AA may exhibit reduced morbidities, as ATR inhibitor dosages may be reduced, e.g., relative to those administered in acorresponding monotherapy. Thus, ATR inhibitors may be used in subtherapeutic regimens in the methods of the disclosure. The present disclosure demonstrates a belief that combination 30 cancer therapies, including an ATR inhibitor and an AA, may synergistically induce cell death in cancer cells through a combination of an ATR inhibitor and an AA, optionally, in close proximity to a cancer cell. Thus, the present disclosure examined both the advantages and disadvantages of using either an ATR inhibitor or an AA to treat cancer and determined that a combination of the two therapies will induce cell death in cancer cells while exhibiting 17 reduced morbidities, e.g., due to the use of subtherapeutic dosages of the agents as relative to the dosages administered in a corresponding monotherapy. It may remain to post-published evidence to confirm the plausibility of these synergistic effects (US Rule 132 Declaration or evidence under EPO Decision G2 / 21). 5 Moreover, it is to be understood that based on the present disclosure, the skilled person, having the common general knowledge of the art, would derive the provision of synergistically active combination therapy for prostate cancer as being encompassed by the technical teaching and embodied by the present disclosure. In particular, it is a synergistically active combination therapy for prostate cancer when combining Camonsertib 10 and Darolutamide. ATR Inhibitors An ATR inhibitor is a compound that upon contacting the enzyme ATR kinase, whether in vitro, in cell culture, or in an animal, reduces the activity of ATR kinase, such that 15 the measured ATR kinase IC50 is 10 µM or less (e.g., 5 µM or less or 1 µM or less). For certain ATR inhibitors, the ATR kinase IC50 may be 100 nM or less (e.g., 10 nM or less, or 1 nM or less) and could be as low as 100 pM or 10 pM. Preferably, the ATR kinase IC50is 0.1 nM to 1 µM (e.g., 0.1 nM to 750 nM, 0.1 nM to 500 nM, or 0.1 nM to 250 nM). Non-limiting examples of ATR inhibitors include, e.g.: 20 , , , BAY1895344 ceralasertib (AZD6738) berzosertib (VE-822) 18 , and pharmaceutically acceptable salts thereof. VX-803 Other non-limiting examples of ATR inhibitors include, e.g., those described in, e.g., International Application Nos. PCT / US2019 / 022727 and PCT / US2018 / 034729, each of 5 which is incorporated by reference herein; U.S. Patent Nos.9,663,535, 9,549,932, 8,552,004, and 8,841,308, each of which is incorporated by reference herein; and U.S. Patent Application Publication No.2019 / 0055240, which is incorporated by reference herein. In one embodiment. an ATR inhibitor is a compound of formula (III): , 10 (III) or a pharmaceutically acceptable salt thereof, wherein is a double bond, and each Y is independently N or CR4; or is a single bond, and each Y is independently NRY, carbonyl, or C(RY)2; where each RYis independently H or optionally substituted C1-6 alkyl;15R1is optionally substituted C1-6 alkyl or H; R2is optionally substituted C2-9heterocyclyl, optionally substituted C1-6alkyl, optionally substituted C3-8 cycloalkyl, optionally substituted C2-9 heterocyclyl C1-6 alkyl, optionally substituted C6-10 aryl, optionally substituted C1-9 heteroaryl, optionally substituted C1-9heteroaryl C1-6alkyl, halogen, –N(R5)2, –OR5, –CON(R6)2, –SO2N(R6)2, –SO2R5A, or – 20 Q–R5B; R3is optionally substituted C1-9 heteroaryl or optionally substituted C1-9 heteroaryl C1- 6 alkyl; 19 each R4is independently hydrogen, halogen, optionally substituted C1-6alkyl, optionally substituted C2-6 alkenyl, or optionally substituted C2-6 alkynyl; each R5is independently hydrogen, optionally substituted C1-6 alkyl, optionally substituted C6-10aryl C1-6alkyl, optionally substituted C6-10aryl, optionally substituted C1-95 heteroaryl, or –SO2R5A; or both R5, together with the atom to which they are attached, combine to form an optionally substituted C2-9 heterocyclyl; each R5Ais independently optionally substituted C1-6alkyl, optionally substituted C3-8cycloalkyl, or optionally substituted C6-10 aryl; R5Bis hydroxyl, optionally substituted C1-6 alkyl, optionally substituted C6-10 aryl, 10 optionally substituted C1-9heteroaryl, –N(R5)2, –CON(R6)2, –SO2N(R6)2, –SO2R5A, or optionally substituted alkoxy; each R6is independently hydrogen, optionally substituted C1-6 alkyl, optionally substituted C2-6 alkoxyalkyl, optionally substituted C6-10 aryl C1-6 alkyl, optionally substituted C6-10aryl, optionally substituted C3-8cycloalkyl, or optionally substituted C1-9heteroaryl; or 15 both R6, together with the atom to which they are attached, combine to form an optionally substituted C2-9 heterocyclyl; Q is optionally substituted C2-9heterocyclylene, optionally substituted C3-8cycloalkylene, optionally substituted C1-9 heteroarylene, or optionally substituted C6-10 arylene; and 20 X is hydrogen or halogen. The ATR inhibitor may be, e.g., a compound of formula (IV): , or a pharmaceutically acceptable salt thereof,25wherein each Y is independently N or CR4; R1is optionally substituted C1-6alkyl or H; R2is optionally substituted C2-9 heterocyclyl, optionally substituted C1-6 alkyl, optionally substituted C3-8cycloalkyl, optionally substituted C2-9heterocyclyl C1-6alkyl, 20 optionally substituted C6-10aryl, optionally substituted C1-9heteroaryl, optionally substituted C1-9 heteroaryl C1-6 alkyl, halogen, –N(R5)2, –OR5, –CON(R6)2, –SO2N(R6)2, –SO2R5A, or – Q–R5B; R3is optionally substituted C1-9heteroaryl or optionally substituted C1-9heteroaryl C1-5 6 alkyl; each R4is independently hydrogen, halogen, optionally substituted C1-6 alkyl, optionally substituted C2-6alkenyl, or optionally substituted C2-6alkynyl; each R5is independently hydrogen, optionally substituted C1-6 alkyl, optionally substituted C6-10 aryl C1-6 alkyl, optionally substituted C6-10 aryl, optionally substituted C1-9 10 heteroaryl, or –SO2R5A; or both R5, together with the atom to which they are attached, combine to form an optionally substituted C2-9heterocyclyl; each R5Ais independently optionally substituted C1-6 alkyl, optionally substituted C3-8 cycloalkyl, or optionally substituted C6-10 aryl; R5Bis hydroxyl, optionally substituted C1-6alkyl, optionally substituted C6-10aryl, 15 optionally substituted C1-9 heteroaryl, –N(R5)2, –CON(R6)2, –SO2N(R6)2, –SO2R5A, or optionally substituted alkoxy; each R6is independently hydrogen, optionally substituted C1-6alkyl, optionally substituted C2-6 alkoxyalkyl, optionally substituted C6-10 aryl C1-6 alkyl, optionally substituted C6-10 aryl, optionally substituted C3-8 cycloalkyl, or optionally substituted C1-9 heteroaryl; or 20 both R6, together with the atom to which they are attached, combine to form an optionally substituted C2-9heterocyclyl; Q is optionally substituted C2-9 heterocyclylene, optionally substituted C3-8 cycloalkylene, optionally substituted C1-9 heteroarylene, or optionally substituted C6-10 arylene; and 25 X is hydrogen or halogen. In some embodiments, in the compound of formula (III), (IV), or (III-b): each Y is independently N or CR4; R1is H or optionally substituted C1-6 alkyl; R2is optionally substituted C1-6 alkyl, optionally substituted C3-8 cycloalkyl, optionally 30 substituted C2-9heterocyclyl, optionally substituted C6-10aryl, optionally substituted C1-9heteroaryl, optionally substituted C1-9heteroaryl C1-6alkyl, –N(R5)2, –CON(R6)2, –SO2N(R6)2, or –SO2R5A; R3is optionally substituted C1-9heteroaryl; each R4is independently H or optionally substituted C1-6alkyl; 21 each R5is independently hydrogen, optionally substituted C1-6alkyl, optionally substituted C6-10 aryl C1-6 alkyl, optionally substituted C6-10 aryl, optionally substituted C1-9 heteroaryl, or –SO2R5A, where each R5Ais independently optionally substituted C1-6 alkyl or optionally substituted C3-8cycloalkyl; or both R5, together with the atom to which they are 5 attached, combine to form an optionally substituted C2-9 heterocyclyl; each R5Ais independently optionally substituted C1-6 alkyl or optionally substituted C3- 8 cycloalkyl; and each R6is independently hydrogen, optionally substituted C1-6 alkyl, optionally substituted C6-10 aryl C1-6 alkyl, optionally substituted C6-10 aryl, or optionally substituted C1-9 10 heteroaryl; or both R6, together with the atom to which they are attached, combine to form an optionally substituted C2-9heterocyclyl. Methods of making compounds of formula (III) are described, e.g., in International Application No. PCT / CA2019 / 051539, hereby incorporated by reference. The ATR inhibitor may be, e.g., a compound of formula (III-a): 15 , (III-a) or a pharmaceutically acceptable salt thereof, where Y, R1, R2, R3, and R4are as described for formula (III). The ATR inhibitor may be, e.g., a compound of formula (III-b): 20 , (III-b) or a pharmaceutically acceptable salt thereof, where Y, R1, R2, R3, and R4are as described for formula (III). 22 The ATR inhibitor may be, e.g., a compound of formula (IIIA): , (IIIA) or a pharmaceutically acceptable salt thereof, where R1, R2, R3, and R4are as described for 5 formula (III). The ATR inhibitor may be, e.g., a compound of formula (IIIA-a): , (IIIA-a) or a pharmaceutically acceptable salt thereof, where R1, R2, R3, and R4are as described for 10 formula (III). The ATR inhibitor may be, e.g., a compound of Formula (IIIB): , 15 or a pharmaceutically acceptable salt thereof, where R1, R2, R3, and R4are as described for formula (III). 23 The ATR inhibitor may be, e.g., a compound of formula (IIIB-a): , (IIIB-a) or a pharmaceutically acceptable salt thereof, where R1, R2, R3, and R4are as described for 5 formula V. The ATR inhibitor may be, e.g., a compound of Formula (IIIC): or a pharmaceutically acceptable salt thereof, where R1, R2, R3, and R4are as described for 10 formula (IIII). The ATR inhibitor may be, e.g., a compound of formula (IIIC-a): (IIIC-a) or a pharmaceutically acceptable salt thereof, where R1, R2, R3, and R4are as described for 15 formula (III). 24 The ATR inhibitor may be, e.g., a compound of formula (IIID): or a pharmaceutically acceptable salt thereof, where R1, R2, R3, and R4are as described for 5 formula (III). The ATR inhibitor may be, e.g., a compound of formula (IIID-a): (IIID-a) or a pharmaceutically acceptable salt thereof, where R1, R2, R3, and R4are as described for 10 formula (III). Preferably, R1is methyl. In some embodiments, R2may be, e.g., optionally substituted C3-8cycloalkyl. For example, R2may be a group of formula (A): , 15 wherein n is 0, 1, 2, or 3; and R7is hydrogen, alkylsulfonyl, cyano, –CON(RA)2, -SON(RA)2, optionally substituted C1-9 heteroaryl, hydroxy, or alkoxy, where each RAis independently H or alkyl; or both RA,20together with the atom to which they are attached, combine to form C2-9 heterocyclyl. 25 In some embodiments, R2may be, e.g., optionally substituted C1-6alkyl (e.g., optionally substituted tertiary C3-6 alkyl. For example, R2may be a group of formula (B): , 5 where R7is hydrogen, alkylsulfonyl, cyano, –CON(RA)2, -SON(RA)2, optionally substituted C1-9 heteroaryl, hydroxy, or alkoxy, where each RAis independently H or alkyl; or both RA, together with the atom to which they are attached, combine to form C2-9 heterocyclyl. In some embodiments, R2may be, e.g., optionally substituted non-aromatic C2-9heterocyclyl.10In some embodiments, R2may be, e.g.: 15 26 5 10 27 5 In some embodiments, R2may be a 5-10 membered bicyclic [p.q.r] heterocyclyl. In some embodiments, R2may be In some embodiments, R2may be 10 . In some embodiments, R3may be, e.g., optionally substituted, monocyclic C1-9heteroaryl including at least one nitrogen atom (e.g., two nitrogen atoms). For example, R3may be a group of formula (C): 15 , where A is optionally substituted, monocyclic C1-9 heteroaryl ring. In some embodiments, A may be, e.g., a group of formula (C1): , 28 (C1) where R8is hydrogen, halogen, or optionally substituted C1-6 alkyl. In some embodiments, R3may be, e.g.: 5 In some embodiments, R3may be, e.g.: . In some embodiments, R4may be, e.g., hydrogen. 10 The ATR inhibitor may be, e.g., a compound listed in Table 1 below or a pharmaceutically acceptable salt thereof. Table 1
[0002]
[0003] 38 ATR inhibitors may be prepared using reactions and techniques known in the art. For example, certain ATR inhibitors may be prepared using techniques and methods disclosed in, e.g., International Application Nos. PCT / CA2019 / 051539 and PCT / US2018 / 034729, each of which is incorporated by reference herein; U.S. Patent Nos.9,663,535, 9,549,932, 8,552,004, 5 and 8,841,308, each of which is incorporated by reference herein; and U.S. Patent Application Publication No.2019 / 0055240, which is incorporated by reference herein. An ATR inhibitor may be isotopically enriched (e.g., enriched for deuterium). In some embodiments, the ATR inhibitor of the present disclosure may be presented as a pharmaceutically acceptable salt. In some embodiments, the ATR inhibitor may come10in the form of a hydrogen sulfate salt thereof. Camonsertib Camonsertib is compound 121 of Table 1, above, and is also known as RP-3500. The terms compound 121, Camonsertib, and RP-3500 may be used interchangeably herein. In some embodiments, the ATR inhibitor is Camonsertib, or a pharmaceutically acceptable salt 15 thereof. In some embodiments, the ATR inhibitor is Camonsertib hydrogen sulfate salt. The hydrogen sulfate salt form of Camonsertib is previously described as example 121 in 39 International Application No. PCT / CA2022 / 050892, which is incorporated by reference herein in its entirety. Camonsertib is an orally bioavailable clinical-stage ATR kinase inhibitor. Camonsertib is highly potent with IC50values of 1.0 and 0.33 nmol / L in biochemical and cell- 5 based assays, respectively. Camonsertib is highly selective for ATR with 30-fold selectivity over mammalian target of rapamycin (mTOR) and more than 2,000-fold selectivity over ataxia telangiectasia mutated (ATM), DNA-dependent protein kinase (DNA-PK), and phosphatidylinositol 3-kinase alpha (PI3Kα) kinases. In vivo, Camonsertib treatment results in potent single-agent efficacy and / or tumor regression in multiple xenograft models at 10 minimum effective doses (MED) of 5 to 7 mg / kg once daily. Pharmacodynamic assessments validate target engagement, with dose-proportional tumor inhibition of phosphorylated checkpoint kinase 1 (pCHK1) (IC80 = 18.6 nmol / L) and induction of phosphorylated H2A.X variant histone (γH2AX), phosphorylated DNA-PK catalytic subunit (pDNA-PKcs), and phosphorylated KRAB-associated protein 1 (pKAP1). Camonsertib exposure at MED 15 indicates that circulating free plasma levels above the in vivo tumor IC80 for 10 to 12 hours are sufficient for efficacy on a continuous schedule. However, short-duration intermittent (weekly 3 days on / 4 days off) dosing schedules as monotherapy or given concomitantly with reduced doses of olaparib or niraparib, maximize tumor growth inhibition while minimizing the impact on red blood cell depletion, emphasizing the reversible nature of erythroid toxicity 20 with Camonsertib, and demonstrating superior efficacy compared with sequential treatment. See Roulston, Anne et al. “RP-3500: A Novel, Potent, and Selective ATR Inhibitor that is Effective in Preclinical Models as a Monotherapy and in Combination with PARP Inhibitors.” Molecular Cancer Therapeutics vol.21,2 (2022): 245-256; and NCT04497116. Camonsertib has been under development for the treatment of solid tumors. In some 25 embodiments, a solid tumor is selected from ovarian cancer, breast cancer, pancreatic cancer, head and neck cancer squamous cell carcinoma, melanoma, hormone refractory (castration resistant, androgen-independent) prostate cancer, and relapsed and refractory chronic lymphocytic leukemia (CLL). Camonsertib can be administered through oral routes. In some embodiments, Camonsertib is undergoing development for the treatment of various diseases. 30 In embodiments, the various diseases include but are not limited to cancer. In embodiments, the cancer is ovarian cancer, breast cancer, colorectal cancer, endometrial cancer, bladder cancer, cervical cancer, or an advanced solid tumor. In some embodiments, the cancer is prostate cancer. In some embodiments, the cancer is a breast cancer. In some embodiments, the cancer is an ovarian cancer. 40 Camonsertib has demonstrated antitumor activity in several xenograft models of cancer as a single agent. Preclinically, PK and PD marker analysis from tumor xenografts demonstrates target engagement and a dose-dependent increase in double-strand DNA breaks leading to tumor cell death in vivo. 5 Antiandrogen Agent An antiandrogen agent (“AA”) is a compound that upon contacting an androgen receptor, whether in vitro, in cell culture, or in an animal, reduces the activity of androgenic hormones and mediates their biological effects. AAs are used to treat an assortment of androgen-dependent conditions. In men, antiandrogens are used in the treatment of prostate 10 cancer, enlarged prostate, scalp hair loss, overly high sex drive, unusual and problematic sexual urges, and early puberty. In women, antiandrogens are used to treat acne, seborrhea, excessive hair growth, scalp hair loss, and high androgen levels, such as those that occur in polycystic ovary syndrome (PCOS). AAs are also used as a component of feminizing hormone therapy for transgender women and as puberty blockers in transgender girls. Some 15 example AAs are flutamide, bicalutamide, nilutamide, enzalutamide, apalutamide, darolutamide, and abiraterone. An AA that may be used in the present disclosure may be a compound of Formula (I): 20wherein, R1is hydrogen, halogen, cyano, nitro or optionally substituted 5- or 6-membered heterocyclic ring; R2 is hydrogen, halogen, cyano, nitro, amino, C1-7 alkyl, halo-C1-7 alkyl, hydroxy-C1-7 25 alkyl, thio-C1-7alkyl, or C1-7alkoxy; R3 is hydrogen, halogen, or C1-7 alkyl, or R2 and R3 together with the carbon atoms to which they are attached form an optionally substituted 5- or 6-membered carbocyclic or heterocyclic ring; 41 wherein at least two of R1, R2and R3are not hydrogen; R4, R4′, R5, R6 and R7 are, independently, hydrogen, C1-7 alkyl, halo-C1-7 alkyl, or hydroxy-C1-7 alkyl; ring atom E is C or N; 5 dashed line means an optional double bond; A is a 5-12 membered heterocyclic ring; B is a 5-membered heterocyclic ring wherein 1-3 of the members are heteroatoms selected from N, O and S; R8 is hydrogen, hydroxy, halogen, nitro, amino, cyano, oxo, C1-7 alkyl, C1-7 alkoxy, 10 halo-C1-7alkyl, hydroxy-C1-7alkyl, cyano-C1-7alkyl, amino-C1-7alkyl, oxo-C1-7alkyl, C1-7alkoxy-C1-7alkyl, methylsulfonamido-C1-7alkyl, oxiran-C1-7alkyl, C1-7alkylamino, hydroxy- C1-7 alkylamino, C1-7 alkoxy-C1-7 alkylamino, C1-7 alkylamino-C1-7 alkyl, hydroxy-C1-7 alkylamino-C1-7 alkyl, hydroxyamino-C1-7 alkyl, halo-C1-7 alkylhydroxy-C1-7 alkyl, —C(O)R10, —OC(O)R17, —NH—C(O)R18or an optionally substituted 5-12 membered carbocyclic or 15 heterocyclic ring, each group optionally linked to A-ring via C1-7 alkylene linker; R9 is hydrogen, halogen, C1-7 alkyl, oxo, hydroxy-C1-7 alkyl, oxo-C1-7 alkyl or an optionally substituted 5 or 6 membered carbocyclic or heterocyclic ring, each group optionally linked to A-ring via C1-7 alkylene linker; R10 is hydrogen, hydroxy, C1-7 alkyl, hydroxy-C1-7 alkyl, halo-C1-7 alkyl, C1-7 alkoxy, 20 NR11R12, or an optionally substituted 5-12 membered carbocyclic or heterocyclic ring; R11is hydrogen, C1-7alkyl, hydroxy-C1-7alkyl, amino-C1-7alkyl, C1-7alkyl-amino-C1-7alkyl, R12 is hydrogen or C1-7 alkyl; R13and R14are, independently, hydrogen, C1-7alkyl, halogen, cyano or hydroxy-C1-725 alkyl; R15 and R16 are, independently, hydrogen, oxo, thioxo, C1-7 alkyl or cyano; R17is C1-7alkyl, C1-7alkoxy, amino-C1-7alkyl or C1-7alkylamino-C1-7alkyl; and R18 is C1-7 alkyl, amino-C1-7 alkyl, or C1-7 alkylamino-C1-7 alkyl. 30 In some embodiments, the AA may be a compound of Formula (I), wherein B is a group of Formula (1’) 42 Z is O, N, C=O, or C=S; X is C or N; 5 Y is C or N; G is CH, C=O, or C=S a dashed line means an optional double bond; the asterisk denotes the point of attachment to the ring; and R13 and R14 are as defined above for compounds of Formula (I).10In some embodiments, the AA may be a compound of Formula (I), wherein B is a group of Formula (2’), (3’), or (4’) 15 In some embodiments, the AA is: (darolutamide). 20 AA may be prepared using reactions and techniques known in the art. For example, certain AA may be prepared using techniques and methods disclosed in, e.g., U.S. Patent Nos. 43 8,975,254; 9,657,003; 10,010,530; 10,383,853; 10,711,013; 10,835,515; 11,046,713; and 11,168,058, each of which is incorporated herein by reference herein in its entirety. Darolutamide has been shown to be safe and efficacious in populations consisting of 5 patients having been treated with chemotherapy, patients having been treated with abiraterone (a CYP17A1 inhibitor), chemotherapy naïve, and abiraterone naïve. Darolutamide is approved in the US to treat non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC) in combination with docetaxel at a 600 mg BID dose (1200 mg / day). Darolutamide is marketed10as NUBEQA® and its prescribing information can be found at https: / / labeling.bayerhealthcare.com / html / products / pi / Nubeqa_PI.pdf, updated 10 / 2023, the disclosure of which is incorporated by reference in its entirety herein. Isomers and Compositions Thereof15The disclosure includes (where possible) individual diastereomers, enantiomers, epimers, and atropisomers of the compounds disclosed herein, and mixtures of diastereomers and / or enantiomers thereof including racemic mixtures. Although the specific stereochemistries disclosed herein are preferred, other stereoisomers, including diastereomers, enantiomers, epimers, atropisomers, and mixtures of these may also have utility in treating 20 diseases. Inactive or less active diastereoisomers and enantiomers may be useful, e.g., for scientific studies relating to the receptor and the mechanism of activation. It is understood that certain molecules can exist in multiple tautomeric forms. This disclosure includes all tautomers even though only one tautomer may be indicated in the examples.25The disclosure also includes pharmaceutically acceptable salts of the compounds, and pharmaceutical compositions including the compounds and a pharmaceutically acceptable carrier. The compounds are especially useful, e.g., in certain kinds of cancer and for slowing the progression of cancer once it has developed in a patient. The compounds disclosed herein may be used in pharmaceutical compositions 30 including (a) the compound(s) or pharmaceutically acceptable salts thereof, and (b) a pharmaceutically acceptable carrier. The compounds may be used in pharmaceutical compositions that include one or more other active pharmaceutical ingredients. The compounds may also be used in pharmaceutical compositions in which the compound disclosed herein or a pharmaceutically acceptable salt thereof is the only active ingredient. 44 Optical Isomers - Diastereomers - Geometric Isomers - Tautomers Compounds disclosed herein may contain, e.g., one or more stereogenic centers and can occur as racemates, racemic mixtures, single enantiomers, individual diastereomers, and mixtures of diastereomers and / or enantiomers. The disclosure includes all such isomeric 5 forms of the compounds disclosed herein. It is intended that all possible stereoisomers (e.g., enantiomers and / or diastereomers) in mixtures and as pure or partially purified compounds are included within the scope of this disclosure (i.e., all possible combinations of the stereogenic centers as pure compounds or in mixtures). Some of the compounds described herein may contain bonds with hindered rotation 10 such that two separate rotomers, or atropisomers, may be separated and found to have different biological activity which may be advantageous. It is intended that all of the possible atropisomers are included within the scope of this disclosure. Some of the compounds described herein may contain olefinic double bonds, and unless specified otherwise, are meant to include both E and Z geometric isomers. 15 Some of the compounds described herein may exist with different points of attachment of hydrogen, referred to as tautomers. An example is a ketone and its enol form, known as keto-enol tautomers. The individual tautomers as well as mixtures thereof are encompassed by the disclosure. Compounds disclosed herein having one or more asymmetric centers may be 20 separated into diastereoisomers, enantiomers, and the like by methods well known in the art. Alternatively, enantiomers and other compounds with chiral centers may be synthesized by stereospecific synthesis using optically pure starting materials and / or reagents of known configuration. Pharmaceutically Acceptable Salt 25 The disclosure also includes pharmaceutically acceptable salts of the compounds, and pharmaceutical compositions including the compounds (e.g., without limitations, Camonsertib) and a pharmaceutically acceptable carrier. The disclosure provides pharmaceutically acceptable salts of various compounds disclosed herein. In embodiments, Camonsertib is presented in the form of a pharmaceutically acceptable salt. In embodiments,30Camonsertib is presented in the form of a hydrogen sulfate salt. Although Camonsertib may be effective in various forms (including, without limitations, as a free base), it may in practice be administered in the form of a salt of a pharmaceutically acceptable acid or base. In embodiments, the hydrogen sulfate salt form of Camonsertib is significantly more effective 45 than other known forms. In embodiments, the hydrogen sulfate salt form of Camonsertib is significantly more effective than the free base form. The hydrogen sulfate salt form of Camonsertib is previously described as example 121 in International Application No. PCT / CA2022 / 050892, which is incorporated by reference herein in its entirety. 5 Isotopically Enriched Derivatives The disclosure includes molecules which have been isotopically enriched at one or more position within the molecule. Thus, compounds enriched for deuterium fall within the scope of the claims. 10 Methods of Use ATR inhibitors and AA may be used together for the treatment of a disease or condition having the symptom of cell hyperproliferation. For example, the disclosure described herein may be applicable for treatment of various oncological conditions harboring sensitizing gene mutations, such as tumors with any deleterious (loss-of-function) alterations 15 and over-expression of androgen receptor. In particular, mutations in one or more of these genes may be frequently found in the following tumor types: renal cell carcinoma, mature B- cell neoplasms, endometrial cancer, ovarian cancer, colorectal cancer, skin cancer (non- melanoma), small bowel cancer, non-small cell lung cancer, melanoma, bladder cancer, pancreatic cancer, head and neck cancer, mesothelioma, glioma, prostate cancer, breast 20 cancer, and esophagogastric cancer. Accordingly, methods of the disclosure are preferably used in the treatment of these cancers. In any and every aspect of the disclosure herein wherein a method of treatment is described, the equivalent use of the compound(s) in treatment, and use of the compound(s) in manufacture of a medicament for treatment use and treatment are contemplated. Further, a 25 combination of an ATR inhibitor and an AA for use in the treatment of a disease or condition having the symptom of cell hyperproliferation, which, without wishing to be bound to a specific theory, subsequently results in cell death. Additionally, a combination of an ATR inhibitor and an AA for use in the treatment of a disease or condition having the symptom of cell hyperproliferation may be used in the manufacture of a medicament for use in the 30 treatment of a disease or condition having the symptom of cell hyperproliferation and subsequently resulting in cell death. Therapeutic methods of the disclosure include the step of administering a therapeutically effective amount of a combination of an ATR inhibitor and an AA to a subject 46 in need thereof. The amount of an ATR inhibitor may be, e.g., a subtherapeutic regimen of an ATR inhibitor when used as a monotherapy. The disease or condition treated using methods of the disclosure may have the symptom of cell hyperproliferation. For example, the disease or condition may be a cancer. 5 The cancer may be prostate cancer. The prostate cancer may be androgen receptor-positive metastatic castration-resistant prostate cancer. Pharmaceutical Compositions The compounds used in the methods described herein are preferably formulated into 10 pharmaceutical compositions for administration to human subjects in a biologically compatible form suitable for administration in vivo. Pharmaceutical compositions typically include a compound as described herein and a pharmaceutically acceptable excipient. Certain pharmaceutical compositions may include one or more additional pharmaceutically active agents described herein. Note that throughout this disclosure, the terms “composition” and 15 “formulation” are used interchangeably. The compounds described herein can also be used in the form of the free base, in the form of salts, zwitterions, solvates, or as prodrugs, or pharmaceutical compositions thereof. All forms are within the scope of the disclosure. The compounds, salts, zwitterions, solvates, prodrugs, or pharmaceutical compositions thereof, may be administered to a patient in a 20 variety of forms depending on the selected route of administration, as will be understood by those skilled in the art. The compounds used in the methods described herein may be administered, for example, by oral, parenteral, buccal, sublingual, nasal, rectal, patch, pump, or transdermal administration, and the pharmaceutical compositions formulated accordingly. Parenteral administration includes intravenous, intraperitoneal, subcutaneous, intramuscular, 25 transepithelial, nasal, intrapulmonary, intrathecal, rectal, and topical modes of administration. Parenteral administration may be by continuous infusion over a selected period of time. For human use, a compound of the disclosure can be administered alone or in admixture with a pharmaceutical carrier selected with regard to the intended route of administration and standard pharmaceutical practice. Pharmaceutical compositions for use in 30 accordance with the present disclosure thus can be formulated in a conventional manner using one or more physiologically acceptable carriers comprising excipients and auxiliaries that facilitate processing of a compound of the disclosure into preparations which can be used pharmaceutically. 47 This disclosure also includes pharmaceutical compositions which can contain one or more pharmaceutically acceptable carriers. In making the pharmaceutical compositions of the disclosure, the active ingredient is typically mixed with an excipient, diluted by an excipient, or enclosed within such a carrier in the form of, for example, a capsule, sachet, paper, or other 5 container. When the excipient serves as a diluent, it can be a solid, semisolid, or liquid material (e.g., normal saline), which acts as a vehicle, carrier or medium for the active ingredient. Thus, the compositions can be in the form of tablets, powders, lozenges, sachets, cachets, elixirs, suspensions, emulsions, solutions, syrups, and soft and hard gelatin capsules. As is known in the art, the type of diluent can vary depending upon the intended route of 10 administration. The resulting compositions can include additional agents, e.g., preservatives. The excipient or carrier is selected on the basis of the mode and route of administration. Suitable pharmaceutical carriers, as well as pharmaceutical necessities for use in pharmaceutical formulations, are described in Remington: The Science and Practice of Pharmacy, 21st Ed., Gennaro, Ed., Lippincott Williams & Wilkins (2005), a well-known 15 reference text in this field, and in the USP / NF (United States Pharmacopeia and the National Formulary). Examples of suitable excipients are lactose, dextrose, sucrose, sorbitol, mannitol, starches, gum acacia, calcium phosphate, alginates, tragacanth, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone, cellulose, water, syrup, and methyl cellulose. The formulations can additionally include: lubricating agents, e.g., talc, magnesium 20 stearate, and mineral oil; wetting agents; emulsifying and suspending agents; preserving agents, e.g., methyl- and propylhydroxy-benzoates; sweetening agents; and flavoring agents. Other exemplary excipients are described in Handbook of Pharmaceutical Excipients, 6th Edition, Rowe et al., Eds., Pharmaceutical Press (2009). These pharmaceutical compositions can be manufactured in a conventional manner, 25 e.g., by conventional mixing, dissolving, granulating, dragee-making, levigating, emulsifying, encapsulating, entrapping, or lyophilizing processes. Methods well known in the art for making formulations are found, for example, in Remington: The Science and Practice of Pharmacy, 21st Ed., Gennaro, Ed., Lippincott Williams & Wilkins (2005), and Encyclopedia of Pharmaceutical Technology, eds. J. Swarbrick and J. C. Boylan, 1988-1999, Marcel 30 Dekker, New York. Proper formulation is dependent upon the route of administration chosen. The formulation and preparation of such compositions is well-known to those skilled in the art of pharmaceutical formulation. In preparing a formulation, the active compound can be milled to provide the appropriate particle size prior to combining with the other ingredients. If the active compound is substantially insoluble, it can be milled to a particle size of less than 48 200 mesh. If the active compound is substantially water soluble, the particle size can be adjusted by milling to provide a substantially uniform distribution in the formulation, e.g., 40 mesh. 5 Dosages The dosage of the compound used in the methods described herein, or pharmaceutically acceptable salts or prodrugs thereof, or pharmaceutical compositions thereof, can vary depending on many factors, e.g., the pharmacodynamic properties of the compound; the mode of administration; the age, health, and weight of the recipient; the nature 10 and extent of the symptoms; the frequency of the treatment, and the type of concurrent treatment, if any; and the clearance rate of the compound in the animal to be treated. One of skill in the art can determine the appropriate dosage based on the above factors. The compounds used in the methods described herein may be administered initially in a suitable dosage that may be adjusted as required, depending on the clinical response. In general, a 15 suitable daily dose of a compound of the disclosure will be that amount of the compound that is the lowest dose effective to produce a therapeutic effect. Such an effective dose will generally depend upon the factors described above. An ATR inhibitor may be administered to the patient in a single dose or in multiple doses. When multiple doses are administered, the doses may be separated from one another 20 by, for example, 1-24 hours, 1-7 days, 1-4 weeks, or 1-12 months. The compound may be administered according to a schedule or the compound may be administered without a predetermined schedule. An active compound may be administered, for example, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 times per day, every 2nd, 3rd, 4th, 5th, or 6th day, 1, 2, 3, 4, 5, 6, or 7 times per week, 1, 2, 3, 4, 5, or 6 times per month, or 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 25 times per year. It is to be understood that, for any particular subject, specific dosage regimes should be adjusted over time according to the individual need and the professional judgment of the person administering or supervising the administration of the compositions. While the attending physician ultimately will decide the appropriate amount and dosage regimen of the ATR inhibitor, an effective amount of a compound of the disclosure 30 may be, for example, a total daily dosage of, e.g., between 0.05 mg and 3000 mg of any of the compounds described herein. Alternatively, the dosage amount can be calculated using the body weight of the patient. Such dose ranges may include, for example, between 0.05-1000 mg (e.g., 0.25-800 mg). In some embodiments, 0.05, 0.1, 0.25, 0.5, 1, 2, 3, 4, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 80, 100, 120, 150, 160, 200, 250, 300, 350, 400, 450, 500, 550, 600, 49 650, 700, 750, 800, 850, 900, 950, or 1000 mg of the compound is administered. Preferably, the doses of the ATR inhibitor are 80, 100, 120, or 160 mg. Preferably, the subtherapeutic regimen of an ATR inhibitor is a low dosage (e.g., at least 10%, 20%, 50%, 80%, 90%, or 95% less than the lowest standard recommended dosage 5 of the ATR inhibitor for a given route of administration). Preferably, the ATR inhibitor is administered once daily or twice daily. In the methods of the disclosure, the time period during which multiple doses of a compound of the disclosure are administered to a patient can vary. For example, in some embodiments, doses of the compounds of the disclosure are administered to a patient over a 10 time period that is 1-7 days; 1-12 weeks; or 1-3 months. In other embodiments, the compounds are administered to the patient over a time period that is, for example, 4-11 months or 1-30 years. In other embodiments, the compounds are administered to a patient at the onset of symptoms. In any of these embodiments, the amount of compound that is administered may vary during the time period of administration. When a compound is 15 administered daily, administration may occur, for example, 1, 2, or 3 times per day. Camonsertib can be self-administered by participants orally (PO) with a 3 days on / 4 days off and 2 weeks on / 1 week off schedule (i.e., Days 1-3 [Week 1] and Days 8-10 [Week 2], of each 3-week cycle). The starting dose of camonsertib can be 50 mg per day, and this may be escalated to 80 mg per day,120 mg per day, and 160 mg per day. The dose of 20 camonsertib can be reduced up to two times for management of drug-related toxicities, and treatment may be temporarily interrupted to manage drug-related toxicities. Darolutamide (600 mg) can be self-administered, two hours after administration of camonsertib, by participants orally (PO) 25 Routes of Administration A compound identified as capable of treating any of the conditions described herein, using any of the methods described herein, may be administered to patients or animals with a pharmaceutically-acceptable diluent, carrier, or excipient, in unit dosage form. The chemical compounds for use in such therapies may be produced and isolated by any standard technique 30 known to those in the field of medicinal chemistry. Conventional pharmaceutical practice may be employed to provide suitable compositions to administer the identified compound to subjects in need thereof. Administration may begin before the patient is symptomatic. Exemplary routes of administration of the compounds (e.g., a compound of the disclosure), or pharmaceutical compositions thereof, used in the present disclosure include 50 oral, sublingual, buccal, transdermal, intradermal, intramuscular, parenteral, intravenous, intra-arterial, intracranial, subcutaneous, intraorbital, intraventricular, intraspinal, intraperitoneal, intranasal, inhalation, and topical administration. The compounds desirably are administered with a pharmaceutically acceptable carrier. Pharmaceutical compositions of 5 the compounds described herein formulated for treatment of the disorders described herein are also part of the present disclosure. Oral administration is a preferred route of administration in the methods of the disclosure. Compositions for Oral Administration The pharmaceutical compositions contemplated by the disclosure include those 10 formulated for oral administration (“oral dosage forms”). Oral dosage forms can be, for example, in the form of tablets, capsules, a liquid solution or suspension, a powder, or liquid or solid crystals, which contain the active ingredient(s) in a mixture with non-toxic pharmaceutically acceptable excipients. These excipients may be, for example, inert diluents or fillers (e.g., sucrose, sorbitol, sugar, mannitol, microcrystalline cellulose, starches including 15 potato starch, calcium carbonate, sodium chloride, lactose, calcium phosphate, calcium sulfate, or sodium phosphate); granulating and disintegrating agents (e.g., cellulose derivatives including microcrystalline cellulose, starches including potato starch, croscarmellose sodium, alginates, or alginic acid); binding agents (e.g., sucrose, glucose, sorbitol, acacia, alginic acid, sodium alginate, gelatin, starch, pregelatinized starch, 20 microcrystalline cellulose, magnesium aluminum silicate, carboxymethylcellulose sodium, methylcellulose, hydroxypropyl methylcellulose, ethylcellulose, polyvinylpyrrolidone, or polyethylene glycol); and lubricating agents, glidants, and antiadhesives (e.g., magnesium stearate, zinc stearate, stearic acid, silicas, hydrogenated vegetable oils, or talc). Other pharmaceutically acceptable excipients can be colorants, flavoring agents, plasticizers, 25 humectants, buffering agents, and the like. Compositions for oral administration may also be presented as chewable tablets, as hard gelatin capsules where the active ingredient is mixed with an inert solid diluent (e.g., potato starch, lactose, microcrystalline cellulose, calcium carbonate, calcium phosphate or kaolin), or as soft gelatin capsules where the active ingredient is mixed with water or an oil 30 medium, for example, peanut oil, liquid paraffin, or olive oil. Powders, granulates, and pellets may be prepared using the ingredients mentioned above under tablets and capsules in a conventional manner using, e.g., a mixer, a fluid bed apparatus or a spray drying equipment. Controlled release compositions for oral use may be constructed to release the active drug by controlling the dissolution and / or the diffusion of the active drug substance. Any of a 51 number of strategies can be pursued in order to obtain controlled release and the targeted plasma concentration versus time profile. In one example, controlled release is obtained by appropriate selection of various formulation parameters and ingredients, including, e.g., various types of controlled release compositions and coatings. Examples include single or 5 multiple unit tablet or capsule compositions, oil solutions, suspensions, emulsions, microcapsules, microspheres, nanoparticles, patches, and liposomes. In certain embodiments, compositions include biodegradable, pH, and / or temperature-sensitive polymer coatings. Dissolution- or diffusion- controlled release can be achieved by appropriate coating of a tablet, capsule, pellet, or granulate composition of compounds, or by incorporating the 10 compound into an appropriate matrix. A controlled release coating may include one or more of the coating substances mentioned above and / or, e.g., shellac, beeswax, glycowax, castor wax, carnauba wax, stearyl alcohol, glyceryl monostearate, glyceryl distearate, glycerol palmitostearate, ethylcellulose, acrylic resins, dl-polylactic acid, cellulose acetate butyrate, polyvinyl chloride, polyvinyl acetate, vinyl pyrrolidone, polyethylene, polymethacrylate, 15 methylmethacrylate, 2-hydroxymethacrylate, methacrylate hydrogels, 1,3 butylene glycol, ethylene glycol methacrylate, and / or polyethylene glycols. In a controlled release matrix formulation, the matrix material may also include, e.g., hydrated methylcellulose, carnauba wax and stearyl alcohol, carbopol 934, silicone, glyceryl tristearate, methyl acrylate-methyl methacrylate, polyvinyl chloride, polyethylene, and / or halogenated fluorocarbon. 20 The liquid forms in which the compounds and compositions of the present disclosure can be incorporated for administration orally include aqueous solutions, suitably flavored syrups, aqueous or oil suspensions, and flavored emulsions with edible oils, e.g., cottonseed oil, sesame oil, coconut oil, or peanut oil, as well as elixirs and similar pharmaceutical vehicles. 25 Compositions for Parenteral Administration The compounds described herein for use in the methods of the disclosure can be administered in a pharmaceutically acceptable parenteral (e.g., intravenous or intramuscular) composition as described herein. The pharmaceutical composition may also be administered parenterally (intravenous, intramuscular, subcutaneous or the like) in dosage forms or 30 compositions containing conventional, non-toxic pharmaceutically acceptable carriers and adjuvants. In particular, compositions suitable for parenteral administration include aqueous and non-aqueous sterile injection solutions which may contain anti-oxidants, buffers, bacteriostats and solutes which render the composition isotonic with the blood of the intended recipient; and aqueous and non-aqueous sterile suspensions which may include suspending 52 agents and thickening agents. For example, to prepare such a composition, the compounds of the disclosure may be dissolved or suspended in a parenterally acceptable liquid vehicle. Among acceptable vehicles and solvents that may be employed are water, water adjusted to a suitable pH by addition of an appropriate amount of hydrochloric acid, sodium hydroxide or a 5 suitable buffer, 1,3-butanediol, Ringer’s solution and isotonic sodium chloride solution. The aqueous composition may also contain one or more preservatives, for example, methyl, ethyl, or n-propyl p-hydroxybenzoate. Additional information regarding parenteral compositions can be found, for example, in the United States Pharmacopeia-National Formulary (USP-NF), herein incorporated by reference. 10 The parenteral composition can be any of the five general types of preparations identified by the USP-NF as suitable for parenteral administration: (1) “Drug Injection:” a liquid preparation that is a drug substance (e.g., a compound of the disclosure), or a solution thereof; (2) “Drug for Injection:” the drug substance (e.g., a compound of the disclosure) as a dry 15 solid that will be combined with the appropriate sterile vehicle for parenteral administration as a drug injection; (3) “Drug Injectable Emulsion:” a liquid preparation of the drug substance (e.g., a compound of the disclosure) that is dissolved or dispersed in a suitable emulsion medium; (4) “Drug Injectable Suspension:” a liquid preparation of the drug substance (e.g., a 20 compound of the disclosure) suspended in a suitable liquid medium; and (5) “Drug for Injectable Suspension:” the drug substance (e.g., a compound of the disclosure) as a dry solid that will be combined with the appropriate sterile vehicle for parenteral administration as a drug injectable suspension. Exemplary compositions for parenteral administration include solutions of the 25 compound prepared in water suitably mixed with a surfactant, e.g., hydroxypropylcellulose. Dispersions can also be prepared in glycerol, liquid polyethylene glycols, DMSO and mixtures thereof with or without alcohol, and in oils. Under ordinary conditions of storage and use, these preparations may contain a preservative to prevent the growth of microorganisms. Conventional procedures and ingredients for the selection and preparation 30 of suitable compositions are described, for example, in Remington: The Science and Practice of Pharmacy, 21st Ed., Gennaro, Ed., Lippincott Williams & Wilkins (2005) and in The United States Pharmacopeia: The National Formulary (USP 36 NF31), published in 2013. Compositions for parenteral administration may, for example, contain excipients, sterile water, or saline, polyalkylene glycols, e.g., polyethylene glycol, oils of vegetable 53 origin, or hydrogenated napthalenes. Biocompatible, biodegradable lactide polymer, lactide / glycolide copolymer, or polyoxyethylene-polyoxypropylene copolymers may be used to control the release of the compounds. Other potentially useful parenteral delivery systems for compounds include ethylene-vinyl acetate copolymer particles, osmotic pumps, 5 implantable infusion systems, and liposomes. Compositions for inhalation may contain excipients, for example, lactose, or may be aqueous solutions containing, for example, polyoxyethylene-9-lauryl ether, glycocholate and deoxycholate, or may be oily solutions for administration in the form of nasal drops, or as a gel. The parenteral composition can be formulated for prompt release or for 10 sustained / extended release of the compound. Exemplary compositions for parenteral release of the compound include: aqueous solutions, powders for reconstitution, cosolvent solutions, oil / water emulsions, suspensions, oil-based solutions, liposomes, microspheres, and polymeric gels. The following examples are meant to illustrate the disclosure. They are not meant to 15 limit the disclosure in any way. EXAMPLES Example 1: Phase Ib / II study of Camonsertib in combination with Darolutamide 20 The purpose of this substudy is to assess the safety, efficacy, and pharmacokinetics of camonsertib in combination with darolutamide (NUBEQA®) and to determine the recommended Phase II dose for further development of the combination in patients with metastatic castration-resistant prostate cancer (mCRPC). This Phase Ib / II multicenter, open-label substudy will investigate the safety, efficacy, 25 and pharmacokinetics of camonsertib in combination with darolutamide in patients with mCRPC who have received prior therapy with abiraterone and ADT in the metastatic hormone-sensitive prostate cancer (mHSPC) or non-metastatic (HSPC) setting and who are not candidates for chemotherapy or PARPi treatment. The Phase Ib dose-escalation part of the substudy will evaluate the safety, tolerability, 30 and pharmacokinetics and determine the maximum tolerated dose (MTD) / maximum administered dose (MAD) and schedule of camonsertib in combination with darolutamide. The Phase Ib dose-expansion part of the substudy will further evaluate the safety, tolerability, and efficacy of the combination at one or more dose levels cleared for MTD and considered safe in the dose escalation phase. 54 The investigational medicinal products for this study are camonsertib and darolutamide. Camonsertib Participants will receive camonsertib at a dose of 120 mg (Dose Level 1) or 160 mg 5 (Dose Level 2) PO on a schedule of 3 days on / 4 days off, 2 weeks on / 1 week off until disease progression or unacceptable toxicity or withdrawal by participant (whichever occurs first). Camonsertib will be administered first, followed by darolutamide administration 2 hours later. Staggered administration will continue until PK data are available when it may be changed to concomitant administration with agreement of the SRC if data from the PK DDI run-in period10demonstrate no significant DDI and support concomitant drug administration. Camonsertib will be self‑administered PO. Camonsertib may be taken with or without a meal. Participants should swallow the camonsertib capsule whole and should not manipulate or chew the study drug prior to swallowing. Participants will be instructed to take their camonsertib dose in the morning at approximately the same time each day. 15 If participants forget to take their dose at their usual time, they should take the missed dose as soon as possible on the same day that it was missed. However, there must be at least 8 hours between the missed dose and the next scheduled dose. If a dose is missed and there is less than 8 hours until the next dose, the missed dose should not be taken, and the participant should record this missed dose in the medication diary. If a participant vomits during or after 20 taking camonsertib, re-dosing is not permitted, and the participant should take their regular dose at the next scheduled dosing time. If camonsertib is discontinued, darolutamide may be continued at the Investigator's discretion. Darolutamide25Darolutamide will be administered orally and as per the prescribing information at a dose of 600 mg (2 tablets of 300 mg) BID, which is equivalent to a total daily dose of 1200 mg, with the first daily fraction administered 2 hours after camonsertib administration, until disease progression or unacceptable toxicity or withdrawal by participant (whichever occurs first). Depending on the results of the PK drug-drug interaction (DDI) run-in period and DDIs 30 with camonsertib, the dose of darolutamide may be adjusted as well as the timing of administration related to camonsertib (staggered vs. concomitant). The participant should 55 take darolutamide at the same time BID twelve hours apart. If the participant misses a dose by more than 6 hours, then the participant should skip that missed dose and simply resume dosing with the next scheduled dose. The participant should not take two doses at once to make up for a missed dose. 5 Of note, for participants in the dose-escalation phase, the dose on Day 1 of Cycle 1 will be 600 mg QD, as these participants are also participating in the PK DDI run-in. As per prescribing information, darolutamide should be taken with food. Therefore, in all cases of concomitant administration of camonsertib with darolutamide both drugs should be taken with food.10The total duration of study participation for each individual is expected to be approximately 36 months. Inclusion criteria for study include: Patients with mCRPC who have received no previous treatment for CRPC and are not a candidate for chemotherapy of a PARPi. Docetaxel treatment during neoadjuvant / adjuvant15 treatment for localized prostate cancer and mHSPC is allowed. Treatment with first- generation antiandrogen agents (e.g., bicalutamide, nilutamide, and flutamide) before enrollment is allowed, but there must be a washout period of 4 weeks. Surgical or ongoing medical castration with testosterone serum levels <50 ng / dL (1.7 nM).20Progression of mCRPC, defined as: (a) PSA progression, defined by a minimum of two rising PSA values from three consecutive assessments with an interval of at least 7 days between assessments, and a PSA value of ≥ 1 ng / mL. (b) The most recent qualifying PSA value must be determined within 14 days of 25 enrollment. (c) Soft tissue disease progression, defined by RECIST 1.1. (d) Bone disease progression, defined by Prostate Cancer Working Group 2 (PCWG3). criteria, with two or more new metastatic bone lesions on a whole-body radionuclide bone scan. 30 Exclusion criteria for study include: 56 (a) Prior treatment with ATRi, DNA-PK inhibitor, PARPi. (b) Prior treatment with other second generation SRSI except for abiraterone (e.g., enzalutamide, apalutamide, darolutamide). (c) Malabsorption syndrome or other condition that would interfere with enteral 5 absorption. (d) Other concurrent anti-cancer therapy, e.g., concurrent cytotozin chemotherapy, immunotherapy, radioligand therapy, or investigational therapy, except for androgen- deprivation therapy. (e) Use of prohibited therapies, including, but not limited to, BCRP inhibitors 10 (e.g., curcumin, cyclosporine A, or eltrombopag), strong CYP3A inhibitors (e.g., ketoconazole, miconazole, itraconazole, fluconazole, etythromycin, clarithromycin, rantidine, cimetidine, verapamil, or rigampicin), CYP3A inducers (e.g., rifampicin, rifabutin, glucocorticoids, carbamazepine, phenytoin, or phenobarbital and St. John’s wort), P-gp inhibitors (e.g., amidarone, clarithromycin, cobicistat, cyclosporine, dronedarone, 15 erythromycin, itraconazole, ketoconazole, lapatinib, lopinavir and ritonavir, quinidine, ranolazine, saquinavir and ritonavir, or verapamil), and P-gp inducers (e.g., apalutamide, carbamazepine, fosphenytoin, lorlatinib, phenytoin, rifamipin, or St. John’s wort). OTHER EMBODIMENTS 20 Various modifications and variations of the described disclosure will be apparent to those skilled in the art without departing from the scope and spirit of the disclosure. Although the disclosure has been described in connection with specific embodiments, it should be understood that the disclosure as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes for carrying out the 25 disclosure that are obvious to those skilled in the art are intended to be within the scope of the disclosure. Other embodiments are in the claims.
Claims
CLAIMS 1. A combination for use in treating a cancer that has an over-expression of androgen receptors on its cell membranes, the combination comprises: (i) a therapeutically effective amount of an ATR inhibitor, wherein the ATR inhibitor is camonsertib or a pharmaceutically acceptable salt thereof; and (ii) a therapeutically effective amount of an antiandrogen agent (“AA”), wherein the AA is darolutamide or a pharmaceutically acceptable salt thereof.
2. A method of treating a cancer that has an over-expression of androgen receptor on its cell membranes in a subject suffering therefrom comprising administering to the subject a therapeutically effective amount of camonsertib or a pharmaceutically acceptable salt thereof and a therapeutically effective amount of darolutamide or a pharmaceutically acceptable salt thereof.
3. A method of treating a cancer that has an overexpression of androgen receptor on its cell membrane, comprising: (i) identifying a cancer having an over-expression of androgen receptor on its cell membrane; and (ii) administering to the subject in need thereof a therapeutically effective amount of camonsertib or a pharmaceutically acceptable salt thereof and a therapeutically effective amount of darolutamide or a pharmaceutically acceptable salt thereof.
4. The combination for use or method of any one of claims 1 to 3, wherein camonsertib is administered as camonsertib hydrogen sulfate salt.
5. The combination for use or method of any one of claims 1 to 4, wherein the therapeutically effective amount comprises a subtherapeutic regimen of the ATR inhibitor.
6. The combination for use or method of claim 5, wherein the subtherapeutic regimen comprises a starting dosage that is at least 50% less than the lowest standard starting dosage that is used for a monotherapy.
577. The combination for use or method of claim 5 or 6, wherein the subtherapeutic regimen comprises a maintenance dosage that is at least 50% less than the lowest standard maintenance dosage that is used for a monotherapy.
8. The combination for use or method of claim 7, wherein the maintenance dosage of the subtherapeutic regimen comprises a first reduced dosage that is at least 50% less than the lowest standard maintenance dosage that is used for a monotherapy.
9. The combination for use or method of claim 7 or 8, wherein the maintenance dosage of the subtherapeutic regimen comprises a second reduced dosage that is at least 60% less than the lowest standard maintenance dosage that is used for a monotherapy.
10. The combination for use or method of claim 8 or 9, wherein the maintenance dosage of the subtherapeutic regimen comprises a third reduced dosage that is at least 70% less than the lowest standard maintenance dosage that is used for a monotherapy.
11. The combination for use or method of any one of claims 1 to 10, wherein the ATR inhibitor is orally administered.
12. The combination for use or method of any one of claims 1 to 11, wherein the ATR inhibitor is administered 1 day / week, 2 days / week, or 3 days / week.
13. The combination for use or method of any one of claims 1 to 12, wherein the ATR inhibitor is administered on days 1, 2, 3, 8, 9, and 10 of a 3-week cycle.
14. The combination for use or method of any one of claims 1 to 13, wherein the ATR inhibitor is administered at a total daily dose of 80 mg.
15. The combination for use or method of any one of claims 1 to 13, wherein the ATR inhibitor is administered at a total daily dose of 100 mg.
16. The combination for use or method of any one of claims 1 to 13, wherein the ATR inhibitor is administered at a total daily dose of 120 mg.5817. The combination for use or method of any one of claims 1 to 13, wherein the ATR inhibitor is administered at a total daily dose of 160 mg.
18. The method of any one of claims 1 to 17, wherein the AA is administered on day 1 of a 3-week cycle.
19. The combination for use or method of any one of claims 1 to 18, wherein the AA is administered orally at a dose of 1200mg / day, optionally in two doses (i.e., 600 mg BID).
20. The combination for use or method of any one of claims 1 to 19, wherein the subject has received at least one prior line of therapy for the cancer.
21. The combination for use or method of claim 20, wherein at least one prior line of therapy comprised an AA.
22. The combination for use or method of any one of claims 1 to 19, wherein the subject has not received a prior therapy for the cancer.
23. The combination for use or method of any one of claims 1 to 22, wherein the cancer is metastatic castration resistant prostate cancer (mCRPC).
24. A method of inducing cell death in aberrant cancer cells having an over-expression of androgen receptor on their cell membranes, the method comprising contacting the cell with an effective amount of a combination of an ATR inhibitor and an antiandrogen agent (“AA”), the effective amount being sufficient to induce cell death in the aberrant cancer cell, wherein the ATR inhibitor is camonsertib or a pharmaceutically acceptable salt thereof, and the AA is darolutamide.
25. The method of claim 24, wherein the ATR inhibitor is camonsertib hydrogen sulfate salt.
26. A method of treating a cancer in a subject having a cancer that has an over-expression of androgen receptor on its cell membranes, comprising: administering a therapeutic combination, wherein the therapeutic combination comprises59(i) a therapeutically effective amount of an ATR inhibitor, wherein the ATR inhibitor is camonsertib or a pharmaceutically acceptable salt thereof; and (ii) a therapeutically effective amount of an antiandrogen agent (“AA”), wherein the AA is darolutamide.
27. The method of claim 26, wherein the ATR inhibitor is administered in a daily dose of 80 mg to 160 mg.
28. The method of claim 27, wherein the daily dose of the ATR inhibitor is 80 mg, 100 mg, 120 mg, or 160 mg.
29. The method of claim 28, wherein the ATR inhibitor is administered in a daily dose of 120 mg.
30. The method of any one of claims 26 to 29, wherein the ATR inhibitor is administered on days 1, 2, 3, 8, 9, and 10 of a 3-week cycle.
31. The method of any one of claims 26 to 30, wherein the AA is administered orally in a dose of 1200mg / day, optionally in two doses (i.e., 600 mg BID).
32. The method of any one of claims 26 to 31, wherein the AA is administered on day 1 of a 3-week cycle.
33. The method of any one of claims 26 to 32, wherein the subject has one or more DDR pathway mutations.
34. The method of claim 33, wherein the DDR pathway mutation comprises one or more of: oncogenic mutations; dysfunctional G1 / S checkpoint control; (e.g., loss of p53 function); defects in other DNA repair pathways (e.g., ATM) and that are subject to the effects of DNA damaging agents, e.g., radiation therapy or chemotherapeutic agents.
35. The method of claim 34, wherein the dysfunctional G1 / S checkpoint is a loss of p53 function.6036. The method of claim 34, wherein the defect in other DNA repair pathways is ATM.
37. The method of claim 34, wherein the DNA damaging agent comprises radiation therapy, chemotherapeutic agents, or combinations thereof.
38. The method of any one of claims 26 to 32, wherein the subject is free of DDR pathway mutations.
39. The method of any one of claims 26 to 38, wherein the therapeutically effective dose of the ATR inhibitor is from about 1% to about 99% of the therapeutically effective dose for a subject that is free of DDR pathway mutations.
40. The method of any one of claims 26 to 39, wherein the subject experiences fewer instances of hematological toxicity after administration of the therapeutic combination than after administration of a monotherapy of the ATR inhibitor.
41. The method of any one of claims 26 to 40, wherein the subject experiences fewer instances of hematological toxicity after administration of the therapeutic combination than after administration of a monotherapy of the AA.61
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