wo - 2004 / 105765 describes the preparation , formulation and pharmaceutical properties of macrocyclic quinazoline derivatives of formula ( i ) as multi targeted kinase inhibitors ( mtkis ). it has now been found that one compound in the aforementioned class , i . e 4 , 6 - ethanediylidenepyrimido [ 4 , 5 - b ][ 6 , 1 , 12 ] benzoxadiazacyclo - pentadecine , 17 - bromo - 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 - octahydro - 20 - methoxy - 13 - methyl , described as compound 22 in the aforementioned pct publication , herein also referred to as mtki 1 or compound 1 , has clinical activity in bone cancer models and accordingly provide the use of these compounds for the preparation of a pharmaceutical composition for treating bone cancer , including primary bone cancers and bone metastases as defined hereinbefore . the present invention also concerns a method of treating tumor - induced osteolytic lesions in bone of a mammal , comprising the step of administering a therapeutically effective amount of a compound according to the invention to said mammal . accordingly , in one aspect the present invention provides the use of 4 , 6 - ethanediylidenepyrimido [ 4 , 5 - b ][ 6 , 1 , 12 ] benzoxadiazacyclo - pentadecine , 17 - bromo - 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 - octahydro - 20 - methoxy - 13 - methyl or a pharmaceutically acceptable acid or base addition salt thereof , in the manufacture of a medicament for the treatment or prevention of bone cancer , including primary bone cancers and bone metastases as defined hereinbefore . a further aspect of the present invention is directed to a method for the treatment of prevention of bone cancer in a mammalian subject , comprising administering a therapeutically effective amount of 4 , 6 - ethanediylidenepyrimido [ 4 , 5 - b ][ 6 , 1 , 12 ] benzoxadiazacyclo - pentadecine , 17 - bromo - 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 - octahydro - 20 - methoxy - 13 - methyl or a pharmaceutically acceptable acid or base addition salt thereof , to a mammalian subject in need of such treatment . the pharmaceutically acceptable acid or base addition salts as mentioned hereinabove are meant to comprise the therapeutically active non - toxic acid and non - toxic base addition salt forms which mtki 1 is able to form . the basic properties can be converted in their pharmaceutically acceptable acid addition salts by treating said base form with an appropriate acid . appropriate acids comprise , for example , inorganic acids such as hydrohalic acids , e . g . hydrochloric or hydrobromic acid ; sulfuric ; nitric ; phosphoric and the like acids ; or organic acids such as , for example , acetic , propanoic , hydroxyacetic , lactic , pyruvic , oxalic , malonic , succinic ( i . e . butanedioic acid ), maleic , fumaric , malic , tartaric , citric , methanesulfonic , ethanesulfonic , benzenesulfonic , p - toluenesulfonic , cyclamic , salicylic , p - aminosalicylic , pamoic and the like acids . the acidic properties may be converted in their pharmaceutically acceptable base addition salts by treating said acid form with a suitable organic or inorganic base . appropriate base salt forms comprise , for example , the ammonium salts , the alkali and earth alkaline metal salts , e . g . the lithium , sodium , potassium , magnesium , calcium salts and the like , salts with organic bases , e . g ., the benzathine , n - methyl - d - glucamine , hydrabamine salts , and salts with amino acids such as , for example , arginine , lysine and the like . the terms acid or base addition salt also comprise the hydrates and the solvent addition forms which mtki 1 is able to form . examples of such forms are e . g ., hydrates , alcoholates and the like . in particular , the present invention is concerned with a use of the dihydrobromide salt of 4 , 6 - ethanediylidenepyrimido [ 4 , 5 - b ][ 6 , 1 , 12 ] benzoxadiazacyclo - pentadecine , 17 - bromo - 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 - octahydro - 20 - methoxy - 13 - methyl , i . e ., 17 - bromo - 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 - octahydro - 20 - methoxy - 13 - methyl - 4 , 6 - ethanediylidenepyrimido [ 4 , 5 - b ][ 6 , 1 , 12 ] benzoxadiazacyclopentadecine dihydrobromide , in any of the aforementioned uses for mtki 1 . in a further embodiment , the present invention provides the use of the aforementioned mtki 1 for the preparation of a pharmaceutical composition for the prevention and / or treatment of bone cancers . the present invention also concerns a method of preventing and / or treating bone cancer in a mammal , comprising the step of administering a therapeutically effective amount of the aforementioned mtki 1 to said mammal . in a further embodiment , the present invention provides the use of mtki 1 for the preparation of a pharmaceutical composition for the prevention and / or treatment of bone loss . the present invention also concerns a method for preventing and / or treating of bone loss associated with cancer metastases in a mammal , comprising the step of administering a therapeutically effective amount of mtki 1 to said mammal . accordingly , in a further aspect , the most preferred compounds for use in accordance with the present invention are those selected from the group consisting of compounds having the following structure : the compounds according to the invention can be prepared and formulated into pharmaceutical compositions by methods known in the art and in particular according to the methods described in the published patent specification wo - 2004 / 105765 mentioned herein and incorporated by reference . a suitable preparation of the preferred compound used in this invention , taken from wo - 2004 / 105765 , follows : a solution of 4 - bromo - 2 - nitro - benzaldehyde ,( 0 . 013 mol ), 5 - amino - 1 - pentanol ( 0 . 013 mol ) and titanium , tetrakis ( 2 - propanolato ) ( 0 . 014 mol ) in etoh ( 15 ml ) was stirred at rt for 1 hour , then the reaction mixture was heated to 50 ° c . and stirred for 30 min . the mixture was cooled to rt and nabh 4 ( 0 . 013 mol ) was added portionwise . the reaction mixture was stirred overnight and then poured out into ice water ( 50 ml ). the resulting mixture was stirred for 20 min ., the formed precipitate was filtered off ( giving filtrate ( i )), washed with h 2 o and stirred in dcm ( to dissolve the product and to remove it from the ti - salt ). the mixture was filtered and then the filtrate was dried ( mgso 4 ) and filtered , finally the solvent was evaporated . filtrate ( i ) was evaporated until etoh was removed and the aqueous concentrate was extracted 2 times with dcm . the organic layer was separated , dried ( mgso 4 ), filtered off and the solvent was evaporated , yielding 3 . 8 g ( 93 %) of intermediate 1 . a solution of intermediate 50 ( 0 . 0047 mol ), formaldehyde ( 0 . 025 mol ) and titanium , tetrakis ( 2 - propanolato ) ( 0 . 0051 mol ) in etoh ( 150 ml ) was heated to 50 ° c . and stirred for 1 hour , then nabh 4 ( 0 . 026 mol ) was added portionwise at rt . the reaction mixture was stirred overnight and then quenched with water ( 100 ml ). the resulting mixture was stirred for 1 hour ; the formed precipitate was filtered off and washed . the organic filtrate was concentrated , then the aqueous concentrate was extracted with dcm and dried . the solvent was evaporated and the residue was filtered over silica gel ( eluent : dcm / ch 3 oh from 98 / 2 to 95 / 5 ). the product fractions were collected and the solvent was evaporated , yielding 0 . 5 g of intermediate 2 . a solution of intermediate 2 ( 0 . 0015 mol ) and pyridine ( 0 . 015 mol ) in acetic anhydride ( 8 ml ) was stirred overnight at rt , then the solvent was evaporated and co - evaporated with toluene , yielding intermediate 3 . a mixture of intermediate 3 ( 0 . 0015 mol ) in thf ( 50 ml ) was hydrogenated with pt / c 5 % ( 0 . 5 g ) as a catalyst in the presence of thiophene solution ( 0 . 5 ml ) [ h179 - 034 ]. after uptake of h 2 ( 3 equiv . ), the catalyst was filtered off and the filtrate was evaporated , yielding 0 . 5 g of intermediate 4 . a mixture of intermediate 4 ( 0 . 0015 mol ) and 4 - chloro - 7 - methoxy - 6 - quinazolinol acetate ( ester ) ( 0 . 0015 mol ) in 2 - propanol ( 30 ml ) was heated to 80 ° c . and the reaction mixture was stirred for 1 day . the solvent was evaporated under reduced pressure and the residue was used as such in the next reaction step , yielding 0 . 83 g of intermediate 5 . a solution of intermediate 5 ( 0 . 0015 mol ) in methanol ( 25 ml ) was stirred at rt and a solution of k 2 co 3 ( 0 . 003 mol ) in h 2 o ( 2 . 5 ml ) was added , then the reaction mixture was heated to 60 ° c . and stirred for 18 hours . the solvent was evaporated and h 2 o ( 20 ml ) was added , then the mixture was neutralized with acetic acid and the formed precipitate was filtered off . the filtrate was concentrated under reduced pressure and the concentrate was extracted with dcm , filtered , then dried ( mgso 4 ) and the mixture was concentrated under reduced pressure , yielding 0 . 5 g ( 70 %) of intermediate 6 . a solution of intermediate 6 ( 0 . 0011 mol ) in thf ( 50 ml ) was stirred at rt and tributylphosphine ( 0 . 0016 mol ) was added , then 1 , 1 ′-( azodicarbonyl ) bis - piperidine ( 0 . 0016 mol ) was added and the reaction mixture was stirred for 2 hours . the solvent was evaporated until ⅓ of the initial volume . the resulting precipitate was filtered off and washed . the filtrate was evaporated and the residue was purified by rp high - performance liquid chromatography . the product fractions were collected and the organic solvent was evaporated . the aqueous concentrate was extracted 2 times with dcm and the organic layer was dried ( mgso 4 ), then filtered off . the solvent was evaporated and the residue was dried ( vac .) at 50 ° c ., yielding 0 . 004 g ( 0 . 8 %) of compound mtki1 . to prepare the aforementioned pharmaceutical compositions , a therapeutically effective amount of the particular compound , optionally in addition salt form , as the active ingredient is combined in intimate admixture with a pharmaceutically acceptable carrier , which may take a wide variety of forms depending on the form of preparation desired for administration . these pharmaceutical compositions are desirably in unitary dosage form suitable , preferably , for systemic administration such as oral , percutaneous , or parenteral administration ; or topical administration such as via inhalation , a nose spray , eye drops or via a cream , gel , shampoo or the like . for example , in preparing the compositions in oral dosage form , any of the usual pharmaceutical media may be employed , such as , for example , water , glycols , oils , alcohols and the like in the case of oral liquid preparations such as suspensions ( including nanosuspensions ), syrups , elixirs and solutions ; or solid carriers such as starches , sugars , kaolin , lubricants , binders , disintegrating agents and the like in the case of powders , pills , capsules and tablets . because of their ease in administration , tablets and capsules represent the most advantageous oral dosage unit form , in which case solid pharmaceutical carriers are obviously employed . for parenteral compositions , the carrier will usually comprise sterile water , at least in large part , though other ingredients , for example , to aid solubility , may be included . injectable solutions , for example , may be prepared in which the carrier comprises saline solution , glucose solution or a mixture of saline and glucose solution . injectable solutions containing compounds of formula ( i ) may be formulated in an oil for prolonged action . appropriate oils for this purpose are , for example , peanut oil , sesame oil , cottonseed oil , corn oil , soy bean oil , synthetic glycerol esters of long chain fatty acids and mixtures of these and other oils . injectable suspensions may also be prepared in which case appropriate liquid carriers , suspending agents and the like may be employed . in the compositions suitable for percutaneous administration , the carrier optionally comprises a penetration enhancing agent and / or a suitable wettable agent , optionally combined with suitable additives of any nature in minor proportions , which additives do not cause any significant deleterious effects on the skin . said additives may facilitate the administration to the skin and / or may be helpful for preparing the desired compositions . these compositions may be administered in various ways , e . g ., as a transdermal patch , as a spot - on or as an ointment . as appropriate compositions for topical application there may be cited all compositions usually employed for topically administering drugs e . g . creams , gels , dressings , shampoos , tinctures , pastes , ointments , salves , powders and the like . application of said compositions may be by aerosol , e . g . with a propellent such as nitrogen , carbon dioxide , a freon , or without a propellent such as a pump spray , drops , lotions , or a semisolid such as a thickened composition which can be applied by a swab . in particular , semisolid compositions such as salves , creams , gels , ointments and the like will conveniently be used . it is especially advantageous to formulate the aforementioned pharmaceutical compositions in dosage unit form for ease of administration and uniformity of dosage . dosage unit form as used in the specification and claims herein refers to physically discrete units suitable as unitary dosages , each unit containing a predetermined quantity of active ingredient calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier . examples of such dosage unit forms are tablets ( including scored or coated tablets ), capsules , pills , powder packets , wafers , injectable solutions or suspensions , teaspoonfuls , tablespoonfuls and the like , and segregated multiples thereof . preferably , a therapeutically effective amount of the pharmaceutical composition comprising a compound according to the invention , is administered orally or parenterally . said therapeutically effective amount is the amount that effectively prevents metastasis and / or growth or reduces the size of a variety of neoplastic disorders or cell proliferative disorders ( supra ) in patients . on the basis of the current data , it appears that a pharmaceutical composition comprising a compound of the present invention , and in particular 4 , 6 - ethanediylidenepyrimido [ 4 , 5 - b ][ 6 , 1 , 12 ] benzoxadiazacyclo - pentadecine , 17 - bromo - 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 - octahydro - 20 - methoxy - 13 - methyl ( mtki1 , or compound 1 ) as the active ingredient can be administered orally in an amount of from 10 mg to several ( 1 to 5 ) grams daily , either as a single dose or subdivided into more than one dose , including , e . g ., two , three or even four times daily . a preferred amount ranges from 500 to 4 , 000 mg daily . a particularly , preferred dosage for such a compound is in the range of 750 mg to 3 , 000 mg daily . it will be appreciated that the amount of a compound according to the present invention , also referred to here as the active ingredient , which is required to achieve a therapeutic effect will , of course , vary with , the route of administration , the age and condition of the recipient , and the particular disorder or disease being treated . the optimum dosage amounts and regimen can be readily determined by those skilled in the art using conventional methods and in view of the information set out herein . this treatment can be given either continuously or intermittently , including , e . g ., but not limited to , cycles of 3 - 4 weeks with treatment given for 1 - 21 days per cycle or other schedules shown to be efficacious and safe . the product mtki1 can be prepared as a 10 - mg / ml oral solution , ph 2 . it contains an excipient , captisol ® ( chemical name : sulfobutyl ether - β - cyclodextrin , sbe - β - cd ), citric acid , tween ® 20 , hcl , and naoh in purified water . the formulation can be stored refrigerated ( 2 - 8 ° c . ; 36 - 46 ° f .) and allowed to warm to room temperature for maximally 1 hour prior to dose preparation . the product mtki1 can also be prepared as 50 - mg , 100 - mg and 300 - mg oral immediate release capsules , containing the active chemical entity mtki1 , lactose monohydrate ( 200 mesh ), sodium lauryl sulphate and magnesium stearate in hard gelatin capsules , sizes 3 , 4 and 00 , respectively . the capsules may also contain any or all of the following ingredients : gelatin , red iron oxide and titanium oxide . the above mtki 1 may be used in combination with one or more other cancer treatments . such combinations could encompass any established antitumor therapy , such as , but not limited to , chemotherapies , irradiation , and target based therapies such as antibodies and small molecules ( such as for example bisphosphonates , taxanes , anthracyclines , capecitabine , herceptin , docetaxel , satraplatin , cetuximab , avastin , aromatase inhibitors and methothrexate ). these therapies may be combined in systemic therapy , or local instillation / administration ( e . g . intrathecally ), depending on optimum efficacy / safety requirements . the mtki 1 and the further anti - cancer agent may be administered simultaneously ( e . g . in separate or unitary compositions ) or sequentially in either order . in the latter case , the two compounds will be administered within a period and in an amount and manner that is sufficient to ensure that an advantageous or synergistic effect is achieved . it will be appreciated that the preferred method and order of administration and the respective dosage amounts and regimens for each component of the combination will depend on the particular mtki and further anti - cancer agents being administered , their route of administration , the particular tumor being treated and the particular host being treated . the optimum method and order of administration and the dosage amounts and regimen can be readily determined by those skilled in the art using conventional methods and in view of the information set out herein . the unique physico - chemical properties of mtki 1 , also referred to herein as compound 1 , has resulted in an extremely favourable tissue distribution profile including the ability to cross the intact blood brain barrier whilst still retaining good cellular activity and oral bioavailability . here , we further demonstrate that this preferential tissue distribution to the bone marrow compartment results in significant anti tumoral activity using experimental models of bone metastases . nctc2472 fibrosarcoma ( atcc rockvile , md . usa ) or mda - mb231 breast cancer cells ( dr . yoneda , univ . of michigan , usa ) ( bone homing variant ) were injected into the tibia of nude mice , the hole sealed and tumor growth observed at predefined times ( vermeirsch , h et al pharmacol biochem behav . 2004 october ; 79 ( 2 ): 243 - 51 ). spontaneous ‘ paw lifting ’ was used as a pain response indicator whilst μct and histology was use to demonstrate osteolytic anti tumor activity and tumor growth . male c3h / hencrl mice for the nctc2472 mouse fibrosarcoma cells ( 20 - 25 g , charles river , sulzfeld , germany ) or female nmri nude mice for the mda mb 231 human breast cancer cells ( janvier , france ) were used . induction of bone cancer was carried out as previously described ( schwei et al ., 1999 1 ). induction of general anaesthesia was performed under 4 % isoflurane in a mixture of 30 % o 2 and 70 % air ( 1000 ml / min ). anaesthesia was then maintained at 2 . 5 % isoflurane for the duration of the surgical procedure . the left hind paw was shaved and disinfected with povidone - iodine followed by 70 % ethanol . a superficial 1 cm incision was made over the knee overlaying the patella . the patella ligament was cut , exposing the condyles of the distal femur . a 23 - gauge needle was inserted at the level of the intercondylar notch and the intramedullary canal of the femur to create a cavity for injection of the cells . tumour cells ( 2 . 5 × 10 6 cells / 20 μl ) were then injected into the bone cavity using a 0 . 3 ml syringe . to prevent leakage of cells outside the bone , the injection site was sealed with dental acrylic ( paladur , heraeus kulzer , gmbh , wehrheim , germany ) and the wound closed with skin stitches . for the sham - operated group , an identical procedure was followed except that medium without cells was injected . treatment was initiated on day 1 following tumor cell induction . mice were treated once daily ( q1d ) with either vehicle ( 20 % hydroxypropyl - β - cyclodextrine , ph 4 . 0 ) or vehicle formulated to give a dose of 200 or 50 mg / kg of compound 1 respectively by gavage ( p . o .) administered in a volume of 10 ml / kg body weight . mice were treated up to 18 days after bone tumor induction . pain behaviours ( see below ) were evaluated in the group of sham and bone tumour mice and were behaviourally tested during a 2 - week period prior to and 7 , 9 , 12 and 14 days after tumour inoculation . at the end of the experiment the femur of the left hind limb was sampled and used for pct scanning as described in vermeirsh et al ., ( 2004 ) 2 . spontaneous lifting behavior : animals were habituated to the laboratory room at least 30 minutes in a transparent acrylic cylinder of 20 cm diameter and thereafter observed during 4 minutes for spontaneous lifting behaviour of the left hind paw . bone analysis was carried out on ipsilateral left hind limbs prior to and 7 , 12 , 15 and 18 days following cell injection . limbs were fixed in 10 % phosphate - buffered formalin and transferred to a plastic cuvette filled with 70 % ethanol for scanning using the skyscan microtomograph ( skyscan 1067 ®, skyscan , aartselaar , belgium ). for medium resolution measurement , the x - ray beam was collimated to a diameter of 18 mm , line spacing and point resolution were set at 0 . 254 and 0 . 127 mm , respectively . after standardized reconstruction , the datasets for each bone were re - sampled using computer software ( ant , 3d - creator vs . 2 . 2e , skyscan , aartselaar , belgium ) so that the medial axis of the bone was centrally oriented for each bone . scans were processed and a two - and three - dimensional morphometric analysis was performed on a 5 mm femur bone segment at proximal end of the patellar trochlea using free software ( ctanalyzer vs . 1 . 02 , skyscan , aartselaar , belgium ). 1 . schwei m j , honore p , rogers s d , salak - johnson j l , finke m p , ramnaraine m l , et al . neurochemical and cellular reorganization of the spinal cord in a murine model of bone cancer pain . j neurosci 1999 ; 19 : 10886 - 97 . 2 . vermeirsch , h ., nuydens , r ., salmon , p . l ., and meert , t . f . pharmacol . biochem . behav . 2004 . 79 : 243 - 251 . animals were habituated to the laboratory room at least 30 minutes in a transparent acrylic cylinder of 20 cm diameter and thereafter observed during 4 minutes for spontaneous lifting behaviour of the left hind paw . the data is presented as the percentage of the time the paw was raised over this period of time . the vehicle group was dosed by oral gavage , daily with a 20 % hpcd solution at ph 4 . 0 . compound 1 was dosed once daily at its maximum tolerated dose ( mtd ) of 200 mg per kg , iressa was also dosed at its maximum tolerated dose , by oral gavage , of 50 mg per kg daily for 14 days . the vehicle treated group of animals displayed detectable paw lifting behaviours starting seven days post tumor cell inoculation . the percentage of the time the animals paws were raised during the observation period increased at both day 9 , 12 and 14 post inoculation at which time the paw was raised 80 % of the time . dosing animals with compound 1 at its mtd was found to reduce the time the animals did not use their left paws quite dramatically so that at day 14 , spontaneous paw lifting behaviour was only detected to occur ˜ 8 % of the time . the reference compound used in this study , iressa when dosed at its mtd also led to a statistically significant reduction in spontaneous paw lifting behaviour , however the effect was far less extensive with spontaneous paw lifting being observed more than 35 % of the time . representative reconstructions from μct s of the ipsilateral left hindlimbs showing osteolytic bone destruction in the tumor inoculated animals ( fig2 ). considerable bone loss was observed in the vehicle and iressa treated groups whilst significantly less bone destruction can be seen in the compound 1 treated animals . the sham operated animals showed no signs of osteolytic activity . in the bone cancer metastasis model mda b231 bone homing clone cells were inoculated into the tibia as described . after 42 days , animals were sacrificed and the amputated paws placed in fixative . the legs were de - calcified and sections cut to determine levels of bone destruction . the vehicle treated animals were observed to have large tumor mass ( encircled area in fig3 ) that has expanded out of the initial site of inoculation ( black arrow in fig3 ) and in the process resulted in significant destruction of the bone ( see fig2 ). the amount of tumor growth and the amount of bone destruction was seen to be dose dependently reduced with the highest dose of compound 1 tested in this study , 100 mg per kg , po , qd , showing no signs of tumor cell not any signs bone destruction . the latter is also apparent from the histological sections in fig3 . in vehicle treated animals a large tumor mass has extended into the femur ( grey arrow ), where in animals treated with 100 mg per kg , po , qd , of mtki 1 , detectable tumor is hardly present ( grey arrow ) and close to the site of inoculation ( black arrow ). while the foregoing specification teaches the principles of the present invention , with examples provided for the purpose of illustration , it will be understood that the practice of the invention encompasses all of the usual variations , adaptations and / or modifications as come within the scope of the following claims and their equivalents .
the present invention is concerned with the finding that the macrocyclic quinazoline derivative 4 , 6 - ethanediylidenepyrimidobenzoxadiazacyclo - pentadecine , 17 - bromo - 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 - octahydro - 20 - methoxy - 13 - methyl -, described as compound 22 in pct publication wo2004 / 105765 , is useful in the manufacture of a medicament for the treatment or prevention of bone cancers and methods for killing bone cancer cells , including osteosarcomas , chondrosarcomas , myeloma bone disease and osteolytic bone metastases from other primary sites . it accordingly provides methods for treating , preventing , delaying or mitigating bone cancer , or for preventing and treating of bone loss associated with cancer metastases .