The current status of camptothecin analogues as antitumor agents

William J. Slichenmyer, Eric K. Rowinsky, Ross C. Donehower, Scott H Kaufmann

Research output: Contribution to journalArticle

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Abstract

The nuclear enzyme topoisomerase I (topo I) has been recently recognized as the target for the anticancer drug camptothecin (CPT) and its derivatives. Two of the agents that target this enzyme-topotecan (TPT) and CPT-11-appear to be active against a broad range of human tumors. In the following presentation, we review 1) the role of topo I in normal cells, 2) the chemistry and proposed mechanism of action of CPT and its analogues, 3) the results of preclinical and clinical testing of TPT and CPT-11, and 4) mechanisms of resistance to these agents. In normal cells, topo I is thought to be involved in gene transcription and DNA replication. During the course of its normal catalytic cycle, topo I transiently forms a covalent bond with DNA. CPT and its derivatives slow the religation step of the enzyme and stabilize the covalent adduct between topo I and DNA. In S-phase cells, advancing replication forks convert these topo I-DNA adducts into double-strand breaks that appear to be responsible for the cytotoxicity of these agents. Preclinical studies demonstrate antineoplastic activity for TPT and CPT-11 in a variety of tumor models. Phase I studies have identified neutropenia as the dose-limiting toxicity for both drugs. Gastrointestinal effects might also be dose-limiting for CPT-11 administered on some schedules. CPT-11 has shown antitumor activity in phase II trials for patients with carcinomas of lung, cervix, ovary, colon, and rectum and for patients with non-Hodgkin's lymphoma. Phase II studies of TPT are in progress. Resistance to the cytotoxic effects of these agents might result from decreased production of topo I or from production of a mutated form of topo I. In addition, decreased metabolic activation of CPT-11 (which is a pro-drug) and active efflux of TPT by P-glycoprotein-mediated transport might contribute to resistance. As agents with a novel mechanism of action, tolerable toxicity, and encouraging antitumor activity in early clinical trials, TPT and CPT-11 are undergoing further clinical development. If these agents can be successfully combined with other active chemotherapy agents, the topo I-directed agents offer the potential for significant advances in the treatment of patients with a variety of malignancies. [J Natl Cancer Inst 85: 271-291, 1993].

Original languageEnglish (US)
Pages (from-to)271-291
Number of pages21
JournalJournal of the National Cancer Institute
Volume85
Issue number4
DOIs
StatePublished - Feb 17 1993
Externally publishedYes

Fingerprint

irinotecan
Camptothecin
Type I DNA Topoisomerase
Topotecan
Antineoplastic Agents
Analogue
Drugs
Enzymes
DNA
Toxicity
Tumors
Tumor
Dose
Neoplasms
Cell
Limiting
Non-Hodgkin's Lymphoma
Derivatives
Derivative
Cytotoxicity

ASJC Scopus subject areas

  • Statistics, Probability and Uncertainty
  • Applied Mathematics
  • Physiology (medical)
  • Radiology Nuclear Medicine and imaging
  • Oncology
  • Cancer Research

Cite this

The current status of camptothecin analogues as antitumor agents. / Slichenmyer, William J.; Rowinsky, Eric K.; Donehower, Ross C.; Kaufmann, Scott H.

In: Journal of the National Cancer Institute, Vol. 85, No. 4, 17.02.1993, p. 271-291.

Research output: Contribution to journalArticle

Slichenmyer, William J. ; Rowinsky, Eric K. ; Donehower, Ross C. ; Kaufmann, Scott H. / The current status of camptothecin analogues as antitumor agents. In: Journal of the National Cancer Institute. 1993 ; Vol. 85, No. 4. pp. 271-291.
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