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Mody H, Vaidya TR, Lezeau J, Taha K, Ait-Oudhia S. In vitro to clinical translation of combinatorial effects of doxorubicin and dexrazoxane in breast cancer: a mechanism-based pharmacokinetic/pharmacodynamic modeling approach. Front Pharmacol 2023; 14:1239141. [PMID: 37927589 PMCID: PMC10620511 DOI: 10.3389/fphar.2023.1239141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
Dexrazoxane (DEX) is the only drug clinically approved to treat Doxorubicin-induced cardiotoxicity (DIC), however its impact on the anticancer efficacy of DOX is not extensively studied. In this manuscript, a proof-of-concept in vitro study is carried out to quantitatively characterize the anticancer effects of DOX and DEX and determine their nature of drug-drug interactions in cancer cells by combining experimental data with modeling approaches. First, we determined the static concentration-response of DOX and DEX in breast cancer cell lines, JIMT-1 and MDA-MB-468. With a three-dimensional (3D) response surface analysis using a competitive interaction model, we characterized their interaction to be modestly synergistic in MDA-MB-468 or modestly antagonistic in JIMT-1 cells. Second, a cellular-level, pharmacodynamic (PD) model was developed to capture the time-course effects of the two drugs which determined additive and antagonistic interactions for DOX and DEX in MDA-MB-468 and JIMT-1, respectively. Finally, we performed in vitro to in vivo translation by utilizing DOX and DEX clinical dosing regimen that was previously identified to be maximally cardioprotective, to drive tumor cell PD models. The resulting simulations showed that a 10:1 DEX:DOX dose ratio over three cycles of Q3W regimen of DOX results in comparable efficacy based on MDA-MB-468 (additive effect) estimates and lower efficacy based on JIMT-1 (antagonistic effect) estimates for DOX + DEX combination as compared to DOX alone. Thus, our developed cell-based PD models can be used to simulate different scenarios and better design preclinical in vivo studies to further optimize DOX and DEX combinations.
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Affiliation(s)
- Hardik Mody
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, FL, United States
| | - Tanaya R Vaidya
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, FL, United States
| | - Jovin Lezeau
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, FL, United States
| | - Kareem Taha
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, FL, United States
| | - Sihem Ait-Oudhia
- Quantitative Pharmacology and Pharmacometrics (QP2), Merck & Co., Inc., Rahway, NJ, United States
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Macedo AVS, Hajjar LA, Lyon AR, Nascimento BR, Putzu A, Rossi L, Costa RB, Landoni G, Nogueira-Rodrigues A, Ribeiro ALP. Efficacy of Dexrazoxane in Preventing Anthracycline Cardiotoxicity in Breast Cancer. JACC: CARDIOONCOLOGY 2019; 1:68-79. [PMID: 34396164 PMCID: PMC8352186 DOI: 10.1016/j.jaccao.2019.08.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/23/2023]
Abstract
Objectives The authors performed a systematic review and meta-analysis of randomized and nonrandomized trials on the efficacy of dexrazoxane in patients with breast cancer who were treated with anthracyclines with or without trastuzumab. Background Breast cancer treatment with anthracyclines and trastuzumab is associated with an increased risk of cardiotoxicity. Among the various strategies to reduce the risk of cardiotoxicity, dexrazoxane is an option for primary prevention, but it is seldom used in clinical practice. Methods Online databases were searched from January 1990 up to March 1, 2019, for clinical trials on the use of dexrazoxane for the prevention of cardiotoxicity in patients with breast cancer receiving anthracyclines with or without trastuzumab. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model meta-analysis. Results Seven randomized trials and 2 retrospective trials with a total of 2,177 patients were included. Dexrazoxane reduced the risk of clinical heart failure (RR: 0.19; 95% CI: 0.09 to 0.40; p < 0.001) and cardiac events (RR: 0.36; 95% CI: 0.27 to 0.49; p < 0.001) irrespective of previous exposure to anthracyclines. The rate of a partial or complete oncological response, overall survival, and progression-free survival were not affected by dexrazoxane. Conclusions Dexrazoxane reduced the risk of clinical heart failure and cardiac events in patients with breast cancer undergoing anthracycline chemotherapy with or without trastuzumab and did not significantly impact cancer outcomes. However, the quality of available evidence is low, and further randomized trials are warranted before the systematic implementation of this therapy in clinical practice.
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Affiliation(s)
- Ariane V S Macedo
- Department of Cardiology of Hospital das Clínicas, Federal University of Minas Gerais and Department of Internal Medicine, School of Medicine of Federal University of Minas Gerais, Belo Horizonte, Brazil.,Oncoclínicas Group, Belo Horizonte, Brazil
| | - Ludhmila A Hajjar
- Department of Cardiopneumology of InCor and Division of Cardio-Oncology, Cancer Institute of Sao Paulo, School of Medicine of São Paulo University, São Paulo, Brazil
| | - Alexander R Lyon
- Cardio-oncology Service, Royal Brompton Hospital and Imperial College London, United Kingdom
| | - Bruno R Nascimento
- Department of Cardiology of Hospital das Clínicas, Federal University of Minas Gerais and Department of Internal Medicine, School of Medicine of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alessandro Putzu
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Lorenzo Rossi
- Institute of Oncology of Southern Switzerland, Bellinzona, Switzerland
| | | | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Angélica Nogueira-Rodrigues
- Division of Oncology of Hospital das Clínicas, Federal University of Minas Gerais and Department of Internal Medicine, School of Medicine of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Antonio L P Ribeiro
- Department of Cardiology of Hospital das Clínicas, Federal University of Minas Gerais and Department of Internal Medicine, School of Medicine of Federal University of Minas Gerais, Belo Horizonte, Brazil
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Jirkovský E, Jirkovská A, Bureš J, Chládek J, Lenčová O, Stariat J, Pokorná Z, Karabanovich G, Roh J, Brázdová P, Šimůnek T, Kovaříková P, Štěrba M. Pharmacokinetics of the Cardioprotective Drug Dexrazoxane and Its Active Metabolite ADR-925 with Focus on Cardiomyocytes and the Heart. J Pharmacol Exp Ther 2017; 364:433-446. [PMID: 29273587 DOI: 10.1124/jpet.117.244848] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022] Open
Abstract
Dexrazoxane (DEX), the only cardioprotectant approved against anthracycline cardiotoxicity, has been traditionally deemed to be a prodrug of the iron-chelating metabolite ADR-925. However, pharmacokinetic profile of both agents, particularly with respect to the cells and tissues essential for its action (cardiomyocytes/myocardium), remains poorly understood. The aim of this study is to characterize the conversion and disposition of DEX to ADR-925 in vitro (primary cardiomyocytes) and in vivo (rabbits) under conditions where DEX is clearly cardioprotective against anthracycline cardiotoxicity. Our results show that DEX is hydrolyzed to ADR-925 in cell media independently of the presence of cardiomyocytes or their lysate. Furthermore, ADR-925 directly penetrates into the cells with contribution of active transport, and detectable concentrations occur earlier than after DEX incubation. In rabbits, ADR-925 was detected rapidly in plasma after DEX administration to form sustained concentrations thereafter. ADR-925 was not markedly retained in the myocardium, and its relative exposure was 5.7-fold lower than for DEX. Unlike liver tissue, myocardium homogenates did not accelerate the conversion of DEX to ADR-925 in vitro, suggesting that myocardial concentrations in vivo may originate from its distribution from the central compartment. The pharmacokinetic parameters for both DEX and ADR-925 were determined by both noncompartmental analyses and population pharmacokinetics (including joint parent-metabolite model). Importantly, all determined parameters were closer to human than to rodent data. The present results open venues for the direct assessment of the cardioprotective effects of ADR-925 in vitro and in vivo to establish whether DEX is a drug or prodrug.
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Affiliation(s)
- Eduard Jirkovský
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Anna Jirkovská
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Jan Bureš
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Jaroslav Chládek
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Olga Lenčová
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Ján Stariat
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Zuzana Pokorná
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Galina Karabanovich
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Jaroslav Roh
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Petra Brázdová
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Tomáš Šimůnek
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Petra Kovaříková
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Martin Štěrba
- Department of Pharmacology, Faculty of Medicine in Hradec Králové (E.J., J.C., O.L., Z.P., P.B., M.Š.), and Departments of Biochemical Sciences (E.J., A.J., T.Š.), Pharmaceutical Chemistry and Pharmaceutical Analysis (J.B., J.S., P.K.), and Inorganic and Organic Chemistry (G.K., J.R.), Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
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Kropp J, Roti Roti EC, Ringelstetter A, Khatib H, Abbott DH, Salih SM. Dexrazoxane Diminishes Doxorubicin-Induced Acute Ovarian Damage and Preserves Ovarian Function and Fecundity in Mice. PLoS One 2015; 10:e0142588. [PMID: 26544188 PMCID: PMC4636352 DOI: 10.1371/journal.pone.0142588] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/23/2015] [Indexed: 11/19/2022] Open
Abstract
Advances in cancer treatment utilizing multiple chemotherapies have dramatically increased cancer survivorship. Female cancer survivors treated with doxorubicin (DXR) chemotherapy often suffer from an acute impairment of ovarian function, which can persist as long-term, permanent ovarian insufficiency. Dexrazoxane (Dexra) pretreatment reduces DXR-induced insult in the heart, and protects in vitro cultured murine and non-human primate ovaries, demonstrating a drug-based shield to prevent DXR insult. The present study tested the ability of Dexra pretreatment to mitigate acute DXR chemotherapy ovarian toxicity in mice through the first 24 hours post-treatment, and improve subsequent long-term fertility throughout the reproductive lifespan. Adolescent CD-1 mice were treated with Dexra 1 hour prior to DXR treatment in a 1:1 mg or 10:1 mg Dexra:DXR ratio. During the acute injury period (2-24 hours post-injection), Dexra pretreatment at a 1:1 mg ratio decreased the extent of double strand DNA breaks, diminished γH2FAX activation, and reduced subsequent follicular cellular demise caused by DXR. In fertility and fecundity studies, dams pretreated with either Dexra:DXR dose ratio exhibited litter sizes larger than DXR-treated dams, and mice treated with a 1:1 mg Dexra:DXR ratio delivered pups with birth weights greater than DXR-treated females. While DXR significantly increased the "infertility index" (quantifying the percentage of dams failing to achieve pregnancy) through 6 gestations following treatment, Dexra pretreatment significantly reduced the infertility index following DXR treatment, improving fecundity. Low dose Dexra not only protected the ovaries, but also bestowed a considerable survival advantage following exposure to DXR chemotherapy. Mouse survivorship increased from 25% post-DXR treatment to over 80% with Dexra pretreatment. These data demonstrate that Dexra provides acute ovarian protection from DXR toxicity, improving reproductive health in a mouse model, suggesting this clinically available drug may provide ovarian protection for cancer patients.
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Affiliation(s)
- Jenna Kropp
- Department of Animal Sciences, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Elon C. Roti Roti
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Ashley Ringelstetter
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Hasan Khatib
- Department of Animal Sciences, University of Wisconsin, Madison, Wisconsin, United States of America
| | - David H. Abbott
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, Madison, Wisconsin 53715, United States of America
| | - Sana M. Salih
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin, United States of America
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Štěrba M, Popelová O, Vávrová A, Jirkovský E, Kovaříková P, Geršl V, Šimůnek T. Oxidative stress, redox signaling, and metal chelation in anthracycline cardiotoxicity and pharmacological cardioprotection. Antioxid Redox Signal 2013; 18:899-929. [PMID: 22794198 PMCID: PMC3557437 DOI: 10.1089/ars.2012.4795] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/15/2012] [Indexed: 12/22/2022]
Abstract
SIGNIFICANCE Anthracyclines (doxorubicin, daunorubicin, or epirubicin) rank among the most effective anticancer drugs, but their clinical usefulness is hampered by the risk of cardiotoxicity. The most feared are the chronic forms of cardiotoxicity, characterized by irreversible cardiac damage and congestive heart failure. Although the pathogenesis of anthracycline cardiotoxicity seems to be complex, the pivotal role has been traditionally attributed to the iron-mediated formation of reactive oxygen species (ROS). In clinics, the bisdioxopiperazine agent dexrazoxane (ICRF-187) reduces the risk of anthracycline cardiotoxicity without a significant effect on response to chemotherapy. The prevailing concept describes dexrazoxane as a prodrug undergoing bioactivation to an iron-chelating agent ADR-925, which may inhibit anthracycline-induced ROS formation and oxidative damage to cardiomyocytes. RECENT ADVANCES A considerable body of evidence points to mitochondria as the key targets for anthracycline cardiotoxicity, and therefore it could be also crucial for effective cardioprotection. Numerous antioxidants and several iron chelators have been tested in vitro and in vivo with variable outcomes. None of these compounds have matched or even surpassed the effectiveness of dexrazoxane in chronic anthracycline cardiotoxicity settings, despite being stronger chelators and/or antioxidants. CRITICAL ISSUES The interpretation of many findings is complicated by the heterogeneity of experimental models and frequent employment of acute high-dose treatments with limited translatability to clinical practice. FUTURE DIRECTIONS Dexrazoxane may be the key to the enigma of anthracycline cardiotoxicity, and therefore it warrants further investigation, including the search for alternative/complementary modes of cardioprotective action beyond simple iron chelation.
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Affiliation(s)
- Martin Štěrba
- Department of Pharmacology, Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
| | - Olga Popelová
- Department of Pharmacology, Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
| | - Anna Vávrová
- Department of Biochemical Sciences, Charles University in Prague, Hradec Králové, Czech Republic
| | - Eduard Jirkovský
- Department of Pharmacology, Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
| | - Petra Kovaříková
- Department of Pharmaceutical Chemistry and Drug Control, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
| | - Vladimír Geršl
- Department of Pharmacology, Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
| | - Tomáš Šimůnek
- Department of Biochemical Sciences, Charles University in Prague, Hradec Králové, Czech Republic
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