Bioreductive drugs: from concept to clinic

被引:138
作者
McKeown, S. R. [1 ]
Cowent, R. L.
Williams, K. J.
机构
[1] Univ Ulster, Inst Biomed Sci, Coleraine BT52 1SA, Londonderry, North Ireland
[2] Univ Manchester, Expt Oncol Grp, Sch Pharm & Pharmaceut Sci, Manchester M13 9PT, Lancs, England
基金
英国医学研究理事会;
关键词
bioreductive drugs; clinical studies; pre-clinical studies; review; tumour hypoxia;
D O I
10.1016/j.clon.2007.03.006
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
One of the key issues for radiobiologists is the importance of hypoxia to the radiotherapy response. This review addresses the reasons for this and primarily focuses on one aspect, the development of bioreductive drugs that are specifically designed to target hypoxic tumour cells. Four classes of compound have been developed since this concept was first proposed: quinones, nitroaromatics, aliphatic and heteroaromatic N-oxides. All share two characteristics: (1) they require hypoxia for activation and (2) this activation is dependent on the presence of specific reductases. The most effective compounds have shown the ability to enhance the anti-tumour efficacy of agents that kill better-oxygenated cells, i.e. radiation and standard cytotoxic chemotherapy agents such as cisplatin and cyclophosphamide. Tirapazamine (TPZ) is the most widely studied of the lead compounds. After successful pre-clinical in vivo combination studies it entered clinical trial; over 20 trials have now been reported. Although TPZ has enhanced some standard regimens, the results are variable and in some combinations toxicity was enhanced. Banoxantrone (AQ4N) is another agent that is showing promise in early phase I/II clinical trials; the drug is well tolerated, is known to locate in the tumour and can be given in high doses without major toxicities. Mitomycin C (MMC), which shows some bioreductive activation in vitro, has been tested in combination trials. However, it is difficult to assign the enhancement of its effects to targeting of the hypoxic cells because of the significant level of its hypoxia-independent toxicity. More specific analogues of MMC, e.g. porfiromycin and apaziquone (E09), have had variable success in the clinic. Other new drugs that have good pre-clinicai profiles are PR 104 and NLCQ-1; data on their clinical safety/efficacy are not yet available. This paper reviews the pre-clinical data and discusses the clinical studies that have been reported.
引用
收藏
页码:427 / 442
页数:16
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