Cancer Chemotherapy and Pharmacology最新文献

Background: Chemotherapy remains a key cancer treatment despite advancements in cancer therapy, with doxorubicin (DOX) widely used for solid and hematological tumors. However, its clinical use is limited by severe acute and chronic cardiotoxicity, primarily driven by oxidative stress and mitophagic dysregulation. Rosuvastatin (RSV), a lipid-lowering drug, has shown cardioprotective effects. This study aimed to investigate the molecular mechanism underlying RSV's protection against DOX-induced cardiotoxicity.

Methods: Adult male Wistar rats were assigned to eight groups: control, RSV-only (20 mg/kg, orally, for 3 weeks), DOX-only (18 mg/kg, intraperitoneally, over 2 weeks), RSV + DOX, CQ + RSV + DOX (chloroquine 25 mg/kg, intraperitoneally, for 2 weeks), CQ-only, RSV + CQ, and CQ + DOX. 48 h after the last DOX injection, serum myocardial injury markers, oxidative stress markers, and autophagic flux biomarkers (LC3II & P62) were assessed. RT-PCR evaluated lncRNA APF gene expression, while western blotting quantified p-SIRT1, FOXO1, p-PINK1, and p-Parkin protein levels.

Results: RSV mitigated DOX-induced myocardial injury and oxidative stress while restoring autophagic flux, as evidenced by P62 and LC3II reversal. RSV enhanced lncRNA APF gene expression, p-SIRT1, p-PINK1, and p-Parkin levels while downregulating FOXO1. The autophagy inhibitor CQ blunted RSV's cardioprotective effects.

Conclusion: RSV protects against DOX-induced cardiotoxicity, at least in part, by restoring autophagic flux and rescuing PINK1/Parkin-mediated mitophagy via upregulation of the SIRT1/FOXO1 pathway. Thus, combining RSV with DOX may enable patients to complete chemotherapy with a reduced risk of cardiotoxicity. However, further studies are warranted to confirm its translational potential.

Introduction: Sonrotoclax (BGB-11417), a second-generation B-cell lymphoma-2 (BCL-2) inhibitor currently in clinical development, requires comprehensive verification of its biotransformation and disposition profiles in safety species.

Methods: [¹⁴C]BGB-11417 was employed to assess its pharmacokinetics, excretion, tissue distribution and metabolite profiles in mice and dogs. Radioactivity in plasma and excreta were analyzed to determine pharmacokinetics and mass balance. The metabolite profiles were generated by the chromatographic separation coupled with radioactivity detector/ mass spectrometry. Quantitative whole-body autoradiography (QWBA) was performed to assess tissue distribution in both pigmented or albino mice. Anaerobic human fecal incubation was conducted to evaluate the biotransformation contribution of gut microbiome.

Results: T_max of [¹⁴C]BGB-11417 radioactivity was observed at 4 h, with a T_1/2 ranging 6.5-7.2 h in both species. The highest tissue exposure was noted in metabolic and excretory organs, with 90% of the administered radioactivity eliminated through mouse excreta within 48 h. Prolonged excretion kinetics accompanied by marked inter-individual variability were observed in dog excreta. A distinct nitro-reduction pathway was detected exclusively in dogs. These metabolites were also detected in anaerobic incubations of [¹⁴C]BGB-11417 with human feces. Aerobic incubation of the nitro-reduction metabolite with dog feces directly yielded lipid-conjugated products, confirming that conjugation occurs spontaneously post-reduction rather than on the parent drug.

Conclusion: The concordance between dog fecal metabolites and human fecal incubations underscored cross-species gut microbiome similarities. These findings offer a mechanistic insight into the fate of sonrotoclax in organisms and guide the interpretation of metabolic clearance in human.

Purpose: Inherited dihydropyrimidine dehydrogenase (DPD) deficiency is a risk factor for severe 5-fluorouracil toxicity. We report a phenotyping approach (thymine challenge test) to prospectively determine DPD activity and the association with severe adverse events.

Methods: The primary aim of this prospective study was to determine whether a thymine challenge test could prospectively identify patients at risk of severe toxicity from treatment with 5-fluorouracil/capecitabine in combination chemotherapy schedules or monotherapy. The focus was prediction of those at risk of ≥ grade 3 gastrointestinal toxicity. DPD activity was determined from the thymine/dihydrothymine (THY/DHT) ratio measured in a urine sample after a thymine test dose (250 mg, oral).

Results: Of the 166 patients, 11.7% had severe diarrhoea/mucositis. The THY/DHT ratio was not significantly different in these individuals compared to those with minimal toxicity. However, post hoc analysis found decreased DPD activity in those who had non-gastrointestinal toxicity, most notably grade ≥ 2 Hand-Foot syndrome (p = 0.001).

Conclusion: The data do not support our primary hypothesis that this phenotyping approach would discriminate those at risk of severe/life-threatening gastrointestinal toxicity. The clinical factors which influence gastrointestinal toxicity, particularly in patients receiving CAPOX require further investigation.

Clinical trial registration: ACTRN 12,617,001,109,392 registered 28/07/2017.

Background: Patients with KRAS wild-type (wt) metastatic colorectal cancer (mCRC) treated with single-agent cetuximab (C) or panitumumab (P), have improved progression-free survival (PFS) and overall survival (OS) compared to best supportive care but an objective response rate (ORR) of only 13-17%. Preclinical and clinical data suggest that dual targeted therapy (e.g., neratinib [N] + C) may improve overall response rates in tumors that are wt for KRAS, NRAS, BRAF, and PIK3CA (quadruple-wt).

Methods: NSABP FC-11 is a multi-center, two-arm, phase II study in patients with quadruple-wt mCRC who had prior oxaliplatin and irinotecan treatment. Arm 1 treated patients with HER2 mutation, with or without prior C or P. Arm 2 treated HER2 non-amplified (14 evaluable) and HER2-amplified (1 evaluable) patients with N + C. The primary aim was PFS at cycle 6 (PFS6). Secondary aims included ORR, objective response, clinical benefit, and safety. Exploratory aims included molecular profiling for mutations, copy number, and RNA expression.

Results: Arm 1 closed early due to low accrual (n = 4) and is not reported. Arm 2 enrolled 21 patients; six discontinued treatment before first scan. Fifteen patients were evaluable with at least one follow-up scan with six demonstrating PFS6. With intention-to-treat (ITT) analysis, this cohort demonstrated an ORR/PFS6 of 28% (6/21). No grade 5 or otherwise unexpected adverse events were noted. Correlative molecular studies did not definitively define responders.

Conclusion: Arm 2 of FC-11 demonstrated an ORR/PFS6 of 28%, which compares favorably to single-agent treatment in this subset of patients.

Clinical trials registration: NCT03457896.

Purpose: Oxaliplatin (L-OHP) is a platinum-based anticancer agent that induces peripheral neuropathy (OIPN), a dose-limiting toxicity caused by platinum accumulation in the dorsal root ganglion (DRG) and neuronal damage. Proton pump inhibitors (PPIs) have recently been proposed as preventive agents for OIPN; however, they have not been clinically implemented. This study aimed to evaluate the ameliorative effects of PPIs on OIPN using real-world data and a pharmacometrics approach based on animal data.

Methods: Real-world database analysis was conducted using the Japanese Adverse Drug Event Report (JADER) database. We calculated the reporting odds ratios to evaluate the effects of the candidate drugs. Rats were intravenously administered L-OHP (5 mg/kg) once a week. Omeprazole (2-20 mg/kg) or esomeprazole (1-10 mg/kg) was orally administered on the five times a week. Blood and DRG samples were collected after L-OHP administration. The OIPN was assessed using the von Frey test. A pharmacokinetic-toxicodynamic (PK-TD) model analysis was performed using the obtained data.

Results: The JADER analysis suggested that omeprazole may have a suppressive effect on OIPN. In animal study, co-administration of omeprazole or esomeprazole significantly decreased the platinum concentration in the DRG compared with L-OHP monotherapy and suppressed the development of OIPN in a dose-dependent manner. The PK-TD model of platinum composed of the DRG compartment quantitatively described the preventive effects of omeprazole and esomeprazole on OIPN.

Conclusion: Omeprazole and esomeprazole may be valuable agents for suppressing OIPN by inhibiting platinum influx into the DRG and exerting a potential neuroprotective effect.

Purpose: Colorectal cancer (CRC) ranks third among most prevalent cancers worldwide. KRAS is the most frequently (30-40%) mutated oncogene in CRC, which has been defined as an "undruggable" therapeutic target over the past four decades.

Methods: In this study, we applied four HT-29 cell lines, namely HT-29-wild-type (HT-29-WT), point-mutated HT-29-KRAS^G12V, HT-29-KRAS^G12C and HT-29-KRAS^G12D, in order to detect the efficiency of RAF-MEK inhibitor VS6766, the BRAF^V600E inhibitor PLX4720 was selected as the control. The analyses of in vitro cytotoxicity, cell cycle and apoptosis of HT-29 cell lines after VS6766 alone or combined with 5-Fluorouracil (5-FU)/MK2206 treatment were carried out by Cell Counting Kit-8 (CCK-8), colony formation, and flow cytometry assay, respectively. The expression changes of proteins were confirmed by western blot.

Results: Treatment with VS6766 inhibited the proliferation of all four HT29 cells, while PLX4720 had a modest inhibitory effect. VS6766 induced G1-phase arrest as well as cell apoptosis, accompanied by the downregulation of p-ERK and p-MEK. Moreover, VS6766 and 5-FU synergistically suppressed HT-29 cells' growth. Meanwhile, p-AKT was upregulated after VS6766 treatment. The AKT inhibitor MK2206 and VS6766 showed synergistic effect in all four cell lines.

Conclusion: Taken together, this study provides the first experimental evidence to demonstrate that all G12 mutation cell lines are sensitive to VS6766 applied either alone or combined with 5-FU or AKT inhibitor.

Purpose: Adherence to 6-mercaptopurine (6-MP)/methotrexate maintenance treatment for acute lymphoblastic leukemia (ALL) is pivotal to preventing relapse, and the 6-MP metabolite DNA-incorporated thioguanine (DNA-TG) is associated with relapse risk. In the ALLTogether-1 (A2G1) Maintenance sub-study (EU CT nr 2022-501050-11-01), DNA-TG, thioguanine nucleotides (TGN), and methylated mercaptopurine metabolites (MeMP) are analyzed regularly. Upon levels below preset limits (TGN < 50, or MeMP < 200 or < 100 nmol/mmol hemoglobin for thiopurine S-methyltransferase (TPMT) wild type and heterozygous patients, respectively), the treating physician is informed of potential non-adherence. We investigated the feasibility of using DNA-TG as the primary flagging of potential non-adherence.

Methods: We analyzed 6-MP metabolites in 3,074 blood samples from 368 children enrolled in the A2G1 Maintenance sub-study.

Results: In 6% of samples, TGN (median 212, 95% range 40-642), MeMP (median 4,959, 95% range 135-23,880) or both were below the flagging potential non-adherence limits. DNA-TG was associated with TGN (estimate = 1.72, p < 0.0001), MeMP (estimate = 1.10, p < 0.0001), and prescribed 6-MP dose (estimate = 1.083 and 1.132, p < 0.0001, for TPMT wild type and heterozygous patients) in linear effects models, and the predicted probability of treatment interruption in logistic regression models. DNA-TG was below 200 fmol TG/µg DNA (13th percentile of all measurements, median 569, 95% range 73-1,823) in all samples with both TGN and MeMP below the flagging potential non-adherence limits.

Conclusion: DNA-TG can provide a cost-effective guidance on when to measure TGN and MeMP to determine whether non-adherence should be suspected, which is an additional benefit to monitoring DNA-TG during maintenance therapy.

Purpose: The impact of the unrecognized mutational dihydropyrimidine-dehydrogenase-gene-(DPYD)-status on high-grade CTC-AE-grades ≥ 3 (NCI-Common Terminology Criteria for Adverse Events, vs. 3.0) was assessed in patients with upper rectal cancer (inferior tumor margin ≥ 12 cm above the anal verge) treated with upfront surgery and 5-Fluorouracil (5-FU) based adjuvant chemotherapy (CTx).

Methods: 75 participants of the GAST-05-phase-IIb-trial (ISRCTN35198481) were tested in this single center analysis for DPYD*2A-wildtype (WT) at staging. After surgery, 43 patients (stages II and III, according to the current 8th TNM/UICC-classification, 2017) received FOLFOX-CTx and entered follow-up (median: 101 months). According to recent recommendations of the European Medicines Agency (EMA) and national guidelines, post-hoc genotyping for DPYD*2A (c.1905 + 1G > A; IVS14 + 1G > A; rs3918290), DPYD*13 (c.1679T > G; rs55886062), polymorphism c.2846 A > T (rs67376798) and Haplotype B3 (HapB3) (c.1236G > A; c.1129-5923 C > G) was performed using cryopreserved blood samples and standardized PCR-techniques.

Results: Five patients were found to have a heterozygous (het_) DPYD-HapB3-status. Across all patients, the adherence to CTx-cycles 1 to 4 was 100%, 97.7%, 95.3%, and 93.0%, respectively. Grade ≥ 3 CTC-AEs were observed in 0.9% of both het_HapB3- and WT-patients. The mean administered dose of 5-FU was 68.8% of the target in DPYD-HapB3 carriers, compared to 92.6% in 38 WT patients. Logistic regression analysis revealed that 5-FU dose reductions were significantly associated with DPYD-HapB3 carrier status (odds ratio [OR] 12.55, p = 0.044) and male sex (OR 0.23, p = 0.049). During follow-up het_HapB3-patients had a recurrence rate of 60.0%, compared to 13,6% for WT-patients. The disease-free survival (DFS) for het_HapB3-patients was significantly reduced vs. WT (p = 0.010). Multivariable analysis showed that het_HapB3-patients had an increased risk for reduced DFS (HR 3.774; p = 0.057). Interestingly, 5-FU dose reductions per se were not significantly associated with limited DFS in the total population.

Conclusion: DPYD genotyping revealed a het_HapB3 variant in 11.6% of DPYD*2A-WT patients treated with FOLFOX. While not linked to increased toxicity, HapB3 status was associated with reduced DFS, suggesting an impact on treatment efficacy. These results support DPYD genotyping and highlight the need for adequate 5-FU plasma level assessment followed by subtile dose escalation (therapeutic drug monitoring) to personalize 5-FU dosing more precisely, safely and most effective.