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Tewari D, Rawat P, Singh PK. Adverse drug reactions of anticancer drugs derived from natural sources. Food Chem Toxicol 2018; 123:522-535. [PMID: 30471312 DOI: 10.1016/j.fct.2018.11.041] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/11/2018] [Accepted: 11/17/2018] [Indexed: 12/20/2022]
Abstract
Cancer, a life threatening disease adversely affects huge population worldwide. Naturally derived drug discovery has emerged as a potential pathway in search of anticancers. Natural products-based drugs are generally considered safe, compared to their synthetic counterparts. A systematic review on adverse drugs reactions (ADRs) of the anticancer natural products has not been performed till date. We reviewed anticancer drugs, derived from plants, microbes and marine sources with their mechanistic action and reported ADRs. PubMed, ScienceDirect and Scopus were searched through Boolean information retrieval method using keywords "natural products", "cancer", "herbal", "marine drugs" and "adverse drug reaction". We documented ADRs of natural products based anticancer agents, mechanisms of action and chemical structures. It was observed that majority of the natural products based anticancer drugs possess ample adverse effects, dominantly hematological toxicities, alopecia, neurotoxicity and cardiotoxicity. These findings deviate from the preconceived notion about safer nature of herbal drugs. We also came across some anti-cancer natural products with less/no reported adverse events like Cabazitaxel and Arglabin. Comprehensive pharmacovigilance studies are needed to report ADRs and thereby predicting safety of anti-cancer drugs, either originated from natural sources or chemically synthesized.
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Affiliation(s)
- Devesh Tewari
- Value Addition Research and Development-Human Health, National Innovation Foundation-India, Autonomous Body of Department of Science and Technology, Govt. of India, Grambharti, Mahudi Road, Gandhinagar, 382650, Gujarat, India
| | - Pooja Rawat
- Value Addition Research and Development-Human Health, National Innovation Foundation-India, Autonomous Body of Department of Science and Technology, Govt. of India, Grambharti, Mahudi Road, Gandhinagar, 382650, Gujarat, India
| | - Pawan Kumar Singh
- Value Addition Research and Development-Human Health, National Innovation Foundation-India, Autonomous Body of Department of Science and Technology, Govt. of India, Grambharti, Mahudi Road, Gandhinagar, 382650, Gujarat, India.
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Schmitt A, Nguyen L, Zorza G, Ferré P, Pétain A. Better characterization of vinflunine pharmacokinetics variability and exposure/toxicity relationship to improve its use: Analyses from 18 trials. Br J Clin Pharmacol 2018; 84:900-910. [PMID: 29341179 PMCID: PMC5903240 DOI: 10.1111/bcp.13518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 01/22/2023] Open
Abstract
AIMS Vinflunine is a novel tubulin-targeted inhibitor indicated as a single agent for the treatment of bladder cancers after failure of prior platinum-based therapy. Its pharmacokinetics (PK) and pharmacodynamics (PD) have been independently characterized through several phase I and phase II studies. However, no global pharmacometric analysis had been conducted as yet. METHODS Vinflunine concentrations and safety data from 18 phase I and phase II studies were used to conduct population PK and PK/PD analysis, using Nonmem. A four-compartment model was used to describe vinflunine PK and several covariates were tested to explain interindividual variability. In terms of PK/PD relationship, a semiphysiological population PK/PD model was applied to describe time course of absolute neutrophil counts (ANC) after vinflunine administration and logistic regression models were used to test the relationship between vinflunine exposure and toxicities. RESULTS Vinflunine clearance is explained by creatinine clearance, body surface area and combination with PEGylated doxorubicin, leading to a decrease from 28.2 to 25.3% of the interindividual variability. When vinflunine dose is decreased, simulations of ANC time course (via a semiphysiological model) after vinflunine administration show a risk of neutropenia grade 3-4 at cycle 2 always lower than when dose is delayed. As an example, for moderate renal impaired patients, the risk is 42.1% when vinflunine is dosed at 320 mg m-2 once every 4 weeks vs. 23.3% for 280 mg m-2 once every 3 weeks. CONCLUSIONS We propose for the first time a global comprehensive clinical pharmacological analysis for intravenous vinflunine that may help drive dose adjustment.
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Affiliation(s)
- Antonin Schmitt
- Centre Georges‐François LeclercDijonFrance
- INSERM U1231University of Burgundy Franche‐ComtéDijonFrance
| | | | | | - Pierre Ferré
- Institut de Recherche Pierre FabreToulouseFrance
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Mannargudi MB, Deb S. Clinical pharmacology and clinical trials of ribonucleotide reductase inhibitors: is it a viable cancer therapy? J Cancer Res Clin Oncol 2017. [PMID: 28624910 DOI: 10.1007/s00432-017-2457-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Ribonucleotide reductase (RR) enzymes (RR1 and RR2) play an important role in the reduction of ribonucleotides to deoxyribonucleotides which is involved in DNA replication and repair. Augmented RR activity has been ascribed to uncontrolled cell growth and tumorigenic transformation. METHODS This review mainly focuses on several biological and chemical RR inhibitors (e.g., siRNA, GTI-2040, GTI-2501, triapine, gemcitabine, and clofarabine) that have been evaluated in clinical trials with promising anticancer activity from 1960's till 2016. A summary on whether their monotherapy or combination is still effective for further use is discussed. RESULTS Among the RR2 inhibitors evaluated, GTI-2040, siRNA, gallium nitrate and didox were more efficacious as a monotherapy, whereas triapine was found to be more efficacious as combination agent. Hydroxyurea is currently used more in combination therapy, even though it is efficacious as a monotherapy. Gallium nitrate showed mixed results in combination therapy, while the combination activity of didox is yet to be evaluated. RR1 inhibitors that have long been used in chemotherapy such as gemcitabine, cladribine, fludarabine and clofarabine are currently used mostly as a combination therapy, but are equally efficacious as a monotherapy, except tezacitabine which did not progress beyond phase I trials. CONCLUSIONS Based on the results of clinical trials, we conclude that RR inhibitors are viable treatment options, either as a monotherapy or as a combination in cancer chemotherapy. With the recent advances made in cancer biology, further development of RR inhibitors with improved efficacy and reduced toxicity is possible for treatment of variety of cancers.
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Affiliation(s)
- Mukundan Baskar Mannargudi
- Clinical Pharmacology Program, Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Subrata Deb
- Department of Biopharmaceutical Sciences, Roosevelt University College of Pharmacy, 1400 N. Roosevelt Blvd., Schaumburg, IL, 60173, USA.
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Abstract
Mutations in cancer cells frequently result in cell cycle alterations that lead to unrestricted growth compared to normal cells. Considering this phenomenon, many drugs have been developed to inhibit different cell-cycle phases. Mitotic phase targeting disturbs mitosis in tumor cells, triggers the spindle assembly checkpoint and frequently results in cell death. The first anti-mitotics to enter clinical trials aimed to target tubulin. Although these drugs improved the treatment of certain cancers, and many anti-microtubule compounds are already approved for clinical use, severe adverse events such as neuropathies were observed. Since then, efforts have been focused on the development of drugs that also target kinases, motor proteins and multi-protein complexes involved in mitosis. In this review, we summarize the major proteins involved in the mitotic phase that can also be targeted for cancer treatment. Finally, we address the activity of anti-mitotic drugs tested in clinical trials in recent years.
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Gerullis H, Wawroschek F, Köhne CH, Ecke TH. Vinflunine in the treatment of advanced urothelial cancer: clinical evidence and experience. Ther Adv Urol 2016; 9:28-35. [PMID: 28042310 DOI: 10.1177/1756287216677903] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Vinflunine (VFL) has been approved in Europe for second-line treatment of metastatic and advanced urothelial cancer after failure of platin-containing therapy. Since approval, the drug has been investigated in few clinical trials. Most of the currently available reports describe experiences with VFL in a daily clinical setting. This review gives a short overview on clinical experiences and clinical trials involving VFL since the approval of this drug in 2009.
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Affiliation(s)
- Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
| | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Claus-Henning Köhne
- University Hospital of Oncology/Haematology, Oncology Center Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
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Genova C, Alama A, Coco S, Rijavec E, Dal Bello MG, Vanni I, Biello F, Barletta G, Rossi G, Grossi F. Vinflunine for the treatment of non-small cell lung cancer. Expert Opin Investig Drugs 2016; 25:1447-1455. [PMID: 27771969 DOI: 10.1080/13543784.2016.1252331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Vinflunine belongs to the class of vinca alkaloids and acts by disrupting the microtubule dynamics during cell cycle; this agent is currently available for previously treated advanced transitional cell carcinoma in Europe. The aim of this invited review is to evaluate the potential role of vinflunine for the treatment of non-small cell lung cancer (NSCLC). Areas covered: The potential role of vinflunine in NSCLC is discussed on the basis of the available data, including full papers and meeting abstracts. Relevant preclinical studies describing the pharmacological properties of vinflunine are also included. The review also summarizes clinical studies, including phase I trials involving NSCLC among other tumors as well as phase II/III trials specifically addressing this malignancy. Additionally, the safety profile and the current regulatory status of vinflunine is discussed. Expert opinion: Vinflunine is active as single agent and as part of platinum-based combinations in NSCLC. It results non-inferior to docetaxel in a randomized phase III trial including previously treated NSCLC patients; additionally, its safety profile is generally considered manageable. Ultimately, further studies are needed to confirm the role of vinflunine in NSCLC, in consideration of the evolving evidence regarding targeted therapies and immune check-point inhibitors.
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Affiliation(s)
- C Genova
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - A Alama
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - S Coco
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - E Rijavec
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - M G Dal Bello
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - I Vanni
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - F Biello
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - G Barletta
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - G Rossi
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
| | - F Grossi
- a UOS Tumori Polmonari , IRCCS AOU San Martino IST-Istituto Nazionale per la Ricerca sul Cancro , Genoa , Italy
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De Santis M, Wiechno PJ, Bellmunt J, Lucas C, Su WC, Albiges L, Lin CC, Senkus-Konefka E, Flechon A, Mourey L, Necchi A, Loidl WC, Retz MM, Vaissière N, Culine S. Vinflunine-gemcitabine versus vinflunine-carboplatin as first-line chemotherapy in cisplatin-unfit patients with advanced urothelial carcinoma: results of an international randomized phase II trial (JASINT1). Ann Oncol 2015; 27:449-54. [PMID: 26673352 PMCID: PMC4769994 DOI: 10.1093/annonc/mdv609] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/05/2015] [Indexed: 01/04/2023] Open
Abstract
This randomized phase II study examined the use of vinflunine in combination with gemcitabine or carboplatin as first-line chemotherapy in cisplatin-ineligible patients with advanced urothelial carcinoma. Both doublets were feasible and offered a similar 77% disease control rate. Response rate (44%), overall survival (14 months) and less haematological toxicity favoured vinflunine–gemcitabine. Background There is no standard first-line chemotherapy for advanced urothelial carcinoma (aUC) in cisplatin-ineligible (cisplatin-unfit) patients. The study assessed the efficacy and tolerability profile of two vinflunine-based cytotoxic regimens in this setting. Patients and methods Patients with aUC a creatinine clearance (CrCl) of <60 but ≥30 ml/min, performance status 0 or 1 and no prior chemotherapy for advanced disease were randomized (1 : 1). They received vinflunine 250 or 280 mg/m2 (based on baseline CrCl) on day 1, plus either gemcitabine [750 mg/m2 escalated to 1000 mg/m2 in cycle 2 if no toxicity grade (G) ≥2 on days 1 and 8 (VG) or plus carboplatin area under the curve 4.5 day 1 (VC) every 21 days]. To detect a 22% improvement in each arm compared with H0 (41%) in the primary end point, disease control rate (DCR = complete response + partial response + stable disease), 31 assessable patients per arm were required (α = 5%, β = 20%). Results Sixty-nine patients were enrolled (34 VG, 35 VC). Less G3/4 haematological adverse events (AEs) were reported with VG: neutropaenia was seen in 38% (versus 68% with VC) and febrile neutropaenia in 3% (versus 14% with VC) of patients. No major differences were observed for non-haematological AEs. DCR was 77% in both groups; overall response rate (ORR) was 44.1% versus 28.6%, with a median progression-free survival of 5.9 versus 6.1 months and median OS of 14.0 versus 12.8 months with VG and VC, respectively. Conclusion Both vinflunine-based doublets offer a similar DCR, ORR and OS. The better haematological tolerance favours the VG combination, which warrants further study. ClinicalTrials.gov protocol identifier NCT 01599013.
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Affiliation(s)
- M De Santis
- Ludwig Boltzmann Institute for ACR VIEnna/LB-CTO ACR-ITR VIEnna, KFJ-Spital, Vienna, Austria Cancer Research Centre, University of Warwick, Coventry, UK
| | - P J Wiechno
- Oncology Institute, Instytut im Sklodowskiej-Curie, Warsaw, Poland
| | - J Bellmunt
- Dana-Farber Cancer Institute-Harvard Medical School, Boston, USA
| | - C Lucas
- Institut de Recherche Pierre Fabre, Boulogne-Billancourt, France
| | - W-C Su
- Department of Internal Medicine, National Cheng Kung University Hospital, Taipei, Taiwan
| | - L Albiges
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - C-C Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - E Senkus-Konefka
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - A Flechon
- Department of Medicine, Centre Léon Bérard, Lyon
| | - L Mourey
- Department of Oncology, Institut Claudius Regaud, Toulouse, France
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - W C Loidl
- Department of Urology, KH Barmherzige Schwestern Linz, Linz, Austria
| | - M M Retz
- Department of Urology, University Hospital Rechts Der Isar, Munich, Germany
| | - N Vaissière
- Institut de Recherche Pierre Fabre, Boulogne-Billancourt, France
| | - S Culine
- Department of Medical Oncology, Hopital Saint-Louis-APHP, Paris-Diderot University, Paris, France
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Reply to the Letter to the Editor Entitled “Vinflunine for Non-small Cell Lung Cancer: Realistic Hopes?”. J Thorac Oncol 2011. [DOI: 10.1097/jto.0b013e31822e2929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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