Wednesday, 28 June 2017

Gallium maltolate kháng HCC

Gallium maltolate kháng HCC

From Wikipedia, the free encyclopedia
Gallium maltolate
Gallium maltolate
Names
IUPAC name
Tris(3-hydroxy-2-methyl-4H-pyran-4-one)gallium
Identifiers
UNII
Properties
Ga(C6H5O3)3
Molar mass445.03 g/mol
AppearanceWhite to pale beige crystalline solid or powder
Density1.56 g/cm3, solid
Melting point220 °C (decomposes)
24(2) mM; 10.7(9) mg/mL (25 °C)
Structure
Orthorhombicspace groupPbca
Distorted octahedral
Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa).
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Infobox references
Gallium maltolate is a coordination complex consisting of a trivalent gallium cation coordinated to three maltolateligands. The compound is undergoing clinical and preclinical testing as a potential therapeutic agent for cancer, infectious disease, and inflammatory disease.[1][2][3][4] It appears to have low toxicity when administered orally, without the renal toxicity observed for intravenously administered gallium nitrate. The lower toxicity probably results because gallium absorbed into the body from oral gallium maltolate becomes nearly entirely protein bound, whereas gallium from intravenous gallium nitrate tends to form anionic gallium hydroxide (Ga(OH)4; gallate) in the blood, which is rapidly excreted in the urine and may be renally toxic.[1] A cosmetic skin cream containing gallium maltolate is marketed under the name Gallixa.

Chemical properties[edit]

In aqueous solutions, gallium maltolate has neutral charge and pH, and is stable between about pH 5 and 8. It has significant solubility in both water and lipids (octanol:water partition coefficient = 0.41).[1]

Research and pharmaceutical development[edit]

Pharmaceutical compositions and uses of gallium maltolate were first patented by Lawrence R. Bernstein.[5][6][7][8][9][10]
Christopher Chitambar and his associates at the Medical College of Wisconsin have found that gallium maltolate is active against several lymphoma cell lines, including those resistant to gallium nitrate.[3]
Gallium maltolate is able to deliver gallium with high oral bioavailability: the bioavailability is several times higher than that of gallium salts such as gallium nitrate and gallium trichloride.[1] In vitro studies have found gallium to be antiproliferative due primarily to its ability to mimic ferric iron (Fe3+). Ferric iron is essential for DNA synthesis, as it is present in the active site of the enzyme ribonucleotide reductase, which catalyzes the conversion of ribonucleotides to the deoxyribonucleotides required for DNA. Gallium is taken up by the rapidly proliferating cells, but it is not functional for DNA synthesis, so the cells cannot reproduce and they ultimately die by apoptosis. Normally reproducing cells take up little gallium (as is known from gallium scans), and gallium is not incorporated into hemoglobin, accounting for the relatively low toxicity of gallium.[11]
Gallium has been repeatedly shown to have anti-inflammatory activity in animal models of inflammatory disease.[2][11][12]Orally administered gallium maltolate has demonstrated efficacy against two types of induced inflammatory arthritis in rats.[12] Experimental evidence suggests that the anti-inflammatory activity of gallium may be due, at least in part, to down-regulation of pro-inflammatory T-cells and inhibition of inflammatory cytokine secretion by macrophages.[2][11][12] Because many iron compounds are pro-inflammatory, the ability of gallium to act as a non-functional iron mimic may contribute to its anti-inflammatory activity.[2]
Gallium maltolate is being studied as a potential treatment for primary liver cancer (hepatocellular carcinoma; HCC). In vitro experiments demonstrated efficacy against HCC cell lines[4] and one clinical case report produced encouraging results.[13]
The activity of gallium against infection-related biofilms, particularly those caused by Pseudomonas aeruginosa, is being studied by Pradeep Singh at the University of Washington, and by others, who have reported encouraging results in mice.[14][15] Pulmonary P. aeruginosa biofilms are responsible for many fatalities in cystic fibrosis and immunocompromised patients; in general, bacterial biofilms are responsible for significant morbidity and mortality.[16] In related research, locally administered gallium maltolate has shown potent efficacy against P. aeruginosa in a mouse burn/infection model.[17]
Oral gallium maltolate is also being investigated as a treatment for Rhodococcus equi foal pneumonia, a common and often fatal disease of newborn horses. R. equican also infect humans with AIDS or who are otherwise immunocompromized. The veterinary studies are being conducted by researchers at Texas A&M University, led by Ronald Martens, Noah Cohen, and M. Keith Chaffin.[18][19]
Topically applied gallium maltolate has been studied in case reports for use in neuropathic pain (severe postherpetic neuralgia and trigeminal neuralgia).[12] It has been hypothesized that any effect on pain may be related to gallium's anti-inflammatory mechanisms, and possibly from its interactions with certain matrix metalloproteinasesand substance P, whose activities are zinc-mediated and which have been implicated in the etiology of pain.[12]

Pexastimogene devacirepvec kháng HCC

Pexastimogene devacirepvec kháng HCC

From Wikipedia, the free encyclopedia
JX-594 is an oncolytic virus (also known as Pexa-Vec,[1] INN pexastimogene devacirepvec[2]) developed by Jennerex and partners: Transgene S.A.; Lee's Pharmaceutical Holdings Ltd.; and Green Cross CorpPexa-Vec is designed to target and destroy cancer cells.[3]
JX-594 is a modified Copenhagen[4] strain (or Wyeth strain[2]vaccinia poxvirus engineered by addition of the GM-CSF gene and deletion of the thymidine kinase gene which limits viral replication to cells with high levels of thymidine kinase, typically seen in cancer cells with a mutated RAS or p53 gene.[5] The virus also has the LacZgene insertion under control of the p7.5 promoter.[2] The virus kills the infected/cancer cells by lysis and also expresses GM-CSF which may help initiate an anti-tumour immune response.[6][7] [8]
It has orphan drug designation from US FDA and EUMA for the treatment of hepatocellular carcinoma (HCC).[1]
In clinical trials doses have been administered by intratumoral or intravenous injection.[2]

Clinical trials[edit]

A global Phase 3 trial (the PHOCUS trial) http://www.pexavectrials.com for patients with advanced stage hepatocellular carcinoma will begin enrolling patients in late 2015. Two Phase I trials have reported results and a phase II trial for primary liver cancer, alone and in combination with sorafenib have been completed.[7]
JX-594[9] Phase I results in 23 patients had encouraging results in 6 of 8 high dosed patients.[10] A small (30 patient) phase II trial in advanced hepatocellular carcinoma (HCC) showed an increased median overall survival of 13.8 months compared 6.7 months for a lower dose (p=0.029).[11]

Brivanib alaninate kháng HCC

Brivanib alaninate kháng HCC

From Wikipedia, the free encyclopedia
Brivanib alaninate
Brivanib alaninate.svg
Clinical data
Routes of
administration
Oral
ATC code
  • none
Legal status
Legal status
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
ChemSpider
ChEMBL
ECHA InfoCard100.167.334
Chemical and physical data
FormulaC22H24FN5O4
Molar mass441.5 g/mol
3D model (Jmol)
Brivanib alaninate (INN/USAN) also known as BMS-582664 is an investigational, anti-tumorigenic drug for oral administration. The drug is being developed by Bristol-Myers Squibb for the treatment of hepatocellular carcinoma or HCC (also called malignant hepatoma), the most common type of liver cancer.
Brivanib alaninate is a multitargeted tyrosine kinase inhibitor (as is sorafenib).
Brivanib alaninate also inhibits VEGFR and fibroblast growth factor receptors (FGFR), which is known to play a major role in the etiopathogenesis of HCC. To date, brivanib alaninate has been investigated in 29 studies, including more than 4,000 patients around the world.[citation needed]

Hepatocellular carcinoma (summary)[edit]

Hepatocellular carcinoma [1] is a primary cancer of the liver and is more common in men than in women. The disease occurs mostly in people who have scarring of the liver (cirrhosis) or after infection with hepatitis B or hepatitis C. Symptoms include pain and swelling in the abdomen, weight loss, weakness, loss of appetite and nausea. Hepatocellular carcinoma is a severe and life-threatening disease that is associated with poor overall survival.[2] While the choice of treatment depends mainly on how advanced the disease is, the only proven therapies to cure the cancer is surgery to remove the tumor and liver transplantation, but these therapies can only be carried out in very few patients. Other treatments include chemotherapy and immunotherapyRadiofrequency ablation and ethanol injection are also used to remove small tumors.[3]
As a result of poor liver function, metastases, or both, only 10% to 20% of patients undergo surgery. In patients having surgery, the 5-year survival rate is only 25% to 50%. Several chemotherapeutic agents have been evaluated for the treatment of hepatocellular carcinoma. Doxorubicin (trade name Adriamycin; also known as hydroxydaunorubicin), the most widely used agent in HCC, has shown a 4% to 10.5% response rate in patients with HCC. Studies have shown that the overall response (OR) rate, but not overall survival (OS), doubles when doxorubicin was given in combination with cisplatinIFN, and 5-fluorouracil. The multitargeted tyrosine kinase inhibitor sorafenib (trade name Nexavar), which inhibits vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor, raf, c-kit, and flt-3, has been shown to inhibit HCC-induced proliferation and angiogenesis. Sorafenib has also been shown to provide a significant improvement in OS in patients with HCC. Based on these results, researchers concluded that this class of agents may be effective in the treatment of HCC.

Biological activity[edit]

Brivanib is the alanine ester of a VEGFR-2 inhibitor BMS-540215 and is hydrolyzed to the active moiety BMS-540215 in vivo. BMS-540215, a dual tyrosine kinase inhibitor, shows potent and selective inhibition of VEGFR and fibroblast growth factor receptor (FGFRtyrosine kinases.[4][5]
BMS-540215 is an ATP-competitive inhibitor of human VEGFR-2, with an IC50 of 25 nmol/L and Ki of 26 nmol/L. In addition, it inhibits VEGFR-1 (IC50 = 380 nmol/L) and VEGFR-3 (IC50 = 10 nmol/L). BMS-540215 also showed good selectivity for FGFR-1 (IC50 = 148 nmol/L), FGFR-2 (IC50 = 125 nmol/L), and FGFR-3 (IC50 = 68 nmol/L). Furthermore, BMS-540215 has been shown to selectively inhibit the proliferation of endothelial cells stimulated by VEGF and FGF in vitro with IC50 values of 40 and 276 nmol/L, respectively.[6][7] It also shows broad-spectrum in vivo antitumor activity over multiple dose levels and induces stasis in large tumors, suggesting that it may have a role in the treatment of hepatocellular carcinoma (HCC).

Pharmacokinetic and pharmacodynamic profiles[edit]

BMS-582664 was originally prepared in an effort to improve the aqueous solubility and oral bioavailability of the parent compound BMS-540215. Both BMS-540215 and its orally active ester prodrug BMS-582664 (brivanib alaninate), demonstrate broad-spectrum in vivo antitumor activity over multiple dose levels as well as being effective at inducing stasis in large tumors. Brivanib alaninate can also be safely dosed in combination with other targeted and cytotoxic drugs including paclitaxelresulting in enhanced antitumor activity as observed by a long period of tumor growth inhibition. Overall survival was significantly extended by brivanib versus sorafenib, both first- line and when second.

Mechanisms of action[edit]

The exact mechanisms by which brivanib treatment induces growth inhibition are not well understood. Ongoing research has shown that brivanib affects the host endothelium based on both in vitro and in vivo effects). Brivanib may prevent the tumor mass from expanding by cutting off the supply of nutrients and growth factors to the tumor cells.
A recent study showed that brivanib effectively inhibits tumor growth and that brivanib-induced growth inhibition is associated with inactivation of VEGFR-2, increased apoptosis, a reduction in microvessel density, inhibition of cell proliferation, and down-regulation of cell cycle regulators, including cyclin D1, Cdk-2, Cdk-4, cyclin B1, and phospho-c-Myc.[4] Based on this study, researchers have concluded that cell cycle arrest due to a reduction in positive cell cycle regulators may be responsible for the observed growth inhibition. The same study showed that treatment with brivanib also led to a decrease in the number of proliferating cells compared with control.

Dosing[edit]

Doses required for achieving complete tumor stasis do not produce overt toxicity as defined by weight loss, mortality or unkempt appearance and behavior. The prodrugbrivanib alaninate, which is completely hydrolyzed to BMS-540215 in vivo, has pharmacokinetic properties suitable for once a day or twice daily oral dosing. Completed and ongoing clinical trials show that brivanib alaninate appears to be tolerable and may exhibits favorable pharmacokinetic and pharmacodynamic profiles with evidence of target inhibition in surrogate tissues. Clinical and pharmacodynamic data support an oral once daily administration at 800 mg. The investigational drugshows promising activity as single agent in HCC. Brivanib also shows promising activity in combination with cetuximab in colorectal cancer.[8] Further evaluations are currently ongoing.

Safety profile[edit]

Ongoing clinical trials have shown brivanib to have a manageable safety profile. The trial drug is one of the first agents to demonstrate promising antitumor activity in advanced HCC patients treated with prior sorafenib.[9]

Adverse reactions[edit]

In clinical trials, brivanib was generally well tolerated. The most common adverse events included fatigue, hypertension, and diarrhea.[10]

Ongoing clinical development program[edit]

To further investigate the benefits of brivanib in patients with advanced HCC, a broad-spectrum, global, phase III clinical development plan called the Brivanib studies in HCC patients at RISK (BRISK), has been initiated.[citation needed] ~[11][12]
Clinical benefits seen with brivanib in the first-line setting, and following the failure of sorafenib therapy, highlight the potential to improve the clinical course of patients with advanced HCC.[citation needed]

Regulatory status[edit]

On 27 October 2011, orphan designation (EU/3/11/918) was granted by the European Commission to Bristol-Myers Squibb for brivanib alaninate for the treatment of hepatocellular carcinoma.[13] At the time of the orphan designation, several medicines were authorized in the EU for the treatment of hepatocellular carcinoma.

Submission and application[edit]

At the time of submission of the application for orphan designation, clinical trials with brivanib alaninate in patients with hepatocellular carcinoma were ongoing. As part of the submission process, Bristol-Myers Squibb has provided sufficient information to show that brivanib alaninate might be of significant benefit for patients with hepatocellular carcinoma because it could provide an alternative for patients who cannot take or for whom existing treatments do not work. Early studies show that it might improve the treatment of patients with this condition, particularly if used when existing treatment had failed. However, this assumption needs to be confirmed at the time of EU marketing authorization, in order to maintain the orphan status.