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Repurposing of Anti-Malarial Drug Quinacrine for Cancer Treatment: A Review. Sci Pharm 2022. [DOI: 10.3390/scipharm90010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Quinacrine (QC), a synthetic drug belonging to the 9-aminoacridine family, has been used extensively to treat malaria and multiple ailments over the past several decades. Following its discovery in the 1920s and extensive use for the treatment of malaria for nearly two decades, numerous studies have explored its antineoplastic potential in both preclinical and clinical settings. Multiple studies spanning over seven decades have examined a wide range of QC anticancer activities across various types of cancers, along with the underlying mechanisms. Many of these mechanisms, including activation of the p53 signaling cascade and simultaneous NF-κB signaling inhibition, have been reported in various studies, bringing QC to a unique polypharmacological category drug possessing the potential to treat a wide variety of diseases, including cancer. This article summarizes most of the research conducted over several decades to uncover new molecular mechanisms activated or inactivated and directly correlate with antineoplastic activity QC.
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Winer A, Denlinger CS, Vijayvergia N, Cohen SJ, Astaturov I, Dotan E, Gallant JN, Wang EW, Kunkel M, Lim B, Harvey HA, Sivik J, Korzekwa K, Ruth K, White K, Cooper HS, Ross EA, Zhou L, El-Deiry WS. First-in-Human Phase 1b Trial of Quinacrine Plus Capecitabine in Patients With Refractory Metastatic Colorectal Cancer. Clin Colorectal Cancer 2020; 20:e43-e52. [PMID: 32972830 DOI: 10.1016/j.clcc.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/30/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Quinacrine plus a fluoropyrimidine has in vivo efficacy against metastatic colorectal cancer (mCRC). This phase 1b trial evaluated the combination of quinacrine plus capecitabine in patients with treatment-refractory mCRC. PATIENTS AND METHODS Using a modified Simon accelerated titration design, adults with treatment-refractory mCRC were treated with capecitabine 1000 mg/m2 twice daily for 14/21-day cycle, and escalating doses of quinacrine 100 mg daily, 100 mg twice daily, and 200 mg twice daily for 21 days. The primary endpoint was identifying the maximum tolerated dose, determining tolerability and safety. In an expansion cohort, it was overall response rate and time to tumor progression (TTP). RESULTS Ten patients (median age of 60 years) were treated in phase 1b. The first 2 quinacrine dosing levels were well tolerated. Dose-limiting toxicities were seen in 3 patients treated with quinacrine 200 mg twice daily. Five additional patients tolerated quinacrine 100 mg twice daily without further dose-limiting toxicities, thus establishing the maximum tolerated dose. Seven additional expansion-cohort patients enrolled onto the study before quinacrine manufacturing ceased within the United States. Five patients experienced stable disease, 1 partial response, and 10 disease progression. Median TTP overall was 2.12 months and median overall survival 5.22 months for the 17 patients. CONCLUSION Capecitabine and quinacrine can be safely administered at the maximum tolerated dose of capecitabine 1000 mg/m2 by mouth twice daily on days 1-14 and quinacrine 100 mg by mouth twice daily on days 1-21 of a 21-day cycle in mCRC patients. Although the expansion study was halted early, TTP was in line with other studies of refractory mCRC, suggesting activity of this regimen in heavily pretreated patients.
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Affiliation(s)
| | | | | | | | | | | | - Jean-Nicolas Gallant
- Vanderbilt University Medical Center, Nashville, TN; Penn State Hershey Medical Center, Hershey, PA
| | - Edward W Wang
- City of Hope Cancer Center, Duarte, CA; Penn State Hershey Medical Center, Hershey, PA
| | | | - Bora Lim
- Penn State Hershey Medical Center, Hershey, PA; MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Karen Ruth
- Fox Chase Cancer Center, Philadelphia, PA
| | | | | | | | - Lanlan Zhou
- Fox Chase Cancer Center, Philadelphia, PA; Penn State Hershey Medical Center, Hershey, PA; The Warren Alpert Medical School, Providence, RI
| | - Wafik S El-Deiry
- Fox Chase Cancer Center, Philadelphia, PA; Penn State Hershey Medical Center, Hershey, PA; The Warren Alpert Medical School, Providence, RI.
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