Phase II study of 2'-deoxycoformycin in patients with renal cell carcinoma. A National Cancer Institute of Canada Clinical Trials Group study

Purine nucleoside analogues: fludarabine, pentostatin, and cladribine

Purpose. The primary objective of this article is to continue the discussion of the pharmacology, phar macokinetics, clinical use, and adverse effects of the currently approved adenosine analogues, focusing on pentostatin. This is part two of a three part series.

Data Sources. We reviewed the literature through a MEDLINE search from 1986 to 1996. Rele vant articles cited in the literature obtained by MED LINE searching also were considered. We searched the following terms: fludarabine, cladribine, pentosta tin, apoptosis, and adenosine analogues. The search was restricted to the English language.

Data Extraction. We have reviewed the current literature in regard to the chemistry, mechanisms of action and pharmacology, pharmacokinetics, clinical use, adverse effects, drug interactions, indications, formulation, dosage, administration, and pharmaceu tical issues of the currently approved adenosoine analogues, focusing on pentostatin.

Data Synthesis. The adenosine analogues are structurally similar agents used in the management of hematological malignancies. Pentostatin and cladrib ine are both active agents in the treatment of hairy cell leukemia. There are no comparative clinical trials between the agents, and we have provided compari sons based on pharmacology, clinical experience, adverse effects, and cost.

The role of systemic chemotherapy in the treatment of kidney cancer

Traditional cytotoxic chemotherapy has been considered to be ineffective in renal cell carcinoma, likely due to multiple mechanisms of high-level drug resistance proteins such as p-glycoprotein expressed by these cancers. Nonetheless, low level activity of several nucleoside analogues and the elucidation of critical molecular pathways and targets in this disease, such as the angiogenic pathway, provide hope that important advances can and will be made.