Combination pharmaceutical compositions and uses thereof

Abstract

The present invention provides for methods and pharmaceutical compositions for treating proliferative disorders. In one aspect, the method comprises administration of two cell-cycle suppressors having a synergistic effect. In another aspect, two cell-cycle suppressors having a synergistic effect are provided in a pharmaceutical composition.

What is claimed is: 
     
         1 . A method of treating a proliferative disorder comprising administering to a subject a first agent followed by administering to said subject an mTOR inhibitor, wherein said first agent suppresses progression of one or more cell-cycle phases after G1 phase. 
     
     
         2 . The method of  claim 1 , wherein said first agent is administered to said subject before any effective amount of mTor inhibitor is administered to said subject. 
     
     
         3 . The method of  claim 1 , wherein said one or more cell-cycle phases after G1 phase is selected from the group consisting of G2 phase, M phase, and G2/M transition phase. 
     
     
         4 . The method of  claim 1 , wherein said first agent is administered at two or more different times before administering said mTOR inhibitor. 
     
     
         5 . The method of  claim 1 , further comprising administering said first agent one or more times after administering said mTOR inhibitor. 
     
     
         6 . The method of  claim 5 , wherein each administration of said first agent is followed by administering said mTOR inhibitor. 
     
     
         7 . The method of  claim 5 , wherein said first agent is administered weekly for at least two weeks. 
     
     
         8 . The method of  claim 1 , wherein said first agent is a tubulin modulator. 
     
     
         9 . The method of  claim 8 , wherein said tubulin modulator binds to polymerized tubulin. 
     
     
         10 . The method of  claim 8 , wherein said tubulin modulator is paclitaxel or an analogue thereof. 
     
     
         11 . The method of  claim 1 , wherein said first agent and said mTOR inhibitor yield a synergistic effect in treating said proliferative disorder. 
     
     
         12 . The method of  claim 11 , wherein said first agent and/or said mTOR inhibitor is administered in an individually sub-therapeutic amount. 
     
     
         13 . The method of  claim 1 , wherein said proliferative disorder is a neoplastic condition. 
     
     
         14 . The method of  claim 13 , wherein said neoplastic condition is selected from the group consisting of NSCLC, head and neck squamous cell carcinoma, pancreatic cancer, breast cancer, ovarian cancer, Kaposi's sarcoma, renal cell carcinoma, prostate cancer, neuoendocrine cancer, colorectal cancer, and endometrial cancer. 
     
     
         15 . The method of  claim 1 , wherein said mTOR inhibitor inhibits mTORC1 selectively. 
     
     
         16 . The method of  claim 15 , wherein said mTOR inhibitor inhibits mTORC1 with an IC50 value of about 1000 nM or less as ascertained in an in vitro kinase. 
     
     
         17 . The method of  claim 15 , wherein said mTOR inhibitor is rapamycin or an analogue of rapamycin. 
     
     
         18 . The method of  claim 17 , wherein the mTOR inhibitor is sirolimus (rapamycin), deforolimus (AP23573, MK-8669), everolimus (RAD-001), temsirolimus (CCI-779), zotarolimus (ABT-578), or biolimus A9 (umirolimus). 
     
     
         19 . The method of  claim 1 , wherein said mTOR inhibitor binds to and directly inhibits both mTORC1 and mTORC2. 
     
     
         20 . The method of  claim 1 , wherein the mTOR inhibitor inhibits both mTORC1 and mTORC2 with an IC50 value of about 100 nM or less as ascertained in an in vitro kinase assay. 
     
     
         21 . The method of  claim 1 , wherein the mTOR inhibitor inhibits both mTORC1 and mTORC2 with an IC50 value of about 10 nM or less as ascertained in an in vitro kinase assay. 
     
     
         22 . The method of  claim 1 , wherein said mTOR inhibitor is administered more than 6, 12, 18, 24, 30, 36, 42, or 48 hours after said first agent. 
     
     
         23 . The method of  claim 1 , wherein said mTOR inhibitor is administered more than 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or 14 days after said first agent. 
     
     
         24 . The method of  claim 1 , wherein said first agent and/or said mTOR inhibitor are administered parenterally, orally, intraperitoneally, intravenously, intraarterially, transdermally, intramuscularly, liposomally, via local delivery by catheter or stent, subcutaneously, intraadiposally, or intrathecally. 
     
     
         25 . The method of  claim 1 , wherein said mTOR inhibitor is a compound of Formula I: 
       
         
           
           
               
               
           
         
         or a pharmaceutically acceptable salt thereof, wherein: 
         X 1  is N or C-E 1 , X 2  is N or C, X 3  is N or C, X 4  is C—R 9  or N, X 5  is N or C-E 1 , X 6  is C or N, and X 7  is C or N; and wherein no more than two nitrogen ring atoms are adjacent; 
         R 1  is H, -L-C 1-10 alkyl, -L-C 3-8 cycloalkyl, -L-C 1-10 alkyl-C 3-8 cycloalkyl, -L-aryl, -L-heteroaryl, -L-C 1-10 alkylaryl, -L-C 1-10 alkylhetaryl, -L-C 1-10 alkylheterocylyl, -L-C 2-10 alkenyl, -L-C 2-10 alkynyl, -L-C 2-10 alkenyl-C 3-8 cycloalkyl, -L-C 2-10 alkynyl-C 3-8 cycloalkyl, -L-heteroalkyl, -L-heteroalkylaryl, -L-heteroalkylheteroaryl, -L-heteroalkyl-heterocylyl, -L-heteroalkyl-C 3-8 cycloalkyl, -L-aralkyl, -L-heteroaralkyl, or -L-heterocyclyl, each of which is unsubstituted or is substituted by one or more independent R 3 ; 
         L is absent, —(C═O)—, —C(═O)O—, —C(═O) N(R 31 )—, —S—, —S(O)—, —S(O) 2 —, —S(O) 2 N(R 31 )—, or —N(R 31 )—; 
         E 1  and E 2  are independently —(W 1 ) j —R 4 ; 
         M 1  is a 5, 6, 7, 8, 9, or-10 membered ring system, wherein the ring system is monocyclic or bicyclic, substituted with R 5  and additionally optionally substituted with one or more —(W 2 ) k —R 2 ; 
         each k is 0 or 1; 
         j in E 1  or j in E 2 , is independently 0 or 1; 
         W 1  is —O—, —NR 7 —, —S(O) 0-2 —, —C(O)—, —C(O)N(R 7 )—, —N(R 7 )C(O)—, —N(R 7 )S(O)—, —N(R 7 )S(O) 2 —, —C(O)O—, —CH(R 7 )N(C(O)OR 8 )—, —CH(R 7 )N(C(O)R 8 )—, —CH(R 7 )N(SO 2 R)—, —CH(R 7 )N(R 8 )—, —CH(R 7 )C(O)N(R 8 )—, —CH(R 7 )N(R 8 )C(O)—, —CH(R 7 )N(R 8 )S(O)—, or —CH(R 7 )N(R)S(O) 2 —; 
         W 2  is —O—, —NR 7 —, —S(O) 0-2 —, —C(O)—, —C(O)N(R 7 )—, —N(R 7 )C(O)—, —N(R 7 )C(O)N(R 8 )—, —N(R 7 )S(O)—, —N(R 7 )S(O) 2 —, —C(O)O—, —CH(R 7 )N(C(O)OR 8 )—, —CH(R 7 )N(C(O)R 8 )—, —CH(R 7 )N(SO 2 R)—, —CH(R 7 )N(R 8 )—, —CH(R 7 )C(O)N(R 8 )—, —CH(R 7 )N(R 8 )C(O)—, —CH(R 7 )N(R 8 )S(O)—, or —CH(R 7 )N(R)S(O) 2 —; 
         R 2  is hydrogen, halogen, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , —C(═S)OR 31 , —C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , NR 31 C(═NR 3 R 32 )OR 3 , NR 31 C(═NR 32 )SR 33 , —OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 31 OR 32 , —SC(═O)NR 31 R 32 , aryl (e.g. bicyclic aryl, unsubstituted aryl, or substituted monocyclic aryl), hetaryl, C 1-10 alkyl, C 3-8 cycloalkyl, C 1-10 alkyl-C 3-8 cycloalkyl, C 3-8 cycloalkyl-C 1-10 alkyl, C 3-8 cycloalkyl-C 2-10 alkenyl, C 3-8 cycloalkyl-C 2-10 alkynyl, C 1-10 alkyl-C 2-10 alkenyl, C 1-10 alkyl-C 2-10 alkynyl, C 1-10 alkylaryl (e.g. C 2-10 alkyl-monocyclic aryl, C 1-10 alkyl-substituted monocyclic aryl, or C 1-10 alkylbicycloaryl), C 1-10 alkylhetaryl, C 1-10 alkylheterocyclyl, C 2-10 alkenyl, C 2-10 alkynyl, C 2-10 alkenyl-C 1-10 alkyl, C 2-10 alkynyl-C 1-10 alkyl, C 2-10 alkenylaryl, C 2-10 alkenylhetaryl, C 2-10 alkenylheteroalkyl, C 2-10 alkenylheterocyclcyl, C 2-10 alkenyl-C 3-8 cycloalkyl, C 2-10 alkynylaryl, C 2-10 alkynylhetaryl, C 2-10 alkynylheteroalkyl, C 2-10 alkynylheterocylyl, C 2-10 alkynyl-C 3-8 cycloalkenyl, C 1-10 alkoxy C 1-10 alkyl, C 1-10 alkoxy-C 2-10 alkenyl, C 1-10 alkoxy-C 2-10 alkynyl, heterocyclyl, heteroalkyl, heterocyclyl-C 1-10 alkyl, heterocyclyl-C 2-10 alkenyl, heterocyclyl-C 2-10 alkynyl, aryl-C 1-10 alkyl (e.g. monocyclic aryl-C 2-10 alkyl, substituted monocyclic aryl-C 1-10 alkyl, or bicycloaryl-C 1-10 alkyl), aryl-C 2-10 alkenyl, aryl-C 2-10 alkynyl, aryl-heterocyclyl, hetaryl-C 1-10 alkyl, hetaryl-C 2-10 alkenyl, hetaryl-C 2-10 alkynyl, hetaryl-C 3-8 cycloalkyl, hetaryl-heteroalkyl, or hetaryl-heterocyclyl, wherein each of said bicyclic aryl or heteroaryl moiety is unsubstituted, or wherein each of bicyclic aryl, heteroaryl moiety or monocyclic aryl moiety is substituted with one or more independent alkyl, heteroalkyl, alkenyl, alkynyl, cycloalkyl, heterocycloalkyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, halo, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , —C(═S)OR 31 , —C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , —NR 31 C(═NR 32 )OR 33 , —NR 31 C(═NR 32 )SR 33 , —OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 310 R 32 , or —SC(═O)NR 31 R 32  and wherein each of said alkyl, cycloalkyl, heterocyclyl, or heteroalkyl moiety is unsubstituted or is substituted with one or more alkyl, heteroalkyl, alkenyl, alkynyl, cycloalkyl, heterocycloalkyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, halo, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —O-aryl, —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 34 R 35 , or —C(═O)NR 31 R 32 ; 
         R 3  and R 4  are independently hydrogen, halogen, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , —C(═S)OR 31 , C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , —NR 31 C(═NR 32 )OR 33 , —R 31 C(═NR 32 ) SR 33 , —OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 31 OR 32 , —SC(═O)NR 31 R 32 , aryl, hetaryl, C 1-4 alkyl, C 1-10 alkyl, C 3-8 cycloalkyl, C 1-10 alkyl-C 3-8 cycloalkyl, C 3-8 cycloalkyl-C 1-10 alkyl, C 3-8 cycloalkyl-C 2-10 alkenyl, C 3-8 cycloalkyl-C 2-10 alkynyl, C 1-10 alkyl-C 2-10 alkenyl, C 1-10 alkyl-C 2-10 alkynyl, C 1-10 alkylaryl, C 1-10 alkylhetaryl, C 1-10 alkylheterocyclyl, C 2-10 alkenyl, C 2-10 alkynyl, C 2-10 alkenyl-C 1-10 alkyl, C 2-10 alkynyl-C 1-10 alkyl, C 2-10 alkenylaryl, C 2-10 alkenylhetaryl, C 2-10 alkenylheteroalkyl, C 2-10 alkenylheterocyclcyl, C 2-10 alkenyl-C 3-8 cycloalkyl, C 2-10 alkynyl-C 3-8 cycloalkyl, C 2-10 alkynylaryl, C 2-10 alkynylhetaryl, C 2-10 alkynylheteroalkyl, C 2-10 alkynylheterocylyl, C 2-10 alkynyl-C 3-8 cycloalkenyl, C 1-10 alkoxy C 1-10 alkyl, C 1-10 alkoxy-C 2-10 alkenyl, C 1-10 alkoxy-C 2-10 alkynyl, heterocyclyl, heterocyclyl-C 1-10 alkyl, heterocyclyl-C 2-10 alkenyl, heterocyclyl-C 2-10 alkynyl, aryl-C 1-10 alkyl, aryl-C 2-10 alkenyl, aryl-C 2-10 alkynyl, aryl-heterocyclyl, hetaryl-C 1-10 alkyl, hetaryl-C 2-10 alkenyl, hetaryl-C 2-10 alkynyl, hetaryl-C 3-8 cycloalkyl, heteroalkyl, hetaryl-heteroalkyl, or hetaryl-heterocyclyl, wherein each of said aryl or heteroaryl moiety is unsubstituted or is substituted with one or more independent halo, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , C(═S)OR 31 , —C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , —NR 31 C(═NR 32 )OR 33 , —NR 31 C(═NR 32 )SR 33 , OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 310 R 32 , or —SC(═O)NR 31 R 32 , and wherein each of said alkyl, cycloalkyl, heterocyclyl, or heteroalkyl moiety is unsubstituted or is substituted with one or more halo, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —O-aryl, —NR 31 R 32 , NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 34 R 35 , or —C(═O)NR 31 R 32 ; 
         R 5  is hydrogen, halogen, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , NR 31 R 32 , NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , —C(═S)OR 31 , —C(═O)SR 31 , NR 31 C(═NR 32 )NR 33 R 32 , —NR 31 C(═NR 32 )OR 33 , —NR 31 C(═NR 32 )SR 33 , —OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 31 OR 32 , or —SC(═O)NR 31 R 32 ; 
         each of R 31 , R 32 , and R 33  is independently H or C 1-10 alkyl, wherein the C 1-10 alkyl is unsubstituted or is substituted with one or more aryl, heteroalkyl, heterocyclyl, or hetaryl group, wherein each of said aryl, heteroalkyl, heterocyclyl, or hetaryl group is unsubstituted or is substituted with one or more halo, —OH, —C 1-10 alkyl, —CF 3 , —O-aryl, —OCF 3 , —OC 1-10 alkyl, —NH 2 , —N(C 1-10 alkyl)(C 1-10 alkyl), —NH(C 1-10 alkyl), —NH(aryl), —NR 34 R 35 , —C(O)(C 1-10 alkyl), —C(O)(C 1-10 alkyl-aryl), —C(O)(aryl), —CO 2 —C 1-10 alkyl, —CO 2 —C 1-10 alkylaryl, —CO 2 -aryl, —C(═O)N(C 1-10 alkyl)(C 1-10 alkyl), —C(═O)NH(C 1-10 alkyl), —C(═O)NR 34 R 35 , —C(═O)NH 2 , —OCF 3 , —O(C 1-10 alkyl), —O-aryl, —N(aryl)(C 1-10 alkyl), —NO 2 , —CN, —S(O) 0-2 C 1-10 alkyl, —S(O) 0-2 C 1-10 alkylaryl, —S(O) 0-2  aryl, —SO 2 N(aryl), —SO 2 N(C 1-10 alkyl)(C 1-10 alkyl), —SO 2 NH(C 1-10 alkyl) or —SO 2 NR 34 R 35 ; 
         R 34  and R 35  in —NR 34 R 35 , —C(═O)NR 34 R 3 , or —SO 2 NR 34 R 35 , are taken together with the nitrogen atom to which they are attached to form a 3-10 membered saturated or unsaturated ring; wherein said ring is independently unsubstituted or is substituted by one or more —NR 31 R 32 , hydroxyl, halogen, oxo, aryl, hetaryl, C 1-6 alkyl, or O-aryl, and wherein said 3-10 membered saturated or unsaturated ring independently contains 0, 1, or 2 more heteroatoms in addition to the nitrogen atom; 
         each of R 7  and R 8  is independently hydrogen, C 1-10 alkyl, C 2-10 alkenyl, aryl, heteroaryl, heterocyclyl or C 3-10 cycloalkyl, each of which except for hydrogen is unsubstituted or is substituted by one or more independent R 6 ; 
         R 6  is halo, —OR 31 , —SH, —NH 2 , —NR 34 R 35 , —NR 31 R 32 , —CO 2 R 31 , —CO 2 aryl, —C(═O)NR 31 R 32 , C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 C 1-10 alkyl, —S(O) 0-2 aryl, —SO 2 NR 34 R 35 , —SO 2 NR 31 R 32 , C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl; aryl-C 1-10 alkyl, aryl-C 2-10 alkenyl, aryl-C 2-10 alkynyl, hetaryl-C 1-10 alkyl, hetaryl-C 2-10 alkenyl, hetaryl-C 2-10 alkynyl, wherein each of said alkyl, alkenyl, alkynyl, aryl, heteroalkyl, heterocyclyl, or hetaryl group is unsubstituted or is substituted with one or more independent halo, cyano, nitro, —OC 1-10 alkyl, C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl, haloC 1-10 alkyl, haloC 2-10 alkenyl, haloC 2-10 alkynyl, —COOH, —C(═O)NR 31 R 32 , —C(═O)NR 3 R 35 , —SO 2 NR 34 R 35 , —SO 2 NR 31 R 32 , NR 31 R 32 , or —NR 34 R 35 ; and 
         R 9  is H, halo, —OR 31 , —SH, —NH 2 , —NR 34 R 35 , —NR 31 R 32 , —CO 2 R 31 , —CO 2 aryl, —C(═O)NR 31 R 32 , C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 C 1-10 alkyl, —S(O) 0-2 aryl, —SO 2 NR 34 R 35 , —SO 2 NR 31 R 32 , C 10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl; aryl-C 1-10 alkyl, aryl-C 2-10 alkenyl, aryl-C 2-10 alkynyl, hetaryl-C 1-10 alkyl, hetaryl-C 2-10 alkenyl, hetaryl-C 2-10 alkynyl, wherein each of said alkyl, alkenyl, alkynyl, aryl, heteroalkyl, heterocyclyl, or hetaryl group is unsubstituted or is substituted with one or more independent halo, cyano, nitro, —OC 1-10 alkyl, C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl, haloC 1-10 alkyl, haloC 2-10 alkenyl, haloC 2-10 alkynyl, —COOH, —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —SO 2 NR 34 R 35 , —SO 2 NR 3 R 32 , NR 31 R 32 , or —NR 34 R 35 . 
       
     
     
         26 . A pharmaceutical composition comprising a combination of an amount of a first agent and an amount of an mTOR inhibitor, wherein (i) said first agent suppresses progression of one or more cell-cycle phases after G1 phase, and (ii) said pharmaceutical composition is formulated to release said mTOR inhibitor after releasing said first agent. 
     
     
         27 . The method of  claim 26 , wherein said one or more cell-cycle phases after G1 phase is selected from the group consisting of G2, M, and G2/M transition. 
     
     
         28 . The pharmaceutical composition of  claim 26  formulated in an oral dosage or in a drug eluting stent. 
     
     
         29 . The pharmaceutical composition of  claim 26 , wherein said first agent and/or said mTOR inhibitor is present in a sub-therapeutic amount. 
     
     
         30 . The pharmaceutical composition of  claim 26 , wherein said first agent is a tubulin modulator. 
     
     
         31 . The pharmaceutical composition of  claim 30 , wherein said tubulin modulator binds to polymerized tubulin. 
     
     
         32 . The pharmaceutical composition of  claim 30 , wherein said tubulin modulator is paclitaxel or an analogue thereof. 
     
     
         33 . The pharmaceutical composition of  claim 26 , wherein said mTOR inhibitor inhibits mTORC1 selectively. 
     
     
         34 . The pharmaceutical composition of  claim 33 , wherein said mTOR inhibitor inhibits mTORC1 with an IC50 value of about 1000 nM or less as ascertained in an in vitro kinase. 
     
     
         35 . The pharmaceutical composition of  claim 33 , wherein said mTOR inhibitor is rapamycin or an analogue of rapamycin. 
     
     
         36 . The pharmaceutical composition of  claim 35 , wherein the mTOR inhibitor is sirolimus (rapamycin), deforolimus (AP23573, MK-8669), everolimus (RAD-001), temsirolimus (CCI-779), zotarolimus (ABT-578), or biolimus A9 (umirolimus). 
     
     
         37 . The pharmaceutical composition of  claim 26 , wherein said mTOR inhibitor binds to and directly inhibits both mTORC1 and mTORC2. 
     
     
         38 . The pharmaceutical composition of  claim 26 , wherein the mTOR inhibitor inhibits both mTORC1 and mTORC2 with an IC50 value of about 100 nM or less as ascertained in an in vitro kinase assay. 
     
     
         39 . The pharmaceutical composition of  claim 26 , wherein the mTOR inhibitor inhibits both mTORC1 and mTORC2 with an IC50 value of about 10 nM or less as ascertained in an in vitro kinase assay. 
     
     
         40 . The pharmaceutical composition of  claim 26 , wherein said mTOR inhibitor is a compound of Formula I: 
       
         
           
           
               
               
           
         
         or a pharmaceutically acceptable salt thereof, wherein: 
         X 1  is N or C-E 1 , X 2  is N or C, X 3  is N or C, X 4  is C—R 9  or N, X 5  is N or C-E 1 , X 6  is C or N, and X 7  is C or N; and wherein no more than two nitrogen ring atoms are adjacent; 
         R 1  is H, -L-C 1-10 alkyl, -L-C 3-8 cycloalkyl, -L-C 1-10 alkyl-C 3-8 cycloalkyl, -L-aryl, -L-heteroaryl, -L-C 1-10 alkylaryl, -L-C 1-10 alkylhetaryl, -L-C 1-10 alkylheterocylyl, -L-C 2-10 alkenyl, -L-C 2-10 alkynyl, -L-C 2-10 alkenyl-C 3-8 cycloalkyl, -L-C 2-10 alkynyl-C 3-8 cycloalkyl, -L-heteroalkyl, -L-heteroalkylaryl, -L-heteroalkylheteroaryl, -L-heteroalkyl-heterocylyl, -L-heteroalkyl-C 3-8 cycloalkyl, -L-aralkyl, -L-heteroaralkyl, or -L-heterocyclyl, each of which is unsubstituted or is substituted by one or more independent R 3 ; 
         L is absent, —(C═O)—, —C(═O)O—, —C(═O) N(R 31 )—, —S—, —S(O)—, —S(O) 2 —, —S(O) 2 N(R 31 )—, or —N(R 31 )—; 
         E 1  and E 2  are independently —(W 1 ) j —R 4 ; 
         M 1  is a 5, 6, 7, 8, 9, or-10 membered ring system, wherein the ring system is monocyclic or bicyclic, substituted with R 5  and additionally optionally substituted with one or more —(W 2 ) k —R 2 ; 
         each k is 0 or 1; 
         j in E 1  or j in E 2 , is independently 0 or 1; 
         W 1  is —O—, —NR 7 —, —S(O) 0-2 —, —C(O)—, —C(O)N(R 7 )—, —N(R 7 )C(O)—, —N(R 7 )S(O)—, —N(R 7 )S(O) 2 —, —C(O)O—, —CH(R 7 )N(C(O)OR 8 )—, —CH(R 7 )N(C(O)R 8 )—, —CH(R 7 )N(SO 2 R 8 )—, —CH(R 7 )N(R 8 )—, —CH(R 7 )C(O)N(R 8 )—, —CH(R 7 )N(R 8 )C(O)—, —CH(R 7 )N(R 8 )S(O)—, or —CH(R 7 )N(R 8 )S(O) 2 —; 
         W 2  is —O—, —NR 7 —, —S(O) 0-2 —, —C(O)—, —C(O)N(R 7 )—, —N(R 7 )C(O)—, —N(R 7 )C(O)N(R 8 )—, —N(R 7 )S(O)—, —N(R 7 )S(O) 2 —, —C(O)O—, —CH(R 7 )N(C(O)OR 8 )—, —CH(R 7 )N(C(O)R 8 )—, —CH(R 7 )N(SO 2 R 8 )—, —CH(R 7 )N(R 8 )—, —CH(R 7 )C(O)N(R 8 )—, —CH(R 7 )N(R 8 )C(O)—, —CH(R 7 )N(R 8 )S(O)—, or —CH(R 7 )N(R)S(O) 2 —; 
         R 2  is hydrogen, halogen, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , —C(═S)OR 31 , —C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , NR 31 C(═NR 3 R 32 )OR 3 , NR 31 C(═NR 32 )SR 33 , —OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 31 OR 32 , —SC(═O)NR 31 R 32 , aryl (e.g. bicyclic aryl, unsubstituted aryl, or substituted monocyclic aryl), hetaryl, C 1-10 alkyl, C 3-8 cycloalkyl, C 1-10 alkyl-C 3-8 cycloalkyl, C 3-8 cycloalkyl-C 1-10 alkyl, C 3-8 cycloalkyl-C 2-10 alkenyl, C 3-8 cycloalkyl-C 2-10 alkynyl, C 1-10 alkyl-C 2-10 alkenyl, C 1-10 alkyl-C 2-10 alkynyl, C 1-10 alkylaryl (e.g. C 2-10 alkyl-monocyclic aryl, C 1-10 alkyl-substituted monocyclic aryl, or C 1-10 alkylbicycloaryl), C 1-10 alkylhetaryl, C 1-10 alkylheterocyclyl, C 2-10 alkenyl, C 2-10 alkynyl, C 2-10 alkenyl-C 1-10 alkyl, C 2-10 alkynyl-C 1-10 alkyl, C 2-10 alkenylaryl, C 2-10 alkenylhetaryl, C 2-10 alkenylheteroalkyl, C 2-10 alkenylheterocyclcyl, C 2-10 alkenyl-C 3-8 cycloalkyl, C 2-10 alkynylaryl, C 2-10 alkynylhetaryl, C 2-10 alkynylheteroalkyl, C 2-10 alkynylheterocylyl, C 2-10 alkynyl-C 3-8 cycloalkenyl, C 1-10 alkoxy C 1-10 alkyl, C 1-10 alkoxy-C 2-10 alkenyl, C 1-10 alkoxy-C 2-10 alkynyl, heterocyclyl, heteroalkyl, heterocyclyl-C 1-10 alkyl, heterocyclyl-C 2-10 alkenyl, heterocyclyl-C 2-10 alkynyl, aryl-C 1-10 alkyl (e.g. monocyclic aryl-C 2-10 alkyl, substituted monocyclic aryl-C 1-10 alkyl, or bicycloaryl-C 1-10 alkyl), aryl-C 2-10 alkenyl, aryl-C 2-10 alkynyl, aryl-heterocyclyl, hetaryl-C 1-10 alkyl, hetaryl-C 2-10 alkenyl, hetaryl-C 2-10 alkynyl, hetaryl-C 3-8 cycloalkyl, hetaryl-heteroalkyl, or hetaryl-heterocyclyl, wherein each of said bicyclic aryl or heteroaryl moiety is unsubstituted, or wherein each of bicyclic aryl, heteroaryl moiety or monocyclic aryl moiety is substituted with one or more independent alkyl, heteroalkyl, alkenyl, alkynyl, cycloalkyl, heterocycloalkyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, halo, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , C(═S)OR 31 , —C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , —NR 31 C(═NR 32 )OR 33 , —NR 31 C(═NR 32 )SR 33 , OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 31 OR 32 , or —SC(═O)NR 31 R 32  and wherein each of said alkyl, cycloalkyl, heterocyclyl, or heteroalkyl moiety is unsubstituted or is substituted with one or more alkyl, heteroalkyl, alkenyl, alkynyl, cycloalkyl, heterocycloalkyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, halo, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —O-aryl, —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 34 R 35 , or —C(═O)NR 31 R 32 ; 
         R 3  and R 4  are independently hydrogen, halogen, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , —C(═S)OR 31 , C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , —NR 31 C(═NR 32 )OR 33 , —NR 31 C(═NR 32 )SR 33 , —OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 31 OR 32 , —SC(═O)NR 31 R 32 , aryl, hetaryl, C 1-4 alkyl, C 1-10 alkyl, C 3-8 cycloalkyl, C 1-10 alkyl-C 3-8 cycloalkyl, C 3-8 cycloalkyl-C 1-10 alkyl, C 3-8 cycloalkyl-C 2-10 alkenyl, C 3-8 cycloalkyl-C 2-10 alkynyl, C 1-10 alkyl-C 2-10 alkenyl, C 1-10 alkyl-C 2-10 alkynyl, C 1-10 alkylaryl, C 1-10 alkylhetaryl, C 1-10 alkylheterocyclyl, C 2-10 alkenyl, C 2-10 alkynyl, C 2-10 alkenyl-C 1-10 alkyl, C 2-10 alkynyl-C 1-10 alkyl, C 2-10 alkenylaryl, C 2-10 alkenylhetaryl, C 2-10 alkenylheteroalkyl, C 2-10 alkenylheterocyclcyl, C 2-10 alkenyl-C 3-8 cycloalkyl, C 2-10 alkynyl-C 3-8 cycloalkyl, C 2-10 alkynylaryl, C 2-10 alkynylhetaryl, C 2-10 alkynylheteroalkyl, C 2-10 alkynylheterocylyl, C 2-10 alkynyl-C 3-8 cycloalkenyl, C 1-10 alkoxy C 1-10 alkyl, C 1-10 alkoxy-C 2-10 alkenyl, C 1-10 alkoxy-C 2-10 alkynyl, heterocyclyl, heterocyclyl-C 1-10 alkyl, heterocyclyl-C 2-10 alkenyl, heterocyclyl-C 2-10 alkynyl, aryl-C 1-10 alkyl, aryl-C 2-10 alkenyl, aryl-C 2-10 alkynyl, aryl-heterocyclyl, hetaryl-C 1-10 alkyl, hetaryl-C 2-10 alkenyl, hetaryl-C 2-10 alkynyl, hetaryl-C 3-8 cycloalkyl, heteroalkyl, hetaryl-heteroalkyl, or hetaryl-heterocyclyl, wherein each of said aryl or heteroaryl moiety is unsubstituted or is substituted with one or more independent halo, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —NR 31 S(O) 0-2 R 32 , C(═S)OR 31 , —C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , —NR 31 C(═NR 32 )OR 33 , —NR 31 C(═NR 32 )SR 33 , OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 31 OR 32 , or —SC(═O)NR 31 R 32  and wherein each of said alkyl, cycloalkyl, heterocyclyl, or heteroalkyl moiety is unsubstituted or is substituted with one or more halo, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —O-aryl, —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 34 R 35 , or —C(═O)NR 31 R 32 ; 
         R 5  is hydrogen, halogen, —OH, —R 31 , —CF 3 , —OCF 3 , —OR 31 , —NR 31 R 32 , —NR 34 R 35 , —C(O)R 31 , —CO 2 R 31 , —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 R 31 , —SO 2 NR 31 R 32 , —SO 2 NR 34 R 35 , —NR 31 C(═O)R 32 , —NR 31 C(═O)OR 32 , —NR 31 C(═O)NR 32 R 33 , —R 31 S(O) 0-2 R 32 , —C(═S)OR 31 , —C(═O)SR 31 , —NR 31 C(═NR 32 )NR 33 R 32 , —NR 31 C(═NR 32 )OR 33 , —NR 31 C(═NR 32 )SR 33 , —OC(═O)OR 33 , —OC(═O)NR 31 R 32 , —OC(═O)SR 31 , —SC(═O)OR 31 , —P(O)OR 31 OR 32 , or —SC(═O)NR 31 R 32 ; 
         each of R 31 , R 32 , and R 33  is independently H or C 1-10 alkyl, wherein the C 1-10 alkyl is unsubstituted or is substituted with one or more aryl, heteroalkyl, heterocyclyl, or hetaryl group, wherein each of said aryl, heteroalkyl, heterocyclyl, or hetaryl group is unsubstituted or is substituted with one or more halo, —OH, —C 1-10 alkyl, —CF 3 , —O-aryl, —OCF 3 , —OC 1-10 alkyl, —NH 2 , —N(C 1-10 alkyl)(C 1-10 alkyl), —NH(C 1-10 alkyl), —NH(aryl), —NR 34 R 35 , —C(O)(C 1-10 alkyl), —C(O)(C 1-10 alkyl-aryl), —C(O)(aryl), —CO 2 —C 1-10 alkyl, —CO 2 —C 1-10 alkylaryl, —CO 2 -aryl, —C(═O)N(C 1-10  alkyl)(C 1-10 alkyl), —C(═O)NH(C 1-10 alkyl), —C(═O)NR 34 R 35 , —C(═O)NH 2 , —OCF 3 , —O(C 1-10 alkyl), —O-aryl, —N(aryl)(C 1-10 alkyl), —NO 2 , —CN, —S(O) 0-2  C 1-10 alkyl, —S(O) 0-2 C 1-10 alkylaryl, —S(O) 0-2  aryl, —SO 2 N(aryl), —SO 2 N(C 1-10 alkyl)(C 1-10 alkyl), —SO 2 NH(C 1-10 alkyl) or —SO 2 NR 34 R 35 ; 
         R 34  and R 35  in —NR 34 R 35 , —C(═O)NR 34 R 35 , or —SO 2 NR 34 R 35 , are taken together with the nitrogen atom to which they are attached to form a 3-10 membered saturated or unsaturated ring; wherein said ring is independently unsubstituted or is substituted by one or more —NR 31 R 32 , hydroxyl, halogen, oxo, aryl, hetaryl, C 1-6 alkyl, or O-aryl, and wherein said 3-10 membered saturated or unsaturated ring independently contains 0, 1, or 2 more heteroatoms in addition to the nitrogen atom; 
         each of R 7  and R 8  is independently hydrogen, C 1-10 alkyl, C 2-10 alkenyl, aryl, heteroaryl, heterocyclyl or C 3-10 cycloalkyl, each of which except for hydrogen is unsubstituted or is substituted by one or more independent R 6 ; 
         R 6  is halo, —OR 31 , —SH, —NH 2 , —NR 34 R 35 , —NR 31 R 32 , —CO 2 R 31 , —CO 2 aryl, —C(═O)NR 31 R 32 , C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 C 1-10 alkyl, —S(O) 0-2 aryl, —SO 2 NR 34 R 35 , —SO 2 NR 31 R 32 , C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl; aryl-C 1-10 alkyl, aryl-C 2-10 alkenyl, aryl-C 2-10 alkynyl, hetaryl-C 1-10 alkyl, hetaryl-C 2-10 alkenyl, hetaryl-C 2-10 alkynyl, wherein each of said alkyl, alkenyl, alkynyl, aryl, heteroalkyl, heterocyclyl, or hetaryl group is unsubstituted or is substituted with one or more independent halo, cyano, nitro, —OC 1-10 alkyl, C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl, haloC 1-10 alkyl, haloC 2-10 alkenyl, haloC 2-10 alkynyl, —COOH, —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —SO 2 NR 34 R 35 , —SO 2 NR 31 R 32 , NR 31 R 32 , or —NR 34 R 35 ; and 
         R 9  is H, halo, —OR 31 , —SH, —NH 2 , —NR 34 R 35 , —NR 31 R 32 , —CO 2 R 31 , —CO 2 aryl, —C(═O)NR 31 R 32 , C(═O)NR 34 R 35 , —NO 2 , —CN, —S(O) 0-2 C 1-10 alkyl, —S(O) 0-2 aryl, —SO 2 NR 34 R 35 , —SO 2 NR 31 R 32 , C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl; aryl-C 1-10 alkyl, aryl-C 2-10 alkenyl, aryl-C 2-10 alkynyl, hetaryl-C 1-10 alkyl, hetaryl-C 2-10 alkenyl, hetaryl-C 2-10 alkynyl, wherein each of said alkyl, alkenyl, alkynyl, aryl, heteroalkyl, heterocyclyl, or hetaryl group is unsubstituted or is substituted with one or more independent halo, cyano, nitro, —OC 1-10 alkyl, C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl, haloC 1-10 alkyl, haloC 2-10 alkenyl, haloC 2-10 alkynyl, —COOH, —C(═O)NR 31 R 32 , —C(═O)NR 34 R 35 , —SO 2 NR 34 R 35 , —SO 2 NR 31 R 32 , NR 31 R 32 , or —NR 34 R 35 .