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Di Francia R, Crisci S, De Monaco A, Cafiero C, Re A, Iaccarino G, De Filippi R, Frigeri F, Corazzelli G, Micera A, Pinto A. Response and Toxicity to Cytarabine Therapy in Leukemia and Lymphoma: From Dose Puzzle to Pharmacogenomic Biomarkers. Cancers (Basel) 2021; 13:cancers13050966. [PMID: 33669053 PMCID: PMC7956511 DOI: 10.3390/cancers13050966] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary In this review, the authors propose a crosswise examination of cytarabine-related issues ranging from the spectrum of clinical activity and severe toxicities, through updated cellular pharmacology and drug formulations, to the genetic variants associated with drug-induced phenotypes. Cytarabine (cytosine arabinoside; Ara-C) in multiagent chemotherapy regimens is often used for leukemia or lymphoma treatments, as well as neoplastic meningitis. Chemotherapy regimens can induce a suboptimal clinical outcome in a fraction of patients. The individual variability in clinical response to Leukemia & Lymphoma treatments among patients appears to be associated with intracellular accumulation of Ara-CTP due to genetic variants related to metabolic enzymes. The review provides exhaustive information on the effects of Ara-C-based therapies, the adverse drug reaction will also be provided including bone pain, ocular toxicity (corneal pain, keratoconjunctivitis, and blurred vision), maculopapular rash, and occasional chest pain. Evidence for predicting the response to cytarabine-based treatments will be highlighted, pointing at their significant impact on the routine management of blood cancers. Abstract Cytarabine is a pyrimidine nucleoside analog, commonly used in multiagent chemotherapy regimens for the treatment of leukemia and lymphoma, as well as for neoplastic meningitis. Ara-C-based chemotherapy regimens can induce a suboptimal clinical outcome in a fraction of patients. Several studies suggest that the individual variability in clinical response to Leukemia & Lymphoma treatments among patients, underlying either Ara-C mechanism resistance or toxicity, appears to be associated with the intracellular accumulation and retention of Ara-CTP due to genetic variants related to metabolic enzymes. Herein, we reported (a) the latest Pharmacogenomics biomarkers associated with the response to cytarabine and (b) the new drug formulations with optimized pharmacokinetics. The purpose of this review is to provide readers with detailed and comprehensive information on the effects of Ara-C-based therapies, from biological to clinical practice, maintaining high the interest of both researcher and clinical hematologist. This review could help clinicians in predicting the response to cytarabine-based treatments.
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Affiliation(s)
- Raffaele Di Francia
- Italian Association of Pharmacogenomics and Molecular Diagnostics, 60126 Ancona, Italy;
| | - Stefania Crisci
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
| | - Angela De Monaco
- Clinical Patology, ASL Napoli 2 Nord, “S.M. delle Grazie Hospital”, 80078 Pozzuoli, Italy;
| | - Concetta Cafiero
- Medical Oncology, S.G. Moscati, Statte, 74010 Taranto, Italy
- Correspondence: or (C.C.); (A.M.); Tel.:+39-34-0101-2002 (C.C.); +39-06-4554-1191 (A.M.)
| | - Agnese Re
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giancarla Iaccarino
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
| | - Rosaria De Filippi
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | | | - Gaetano Corazzelli
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences, IRCCS—Fondazione Bietti, 00184 Rome, Italy
- Correspondence: or (C.C.); (A.M.); Tel.:+39-34-0101-2002 (C.C.); +39-06-4554-1191 (A.M.)
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
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Fattahi N, Shahbazi MA, Maleki A, Hamidi M, Ramazani A, Santos HA. Emerging insights on drug delivery by fatty acid mediated synthesis of lipophilic prodrugs as novel nanomedicines. J Control Release 2020; 326:556-598. [PMID: 32726650 DOI: 10.1016/j.jconrel.2020.07.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/25/2022]
Abstract
Many drug molecules that are currently in the market suffer from short half-life, poor absorption, low specificity, rapid degradation, and resistance development. The design and development of lipophilic prodrugs can provide numerous benefits to overcome these challenges. Fatty acids (FAs), which are lipophilic biomolecules constituted of essential components of the living cells, carry out many necessary functions required for the development of efficient prodrugs. Chemical conjugation of FAs to drug molecules may change their pharmacodynamics/pharmacokinetics in vivo and even their toxicity profile. Well-designed FA-based prodrugs can also present other benefits, such as improved oral bioavailability, promoted tumor targeting efficiency, controlled drug release, and enhanced cellular penetration, leading to improved therapeutic efficacy. In this review, we discuss diverse drug molecules conjugated to various unsaturated FAs. Furthermore, various drug-FA conjugates loaded into various nanostructure delivery systems, including liposomes, solid lipid nanoparticles, emulsions, nano-assemblies, micelles, and polymeric nanoparticles, are reviewed. The present review aims to inspire readers to explore new avenues in prodrug design based on the various FAs with or without nanostructured delivery systems.
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Affiliation(s)
- Nadia Fattahi
- Department of Chemistry, Faculty of Science, University of Zanjan, P.O. Box 45195-313, Zanjan, Iran; Trita Nanomedicine Research Center (TNRC), Trita Third Millennium Pharmaceuticals, 45331-55681 Zanjan, Iran
| | - Mohammad-Ali Shahbazi
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki FI-00014, Finland; Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran; Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC), Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Aziz Maleki
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran; Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC), Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehrdad Hamidi
- Trita Nanomedicine Research Center (TNRC), Trita Third Millennium Pharmaceuticals, 45331-55681 Zanjan, Iran; Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran; Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC), Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Ali Ramazani
- Department of Chemistry, Faculty of Science, University of Zanjan, P.O. Box 45195-313, Zanjan, Iran; Research Institute of Modern Biological Techniques (RIMBT), University of Zanjan, P.O. Box 45195-313, Zanjan, Iran
| | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki FI-00014, Finland; Helsinki Institute of Life Science (HiLIFE), Faculty of Pharmacy, University of Helsinki, Helsinki FI-00014, Finland.
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Signorell RD, Luciani P, Brambilla D, Leroux JC. Pharmacokinetics of lipid-drug conjugates loaded into liposomes. Eur J Pharm Biopharm 2018; 128:188-199. [PMID: 29678733 DOI: 10.1016/j.ejpb.2018.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/01/2018] [Accepted: 04/04/2018] [Indexed: 01/02/2023]
Abstract
Drugs that are neither lipophilic nor suitable for encapsulation via remote loading procedures are generally characterized by low entrapment efficiencies and poor retention in liposomes. One approach to circumvent this problem consists in covalently linking a lipid to the drug molecule in order to permit its insertion into the vesicle membrane. The nature of the conjugated lipid and linker, as well as the composition of the liposomal bilayer were found to have a profound impact on the pharmacokinetic properties and biodistribution of the encapsulated drugs as well as on their biological activity. This contribution reviews the past and recent developments on liposomal lipid-drug conjugates, and discusses important issues related to their stability and in vivo performance. It also provides an overview of the data that were generated during the clinical assessment of these formulations. The marketing authorization of the immunomodulating compound mifamurtide in several countries as well as the promising results obtained with the lipid prodrug of mitomycin C suggest that carefully designed liposomal formulations of lipid-drug conjugates is a valid strategy to improve a drug's pharmacokinetic profile and with that its therapeutic index and/or efficacy.
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Affiliation(s)
- Rea D Signorell
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Paola Luciani
- Institute of Pharmacy, Department of Pharmaceutical Technology, Friedrich Schiller University Jena, 07743 Jena, Germany
| | - Davide Brambilla
- Faculty of Pharmacy, University of Montreal, H3T 1J4 Montreal, QC, Canada
| | - Jean-Christophe Leroux
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland.
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Xavier NM, Porcheron A, Batista D, Jorda R, Řezníčková E, Kryštof V, Oliveira MC. Exploitation of new structurally diverse d-glucuronamide-containing N-glycosyl compounds: synthesis and anticancer potential. Org Biomol Chem 2018; 15:4667-4680. [PMID: 28517004 DOI: 10.1039/c7ob00472a] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The synthesis and anticancer evaluation of novel N-glycosyl derivatives containing N-substituted glucuronamide moieties, as nucleoside analogs or as prospective mimetics of glycosyl phosphates or of nucleotides, is reported. These compounds comprise N-anomerically-linked nucleobases or motifs that are surrogates of a phosphate group, such as sulfonamide or phosphoramidate moieties. 1-Sulfonamido glucuronamides containing N-benzyl, N-propargyl or N-dodecyl carboxamide units were synthesized through glycosylation of methanesulfonamide with tetra-O-acetyl glucuronamides. 1-Azido glucuronamides were accessed by microwave-assisted reactions of tetra-O-acetyl glucuronamides with TMSN3 and were further converted into N-glycosylphosphoramidates by treatment with trimethyl phosphite. Potential glucuronamide-based nucleotide mimetics comprising both an anomeric sulfonamide/phosphoramidate group and a benzyltriazolylmethyl amide system at C-5, as nucleobase mimetics, were synthesized via 'click' cycloaddition of N-propargyl glucuronamide derivatives with benzyl azide. N-Dodecyl tetra-O-acetyl glucuronamides were converted into uracil and purine nucleosides via N-glycosylation of the corresponding silylated nucleobases. Biological screening revealed significant antiproliferative activities of the N-dodecyl glucuronamide-containing sulfonamide, phosphoramidate and nucleosides in K562 and MCF-7 cells. The highest effect was exhibited by the N9-linked purine nucleoside in the breast cancer cell MCF-7 with a GI50 value similar to that of clinically used 5-fluorouracil. Immunoblotting and cell cycle analysis of K562 cells treated with the most active compound as well as evaluation of the effect of this nucleoside on the activities of caspases 3 and 7 showed induction of apoptosis as the mechanism of cell death.
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Affiliation(s)
- Nuno M Xavier
- Centro de Química e Bioquímica, Faculdade de Ciências, Universidade de Lisboa, Ed. C8, 5° Piso, Campo Grande, 1749-016 Lisboa, Portugal.
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Sun B, Luo C, Cui W, Sun J, He Z. Chemotherapy agent-unsaturated fatty acid prodrugs and prodrug-nanoplatforms for cancer chemotherapy. J Control Release 2017; 264:145-159. [DOI: 10.1016/j.jconrel.2017.08.034] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 12/22/2022]
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Shelton J, Lu X, Hollenbaugh JA, Cho JH, Amblard F, Schinazi RF. Metabolism, Biochemical Actions, and Chemical Synthesis of Anticancer Nucleosides, Nucleotides, and Base Analogs. Chem Rev 2016; 116:14379-14455. [PMID: 27960273 DOI: 10.1021/acs.chemrev.6b00209] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nucleoside, nucleotide, and base analogs have been in the clinic for decades to treat both viral pathogens and neoplasms. More than 20% of patients on anticancer chemotherapy have been treated with one or more of these analogs. This review focuses on the chemical synthesis and biology of anticancer nucleoside, nucleotide, and base analogs that are FDA-approved and in clinical development since 2000. We highlight the cellular biology and clinical biology of analogs, drug resistance mechanisms, and compound specificity towards different cancer types. Furthermore, we explore analog syntheses as well as improved and scale-up syntheses. We conclude with a discussion on what might lie ahead for medicinal chemists, biologists, and physicians as they try to improve analog efficacy through prodrug strategies and drug combinations.
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Affiliation(s)
- Jadd Shelton
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Xiao Lu
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Joseph A Hollenbaugh
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Jong Hyun Cho
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Franck Amblard
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Raymond F Schinazi
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
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Alexander P, Kucera G, Pardee TS. Improving nucleoside analogs via lipid conjugation: Is fatter any better? Crit Rev Oncol Hematol 2016; 100:46-56. [PMID: 26829896 DOI: 10.1016/j.critrevonc.2016.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/22/2015] [Accepted: 01/16/2016] [Indexed: 10/22/2022] Open
Abstract
In the past few decades, nucleoside analog drugs have been used to treat a large variety of cancers. These anti-metabolite drugs mimic nucleosides and interfere with chain lengthening upon incorporation into the DNA or RNA of actively replicating cells. However, efficient delivery of these drugs is limited due to their pharmacokinetic properties, and tumors often develop drug resistance. In addition, nucleoside analogs are generally hydrophilic, resulting in poor bioavailability and impaired blood-brain barrier penetration. Conjugating these drugs to lipids modifies their pharmacokinetic properties and may improve in vivo efficacy. This review will cover recent advances in the field of conjugation of phospholipids to nucleoside analogs. This includes conjugation of myristic acid, 12-thioethyldodecanoic acid, 5-elaidic acid esters, phosphoramidate, and self-emulsifying formulations. Relevant in vitro and in vivo data will be discussed for each drug, as well as any available data from clinical trials.
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Affiliation(s)
- Peter Alexander
- Cancer Biology, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, United States
| | - Gregory Kucera
- Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, United States; Cancer Biology, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, United States
| | - Timothy S Pardee
- Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, United States; Cancer Biology, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, United States.
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Rein LAM, Rizzieri DA. Clinical potential of elacytarabine in patients with acute myeloid leukemia. Ther Adv Hematol 2014; 5:211-20. [PMID: 25469211 DOI: 10.1177/2040620714552615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Acute myeloid leukemia (AML) has been treated for over four decades with standard induction chemotherapy including seven days of cytosine arabinoside (cytarabine, ara-C) infusion. Cytarabine, while effective in killing leukemic cells, is subject to development of several resistance mechanisms rendering the drug ineffective in many patients. Elacytarabine, a lipophilic 5'-elaidic acid ester or nucleoside analogue of cytosine arabinoside, was created with the intent of overcoming resistance mechanisms including reduced expression of the human equilibrative nucleoside transporter 1 (hENT1) required for cytarabine entry into cells, as well as increased activity of cytidine deaminase (CDA) which breaks down the active metabolite of cytarabine, ara-CTP. Elacytarabine enters cells independently of transporters, has a longer half life compared with cytarabine and is not subject to deactivation by CDA. Preclinical data were encouraging although subsequent clinical studies have failed to show superiority of elacytarabine compared with standard of care as monotherapy in patients with AML. Clinical trials utilizing elacytarabine in combination with anthracyclines are ongoing. Use of hENT1 expression as a predictive marker for cytarabine or elacytarabine response has been studied with no conclusive validation to date. Despite promising early results, the jury is still out in regards to this novel agent as an effective alternative to standard cytarabine therapy in acute leukemias, especially in combination with additional agents such as anthracyclines.
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Affiliation(s)
| | - David A Rizzieri
- Duke University Medical Center - Medicine, 1149 North Pavilion Duke University Durham, NC 27710, USA
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Roboz GJ, Rosenblat T, Arellano M, Gobbi M, Altman JK, Montesinos P, O'Connell C, Solomon SR, Pigneux A, Vey N, Hills R, Jacobsen TF, Gianella-Borradori A, Foss Ø, Vetrhusand S, Giles FJ. International Randomized Phase III Study of Elacytarabine Versus Investigator Choice in Patients With Relapsed/Refractory Acute Myeloid Leukemia. J Clin Oncol 2014; 32:1919-26. [DOI: 10.1200/jco.2013.52.8562] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Most patients with acute myeloid leukemia (AML) eventually experience relapse. Relapsed/refractory AML has a dismal prognosis and currently available treatment options are generally ineffective. The objective of this large, international, randomized clinical trial was to investigate the efficacy of elacytarabine, a novel elaidic acid ester of cytarabine, versus the investigator's choice of one of seven commonly used AML salvage regimens, including high-dose cytarabine, multiagent chemotherapy, hypomethylating agents, hydroxyurea, and supportive care. Patients and Methods A total of 381 patients with relapsed/refractory AML were treated in North America, Europe, and Australia. Investigators selected a control treatment for individual patients before random assignment. The primary end point was overall survival (OS). Results There were no significant differences in OS (3.5 v 3.3 months), response rate (23% v 21%), or relapse-free survival (5.1 v 3.7 months) between the elacytarabine and control arms, respectively. There was no significant difference in OS among any of the investigator's choice regimens. Prolonged survival was only achieved in a few patients in both study arms whose disease responded and who underwent allogeneic stem-cell transplantation. Conclusion Neither elacytarabine nor any of the seven alternative treatment regimens provided clinically meaningful benefit to these patients. OS in both study arms and for all treatments was extremely poor. Novel agents, novel clinical trial designs, and novel strategies of drug development are all desperately needed for this patient population.
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Affiliation(s)
- Gail J. Roboz
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Todd Rosenblat
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Martha Arellano
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Marco Gobbi
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Jessica K. Altman
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Pau Montesinos
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Casey O'Connell
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Scott R. Solomon
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Arnaud Pigneux
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Norbert Vey
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Robert Hills
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Tove Flem Jacobsen
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Athos Gianella-Borradori
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Øivind Foss
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Sylvia Vetrhusand
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
| | - Francis J. Giles
- Gail J. Roboz, Weill Cornell Medical College and the New York Presbyterian Hospital; Todd Rosenblat, Columbia University Medical Center, New York, NY; Martha Arellano, Winship Cancer Institute at Emory University; Scott R. Solomon, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA; Jessica K. Altman, Francis J. Giles, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Casey O'Connell, University of Southern California Norris Comprehensive Cancer Center and
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Knapper S, Chevassut T, Duarte R, Bergua JM, Salamero O, Johansen M, Jacobsen TF, Hals PA, Rasch W, Gianella-Borradori A, Smith M. Elacytarabine in relapsed/refractory acute myeloid leukaemia: an evaluation of clinical efficacy, pharmacokinetics, cardiac safety and effects on lipid profile. Leuk Res 2014; 38:346-51. [PMID: 24433865 DOI: 10.1016/j.leukres.2013.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/25/2022]
Abstract
Elacytarabine is the elaidic acid ester derivative of cytarabine, designed to enter cells independently of nucleoside transporters. Effects of elacytarabine on QT interval, serum lipid profile and clinical activity were investigated in 43 relapsed/refractory AML patients. Mean maximum increase in corrected QT interval of 24( ± 29)ms occurred 48 h after elacytarabine infusion without associated arrhythmias or clinical symptoms. A non-clinically significant, elacytarabine exposure-dependent increase in cholesterol was caused by a cholesterol rich lipoprotein depleted of apolipoprotein B formed by infused phospholipids complexing cholesterol. Elacytarabine is clinically active in relapsed/refractory AML: overall response rate (CR + CRi) was 44% (16/36 with 7 non-evaluable patients) and adverse events were manageable. Clinical Trials.gov Identifier: NCT01258816.
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Affiliation(s)
- Steven Knapper
- Department of Haematology, Cardiff University, Cardiff, UK.
| | | | | | | | - Olga Salamero
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
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12
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Keane N, Freeman C, Swords R, Giles FJ. Elacytarabine: lipid vector technology under investigation in acute myeloid leukemia. Expert Rev Hematol 2014; 6:9-24. [DOI: 10.1586/ehm.12.68] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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13
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Developmental therapeutics in acute myelogenous leukemia: are there any new effective cytotoxic chemotherapeutic agents out there? Curr Hematol Malig Rep 2013; 8:156-62. [PMID: 23640069 DOI: 10.1007/s11899-013-0158-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Therapies for AML have remained mostly unchanged since the introduction of anthracyline- and cytarabine-based regimens in the 1970s. Though some changes have been made in the dosing of anthracylines, in the choice of consolidation regimens versus allogeneic stem cell transplant, and in supportive care, clinical outcomes remain poor for most patients. As we continue to strive for better treatment options to improve upon outcomes, different agents, both chemotherapeutic and targeted therapies, are being studied. Here we discuss new chemotherapeutic agents that show promise in recent clinical trials and attempt to answer the question if there are any new effective cytotoxic chemotherapy agents out there.
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14
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DiNardo CD, O'Brien S, Gandhi VV, Ravandi F. Elacytarabine (CP-4055) in the treatment of acute myeloid leukemia. Future Oncol 2013; 9:1073-82. [PMID: 23902239 DOI: 10.2217/fon.13.130] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Elacytarabine (formerly CP-4055) is a lipid-conjugated derivative of the nucleoside analog cytarabine. Elacytarabine was rationally designed to circumvent cytarabine resistance related to decreased cellular uptake, due to the ability of the lipophilic drug moiety to enter the cell without the requirement of specialized nuclear transport proteins, including the hENT1. In preclinical and clinical studies, elacytarabine has demonstrated both safety and efficacy in acute myeloid leukemia (AML), with noteworthy activity among the cytarabine-refractory AML population. Elacytarabine was granted orphan drug designation status from the European Commission in 2007 and from the US FDA in 2008, with a fast-track approval designation from the FDA in 2010. Results of a recent randomized Phase III clinical trial, however, failed to show superiority of elacytarabine over the investigator's choice of therapy for relapsed or refractory AML.
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Affiliation(s)
- Courtney D DiNardo
- Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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15
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Jamieson K, Odenike O. Late-phase investigational approaches for the treatment of relapsed/refractory acute myeloid leukemia. Expert Opin Pharmacother 2012; 13:2171-87. [DOI: 10.1517/14656566.2012.724061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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O'Brien S, Rizzieri DA, Vey N, Ravandi F, Krug UO, Sekeres MA, Dennis M, Venditti A, Berry DA, Jacobsen TF, Staudacher K, Bergeland T, Giles FJ. Elacytarabine has single-agent activity in patients with advanced acute myeloid leukaemia. Br J Haematol 2012; 158:581-8. [PMID: 22702906 DOI: 10.1111/j.1365-2141.2012.09186.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/03/2012] [Indexed: 01/14/2023]
Abstract
Elacytarabine is a novel cytotoxic nucleoside analogue, independent of nucleoside transporters (e.g. human Equilibrative Nucleoside Transporter 1 [hENT1]) for cell uptake, and mechanisms of action similar to those of cytarabine. This Phase II study assessed the efficacy and safety of elacytarabine in patients with advanced stage acute myeloid leukaemia (AML). Patients received 2000 mg/m(2) per d continuously i.v. during days 1-5 every 3 weeks. Patients were matched by six risk factors with historical controls; remission rate (assessed after 1 or 2 cycles) and 6-month survival were compared. Sixty-one patients, median age 58 years, were enrolled; 52% had five or six risk factors. The remission rate was 18% (95% confidence interval: 9-30%) vs. 4% in controls (P < 0·0001), 6-month survival rate was 43%, median overall survival was 5·3 months (vs. 1·5 months); 10 patients (16%) were referred for stem cell transplantation after treatment. Side effects were predictable and manageable. The most common grade 3/4 non-haematological adverse events were febrile neutropenia, hypokalemia, fatigue, hyponatraemia, dyspnoea and pyrexia. Thirty-day all-cause mortality, after start of treatment, was 13% vs. 25% in controls. Elacytarabine has monotherapy activity in patients with advanced AML. This study provides proof-of-concept that lipid esterification of nucleoside analogues is clinically relevant.
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Affiliation(s)
- Susan O'Brien
- Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston, TX 77230, USA.
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Elacytarabine, a novel 5'-elaidic acid derivative of cytarabine, and idarubicin combination is active in refractory acute myeloid leukemia. Leuk Res 2012; 36:e71-3. [PMID: 22226018 DOI: 10.1016/j.leukres.2011.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/09/2011] [Accepted: 12/12/2011] [Indexed: 11/21/2022]
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