Icotinib

Last updated
Icotinib
Icotinib.svg
Clinical data
Trade names Conmana
Other namesBPI-2009H
Routes of
administration
By mouth tablets
ATC code
Pharmacokinetic data
Bioavailability 52%
Metabolism Liver (mainly CYP3A4, less CYP1A2)
Elimination half-life 5.5 hrs (median)
Excretion >98% as metabolites, of which >90% via faeces, 9% via urine
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
Formula C22H21N3O4
Molar mass 391.427 g·mol−1
3D model (JSmol)
  • C#Cc1cccc(Nc2ncnc3cc4c(cc23)OCCOCCOCCO4)c1
  • InChI=1S/C22H23N3O4/c1-4-16-6-5-7-17(12-16)25-22-18-13-20(28-10-8-26-2)21(29-11-9-27-3)14-19(18)23-15-24-22/h1,5-7,12-15H,8-11H2,2-3H3,(H,23,24,25) Yes check.svgY
  • Key:QQLKULDARVNMAL-UHFFFAOYSA-N Yes check.svgY
   (verify)

Icotinib (trade name Conmana) is a highly selective, first generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). Icotinib is approved for use in China as first-line monotherapy in patients with non-small-cell lung cancer with somatic EGFR mutations.

Contents

Development

Icotinib was first synthesized in 2002 by the company Betta Pharma. [1] The US patent application for the preparation of icotinib and icotinib hydrochloride was filed on December 28, 2012, and granted on July 21, 2015. [2]

Mechanism of action

Icotinib is a quinazoline derivative that competitively inhibits the ATP binding site of the EGFR receptor protein. EGFR drives malignant growth of cells when mutations occur within the tyrosine kinase domain of this protein. Such mutations cause unchecked cell proliferation, which inappropriately activates the anti-apoptotic Ras signaling pathway. By blocking the binding of ATP to EGFR, icotinib prevents activity of the signal transduction cascade that initiates mitosis. [3]

Indications

Icotinib is approved in China for the treatment of non-small cell lung cancer in patients with an EGFR mutation who have advanced or metastatic disease. [4]

Clinical research

The ICOGEN trial was a double-blind, head-to-head phase III study comparing icotinib with gefitinib in 399 patients across 27 centers in China. Results showed icotinib to have a median progression-free survival of 4.6 months (95% CI 3.5 – 6.3) as compared to gefitinib which has a PFS of 3.4 months (95% CI 2.3 – 3.8). Post-hoc analysis found fewer adverse events with icotinib than gefitinib (61% versus 70% respectively, p = 0.046). [5]

The ISAFE trial was a phase IV study evaluating the safety and toxicity of icotinib in 5,549 patients. It showed an overall adverse event rate of 31.5% and response rate of 30% to the drug. [6]

After receiving approval from the FDA to study icotinib in NSCLC patients, [7] a phase 1 study was planned to be conducted at Roswell Park Comprehensive Cancer Center in New York State, however the trial was withdrawn prior to enrollment. No further pursuits of US-based studies of icotinib have transpired since. [8]

Regulatory approvals

Icotinib was approved in China by the SFDA in June, 2011. [9] An indication for icotinib was approved in China by the SFDA in November 2014 as first-line treatment for patients with advanced-stage NSCLC with EGFR mutation. [10]

Related Research Articles

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A tyrosine kinase is an enzyme that can transfer a phosphate group from ATP to the tyrosine residues of specific proteins inside a cell. It functions as an "on" or "off" switch in many cellular functions.

<span class="mw-page-title-main">Gefitinib</span> Drug used in fighting breast, lung, and other cancers

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<span class="mw-page-title-main">Erlotinib</span> EGFR inhibitor for treatment of non-small-cell lung cancer

Erlotinib, sold under the brand name Tarceva among others, is a medication used to treat non-small cell lung cancer (NSCLC) and pancreatic cancer. Specifically it is used for NSCLC with mutations in the epidermal growth factor receptor (EGFR) — either an exon 19 deletion (del19) or exon 21 (L858R) substitution mutation — which has spread to other parts of the body. It is taken by mouth.

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<span class="mw-page-title-main">Non-small-cell lung cancer</span> Any type of epithelial lung cancer other than small-cell lung carcinoma

Non-small-cell lung cancer (NSCLC) is any type of epithelial lung cancer other than small-cell lung carcinoma (SCLC). NSCLC accounts for about 85% of all lung cancers. As a class, NSCLCs are relatively insensitive to chemotherapy, compared to small-cell carcinoma. When possible, they are primarily treated by surgical resection with curative intent, although chemotherapy has been used increasingly both preoperatively and postoperatively.

Matuzumab is a humanized monoclonal antibody for the treatment of cancer. It binds to the epidermal growth factor receptor (EGFR) with high affinity. The mouse monoclonal antibody (mAb425) from which matuzumab was developed at the Wistar Institute in Philadelphia, Pennsylvania

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<span class="mw-page-title-main">Combined small-cell lung carcinoma</span> Medical condition

Combined small cell lung carcinoma is a form of multiphasic lung cancer that is diagnosed by a pathologist when a malignant tumor, arising from transformed cells originating in lung tissue, contains a component of;small cell lung carcinoma (SCLC), admixed with one components of any histological variant of non-small cell lung carcinoma (NSCLC) in any relative proportion.

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Targeted therapy of lung cancer refers to using agents specifically designed to selectively target molecular pathways responsible for, or that substantially drive, the malignant phenotype of lung cancer cells, and as a consequence of this (relative) selectivity, cause fewer toxic effects on normal cells.

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Crizotinib, sold under the brand name Xalkori among others, is an anti-cancer medication used for the treatment of non-small cell lung carcinoma (NSCLC). It acts as an ALK and ROS1 inhibitor.

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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.

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<span class="mw-page-title-main">Dacomitinib</span> Drug for the treatment of lung carninoma

Dacomitinib, sold under the brand name Vizimpro, is a medication for the treatment of non-small-cell lung carcinoma (NSCLC). It is a selective and irreversible inhibitor of EGFR.

<span class="mw-page-title-main">Ceritinib</span> ALK inhibitor for treatment of non-small-cell lung cancer

Ceritinib is a prescription-only drug used for the treatment of non-small cell lung cancer (NSCLC). It was developed by Novartis and received FDA approval for use in April 2014..Ceritinib is also sold under the brand name Spexib in few countries by Novartis.

<span class="mw-page-title-main">Atezolizumab</span> Monoclonal anti-PD-L1 antibody

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

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<span class="mw-page-title-main">Mobocertinib</span> Small molecule tyrosine kinase inhibitor


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References

  1. "About Us". Beta Pharma. Retrieved 31 October 2017.
  2. US 9085588,Hu S, Long W, Wang F, Li Z,"Methods of preparing icotinib and icotinib hydrochloride, and intermediates thereof",issued 21 July 2015, assigned to Betta Pharmaceuticals Co Ltd
  3. Sordella R, Bell DW, Haber DA, Settleman J (August 2004). "Gefitinib-sensitizing EGFR mutations in lung cancer activate anti-apoptotic pathways". Science. 305 (5687): 1163–7. Bibcode:2004Sci...305.1163S. doi:10.1126/science.1101637. PMID   15284455. S2CID   34389318.
  4. "Product: Icotinib". Betta Pharma. Retrieved 1 November 2017.
  5. Shi Y, Zhang L, Liu X, Zhou C, Zhang L, Zhang S, et al. (September 2013). "Icotinib versus gefitinib in previously treated advanced non-small-cell lung cancer (ICOGEN): a randomised, double-blind phase 3 non-inferiority trial". The Lancet. Oncology. 14 (10): 953–61. doi:10.1016/S1470-2045(13)70355-3. PMID   23948351.
  6. Tan F, Gu A, Zhang Y, Jiao SC, Wang CL, He J, et al. (2013). "Safety and efficacy results of a phase IV, open-label, multicenter, safety-monitoring study of icotinib in treating advanced non-small cell lung cancer (NSCLC): ISAFE study". ASCO 2013 Meeting: e19161.
  7. "Icotinib & Phase IV ISAFE Trial Poster" (PDF). Beta Pharma. Retrieved 1 November 2017.
  8. Clinical trial number NCT02033148 for "Icotinib Hydrochloride in Treating Patients With Advanced Cancers" at ClinicalTrials.gov
  9. Chen X, Zhu Q, Liu Y, Liu P, Yin Y, Guo R, et al. (16 May 2014). "Icotinib is an active treatment of non-small-cell lung cancer: a retrospective study". PLOS ONE. 9 (5): e95897. Bibcode:2014PLoSO...995897C. doi: 10.1371/journal.pone.0095897 . PMC   4023939 . PMID   24836053.
  10. "Betta Pharmaceuticals received marketing approval of Icotinib indicating for first-line treatment of patients with advanced-stage NSCLC with EGFR mutation". Betta Pharmaceuticals. Retrieved 1 November 2017.