CDK inhibitor

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A CDK (cyclin-dependent kinase) inhibitor is any chemical that inhibits the function of CDKs. They are used to treat cancers by preventing overproliferation of cancer cells. The US FDA approved the first drug of this type, palbociclib (Ibrance), [1] a CDK4/6 inhibitor, in February 2015, for use in postmenopausal women with breast cancer that is estrogen receptor positive and HER2 negative. While there are multiple cyclin/CDK complexes regulating the cell cycle, CDK inhibitors targeting CDK4/6 have been the most successful; four CDK4/6 inhibitors have been FDA approved. [2] No inhibitors targeting other CDKs have been FDA approved, but several compounds are in clinical trials.

Contents

CDKs as cancer target

See also Ribociclib#Mechanism of action re: CDK4
The cyclin-CDK complexes associated with each phase of the cell cycle. These CDKs are the target of CDK inhibitors in order to cause cell cycle arrest and prevent unwanted cell proliferation. Cell cycle and CDK.jpg
The cyclin-CDK complexes associated with each phase of the cell cycle. These CDKs are the target of CDK inhibitors in order to cause cell cycle arrest and prevent unwanted cell proliferation.

The cell cycle is a highly regulated process governing cell division and is controlled by several cyclins and CDKs. Cyclins phosphorylate CDKs, forming complexes that stabilize them and allow them to enact their function. [3] While cyclins activate CDKs, there are other regulatory molecules that can inhibit their function. Under normal conditions, the activation and inhibition of CDK complexes controls the behavior of the cell at many important cell cycle checkpoints to regulate healthy division. However, this process can become dysregulated, leading to the uncontrolled division of cells known as cancer. [4] In fact, in many human cancers, CDKs are overactive or CDK-inhibiting proteins are not functional. [5] [6] CDK inhibitors as a therapy emerged from the idea that order could be restored to an overreactive cell cycle by inhibiting the CDKs whose activation drives the cell cycle forward. Therefore, it is rational to target CDK function to prevent unregulated proliferation of cancer cells.

However, the validity of CDK as a cancer target should be carefully assessed because genetic studies have revealed that knockout of one specific type of CDK often does not affect proliferation of cells or has an effect only in specific tissue types. For example, most adult cells in mice proliferate normally even without both CDK4 and CDK2. [7]

Furthermore, specific CDKs are only active in certain periods of the cell cycle. Therefore, the pharmacokinetics and dosing schedule of the candidate compound must be carefully evaluated to maintain active concentration of the drug throughout the entire cell cycle. [8]

Limitations

Another remaining question surrounding CDK inhibitors as a therapy is if certain cancers will evade or be resistant to treatment. One study showed that 20% of the patients being treated for metastatic ER+ HER2-breast cancer did not respond at all to treatment with a CDK4/6 inhibitor due to preexisting mutations allowing the cancer cells to continue proliferating despite treatment with the drug. [9] Other studies have shown this number to be as high as 30%. [10] Another study notes that the usefulness of CDK4/6 in the clinical may be limited by acquired drug resistance. In this study, treatment with CDK4/6 inhibitors in ER+ breast cancer and non-small cell lung carcinoma harboring KRAS mutations resulted in upregulation of cyclin D1, CDK4, and cyclin E1, negating the effects of administering the drug. [11]

Types

Malumbres et al., categorized CDK inhibitors based on their target specificity: [8]

Broad CDK inhibitors

Specific CDK inhibitors

Multiple Target Inhibitors

Approved

CDK4/CDK6 inhibitors

The current FDA approved drugs are all CDK4/6 inhibitors targeting CDK4 and CDK6, two enzymes that control the cell cycle checkpoint transition checkpoint from the G1 to the S phase of the cell cycle. These cell cycle inhibitors work by inducing cell cycle arrest at G1. [13]

Several drugs have been approved by the US FDA for HR-positive, HER2-negative breast cancer.

Palbociclib (PD-033299, trade name Ibrance) gave encouraging results in a phase II clinical trial on patients with HR-positive, HER2-negative advanced breast cancer. [14] The addition of PD-0332991 to letrozole trebled median time to disease progression to 26.1 months compared with 7.5 months for letrozole alone. The FDA granted it Accelerated Approval in Feb 2015. [15]

Ribociclib (LEE011, trade names Kisqali and Kryxana), is US FDA approved in combination with letrozole for treatment of breast cancer in patients with HR-positive, HER2-negative advanced metastatic breast cancer. [16] A phase three clinical trial found that ribociclib administered in combination with letrozole increased the likelihood of progression free survival to 63% in the first 18 months of therapy versus 42% for letrozole alone. [17] Subsequent analysis demonstrated that patients treated with ribociclib and letrozole showed a median progression-free survival of 25.3 months. [16]

Abemaciclib (LY2835219, trade name Verzenio) [18] was approved in September 2017 by the FDA for "adult patients who have hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer that has progressed after taking therapy that alters a patient's hormones". [19]

One drug has been FDA approved for mediating chemotherapy-induced side effects.

Trilaciclib (V03AF12, trade name Cosela) was approved in February 2021 to reduce chemotherapy-induced myelosuppression in patients with late-stage small-cell lung cancer (ES-SCLC). [20] However, there are active clinical trials evaluating the use of trilaciclib in other forms of cancer, including small cell lung cancer, breast cancer, and colorectal cancer. [21]

Dalpiciclib is approved in China for use in combination with fulvestrant for treatment of HR-positive, HER2-negative recurrent, or metastatic breast cancer in patients who have progressed after previous endocrine therapy. [22]

In clinical trials

There are more than 10 CDK inhibitor compounds that have gone through or currently ongoing clinical trials, as of 2009. Most of them are targeting multiple CDKs, but some are targeting specific CDKs. For example, P1446A-05 targets CDK4. Various types of cancers including leukemia, melanoma, solid tumors, and other types are being targeted. In some cases, very specific cancer types, such as 'melanoma positive for cyclin D1 expression' are targeted to maximize the efficacy. [23]

As of February 2017, trilaciclib (G1T28, CDK4/6 inhibitor, G1 Therapeutics) is in multiple phase II clinical trials. [24] The drug is being tested as a method for reducing the adverse effects of chemotherapy. In August 2019, trilaciclib received breakthrough therapy designation [25] for its ability to minimize chemotherapy-induced bone marrow suppression. As of August 2020, the drug was under Food and Drug Administration (FDA) priority review for small-cell lung cancer with an application decision date of February 15, 2021. [26]

Although CDK4/6 inhibitors have had the most success, CDK inhibitors targeting other CDKs are also undergoing clinical trials. [27]

Combination Therapies

Due to recurrent issues with CDK inhibitor resistance and non-responders, the current focus of many clinical trials includes examining the outcomes of administering CDK inhibitors in combination with other existing therapies. The interest in combined therapies is also in part due to the fact that CDK inhibitors halt the cell cycle to stop cancer growth, but they do not induce apoptosis to reduce tumor size. [10] Therefore, many clinical trials are interested in observing if there are better health outcomes by combining CDK inhibitors with other forms of therapy. For example, using a combination of Palbociclib (CDK4/6 inhibitor), Fulvestrant (estrogen receptor antagonist), and Avelumab (monoclonal antibody) for the treatment of metastatic ER+ HER- breast cancer is currently undergoing Phase II clinical trials. [30]

Other

Based on molecular docking results, Ligands-3, 5, 14, and 16 were screened among 17 different Pyrrolone-fused benzosuberene compounds as potent and specific inhibitors without any cross-reactivity against different CDK isoforms. Analysis of MD simulations and MM-PBSA studies, revealed the binding energy profiles of all the selected complexes. Selected ligands performed better than the experimental drug candidate (Roscovitine). Ligands-3 and 14 show specificity for CDK7 and Ligands-5 and 16 were specific against CDK9. These ligands are expected to possess lower risk of side effects due to their natural origin. [32]

Interpretation of dynamic simulations and binding free energy studies unveiled that Ligand2 (Out of 17 in-house synthesized pyrrolone-fused benzosuberene (PBS) compounds) has a stable and equivalent free energy to Flavopiridol, SU9516, and CVT-313 inhibitors. Ligand2 scrutinized as a selective inhibitor of CDK2 without off-target binding (CDK1 and CDK9) based on ligand efficiency and binding affinity. [33]

Graphical abstract of CDK2 CDK2-Selective inhibitor.png
Graphical abstract of CDK2

See also

Related Research Articles

<span class="mw-page-title-main">Cell cycle</span> Series of events and stages that result in cell division

The cell cycle, or cell-division cycle, is the series of events that take place in a cell that causes it to divide into two daughter cells. These events include the duplication of its DNA and some of its organelles, and subsequently the partitioning of its cytoplasm, chromosomes and other components into two daughter cells in a process called cell division.

<span class="mw-page-title-main">Trastuzumab</span> Medication

Trastuzumab, sold under the brand name Herceptin among others, is a monoclonal antibody used to treat breast cancer and stomach cancer. It is specifically used for cancer that is HER2 receptor positive. It may be used by itself or together with other chemotherapy medication. Trastuzumab is given by slow injection into a vein and injection just under the skin.

<span class="mw-page-title-main">Cyclin-dependent kinase</span> Class of enzymes

Cyclin-dependent kinases (CDKs) are a predominant group of serine/threonine protein kinases involved in the regulation of the cell cycle and its progression, ensuring the integrity and functionality of cellular machinery. These regulatory enzymes play a crucial role in the regulation of eukaryotic cell cycle and transcription, as well as DNA repair, metabolism, and epigenetic regulation, in response to several extracellular and intracellular signals. They are present in all known eukaryotes, and their regulatory function in the cell cycle has been evolutionarily conserved. The catalytic activities of CDKs are regulated by interactions with CDK inhibitors (CKIs) and regulatory subunits known as cyclins. Cyclins have no enzymatic activity themselves, but they become active once they bind to CDKs. Without cyclin, CDK is less active than in the cyclin-CDK heterodimer complex. CDKs phosphorylate proteins on serine (S) or threonine (T) residues. The specificity of CDKs for their substrates is defined by the S/T-P-X-K/R sequence, where S/T is the phosphorylation site, P is proline, X is any amino acid, and the sequence ends with lysine (K) or arginine (R). This motif ensures CDKs accurately target and modify proteins, crucial for regulating cell cycle and other functions. Deregulation of the CDK activity is linked to various pathologies, including cancer, neurodegenerative diseases, and stroke.

<span class="mw-page-title-main">Cyclin-dependent kinase complex</span>

A cyclin-dependent kinase complex is a protein complex formed by the association of an inactive catalytic subunit of a protein kinase, cyclin-dependent kinase (CDK), with a regulatory subunit, cyclin. Once cyclin-dependent kinases bind to cyclin, the formed complex is in an activated state. Substrate specificity of the activated complex is mainly established by the associated cyclin within the complex. Activity of CDKCs is controlled by phosphorylation of target proteins, as well as binding of inhibitory proteins.

<span class="mw-page-title-main">Restriction point</span> Animal cell cycle checkpoint

The restriction point (R), also known as the Start or G1/S checkpoint, is a cell cycle checkpoint in the G1 phase of the animal cell cycle at which the cell becomes "committed" to the cell cycle, and after which extracellular signals are no longer required to stimulate proliferation. The defining biochemical feature of the restriction point is the activation of G1/S- and S-phase cyclin-CDK complexes, which in turn phosphorylate proteins that initiate DNA replication, centrosome duplication, and other early cell cycle events. It is one of three main cell cycle checkpoints, the other two being the G2-M DNA damage checkpoint and the spindle checkpoint.

<span class="mw-page-title-main">Targeted therapy</span> Type of therapy

Targeted therapy or molecularly targeted therapy is one of the major modalities of medical treatment (pharmacotherapy) for cancer, others being hormonal therapy and cytotoxic chemotherapy. As a form of molecular medicine, targeted therapy blocks the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth, rather than by simply interfering with all rapidly dividing cells. Because most agents for targeted therapy are biopharmaceuticals, the term biologic therapy is sometimes synonymous with targeted therapy when used in the context of cancer therapy. However, the modalities can be combined; antibody-drug conjugates combine biologic and cytotoxic mechanisms into one targeted therapy.

<span class="mw-page-title-main">Lapatinib</span> Cancer medication

Lapatinib (INN), used in the form of lapatinib ditosylate (USAN) is an orally active drug for breast cancer and other solid tumours. It is a dual tyrosine kinase inhibitor which interrupts the HER2/neu and epidermal growth factor receptor (EGFR) pathways. It is used in combination therapy for HER2-positive breast cancer. It is used for the treatment of patients with advanced or metastatic breast cancer whose tumors overexpress HER2 (ErbB2).

<span class="mw-page-title-main">Cyclin-dependent kinase 2</span> Protein-coding gene in the species Homo sapiens

Cyclin-dependent kinase 2, also known as cell division protein kinase 2, or Cdk2, is an enzyme that in humans is encoded by the CDK2 gene. The protein encoded by this gene is a member of the cyclin-dependent kinase family of Ser/Thr protein kinases. This protein kinase is highly similar to the gene products of S. cerevisiae cdc28, and S. pombe cdc2, also known as Cdk1 in humans. It is a catalytic subunit of the cyclin-dependent kinase complex, whose activity is restricted to the G1-S phase of the cell cycle, where cells make proteins necessary for mitosis and replicate their DNA. This protein associates with and is regulated by the regulatory subunits of the complex including cyclin E or A. Cyclin E binds G1 phase Cdk2, which is required for the transition from G1 to S phase while binding with Cyclin A is required to progress through the S phase. Its activity is also regulated by phosphorylation. Multiple alternatively spliced variants and multiple transcription initiation sites of this gene have been reported. The role of this protein in G1-S transition has been recently questioned as cells lacking Cdk2 are reported to have no problem during this transition.

<span class="mw-page-title-main">Cyclin-dependent kinase 4</span> Human protein

Cyclin-dependent kinase 4 also known as cell division protein kinase 4 is an enzyme that in humans is encoded by the CDK4 gene. CDK4 is a member of the cyclin-dependent kinase family.

The Cyclin D/Cdk4 complex is a multi-protein structure consisting of the proteins Cyclin D and cyclin-dependent kinase 4, or Cdk4, a serine-threonine kinase. This complex is one of many cyclin/cyclin-dependent kinase complexes that are the "hearts of the cell-cycle control system" and govern the cell cycle and its progression. As its name would suggest, the cyclin-dependent kinase is only active and able to phosphorylate its substrates when it is bound by the corresponding cyclin. The Cyclin D/Cdk4 complex is integral for the progression of the cell from the Growth 1 phase to the Synthesis phase of the cell cycle, for the Start or G1/S checkpoint.

CDK7 is a cyclin-dependent kinase shown to be not easily classified. CDK7 is both a CDK-activating kinase (CAK) and a component of the general transcription factor TFIIH.

<span class="mw-page-title-main">Cyclin-dependent kinase 7</span> Protein-coding gene in the species Homo sapiens

Cyclin-dependent kinase 7, or cell division protein kinase 7, is an enzyme that in humans is encoded by the CDK7 gene.

<span class="mw-page-title-main">ALK inhibitor</span>

ALK inhibitors are anti-cancer drugs that act on tumours with variations of anaplastic lymphoma kinase (ALK) such as an EML4-ALK translocation. They fall under the category of tyrosine kinase inhibitors, which work by inhibiting proteins involved in the abnormal growth of tumour cells. All the current approved ALK inhibitors function by binding to the ATP pocket of the abnormal ALK protein, blocking its access to energy and deactivating it. A majority of ALK-rearranged NSCLC harbour the EML4-ALK fusion, although as of 2020, over 92 fusion partners have been discovered in ALK+ NSCLC. For each fusion partner, there can be several fusion variants depending on the position the two genes were fused at, and this may have implications on the response of the tumour and prognosis of the patient.

<span class="mw-page-title-main">Palbociclib</span> Medication for HR+ HER2− breast cancer

Palbociclib, sold under the brand name Ibrance among others, is a medication developed by Pfizer for the treatment of HR-positive and HER2-negative breast cancer. It is a selective inhibitor of the cyclin-dependent kinases CDK4 and CDK6. Palbociclib was the first CDK4/6 inhibitor to be approved as a cancer therapy.

<span class="mw-page-title-main">Abemaciclib</span> Anti-breast cancer medication

Abemaciclib, sold under the brand name Verzenio among others, is a medication for the treatment of advanced or metastatic breast cancers. It was developed by Eli Lilly and it acts as a CDK inhibitor selective for CDK4 and CDK6.

<span class="mw-page-title-main">Ribociclib</span> Chemical compound

Ribociclib, sold under the brand name Kisqali, is a medication used for the treatment of certain kinds of breast cancer. Ribociclib is a kinase inhibitor. It was developed by Novartis and Astex Pharmaceuticals.

<span class="mw-page-title-main">Trilaciclib</span> Chemical compound

Trilaciclib, sold under the brand name Cosela, is a medication used to reduce the frequency of chemotherapy-induced bone marrow suppression.

<span class="mw-page-title-main">Gedatolisib</span> Chemical compound

Gedatolisib (PF-05212384) is an experimental drug for treatment of cancer in development by Celcuity, Inc. The mechanism of action is accomplished by binding the different p110 catalytic subunit isoforms of PI3K and the kinase site of mTOR.

<span class="mw-page-title-main">G1 Therapeutics</span> Pharmaceutical company

G1 Therapeutics, Inc. is an American biopharmaceutical company headquartered in Research Triangle Park, North Carolina. The company specializes in developing and commercializing small molecule therapeutics for the treatment of patients with cancer.

<span class="mw-page-title-main">Dalpiciclib</span> Chemical compound

Dalpiciclib is a drug for the treatment of various forms of cancer.

References

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  2. ↑ Mughal, Muhammad Jameel; Bhadresha, Kinjal; Kwok, Hang Fai (2023-01-01). "CDK inhibitors from past to present: A new wave of cancer therapy". Seminars in Cancer Biology. 88: 106–122. doi: 10.1016/j.semcancer.2022.12.006 . ISSN   1044-579X. PMID   36565895.
  3. ↑ Ding, Lei; Cao, Jiaqi; Lin, Wen; Chen, Hongjian; Xiong, Xianhui; Ao, Hongshun; Yu, Min; Lin, Jie; Cui, Qinghua (2020-03-13). "The Roles of Cyclin-Dependent Kinases in Cell-Cycle Progression and Therapeutic Strategies in Human Breast Cancer". International Journal of Molecular Sciences. 21 (6): 1960. doi: 10.3390/ijms21061960 . ISSN   1422-0067. PMC   7139603 . PMID   32183020.
  4. ↑ Malumbres, Marcos; Barbacid, Mariano (March 2009). "Cell cycle, CDKs and cancer: a changing paradigm". Nature Reviews Cancer. 9 (3): 153–166. doi:10.1038/nrc2602. ISSN   1474-1768. PMID   19238148. S2CID   2613411.
  5. ↑ Malumbres, M; Barbacid, M (2001). "To cycle or not to cycle: A critical decision in cancer". Nature Reviews Cancer. 1 (3): 222–31. doi:10.1038/35106065. PMID   11902577. S2CID   1967666.
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  7. ↑ Barrière, C; Santamaría, D; Cerqueira, A; Galán, J; Martín, A; Ortega, S; Malumbres, M; Dubus, P; Barbacid, M (2007). "Mice thrive without Cdk4 and Cdk2". Molecular Oncology. 1 (1): 72–83. doi:10.1016/j.molonc.2007.03.001. PMC   5543859 . PMID   19383288.
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  16. 1 2 "Novartis Kisqali® (ribociclib, LEE011) receives FDA approval as first-line treatment for HR+/HER2- metastatic breast cancer in combination with any aromatase inhibitor". Novartis. Retrieved 12 September 2017.
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  19. ↑ "FDA approves new treatment for certain advanced or metastatic breast cancers" (Press release). U.S. Food and Drug Administration (FDA). September 28, 2017.
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  31. ↑ Purvalanol A, Olomoucine II and Roscovitine Inhibit ABCB1 Transporter and Synergistically Potentiate Cytotoxic Effects of Daunorubicin In Vitro.
  32. ↑ Singh R, Bhardwaj VK, Das P, Purohit R (November 2019). "Natural analogues inhibiting selective cyclin-dependent kinase protein isoforms: a computational perspective". Journal of Biomolecular Structure and Dynamics. 38 (17): 5126–5135. doi:10.1080/07391102.2019.1696709. PMID   3176087. S2CID   208276454.
  33. 1 2 Singh R, Bhardwaj VK, Sharma J, Das P, Purohit R (March 2021). "Identification of selective cyclin-dependent kinase 2 inhibitor from the library of pyrrolone-fused benzosuberene compounds: an in silico exploration". Journal of Biomolecular Structure and Dynamics. 40 (17): 7693–7701. doi:10.1080/07391102.2021.1900918. PMID   33749525. S2CID   232309609.
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