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PubMed2005

Role of cytochrome P450 activity in the fate of anticancer agents and in drug resistance: focus on tamoxifen, paclitaxel and imatinib metabolism.

Although activity of cytochrome P450 isoenzymes (CYPs) plays a major role in the fate of anticancer agents in patients, there are relatively few clinical studies that evaluate drug metabolism with therapeutic outcome. Nevertheless, many clinical reports in various non-oncology fields have shown the dramatic importance of CYP activity in therapeutic efficacy, safety and interindividual variability of drug pharmacokinetics. Moreover, variability of drug metabolism in the liver as well as in cancer cells must also be considered as a potential factor mediating cancer resistance. This review underlines the role of drug metabolism mediated by CYPs in pharmacokinetic variability, drug resistance and safety. As examples, biotransformation pathways of tamoxifen, paclitaxel and imatinib are reviewed. This review emphasises the key role of therapeutic drug monitoring as a complementary tool of investigation to in vitro data. For instance, pharmacokinetic data of anticancer agents have not often been published within subpopulations of patients who show ultra-rapid, extensive or poor metabolism (e.g. due to CYP2D6 and CYP2C19 genotypes). Besides kinetic variability in the systemic circulation, induction of CYP activity may participate in creating drug resistance by speeding up the cancer agent degradation specifically in the target cells. For one cancer agent, various mechanisms of resistance are usually identified within different cell clones. This review also tries to emphasise that drug resistance mediated by CYP activity in cancer cells should be taken into consideration to a greater degree. The unequivocal identification of the metabolising enzymes involved in clinical conditions will eventually allow improvement and individualisation of anticancer agent therapy, i.e. drug dosage and selection. In addition, a more complete understanding of the metabolism of anticancer agents will assist in the prediction of drug-drug interactions, as anticancer agent combinations are becoming more prevalent.

Antineoplastic Agents↗

PubMed1998

Glutathione-related mechanisms in cellular resistance to anticancer drugs.

Glutathione conjugation and transport of glutathione conjugates of anticancer drugs out of cells have been shown to work as a system in the detoxification of many anticancer drugs. The major components of this system include glutathione (GSH), GSH-related enzymes and glutathione conjugate export pump (GS-X pump). GSH can combine with anticancer drugs to form less toxic and more water soluble GSH conjugates, the conjugation reaction is catalysed by glutathione S-transferases (GSTs). The GSH conjugates of anticancer drugs can be exported from cells by GS-X pump or multidrug resistance-associated protein (MRP). GSH, glutathione-related enzymes and GS-X pump or MRP have been found to be increased or overexpressed in many drug resistant cells. Increased detoxification of anticancer drugs by this system may confer drug resistance. Inhibition of this detoxification system is a strategy for modulation of drug resistance.

ATP-Binding Cassette Transporters↗

PubMed2001

Enhancement of antitumor effect by intratumoral administration of bax gene in combination with anticancer drugs in gastric cancer.

Proapototic gene is an important target to enhance the chemotherapeutic effect in cancer cells. Based on in vitro study showing that the introduction of bax gene enhanced the sensitivity to anticancer drugs, we examined whether the intratumoral administration of bax gene could enhance the anti-tumor effect in combination with anticancer drugs in gastric cancer. The human gastric cancer cell line, MKN45 was transplanted into nude mice, and the intratumoral administration of bax gene was performed using the bax cDNA plasmid complexed with a cationic lipopolyamine. The enhancement of antitumor effect was examined in the combination with 5-fluorouracil (5-FU) and cisplatin (CDDP). The anticancer drugs were administered intraperitoneally with one third of LD50 four times at 4-day intervals, and the antitumor effect was assessed by the NCI protocol. The expression of bax gene was analyzed by RT-PCR and the apoptotic cell death was assessed by TUNEL method. The intratumoral administration of bax gene alone showed slight anti-tumor effect as compared to that of control tumor injected with vector alone. The antitumor effect of 5-FU and CDDP was significantly enhanced in the combination with intra-tumoral administration of bax gene as compared to that of CDDP and 5-FU alone (p<0.05, Student's t-test). The enhancement of antitumor effect was associated with the constitutive overexpression of bax gene and with the induction of apoptosis in the tumor treated with anticancer drug and bax gene. These results indicate that the combination therapy of intratumoral administration of bax gene complexed with a cationic lipopolyamine and anticancer drugs may provide us a new strategy for cancer chemotherapy to enhance its therapeutic efficacy in gastric cancer as termed with gene-chemotherapy.

Animals↗

PubMed2005

Caspase-8 is scarcely silenced and its activity is well correlated with the anticancer effect of tumor necrosis factor-related apoptosis-inducing ligand in gastric cancer cells.

The main apoptotic signal stimulated by tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) streams through caspase-8 activation and evokes caspase-3, a central apoptosis activator. In this study, the status of caspase-8 and -3 in gastric cancer cells related to the anticancer effects of TRAIL was investigated. In the caspase-8 gene promoter, 9 of 10 gastric cancer cell lines harbor no hypermethylation. The pretreatment amounts of caspase-8 and -3 in these cells were not predictors for the anticancer effect of TRAIL. Caspase-8 activity 24 h after treatment with TRAIL was well correlated with the anticancer effect of TRAIL (r=0.777, p=0.0060). Caspase-3 activity 24 h after treatment with TRAIL showed a trend towards an association with the anticancer effect of TRAIL (r=0.544, p=0.1067). These results suggested that gastric cancer might be a good target of TRAIL therapy because the majority of tumor cells have intact caspase-8 expression. The anticancer efficacy may be predicted by the degree of caspase-8 activation after TRAIL treatment.

Apoptosis Regulatory Proteins↗

PubMed1999

[Clinical outcome of an anticancer agent screening test with primary culture cells].

Cancer cells are tested for sensitivity to anticancer agents before the drugs are used for treatment in clinical settings, but the results of these tests have not always been reported fully. Since 1973, one of the authors (Hirono) has been performing sensitivity tests of anticancer drugs by using primary culture cells derived from human cancer tissue, taking into account in vivo status and taking great care to reduce the number of procedural errors. From 1991, flow cytometry has also been adopted for use in anticancer drug sensitivity tests. In the present study, the outcomes of cancer patients were compared by dividing them into a group treated only with anticancer agents to which cancer cells had responded in sensitivity tests, and a group treated with other drugs. The subjects consisted of 132 patients with endometrial cancer stage III (n = 26) and IV (n = 10), ovarian cancer stage III (n = 26) and IV (n = 7), peritonitis carcinomatosa (n = 18), and suspected advanced ovarian cancer (n = 45). There was a significant prolongation in median survival time and survival time among the non-survivors according to the results of a Kaplan-Meier analysis. These findings suggest that sensitivity testing of cancer cells to anticancer drugs should be performed before the start of cancer chemotherapy in the clinical setting.

Adult↗

PubMed2001

[New oral anticancer drug, TS-1 (S-1)--from bench to clinic].

We describe in this paper a therapeutic modality which is based on a self-rescuing concept (SRC) featuring dual activity, i.e., effect-enhancing activity and adverse reaction-reducing activity. We present the theory and practice of S-1, a novel oral fluoropyrimidine anticancer agent designed to enhance anticancer activity and reduce gastrointestinal toxicity through the deliberate combination of the following components: an oral fluoropyrimidine agent, tegafur (FT); a DPD inhibitor (CDHP: 5-chloro-2, 4-dihydroxypyridine) which is about 200-fold more potent than uracil used in UFT; and an ORTC inhibitor (Oxo: potassium oxonate) which is localized in the gastrointestinal tract. We devised a novel oral anticancer agent, S-1, as a combination drug with a molar ratio of 1:0.4:1 for FT, CDHP, and Oxo, respectively. To compare S-1, FT, and UFT in terms of their anticancer activity and adverse reactions, a colon cancer implantation model in rats was used for 4-week consecutive oral administration from the time when the postimplantation tumor weight become about 2 g. The tumor disappeared on day 16 at a given dose of S-1 (as 22.5 mg/kg FT), and the tumor did not reappear for at least three months. Antitumor activity was more marked with S-1 than FT and UFT. Adverse reaction, i.e., stomatitis, depilation, and weight loss, were less frequent in the S-1 group than in the other groups. A clinical pharmacology study examined blood concentrations of 5-FU after twice-a-day administration after meals of S-1 at a dose of 40 mg/m2. Blood concentrations of 5-FU were 60 to 200 ng/ml in all twelve patients examined. Late phase II clinical trials of S-1 were conducted in patients with advanced and recurrent stomach cancers, in the same regimen as for the clinical pharmacology study. It basically consisted in four cycles, each of which comprised 4-week, twice-a-day, consecutive oral administration with a 2-week withdrawal. The overall response rate was 44.6% (45/101). Median survival time (MST) was 224 days. S-1 was given manufacturing approval by the Ministry of Health and Welfare of Japan after a priority review, with indications for advanced and recurrent stomach cancers. A late phase II clinical study of S-1 in patients with advanced/recurrent head and neck cancer was conducted in 59 eligible patients. Objective responses were 4 complete response (CR) and 13 partial response (PR), for a response rate of 28.8% (17/59). MST was 344 days. Grade 4 hemoglobin decrease was observed in one case; however, this returned to normal after the termination of drug administration and blood transfusion. Therefore, this event was confirmed to be reversible. A late phase II clinical trial of S-1 was conducted to evaluate the efficacy and toxicities in patients with metastatic colorectal carcinoma. Sixty-three patients with measurable metastatic colorectal carcinoma were enrolled in this clinical trial. The overall response rate was 35.5% (22/62), and the MST was 378 days. The main adverse reactions were myelosuppression and GI toxicities. The incidence of neutropenia (Grade 3 or 4) was 13%, while the incidence of other adverse reactions was 10% or below. None of 53 outpatients required to be hospitalization due to adverse reactions. Late phase II clinical trials of S-1 are in progress for colorectal cancer, breast cancer and non-small cell lung cancer. To establish the standard therapeutic modality for cancers, including gastrointestinal cancers, in Japan, the conduction of clinical trials combining S-1 and other anticancer drugs holds promise for the future.

Administration, Oral↗

PubMed1999

[Transferring of mdr1 gene into murine bone marrow cells and its protective effects on hematopoietic cells against toxicities of anticancer agent].

OBJECTIVE: To investigate the protective effects of mdr1 gene on hematopoietic cells against anticancer agents and to explore an effective approach to prevent myelosuppression due to chemotherapy. METHODS: mdr1 gene was transferred into murine bone marrow cells with plasmid pHaMDR1/A by the mediation of lipofection. Pgp, a product of mdr1 gene expression, and its function were detected by flow cytometry, immunohistochemistry, and rhodamine test respectively. Also, the resistance of transferred murine bone marrow cells to anticancer agents was tested by colony-forming unit test after exposure to anticancer agents and by bone marrow transplantation murine model. RESULTS: mdr1 gene was successfully transferred and expressed in bone marrow cells. Transferred murine bone marrow cells were resistant to anticancer agents both in vitro and in vivo. CONCLUSIONS: Transfection of mdr1 gene into hematopietic cells can protect bone marrow cells against the toxicities of anticancer agents.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMedDate not supplied

Prediction of cell kill kinetics of anticancer agents using the collagen gel droplet embedded-culture drug sensitivity test.

A vital component of chemotherapy is selecting effective anticancer agents for the patient and determining an appropriate dose and administration regimen. Prediction of the drug sensitivity of each patient and cell kill kinetics of the drug may improve the outcome of treatment and avoid unnecessary dosing of the drug. For this reason, the development and clinical application of anticancer drug sensitivity tests and cell kill kinetics tests which successfully reflect clinical outcomes are required. In the present study, we tried to establish a cell kill kinetics test through the use of new anticancer agents: paclitaxel, docetaxel, SN-38, vinorelbine, and gemcitabine. These agents were studied at concentrations close to their clinical doses using a collagen gel droplet embedded-culture drug sensitivity test (CD-DST). It is thought that the mechanism, by which the anticancer agents used in this study exert their effects is dependent on the cell cycle; however, the cell kill kinetics of these agents at clinical concentrations has not yet been clarified in vitro. We investigated the drug sensitivity and cell kill kinetics of these new anticancer agents against a human colon cancer strain. Results of this study suggest that the test method established by us can predict drug sensitivity and cell kill kinetics of the agents, and can be a useful tool in deciding appropriate treatment regimen for individual patients.

Antimetabolites, Antineoplastic↗

PubMed2002

An integrated database of chemosensitivity to 55 anticancer drugs and gene expression profiles of 39 human cancer cell lines.

To explore genes that determine the sensitivity of cancer cells to anticancer drugs, we investigated using cDNA microarrays the expression of 9216 genes in 39 human cancer cell lines pharmacologically characterized on treatment with various anticancer drugs. A bioinformatical approach was then exploited to identify genes related to anticancer drug sensitivity. An integrated database of gene expression and drug sensitivity profiles was constructed and used to identify genes with expression patterns that showed significant correlation to patterns of drug responsiveness. As a result, sets of genes were extracted for each of the 55 anticancer drugs examined. Whereas some genes commonly correlated with various classes of anticancer drugs, other genes correlated only with specific drugs with similar mechanisms of action. This latter group of genes may reflect the efficacy of each class of drugs. Therefore, the integrated database approach of gene expression and chemosensitivity profiles may be useful in the development of systems to predict drug efficacies of cancer cells by examining the expression levels of particular genes.

Antineoplastic Agents↗

PubMed2002

Anticancer drug discovery and development throughout the world.

This year's American Society of Clinical Oncology International Symposium devoted 2 hours to a lively discussion of various aspects of anticancer drug discovery and development throughout the world. The scientific program started with an overview of efforts directed toward promoting international collaboration in natural product-derived anticancer drug discovery. This was followed by a discussion on the importance of interethnic differences and pharmacogenetics in anticancer drug development. Thereafter, this part of the program was completed by a description of the activities of the newly created Singapore-Hong Kong-Australia Drug Development Consortium and an overview of the contribution of Japan to anticancer drug development. The logistics and regulatory aspects of clinical trials with new anticancer agents in different parts of the world were then presented, with an emphasis on Europe, North America, and Japan. The program was completed with a panel discussion of the efforts to harmonize the exchange of clinical data originating from one region of the globe with other territories, with input from official representatives of the United States Food and Drug Administration and the Medical Devices Evaluation Center of Japan.

Antineoplastic Agents↗

PubMed2003

A synergistic increase of apoptosis utilizing Fas antigen expression induced by low doses of anticancer drug.

Anticancer drugs have been known to enhance both Fas receptor and Fas ligand expression on tumor cells. Recently, low doses of cytosine arabinoside (ara-C) were reported to enhance Fas antigen expression in the human myeloid leukemia cell line HL60. Here, we showed that low doses of ara-C (LD-ara-C) and etoposide (LD-VP-16) but not vincristine (LD-VCR) induce Fas expression in the human monocytic leukemia cell line U937. We determined the concentrations of ara-C, VP-16 and VCR as 10, 100 and 1 ng/ml, respectively. The ratios for Fas antigen expression induced in non-treated U937 by 24 h incubations with ara-C, VP-16 or VCR were 1.90, 1.36 and 1.00, respectively. Utilizing the Fas antigen expression induced by low doses of anticancer drugs, we examined whether anti-Fas IgM monoclonal antibody (CH-11) combined with LD-ara-C, LD-VP-16 or LD-VCR enhances apoptosis. When CH-11 and LD-anticancer drug were added simultaneously, the ratios of annexin V positive cells were 67.8 +/- 2.4% with ara-C, 70.0 +/- 1.6% with VP-16 and 54.2 +/- 1.3% with VCR. Thus, the ratios of annexin V positive cells significantly increased when CH-11 was simultaneously added to the cells with ara-C (p < 0.0001) and VP-16 (p < 0.0001), but not with VCP (p = 0.5559), compared with the sums of annexin V positive ratios of CH-11 and LD-anticancer drug added separately. We examined whether a broad-range caspase inhibitor (C.I.) can inhibit the Fas expression enhanced by LD-anticancer drugs. However, the Fas expression enhanced by LD-ara-C or LD-VP-16 was not inhibited by a broad-range caspase inhibitor. We demonstrated that apoptosis induced by LD-ara-C or LD-VP-16 is synergistically increased by the addition of CH-11 in U937.

Antibodies, Monoclonal↗

PubMed1992

Gene-specific oligonucleotide probes for alpha, mu, pi, and microsomal rat glutathione S-transferases: analysis of liver transferase expression and its modulation by hepatic enzyme inducers and platinum anticancer drugs.

Glutathione S-transferases (GSTs) play an important role in the detoxification of diverse electrophilic chemicals, including anticancer drugs. Gene-specific oligonucleotide probes were developed to monitor the expression of individual GST mRNAs in livers of adult male rats treated with drugs and other chemical modulators of GST expression. Northern blot analysis of total liver RNA using probes specific for individual GSTs belonging to classes alpha (GSTs Ya1, Ya2, Yc), mu (GSTs Yb1, Yb2, Yb3), pi (GST Yp), and GSTms demonstrated the expression in liver of all but Yp mRNA. Kidney GST expression was at least as high as that in liver for GSTs Ya1, Yc, and Yp, while it was substantially lower but still detectable for GSTs Ya2, Yb2, and GSTms. Several of the liver GST class alpha mRNAs, in particular Ya2, were inducible by pretreatment of rats with phenobarbital or isosafrole. In contrast, dexamethasone preferentially induced Yb1, Yb2, and Ya2, while two other inducers of liver drug metabolism, isoniazid and clofibrate, were less effective with respect to GST induction. GSTms mRNA was induced to a small extent or not at all by the agents tested. Treatment of adult male rats with the anticancer drug cisplatin increased liver expression of GST Yc mRNA and suppressed Ya1 mRNA levels with little or no major effect on several other GST mRNAs. Western blot analysis of liver cytosols prepared from the cisplatin-treated rats revealed corresponding changes in GST Yc and Ya protein levels. Comparable changes in liver GST Ya1 and Yc expression were effected by the cisplatin analogue iproplatin but not by carboplatin or transplatin. This pattern of response to these platinum drugs is comparable to that seen with respect to platinum drug-induced gonadal toxicity and modulation of liver cytochrome P450 expression, suggesting a common mechanistic basis for these diverse effects of platinum anticancer drugs on hepatic enzymes of drug metabolism. Together, these studies demonstrate the utility of oligonucleotide probes for phenotyping liver tissue for the expression of GST enzymes that can contribute to anticancer drug metabolism and resistance. They also raise the possibility of drug-drug interactions involving cisplatin and alkylating agent anticancer drugs that can be metabolized in liver by alpha-class GSTs.

Animals↗

PubMedDate not supplied

Death receptor-dependent and -independent pathways in anticancer drug-induced apoptosis of breast cancer cells.

Apoptosis is a crucial event for anticancer drug efficacy. The signal pathways activated by anticancer drugs are classified as death receptor (DR) -dependent or -independent. The mechanisms by which anticancer drugs induce apoptosis via DR-dependent pathways are not fully understood. In the present study, we assessed differential activation of signal transduction pathways leading to apoptosis by anticancer drugs in breast cancer cell lines. Three breast cancer cell lines, MDA-MB-231, MCF-7, and MCF-7ADM, which is drug-resistant, were used. Drug sensitivity and apoptosis were assessed by MTT assay and TUNEL, respectively. Expression of apoptosis-related protein was assessed by Western blotting and RT-PCR. The sensitivities of MDA-MB-231 and MCF-7 cells to mitomycin C (MMC) and adriamycin (ADM) were similar. In contrast, sensitivity of MDA-MB-231 cells to paclitaxel (TXL) was 30-fold greater than that of MCF-7 cells, 0.03 micro M in MDA-MB-231 and 0.9 micro M in MCF-7 cells, respectively. Treatment with MMC increased expression of DR4 and Fas in a time-dependent manner in MDA-MB-231 cells. Treatment with ADM increased expression of DR4 and DR5 but not Fas, whereas treatment with TXL increased expression of Fas but not DR4 and DR5 in MDA-MB-231 cells. Although treatment of MCF-7 cells with ADM increased expression of DR4 and DR5 but not Fas, expression of DR4, DR5, and Fas by the drug-resistant cells did not change following treatment with ADM. Activation of Fas, DR4, and DR5 in drug-sensitive cells in response to anticancer drugs is dependent on the cytotoxic effect of each drug. In drug-resistant cells, apoptosis is induced via DR-independent pathways mediated by mitochondrial dysfunction.

Antibiotics, Antineoplastic↗

PubMed2004

[Anticancer drugs use evaluation: limits of the approved labeling].

A practice survey was performed in Tenon hospital on 396 consecutive patients treated for solid tumors during 4 weeks in november 2002. 33% of anticancer drugs were off label used. The wording heterogeneity of the different anticancer drugs approved labeling and the lack of anticancer drugs in a number of cancers can explain those results. On one hand, randomised comparative clinical trial, considered as the best level of evidence to obtain a label used, is not always possible in cancerology, especially for rare tumors. One the other hand, pharmaceutical firm are not obliged to asked a label used for an anticancer drugs in spite of high level of evidence. So, label used can not be the own references for anticancer drugs prescribing, therapeutic advanced can be realised and disseminated before their taking into account in the label used.

Antineoplastic Agents↗

PubMed2003

[Study on the anticancer activities (in vivo) of the extract from Citrus reticulata Blanco and its influence on sarcoma-180 cells cycle].

OBJECTIVE: To study the anticancer activity of the extract from Citrus reticulata in vivo. METHOD: Anticancer activities were tested with tumor model in vivo (Sarcoma-180 cells, Heps cells, EAC cells implanted in mice). RESULT: The extract from Citrus reticulata showed marked anticancer activities on Sarcoma-180 cells and Heps cells implanted in mice, had no marked anticancer activities on EAC cells implanted in mice and induced apoptosis of Sarcoma-180 cell. CONCLUSION: The extract from Citrus reticulata will have promising prospects as an anticancer Chinese medicine, but further studies will be needed.

Animals↗

PubMedDate not supplied

Successful analysis of anticancer drug sensitivity by CD-DST using pleural fluid and ascites from patients with advanced ovarian cancer: case reports.

In vitro anticancer drug sensitivity tests have been performed for various types of cancers, and a relationship with clinical response has been observed. The collagen gel droplet-embedded culture drug sensitivity test (CD-DST) is a new in vitro anticancer drug sensitivity test by Yabushita et al., recently reported to be useful in ovarian cancer. CD-DST allows analysis of a small number of cells, compared to other anticancer drug sensitivity tests. Here, we report a successful analysis of anticancer drug sensitivity by CD-DST using cancerous ascites and pleural fluid samples from 2 patients with advanced ovarian cancer. To our knowledge, this is only the second report of the application of CD-DST in ovarian cancer, and our results suggest that CD-DST could be helpful in the selection of anticancer drugs for neoadjuvant chemotherapy in advanced ovarian cancer.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2006

[The role of electroporation in increasing the effectiveness of anticancer drugs].

By applying electric pulses to tumor the membrane of tumor cells undergoes destabilization that enables the drug molecules to enter into the cells more freely and selectivity of anticancer drugs increases. Thus, administering smaller doses of anticancer drugs it might be possible to achieve a better therapeutic effect and to reduce side effects of cytostatic therapy. Such combination of chemotherapy with electric pulses is called electrochemotherapy. The aim of this study was to evaluate the anticancer effectiveness of single and repeated courses of electrochemotherapy with three different anticancer agents (cyclophosphamide, carboplatinum and bleomycin) using experimental animals. It was established that electrochemotherapy used as a single treatment the best increases cytotoxicity of bleomycin. While applying the electrochemotherapy course for 5 days all investigated anticancer drugs showed higher cytotoxicity as compared to the effect of these cytostatics without electroporation. It is notable that in this case antitumor effect of bleomycin was the highest--99% of treated tumors showed a high response rate and no recurrence was observed for 30 days.

Animals↗

PubMed2006

[Current status and problems of anticancer drug-induced lung injuries].

Some large-scale clinical investigations on gefitinib-induced lung injury have been performed,which have much new information about anticancer drug-induced lung injuries and indicated significant problems in the development of new anticancer drugs. Analysis of gefitinib-induced lung injury revealed varying patterns of clinical features, ethnic differences in onset, risk factors for development and diagnostic difficulties in anticancer drug-induced lung injuries. Furthermore, we realized again underlying problems in the process of developing new anticancer drugs and the importance of post-marketing surveillance. We must elucidate the mechanism of anticancer drug-induced lung injuries to manage them effectively.

Antineoplastic Agents↗