AU2003218119A1 - Extended cycle estrogen and sulfatase inhibiting progestogen contraceptive regimens - Google Patents

Description

WO 03/077926 PCT/USO3/07601 EXTENDED CYCLE ESTROGEN AND SULFATASE INHIBITING PROGESTOGEN CONTRACEPTIVE REGIMENS The present invention relates to extended cycle contraceptive regimens for 5 menstruating females. More particularly, the present invention relates to extended cycle contraceptive regimens containing a potent sulfatase inhibiting progestogen, such as, norgestimate (NGM) or norelgestromin (NGMN), and an estrogen. BACKGROUND OF THE INVENTION 10 A substantial percentage of human breast carcinomas are hormone-dependent. Animal studies and clinical trials have confirmed that estrogens, particularly estradiol, are the most important hormones involved in supporting growth of hormone-dependent breast tumours. (see refs #1 at 493, #2 at 967, #7 at 1589, #8 at 525, #9 at 135, #10 at 15 225,#11 at625 and #12 at 1497) Plasma levels of estrone and estradiol in post-menopausal women are very low. (see refs #1 at 493 and #11 at 626) Yet, breast tumor tissue concentration of estrone and estradiol is an order of magnitude higher than plasma concentrations. (see refs #1 at 493, #2 at 967 and #13 at 641) Figure 1 shows the enzymatic process by which 20 estrogens are locally formed in human breast cancer cells and thereby made available to support growth. (see ref #10 at 229). Referring to Figure 1, studies have shown that the sulfatase enzyme appears to be at least 10 Ox more important in the formation of estrogens than the aromatase enzyme. (see refs #1 at 493, #2 at 967, #4 at 17, #5 at 931, #7 at 1589, #8 at 525, #9 at 135, #10 at 228, #11 at 626 and 628 and #13 at 641) 25 Thus, it is the sulfatase pathway that is the primary pathway promoting local formation of estrogens in human breast cancer cells. Since estradiol is one of the main factors involved in supporting growth of hormone-dependent breast tumours and the sulfatase pathway is the main pathway for the formation of estradiol in the breast, then a decrease of estradiol formation by 30 suppression of the sulfatase pathway would have potential therapeutic activity in the management of breast cancer. (see refs #1 at 493, #3 at 55, #4 at 17, #5 at 931, #6 at 123 and #11 at 631) Suppression of the sulfatase pathway will have a breast protective effect. 1 WO 03/077926 PCT/USO3/07601 Local formation of estrogens in the breast is only one source for exposure of breast tissues to estrogens. Another source of estrogen present in breast tissues is estrogen containing contraceptive regimens. Most such regimens follow a cycle of 28 days including 7 days without administration of a hormone, including estrogen, 5 preceded by 21 days of combined administration of progestogen and estrogen. There is presently an increased interest in regimens of longer than 28 days. Such regimens would have extended cycles of 6 to 26 weeks, such as 6, 8, 12 or 13 weeks. In such extended cycles, the period of hormone free or estrogen free administration would not increase over the hormone free or estrogen free period of 28 day cycle regimens. Thus, 10 a 91 day cycle would include 7 days without administration of a hormone, including estrogen, preceded by 84 days of combined administration of progestogen and estrogen. As compared to a 28 day cycle, a 91 day cycle would require the administration of an estrogen for 84 of 91 days rather than 21 of 28 days. On a yearly basis this would mean 4 weeks without estrogen administration for the 91 day cycle as compared to 13 weeks 15 without estrogen administration for the 28 day cycle. The increased exposure to estrogen is recognized as a possible disadvantage (see refs #14 at 275 and #15 at 94). It is an object of the present invention to provide an extended cycle contraceptive regimen to continuously suppress sulfatase activity in human breast cancer cells. 20 It is also an object of the present invention to provide an extended cycle contraceptive regimen with exceptional suppression of sulfatase activity in human breast cancer cells. It is also an object of the present invention to provide an extended cycle contraceptive regimen to continuously suppress estrogen formation in human breast 25 cancer cells. It is yet another object of the present invention to provide an extended cycle contraceptive regimen with exceptional suppression of estrogen formation in human breast cancer cells. It is still another object of the present invention to provide an extended cycle 30 contraceptive regimen which minimizes exposure of the breast to locally formed estrogen. 2 WO 03/077926 PCT/USO3/07601 It is another object of the present invention to provide an extended cycle contraceptive regimen which reduces exposure of the breast to estrogens as compared to other extended cycle contraceptive regimens of equivalent estrogen dose. It is another object of the present invention to provide an extended cycle 5 contraceptive regimen with the lowest levels of breast estrogen exposure as compared to other extended cycle contraceptive regimens of equivalent estrogen dose. It is another object of the present invention to provide an extended cycle contraceptive regimen which closely limits exposure of the breast to those levels of estrogens which are administered in the regimen or produced in vivo outside the breast. 10 It is still another object of the present invention to provide an extended cycle contraceptive regimen which provides exceptional and continuous breast protective effect. It is another object of the present invention to provide an extended cycle contraceptive regimen which minimizes risk factors associated with breast cancer. 15 References: 1. Inhibition of Estrone Sulfatase Enzyme in Human Placenta and Human Breast Carcinoma; T.R. JEFFRY EVANS et al., J. Steroid Biochem. Molec. Biol. Vol. 39, No. 4A 1991, pp. 493-499. 20 2. In Vitro Effect of Synthetic Progestogens on Estrone Sulfatase Activity in Human Breast Carcinoma; ODILE PROST-AVALLET et al., J. Steroid Biochem. Molec. Biol., Vol. 39, No. 6, 1991, pp.967-973. 3. Effect of the progestagen R5020 (promegestone) and of progesterone on the uptake and on the transformation of estrone sulfate in MCF-7 and T-47d human mammary 25 cancer cells: correlation with progesterone receptor levels; JORGE R. PASQUALINI et al., Cancer Letters, 66 (1992) 55-60, Elsevier Scientific Publishers Ireland Ltd. 4. Action of Danazol On The Conversion Of Estrone Sulfate To Estradiol And On The Sulfatase Activity In The MCF-7, T-47D and MDA-MB-231 Human Mammary 30 Cancer Cells; B-L NGUYEN et al., J. Steroid Biochem, Molec. Biol. Vol. 46, No. 1, 1993, pp. 17-23. 3 WO 03/077926 PCT/USO3/07601 5. Effect of Promegestone, Tamoxifen, 4-Hydroxytamoxifen and ICI 164,384 on the Oestrone Sulphatase Activity of Human Breast Cancer Cells; GERARD CHETRITE et al., Anticancer,Research 13: 931-934 (1993). 6. Inhibition Of Steroid Sulfatase Activity By Danazol; KJELL CARLSTROM et al., 5 Acta Obstet Gynecol Scand Suppl. 107-111. 7. Effect of the Progestagen Promegestone (R-5020) on mRNA of the Oestrone Sulphatase in the MCF-7 Human Mammary Cancer Cells; JORGE R. PASQUALINI et al., Anticancer Research 14: 1589-1594 (1994). 8. Effect of Nomegestrol Acetate on Estrone-sulfatase and 170-Hydroxysteroid 10 Dehydrogenase Activities in Human Breast Cancer Cells; G. CHETRITE et al., J. Steroid Biochem. Molec. Biol. Vol. 58, No.5/6, pp. 525-531, 1996. 9. Effect of Tibolone (Org OD14) and its Metabolites on Estrone Sulphatase Activity in MCF-7 and T-47D Mammary Cancer Cells; G. CHETRITE et al., Anticancer Research 17: 135-140 (1997). 15 10. Progestins and Breast Cancer; J.R. PASQUALINI et al., J. Steroid Biochem. Molec. Biol. Vol. 65, No. 1-6, pp.225-235, 1998. 11. Control of Estradiol In Human Breast Cancer. Effect of Medrogestone on Sulfatase, 176-Hydroxysteroid Dehydrogenase And Sulfotransferase Activities in Human Breast Cancer Cells; JORGE RAUL PASQUALINI et al., Euro. Congr. On 20 Menopause (1998), pp. 625-633. 12. Constitutive Expression of the Steroid Sulfatase Gene Supports theGrowth of MCF 7 Human Breast Cancer Cells in Vitro and in Vitro; MATTIE R. JAMES et al., Endocrinology, Vol. 142, No.4, pp 1497-1505. 13. Concentrations of Estrone, Estradiol and Their Sulfates, And Evaluation of 25 Sulfatase and Aromatase Activities in Patients with Breast Fibroadenoma; J.R. PASQUALINI et al., Int. J. Cancer, 70, pp. 639-643 (1997). 14. A Trimonthly Regimen for Oral Contraceptives; G. T. KOVACS et al., The Brit. J. of Family Planning, 19, pp. 274-275 (1994) 15. Manipulation of Human Ovarian Function: Physiological Concepts and Clinical 30 Consequences; B. C. J. M. FAUSER, Endocrine Review, Vol. 18, No. 1, (1997). 4 WO 03/077926 PCT/US03/07601 SUMMARY OF THE INVENTION According to the present invention there is provided, a method of contraception comprising the step of administering to a menstruating female a cycle of contraceptive therapy, said cycle of therapy including, for at least 42 successive days, the 5 administration of a combination of an estrogen and a progestogen in a contraceptively effective daily dosage wherein said progestogen is a potent sulfatase inhibiting progestogen and said cycle of therapy including 4-8 days which are free of estrogen administration following said at least 42 successive days. There is also provided by the present invention, a contraceptive therapy unit for 10 administration to a menstruating female comprising a cycle of separate dosage units, said cycle of dosage units including at least 42 dosage units adapted for successive daily oral administration, wherein said dosage units contain, in admixture with a pharmaceutically acceptable carrier, a combination of an estrogen and a progestogen in a contraceptively effective daily dosage wherein said progestogen is a potent sulfatase 15 inhibiting progestogen and, optionally, said cycle of dosage units including 4-8 dosage units containing no estrogen. There is also provided by the present invention, a contraceptive therapy unit for administration to a menstruationg female comprising a cycle of transdermal patches, said cycle of transdermal patches including a sufficient number of patches adapted for 20 successive administration to provide for at least 42 successive days of therapy, wherein said transdermal patches contain, in a suitable matrix, a combination of an estrogen and a progestogen for delivery in a contraceptively effective daily dosage wherein said progestogen is a potent sulfatase inhibiting progestogen and, optionally, said cycle of transdermal patches including a patch for 4-8 days of use containing no estrogen. 25 There is also provided by the present invention, a contraceptive therapy unit for administration to a menstruationg female comprising a cycle of vaginal rings, said cycle of vaginal rings including a sufficient number of rings adapted for successive administration to provide for at least 42 successive days of therapy, wherein the vaginal rings contain, in a suitable matrix, a combination of an estrogen and a progestogen for 30 delivery in a contraceptively effective daily dosage wherein said progestogen is a potent sulfatase inhibiting progestogen and, optionally, said cycle of vaginal rings including a ring for 4-8 days of use containing no estrogen. 5 WO 03/077926 PCT/US03/07601 Applicants have surprisingly discovered that such a regimen is expected to have reduced levels of estrogen in the breast as compared to other extended cycle contraceptive regimens having equivalent doses of estrogens. 5 BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 - Shows the enzymatic process involved in the formation and transformation of estrogens in human breast cancers. DETAILED DESCRIPTION OF THE INVENTION 10 The contraceptive regimen according to the present invention is administered cycle after cycle to a menstruating female to achieve a long term contraceptive effect. Menstruating female is intended to refer to fertile women of child bearing age. The method of administration might be transdermal, vaginal or oral. Where administration is transdermal, a suitable patch is continuously worn with replacement as required. 15 Where administration is vaginal, a suitable vaginal device, such as a ring, is continuously inserted with replacement as required. Where administration is oral, daily oral dosage units are administered. Many common contraceptive regimens have a cycle of 28 days including 21 days of combined estrogen and progestogen administration followed by an off period of 20 7 days without administration of these hormones. Extended cycle contraceptive regimen, as the phrase is used herein, is intended to refer to contraceptive regimens having combined estrogen and progestogen administration of 42 days or longer followed by an off period of time without or with reduced administration of these hormones to allow menstruation. Thus, a minimum extended cycle would cover a 25 period of time, which is 42 days of drug administration plus an off period of 4-8 days without drug or with reduced drug. A preferred extended cycle is 11 or 12 weeks of drug administration followed by an off period off 4-8 days without drug or with reduced drug. Another preferred extended cycle is 25 weeks of drug administration followed by an off period of 4-8 days without drug or with reduced drug. 30 The off period without or with reduced administration of hormone is to allow for menstruation as stated. During the off period there should be no estrogen administered. However, as can be understood from a general sense of the present invention, it may be desirable to continue the administration of a potent sulfatase 6 WO 03/077926 PCT/US03/07601 inhibiting progestogen to obtain a continuation of its breast protecting effect. It would be desirable to continue progestogen administration to the extent that such administration does not interfere with menstruation. Therefore, it may be desirable to administer a full dose or reduced dose ofprogestogen for the full off period. A full 5 dose is intended to mean a continuation of the dose administered in the active period of the cycle or of a progestogen dose named below as suitable for administration in the active period of the cycle. A reduced or minimized dose might be a tablet delivered oral norgestimate equivalent dose of 30 or 60 mcg or device delivered systemic circulation norgestimate equivalent dose of 18 or 30 mcg. Alternatively, it may be 10 desirable to interrupt progestogen administration for a number of days less than the full off period. For example, there could be three days without estrogen or progestogen administration and for the remaining days of the off period there could be administered a full dose or reduced dose of progestogen. A preferred off period of time without or with reduced hormone to allow for menstruation is 7 days. 15 The extended cycle regimens herein may include a regimen in which there is a day to day or week to week variation in the dose of active administered according to a set pattern. In such a case the regimen, including variation of dose, is repeated in cycle following cycle. The extended cycle regimen may also be one in which there is no variation in the dose of the active administered. Whatever the case, an extended cycle 20 contraceptive product utilizing the contraceptive regimen of the present invention is prescribed, sold and administered in units of cycles. The contraceptive product based on a cycle might be 4 to 25 vaginal rings that are inserted and then replaced every 7, 14 or 21 days according to their design. The contraceptive product based on a cycle might be 4 to 25 transdermal patches that are attached and then replaced every 7, 10 or 14 25 days according to their design. The contraceptive product based on a cycle might be 42, 49, 63, 84, 91, 126 or 182 tablets that are orally administered daily in a cycle that is 42/7, 49/7, 63/7, 84/7, 91/7, 126/7 or 182/7. The estrogen in combination with the progestogen is administered in sufficient amounts to provide a contraceptive effect. Additionally, the estrogen dose in 30 contraceptive regimens described herein is closely associated with the control of bleeding and spotting in the cycle. Between menstruations, bleeding and spotting should be minimized. Thus, 17c-ethinylestradiol might be also administered in 7 WO 03/077926 PCT/US03/07601 sufficient amounts to control or minimize or eliminate bleeding and spotting during the inter-menstruation period of the cycle. "Estrogen" herein refers to an estrogen receptor modulator having either an agonistic or antagonistic effect on the estrogen receptor, but preferably an agonistic 5 effect. Any conventional estrogen may be employed as a suitable component in the contraceptive regimen of this invention. The particular estrogen employed should be selected and administered such that it is equivalent in contraceptive effect to a daily dosage of about 0.005-0.050 mg of 17ca-ethinylestradiol. The preferred dosage of the estrogen employed is one equal to a daily dosage of about 0.010- 0.035 mg of 17a 10 ethinylestradiol. In addition to the commonly employed 173-estradiol, there can be also be employed 17ca-ethinylestradiol, esters and ethers of 17ca-ethinylestradiol such as, for example, 17a-ethinylestradiol 3-dimethylamino propionate, 17a-ethinylestradiol 3 cyclopentyl ether (quienestrol) and 17cc-ethinylestradiol 3-methyl ether (mestranol) as 15 the estrogen component. Natural estrogens such as estrone, estrone sulfate, estrone sulfate piperazine salt, estradiol and estriol, and their esters, may also be employed. Conjugated equine estrogens (CEE) or conjugated estrogens (CE) are well known for this use. Suitable synthetic estrogens or synthetic estrogen modulators for use herein include tamoxifen, toremifene, ormeloxifene, modrefen, fulvestrant, lasofoxifene, 20 bazedoxifene (TSE-424), arzoxifene, tesmilifene, miproxifene, EM-652 (Sch-57068), 3339 (Aventis), Ospemifene (Fc 1271A), ERA-923, GTx-006, HM-101, DPC-974, A 007, SP-8490, WAY-140424, tibolone, levodoxiphen, raloxifene. In the case of a daily oral tablet, there is administered a preferred dose of 17ca ethinylestradiol (or contraceptively equivalent amount of a suitable estrogen) between 25 about 0.005 mg to about 0.050 mg and more preferably between about 0.010 mg to about 0.035 mg. Specific daily oral tablets might contain 0.015, 0.020, 0.025 or 0.035 mg of 17ca-ethinylestradiol. In the case of a vaginal ring, the preferred ring delivers to systemic circulation a daily dose of 17c-ethinylestradiol (or contraceptively equivalent amount of a suitable estrogen) between about 0.003 mg to about 0.030 mg and more 30 preferrably between about 0.006 mg to about 0.020 mg. A specific vaginal ring might be inserted for one week and deliver to systemic circulation in that period of time an average daily dose of 0.009, 0.012, 0.015 or 0.020 mg of 17c-ethinylestradiol. In the 8 WO 03/077926 PCT/US03/07601 case of a transdermal patch, a preferred patch delivers to systemic circulation a daily dose of 17ca-ethinylestradiol (or contraceptively equivalent amount of a suitable estrogen) between about 0.003 mg to about 0.030 mg and more preferrably between about 0.006 mg to about 0.020 mg. A specific patch might be worn for one week and 5 deliver to the surface of the skin in that period of time an average daily dose of 0.009, 0.012, 0.015 or 0.020 mg of 17(x-ethinylestradiol. Regardless of the foregoing, it is intended herein to use conventional amounts of estrogen since it is not the estrogen component which is critical to the invention. Persons skilled in the art well understand required doses of estrogen required in contraceptive regimens. 10 A potent sulfatase inhibiting progestogen is preferably herein defined as a progestogen which has (or a progestogen with a substantial metabolite thereof which has) an IC 5 0 in the conversion of ElS to E 2 in either the MCF-7 or T-47D breast cancer cell lines of about the corresponding

IC

5 0 of norelgestromin or lower. A potent sulfatase inhibiting progestogen may also be a progestogen which has (or a progestogen 15 with a substantial metabolite thereof which has) an IC 50 in the conversion of E 1 S to E 2 in either the MCF-7 or T-47D breast cancer cell lines of substantially less than the corresponding IC 5 0 of medroxyprogesterone acetate, for example, on the order of 1/3, 1/2 or 1/5 of the IC 5 0 of medroxyprogesterone acetate. A potent sulfatase inhibiting progestogen can also be defined as a progestogen having (or a progestogen with a 20 substantial metabolite thereof which has) an IC 5 0 in the conversion of E 1 S to E 2 in either the MCF-7 or T-47D breast cancer cell lines of at most about 1/10, or about preferably 1/100, the corresponding IC 5 0 of medroxyprogesterone acetate (MPA). A potent sulfatase inhibiting progestogen can also be defined as a progestogen which inhibits (or a progestogen with a substantial metabolite thereof which inhibits) at least 25 about 70% and preferably at least about 90% of the conversion of E 1 S to E 2 in either the MCF-7 or T-47D breast cancer cell lines where employed in the test at a concentration of 50 x 10 -6 mol/1. Norgestimate (NGM) or norelgestromin (NGMN) are the preferred progestogens utilized herein and are each known to the art of contraceptive therapy. In 30 fact, norgestimate is now used in a number of commercially available contraceptive products. The most preferred progestogen is norelgestromin (17-d-norgestimate). Norelgestromin is the major metabolite of norgestimate in humans with 80% and higher of norgestimate being converted to norelgestromin in vivo. For this reason, inhibition 9 WO 03/077926 PCT/US03/07601 of sulfatase enzyme activity which is demonstrated for norelgestromin is inferred to norgestimate. Of course, to obtain equivalent inhibition of sulfatase enzyme activity (but not progestogenic effect), it may be necessary to administer a somewhat greater dose of norgestimate as compared to any dose of norelgestromin. 5 The progestogen is administered in conjunction with the estrogen in an amount sufficient to produce a contraceptive effect. The progestogen will also oppose the action of the estrogen on the endometrium. It has been observed that the long term administration of an estrogen which is unopposed by the administration of a progestogen leads to a substantial increase in the incidence of endometrial cancer. 10 Thus, it is also desirable in a contraceptive regimen that the progestogen be administered in an amount which is an effective endometrium protective amount. According to the present invention, it is now an additional requirement that the progestogen be administered in an amount which is an effective breast protective amount. More specifically, in a first characterization of a breast protective and 15 otherwise suitable amount ofprogestogen, there is selected and administered sufficient sulfatase inhibiting progestogen such that it is at least equivalent in both contraceptive and breast protecting effect to about 0.030 mg to about 0.500 mg of orally administered norgestimate. Preferably, there is selected and administered sufficient sulfatase inhibiting progestogen such that it is at least equivalent in both contraceptive and breast 20 protecting effect to about 0.050 mg to about 0.300 mg of orally administered norgestimate. In another characterization of a breast protective amount ofprogestogen and assuming a contraceptively effective amount, there is administered sufficient active compound to provide for, during a substantial portion of each day, a substantial supression of sulfatase activity, for example, of 50% or greater and preferably of 67% 25 or greater and most preferably of 75% or greater. A substantial portion of a day is intended to mean a period of at least 4 hours, but within the invention might mean a period of at least 8 hours or 12 hours or even 24 hours. In the case of a daily oral tablet, there is administered a preferred dose of norgestimate or norelgestromin (or contraceptively equivalent amount of a suitable progestogen) between about 30 mcg to 30 about 500 mcg and more preferably between about 50 mcg to about 300 mcg. Specific daily oral tablets might contain 125, 180, 215, 250 or 300 mcg of norgestimate or norelgestromin. In the case of a vaginal ring, a preferred ring delivers to systemic circulation a daily dose of norgestimate or norelgestromin (or contraceptively 10 WO 03/077926 PCT/US03/07601 equivalent amount of a suitable progestogen) between about 18 mcg to about 300 mcg and more preferrably between about 30 mcg to about 175 mcg. A specific vaginal ring might be inserted for one week and deliver to systemic circulation in that period of time an average daily dose of 70, 100, 125, 140 or 175 mcg of norgestimate or 5 norelgestromin. In the case of a transdermal patch, a preferred patch delivers to systemic circulation a daily dose of norgestimate or norelgestromin (or contraceptively equivalent amount of a suitable progestogen) between about 18 mcg to about 300 mcg and more preferrably between about 30 mcg to about 175 mcg. A specific patch might be worn for one week and deliver to systemic circulation in that period of time an 10 average daily dose of 70, 100, 125, 140 or 175 mcg of norgestimate or norelgestromin. In Table 1, there are disclosed preferred oral daily extended cycle contraceptive regimens according to the present invention containing norgestimate (NGM) or norelgestromin (NGMN). A placebo containing no hormone is administered in the off period and a single tablet is administered in the active period containing the hormones 15 as reported. Table 1 Regimen # Active/Placebo Tablet 17c- Tablet progestogen content days ethinylestradiol content 1 42/7 20 mcg 125 mcg NGM or NGMN 2 42/7 20 meg 180 mcg NGM or NGMN 3 42/7 20 mcg 250 meg NGM or NGMN 4 42/7 25 mcg 125 mcg NGM or NGMN 5 42/7 25 mcg 180.mcg NGM or NGMN 6 42/7 25 mcg 250 mcg NGM or NGMN 7 42/7 35 mcg 125 mcg NGM or NGMN 8 42/7 35 mcg 180 meg NGM or NGMN 9 42/7 35 mcg 250 mcg NGM or NGMN 10 . 63/7 20 mcg 125 mcg NGM or NGMN 11 63/7 20 mcg 180 mcg NGM or NGMN 12 63/7 20 mcg 250 mcg NGM or NGMN 13 63/7 25 mcg 125 mcg NGM or NGMN 14 63/7 25 mcg 180.mcg NGM orNGMN 11 WO 03/077926 PCT/US03/07601 15 63/7 25 mcg 250 mcg NGM or NGMN 16 63/7 35 mcg 125 mcg NGM or NGMN 17 63/7 35 mcg 180 mcg NGM or NGMN 18 63/7 35 mcg 250 mcg NGM or NGMN 19 84/7 20 mcg 125 mcg NGM or NGMN 20 84/7 20 mcg 180 mcg NGM or NGMN 21 84/7 20 mcg 250 mcg NGM or NGMN 22 84/7 25 mcg 125 mcg NGM or NGMN 23 84/7 25 mcg 180.mcg NGM or NGMN 24 84/7 25 mcg 250 mcg NGM or NGMN 25 84/7 35 mcg 125 mcg NGM or NGMN 26 84/7 35 mcg 180 mcg NGM or NGMN 27 84/7 35 mcg 250 mcg NGM or NGMN 28 126/7 20 mcg 125 mcg NGM or NGMN 29 126/7 20 mcg 180 mcg NGM or NGMN 30 126/7 20 mcg 250 mcg NGM or NGMN 31 126/7 25 mcg 125 mcg NGM or NGMN 32 126/7 25 mcg 180.mcg NGM or NGMN 33 126/7 25 mcg 250 mcg NGM or NGMN 34 126/7 35 mcg 125 mcg NGM or NGMN 35 126/7 35 mcg 180 mcg NGM or NGMN 36 126/7 35 mcg 250 mcg NGM or NGMN Each of the regimens of Table 1 might be modified by continuing the administration of a NGM or NGMNI in a progestogen only tablet for all days of the off period. The dose might be full dose, which is the same as that administered in the 5 active period, or it might be a dose of 125 mcg or it might be a minimized dose of 50 mcg. In Table 2, there are disclosed preferred contraceptive transdermal regimens or vaginal ring regimens according to the present invention using weekly patches or rings containing norgestimate (NGM) or norelgestromin (NGMN). The weekly patches or 10 rings deliver to systemic circulation the reported average daily dose of NGM or NGMN. No device is administered in the off period. 12 WO 03/077926 PCT/US03/07601 Table 2 Regimen # Device/Off Device 17/3- Device progestogen weeks estradiol delivery delivery rate rate 37 6/1 12 mcg 70 mcg NGM or NGMN 38 6/1 12 mcg 100 mcg NGM or NGMN 39 6/1 12 mcg 140 mcg NGM or NGMN 40 6/1 15 mcg 70 mcg NGM or NGMN 41 6/1 15 mcg 100 mcg NGM or NGMN 42 6/1 15 mcg 140 mcg NGM or NGMN 43 6/1 20 mcg 70 mcg NGM or NGMN 44 6/1 20 mcg 100 mcg NGM or NGMN 45 6/1 20 mcg 140 mcg NGM or NGMN 46 9/1 12 mcg 70 mcg NGM or NGMN 47 9/1 12 mcg 100 mcg NGM or NGMN 48 9/1 12 mcg 140 mcg NGM or NGMN 49 9/1 15 mcg 70 mcg NGM or NGMN 50 9/1 15 meg 100 mcg NGM or NGMN 51 9/1 15 mcg 140 mcg NGM or NGMN 52 9/1 20 meg 70 mcg NGM or NGMN 53 9/1 20 mcg 100 mcg NGM or NGMN 54 9/1 20 mcg 140 mcg NGM or NGMN 55 12/1 12 mcg 70 mcg NGM or NGMN 56 12/1 12 mcg 100 mcg NGM or NGMN 57 12/1 12 mcg 140 mcg NGM or NGMN 58 12/1 15 mcg 70 mcg NGM or NGMN 59 12/1 15 mcg 100 mcg NGM or NGMN 60 12/1 15 mcg 140 mcg NGM orNGMN 61 12/1 20 mcg 70 mcg NGM or NGMN 62 12/1 20 mcg 100 mcg NGM or NGMN 63 12/1 20 mcg 140 mcg NGM or NGMN 64 18/1 12 mcg 70 mcg NGMorNGMN 13 WO 03/077926 PCT/USO3/07601 65 18/1 12 mcg 100 mcg NGM or NGMN 66 18/1 12 mcg 140 mcg NGM or NGMN 67 18/1 15 mcg 70 mcg NGM or NGMN 68 18/1 15 mcg 100 mcg NGM or NGMN 69 18/1 15 mcg 140 mcg NGM or NGMN 70 18/1 20 mcg 70 mcg NGM or NGMN 71 18/1 20 mcg 100 mcg NGM or NGMN 72 18/1 20 mcg 140 mcg NGM or NGMN Each of the regimens of Table 2 might be modified by continuing the administration of a NGM or NGMN in a progestogen only device during the off period. The dose might be full dose, which is the same as that administered in the active period, 5 or it might be a dose of 70 mcg or it might be a minimized dose of 30 meg. The estrogen and progestogen component are orally administered preferably together in tablets also containing a pharmaceutically acceptable non-toxic carrier, but they can also be administered separately. Suitable carriers include magnesium carbonate, magnesium stearate, talc, lactose, sugar, peptin, dextrin, starch, 10 methylcellulose, sodium carboxylmethylcellulose, and the like. The tablet may also contain one or more substances, which act as diluents, flavoring agents, solubilizers, lubricants, suspending agents, binders, or tablet disintegrating agents as well as encapsulating materials. In general, the active agents are processed, together with the usual additives, vehicles and/or flavor-ameliorating agents normally employed in 15 Galenic pharmacy, in accordance with generally accepted pharmaceutical practices. The hormone containing tablets might also contain nutritional supplements such as, for example, iron supplements, folic acid, calcium, vitamin B 6 , vitamin B 12 , etc. In the manufacture of a typical tablet, the active agents are granulated with spray dried lactose, a lubricating agent and a colorant and compressed. 20 Oral tablets are preferably packaged in the form of a pharmaceutical kit or package in which the daily dosages are arranged for proper sequential administration. This invention also relates, therefore, to a pharmaceutical unit which contains the tablets of the regimen in a synchronized, fixed sequence, wherein the sequence or arrangement of the dosage units corresponds to the regimen of daily administration. 14 WO 03/077926 PCT/USO3/07601 The estrogen and progestogen component may be transdermally administered, preferably together, by use of a patch. Broadly, patches are devices which contain at a minimum a drug reservoir matrix for holding the drug and metering the drug deposition or delivery to the skin, a backing, and an adhesive layer for adhering the device to the 5 patient. The device may contain other layers such as a drug release rate controlling layer for modulating delivery rate, and the like. The device may contain permeation enhancers to increase the rate of penetration of drugs across the skin. Patches are well known and understood by persons skilled in the art. Patches are now employed in marketed products for the administration of certain progestogens and estrogens. 10 Specific patches and even their application to steroids of the type described herein are described in U.S. Pat. Nos. 5474783; 5656286; 5958446; 6024976; 5252334; 5006342; and 4906463. The estrogen and progestogen component may be intravaginally administered, preferably together, by use of a ring. Broadly, rings are devices having an elastomeric 15 portion or body into which the active steroid is dispersed and which acts as a reservoir and meter for the diffusion of active to the lining of the vagina. The ring may be composed entirely of elastomer with steroid homogenously dispersed throughout as described in US Pat. No. 3545397. The ring may have an inert inner core surrounded by an active containing elastomeric layer as described in US Pat. No. 4012496. The 20 ring may have an elastomeric active containing inner core surrounded by a thin elastomeric layer initially containing no active. The ring may have an inert core, surrounded by an active containing elastomeric layer and further surrounded by an elastomeric outer layer of variable thickness initially containing no active as described in US Pat. No. 4292965. The elastomer, the layered design of the ring, its surface area, 25 the concentration of active, the nature of the active, etc. all combine to determine the release rate of active. Rings are well known and understood by persons skilled in the art. Rings are now employed in marketed products for the administration of certain steroids. Further specific rings and their application to steroids of the type described herein are described in U.S. Pat. Nos 4871543 and 5188835. 30 15 WO 03/077926 PCT/US03/07601 BIOLOGICAL TEST METHODS Chemicals [6,7- 3 H(N)]-estrone sulfate ( 3 H-EIS), ammonium salt (sp. act. 53 Ci/mmol) and [4- 1 4 C] -estradiol ( 14

C-E

2 ) (sp. act. 57 mCi/mmol) were purchased from New England 5 Nuclear Division (DuPont de Nemours, Les Ulls, France). The purity of the radioisotopes was assessed by thin-layer chromatography (TLC) in the appropriate system before use. E 1 S, ammonium salt, unlabeled E 1 and E 2 , (analytical grade) were obtained from Sigma-Aldrich Chimle, (St Quentin Fallavier, France). 17 deacetylnorgestimate (NGMN; 13-ethyl- 17-hydroxy- 18,19-dinor- 1 7u-pregn-4-en-20 10 yn-3-one oxime) was a gift from R. W. Johnson Pharmaceutical Research Institute, Medicinal Chemistry Department, (Raritan, NJ, USA); medroxyprogesterone acetate (MPA, 17a-acetoxy-6c-methylprogesterone) was obtained from Sigma-Aldrich Chimie. All other chemicals were of the highest grade commercially available. 15 Cell culture The hormone-dependent MCF-7 and T-47D human mammary cancer cell lines were grown in Eagle's Minimal Essential Medium (MEM) buffered with 10 mmol/1 HEPES (pH 7.6), supplemented with 2 mmol/1 L-glutamine, 100 U/ml penicillin streptomycin and 5% fetal calf serum (FCS) (A.T.G.C., Marne-la-Vall6e, France) for T 20 47D, or 10% FCS for MCF-7 cells, and incubated at 37C n a humidified atmosphere of 5% CO 2 . Media were changed twice a week. The cells were passed every 10-12 days and replated in 75 cm 2 flasks (A.T.G.C.) at 3 x 106 cells/flask. Four days before the experiments, the cells were transferred to MEM containing 5% steroid-depleted treated FCS. The FCS had been treated overnight at 4 C with dextran-coated charcoal 25 (DCC)(0.1-1% w/v, DCC-FCS). The MCF-7 and T-47D cell lines used herein were deposited in accordance with the Budapest Treaty under the references MCF7_JJPRD and T47D JJPRD on May 17, 2002 at The Belgian Co-ordinated Collections of Micro organisms (BCCM), Laboratorium voor Moleculaire Biologie, Universiteit Gent, K. L. Ledeganckstraat 35, B-9000 Gent, Belgium and are publicly available under accession 30 numbers LMBP 5862CB and LMBP 5863CB, respectively. 16 WO 03/077926 PCT/US03/07601 Isolation and quantification of [ 3 H]-estradiol from human mammary cancer cells incubated with [ 3

H]-E

1 S Preconfluent cells were incubated for 4 hours at 37 oC in MEM-DCC-FCS with the addition of 5x10 -9 mol/1 of [ 3

H]-E

1 S, alone (control cells) or in combination with the 5 different compounds: NGMN or MPA, dissolved in ethanol (final concentration < 0.2%), at a range of concentrations of 5x10- -5x10~ 9 mol/1. Control cells received ethanol vehicle only. After 24 hours, the medium was removed, the cells washed twice with ice-cold Hank's Buffered Saline Solution (HBSS, calcium-magnesium free)(A.T.G.C.) and harvested by scraping. After centrifugation, the pallet was treated 10 with 80% ethanol and the radioactivity extracted for at least 24h at -20 oC. The cellular radioactivity uptake was determined in the ethanolic supernatant and the DNA content in the remaining pellet was evaluated according to Burton Biochemn Journal 62:315 323, 1956. [14C]-E 2 (5,000 dpm) was added to monitor analytical losses and unlabeled

E

1 and E 2 (50gg) were used as carriers and reference indicators. In the total ethanolic 15 extracts, E 2 was isolated by thin layer chromatography (TLC) on silica gel 60F 254 (Merck, Darmstadt, Germany), developed with chloroform-ethylacetate (4:1, v/v) system. After visualization of the estrogens under U.V. at 254 nm, the appropriate areas were cut off into small pieces, placed in liquid scintillation vials with ethanol (0.5 ml) and allowed to extract for 30 mn. Three ml of Opti-fluor (Packard, Rungis, France) 20 were added and the vials were analyzed for 3 H and 14 C contents with quench correction by external standarization. The quantitative evaluation of E 2 was calculated as a percentage of the total radioactivity associated with the cells and then expressed as fmol of E 2 formed /mg DNA from E 1 S. 25 Statistical analysis Data are expressed as the mean - standard error of the mean (SEM) values. Student's t-test was used to assess the significance of the differences between means; p values < 0.05 were considered significant. 30 RESULTS Table 3 shows the effects of NGMN and medroxyprogesterone acetate (MPA) concentrations on the conversion of E 1 S to E 2 in the hormone-dependent human breast cancer cell line T-47D The data are the mean + SEM of duplicate determinations of 3 17 WO 03/077926 PCT/USO3/07601 independent experiments. * p < 0.05 vs contol values (non-treated cells); ** p < 0.005 vs contol values (non-treated cells) TABLE 3 T-47D NGMN or MPA NGMN MPA conc 1x10 -6

E

2 formed fmol/mg DNA E 2 formed fmiol/mg DNA mol/1 (% inhibition) (% inhibition) 0 (control) 1805 + 152 (0%) 0.005 1029 + ? (43 + 7%)* 1245 + ? (31 + 5%)* 0.5 469 + ? (74 + 4%)* 957 + ? (47 + 3%)* 50 54 + ? (97 + 2%)** 704 + ? (61 + 3%)* 5 Table 4 shows the effects of NGMN and medroxyprogesterone acetate (MPA) concentrations on the conversion of E 1 S to E 2 in the hormone-dependent human breast cancer cell line MCF-7. The data are the mean + SEM of duplicate determinations of 3 independent experiments. * p < 0.05 vs contol values (non-treated cells); ** p < 0.005 10 vs contol values (non-treated cells) TABLE 4 MCF-7 NGMN or MPA NGMN MPA conc xl10 -6

E

2 formed fmol/mg DNA E 2 formed fmiol/mg DNA mol/l (% inhibition) (% inhibition) 0 / control 2185 + 101 (0%) 0.005 1639 + ? (25 + 4%)* 2054 + ? (6 + 3%) 0.5 940 + ? (57 + 5%)* 1748 + ? (20 + 3%) 50 87 + ? (96 + 2%)** 808 + ? (63 + 4%)* 15 Table 5 shows the IC 50 values for NGMN and medroxyprogesterone acetate (MPA) in the conversion of EIS to E 2 in the hormone-dependent human breast cancer cell lines MCF-7 and T-47D. IC 5 0 values correspond to the 50% inhibition of the conversion of El S to E 2 and were determined using non-linear regression analysis. 18 WO 03/077926 PCT/USO3/07601 TABLE 5

IC

50 so, 1 x 106 mol/1 T-47D MCF-7 NGMN 0.0127 0.178 MPA 2.15 26.1 Having described the invention in specific detail and exemplified the manner in which it may be carried into practice, it will be apparent to those skilled in the art that 5 imnumerable variations, applications, modifications, and extensions of the basic principles involved may be made without departing from its spirit or scope. It is to be understood that the foregoing is merely exemplary and the present invention is not to be limited to the specific form or arrangements of parts herein described and shown. 10 19

Claims (4)

1. A method of contraception comprising the step of administering to a menstruating female a cycle of contraceptive therapy, said cycle of therapy including, 5 for at least 42 successive days, the administration of a combination of an estrogen and a progestogen in a contraceptively effective daily dosage wherein said progestogen is a potent sulfatase inhibiting progestogen and said cycle of therapy including 4-8 days which are free of estrogen administration following said at least 42 successive days.

2. A contraceptive therapy unit for administration to a menstruationg female 10 comprising a cycle of separate dosage units, said cycle of dosage units including at least 42 dosage units adapted for successive daily oral administration, wherein said dosage units contain, in admixture with a pharmaceutically acceptable carrier, a combination of an estrogen and a progestogen in a contraceptively effective daily dosage wherein said progestogen is a potent sulfatase inhibiting progestogen and, optionally, said cycle of 15 dosage units including 4-8 dosage units containing no estrogen.

3. There is also provided by the present invention, a contraceptive therapy unit for administration to a menstruationg female comprising a cycle of transdermal patches, said cycle of transdermal patches including a sufficient number of patches adapted for successive administration to provide for at least 42 successive days of therapy, wherein 20 said transdermal patches contain, in a suitable matrix, a combination of an estrogen and a progestogen for delivery in a contraceptively effective daily dosage wherein said progestogen is a potent sulfatase inhibiting progestogen and, optionally, said cycle of transdermal patches including a patch for 4-8 days of use containing no estrogen.

4. There is also provided by the present invention, a contraceptive therapy unit for 25 administration to a menstruating female comprising a cycle of vaginal rings, said cycle of vaginal rings including a sufficient number of rings adapted for successive administration to provide for at least 42 successive days of therapy, wherein the vaginal rings contain, in a suitable matrix, a combination of an estrogen and a progestogen for delivery in a contraceptively effective daily dosage wherein said progestogen is a potent 30 sulfatase inhibiting progestogen and, optionally, said cycle of vaginal rings including a ring for 4-8 days of use containing no estrogen. 20