Palonosetron

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Palonosetron
Palonosetron structure.svg
Clinical data
Pronunciation /pæləˈnoʊsətrɒn/ pal-ə-NOH-sə-tron
Trade names Aloxi
AHFS/Drugs.com Monograph
MedlinePlus a610002
License data
Pregnancy
category
Routes of
administration 		Intravenous, by mouth
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability 97% (oral)
Protein binding 62%
Metabolism Liver, 50% (mostly CYP2D6-mediated, CYP3A4 and CYP1A2 also involved)
Elimination half-life Approximately 40–50 hours
Excretion Kidney, 80% (of which 49% unchanged); fecal (5 to 8%)
Identifiers
  • (3aS)-2-[(3S)-1-Azabicyclo[2.2.2]oct-3-yl]-2,3,3a,4,5,6-hexahydro-1H-benz[de]isoquinolin-1-one
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
PDB ligand
CompTox Dashboard (EPA)
Chemical and physical data
Formula C19H24N2O
Molar mass 296.414 g·mol−1
3D model (JSmol)
Specific rotation [α]D −136°
[α]D –94.1° (HCl)
Melting point 87 to 88 °C (189 to 190 °F)
  • O=C5N([C@H]2C1CCN(CC1)C2)C[C@@H]4c3c5cccc3CCC4
  • InChI=1S/C19H24N2O/c22-19-16-6-2-4-14-3-1-5-15(18(14)16)11-21(19)17-12-20-9-7-13(17)8-10-20/h2,4,6,13,15,17H,1,3,5,7-12H2/t15-,17-/m1/s1 Yes check.svgY
  • Key:CPZBLNMUGSZIPR-NVXWUHKLSA-N Yes check.svgY
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Palonosetron, sold under the brand name Aloxi, is a medication used for the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV). [2] [4] [5] It is a 5-HT3 antagonist. [2] [4] [5]

Contents

Palonosetron is administered intravenously, [6] or as a single oral capsule. [7] It has a longer duration of action than other 5-HT3 antagonists. The oral formulation was approved on August 22, 2008, for prevention of acute CINV alone, as a large clinical trial did not show oral administration to be as effective as intravenous use against delayed CINV. [7] It is on the World Health Organization's List of Essential Medicines. [8]

The oral combination netupitant/palonosetron is approved for both acute and delayed CINV. [9] [10] [11] [12]

Adverse effects

The most common adverse effects are headache, which occurs in 4–11% of patients, and constipation in up to 6% of patients. In less than 1% of patients, other gastrointestinal disorders occur, as well as sleeplessness, first- and second-degree atrioventricular block, muscle pain and shortness of breath. Palonosetron is similarly well tolerated as other 5-HT3 antagonists, and slightly less than placebo. [13] [14]

Interactions

Palonosetron does not relevantly inhibit or induce cytochrome P450 liver enzymes. There are case reports about serotonin syndrome when the drug is combined with serotonergic substances, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), two common types of antidepressants. [13] [14]

Pharmacology

Mechanism of action

Palonosetron is a 5-HT3 antagonist, commonly known as a setron. These drugs act by blocking serotonin from binding to the 5-HT3 receptor. [15]

Pharmacokinetics

Orally taken palonosetron is absorbed well from the gut and has a bioavailability of 97%. Highest blood plasma levels are reached after 5.1±1.7 hours, independently of food intake, and plasma protein binding is 62%. 40% of the substance are eliminated in the unchanged form, and a further 45–50% are metabolized by the liver enzyme CYP2D6 and to a lesser extent by CYP3A4 and CYP1A2. The two main metabolites, the N-oxide and a hydroxy derivative, have less than 1% of palonosetron's antagonistic effect and are thus practically inactive. [13] [14]

Palonosetron and its metabolites are mainly (to 80–93%) eliminated via the kidney. Biological half-life in healthy persons was 37±12 hours in a study, and 48±19 hours in cancer patients. In 10% of patients, half-life is over 100 hours. [13] [14] Most other marketed setrons have half-lives in the range of about two to 15 hours.

The main metabolites of palonosetron, palonosetron N-oxide (left) and 6S-hydroxy-palonosetron (right) Palonosetron metabolites.svg
The main metabolites of palonosetron, palonosetron N-oxide (left) and 6S-hydroxy-palonosetron (right)

Chemistry

The substance is solid at room temperature and melts at 87 to 88 °C (189 to 190 °F). [16] The infusions and capsules contain palonosetron hydrochloride, [13] which is also a solid. The hydrochloride is easily soluble in water, soluble in propylene glycol, and slightly soluble in ethanol and isopropyl alcohol. [14] [17]

The molecule has two asymmetric carbon atoms. It is used in form of the pure (S,S)-stereoisomer. [17]

Society and culture

Economics

Palonosetron was developed by Helsinn around 2001. In January 2003, Helsinn filed a provisional patent application on palonosetron. Over the next 10 years, Helsinn filed four patent applications that claimed priority to the January 2003 date. Relevant here, Helsinn filed its fourth patent application in 2013. That patent (the ’219 patent) covers a fixed dose of 0.25 mg of palonosetron in a 5 ml solution. While developing the drug, Helsinn entered into a confidential licensing agreement with a company called MGI to sell palonosetron in the United States. This licensing agreement contained chemical information about palonosetron and dosage requirements. However, Helsinn did not file for a patent on palonosetron until two years after they had signed their agreement with MGI.

In 2011 Teva Pharmaceuticals - a generic drug manufacturer- challenged the validity of Helsinn's patent(s) by filing an application for a generic version of palonosetron with the FDA. Teva claimed that, because Helsinn disclosed/sold the 0.25 mg dose of palonosetron to MGI in 2003, which is more than a year (actually about 2 years) before the priority date of its '219 patent, this "secret" sale barred Helsinn from receiving a patent. This conclusion results from the language of the America Invents Act, which bars patents on inventions, which were “in public use, on sale, or otherwise available to the public before the effective filing date of the claimed invention,” 35 U. S. C. §102(a)(1).

The District Court held that the AIA's “on sale” provision did not apply, because the public disclosure of the agreements did not disclose the 0.25 mg dose. The Federal Circuit reversed, holding that the sale was publicly disclosed, regardless of whether the details of the invention were publicly disclosed in the terms of the sale agreements. The SCOTUS agreed with the Federal Circuit, that in this case a commercial sale to a third party, who is required to keep the invention confidential, nevertheless placed the invention “on sale” under USC §102(a).

Related Research Articles

An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer. They may be used for severe cases of gastroenteritis, especially if the patient is dehydrated.

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<span class="mw-page-title-main">Granisetron</span> Serotonin 5-HT3 antiemetic

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<span class="mw-page-title-main">Ondansetron</span> Medication to prevent nausea and vomiting

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5-HT<sub>3</sub> antagonist Anti-nausea group of medications

The 5-HT3 antagonists, informally known as "setrons", are a class of drugs that act as receptor antagonists at the 5-HT3 receptor, a subtype of serotonin receptor found in terminals of the vagus nerve and in certain areas of the brain. With the notable exceptions of alosetron and cilansetron, which are used in the treatment of irritable bowel syndrome, all 5-HT3 antagonists are antiemetics, used in the prevention and treatment of nausea and vomiting. They are particularly effective in controlling the nausea and vomiting produced by cancer chemotherapy and are considered the gold standard for this purpose.

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Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of many cancer treatments. Nausea and vomiting are two of the most feared cancer treatment-related side effects for cancer patients and their families. In 1983, Coates et al. found that patients receiving chemotherapy ranked nausea and vomiting as the first and second most severe side effects, respectively. Up to 20% of patients receiving highly emetogenic agents in this era postponed, or even refused, potentially curative treatments. Since the 1990s, several novel classes of antiemetics have been developed and commercialized, becoming a nearly universal standard in chemotherapy regimens, and helping to better manage these symptoms in a large portion of patients. Efficient mediation of these unpleasant and sometimes debilitating symptoms results in increased quality of life for the patient, and better overall health of the patient, and, due to better patient tolerance, more effective treatment cycles.

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Cancer and nausea are associated in about fifty percent of people affected by cancer. This may be as a result of the cancer itself, or as an effect of the treatment such as chemotherapy, radiation therapy, or other medication such as opiates used for pain relief. About 70–80% of people undergoing chemotherapy experience nausea or vomiting. Nausea and vomiting may also occur in people not receiving treatment, often as a result of the disease involving the gastrointestinal tract, electrolyte imbalance, or as a result of anxiety. Nausea and vomiting may be experienced as the most unpleasant side effects of cytotoxic drugs and may result in patients delaying or refusing further radiotherapy or chemotherapy.

Netupitant/palonosetron, sold under the brand name Akynzeo, is a fixed-dose combination medication used for the prevention of acute and delayed chemotherapy-induced nausea and vomiting. It is marketed and distributed by Helsinn Therapeutics. Netupitant is an NK1 receptor antagonist and palonosetron is a 5-HT3 receptor antagonist.

<span class="mw-page-title-main">Rolapitant</span> Pharmaceutical drug

Rolapitant (INN, trade name Varubivə-ROO-bee in the US and Varuby in the European Union) is a drug originally developed by Schering-Plough and licensed for clinical development by Tesaro, which acts as a selective NK1 receptor antagonist (antagonist for the NK1 receptor). It has been approved as a medication for the treatment of chemotherapy-induced nausea and vomiting (CINV) after clinical trials showed it to have similar or improved efficacy and some improvement in safety over existing drugs for this application.

References

  1. 1 2 https://www.tga.gov.au/resources/auspar/auspar-palonosetron-hydrochloride [ bare URL ]
  2. 1 2 3 "Aloxi 250 micrograms solution for injection - Summary of Product Characteristics (SmPC)". (emc). 18 May 2018. Archived from the original on 24 January 2022. Retrieved 23 January 2022.
  3. ↑ "Aloxi 500 micrograms soft capsules - Summary of Product Characteristics (SmPC)". (emc). 18 May 2018. Archived from the original on 24 January 2022. Retrieved 24 January 2022.
  4. 1 2 3 "Aloxi- palonosetron hydrochloride injection". DailyMed. Archived from the original on 24 January 2022. Retrieved 23 January 2022.
  5. 1 2 3 "Aloxi EPAR". European Medicines Agency. 13 March 2009. Archived from the original on 14 April 2021. Retrieved 23 January 2022.
  6. ↑ De Leon A (October 2006). "Palonosetron (Aloxi): a second-generation 5-HT₃ receptor antagonist for chemotherapy-induced nausea and vomiting". Proceedings. 19 (4): 413–6. doi:10.1080/08998280.2006.11928210. PMC   1618755 . PMID   17106506.
  7. 1 2 Waknine Y (September 4, 2008). "FDA Approvals: Nplate, Aloxi, Vidaza". Medscape. Archived from the original on 2008-12-02. Retrieved 2008-09-04. Freely available with registration.
  8. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl: 10665/345533 . WHO/MHP/HPS/EML/2021.02.
  9. ↑ "Akynzeo EPAR". European Medicines Agency. 23 June 2015. Archived from the original on 19 March 2020. Retrieved 23 January 2022.
  10. 1 2 "Akynzeo: Summary of Product Characteristics" (PDF). European Medicines Agency. Archived (PDF) from the original on 26 June 2016. Retrieved 12 July 2016.
  11. ↑ "Akynzeo 300 mg/0.5 mg hard capsules - Summary of Product Characteristics (SmPC)". (emc). 11 February 2020. Archived from the original on 24 January 2022. Retrieved 23 January 2022.
  12. ↑ "Akynzeo- netupitant and palonosetron capsule Akynzeo- fosnetupitant and palonosetron injection". DailyMed. Archived from the original on 18 October 2020. Retrieved 24 January 2022.
  13. 1 2 3 4 5 Haberfeld H, ed. (2015). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag.
  14. 1 2 3 4 5 Dinnendahl V, Fricke U, eds. (2010). Arzneistoff-Profile (in German). Vol. 7 (23 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. ISBN   978-3-7741-9846-3.
  15. ↑ Billio A, Morello E, Clarke MJ (January 2010). Billio A (ed.). "Serotonin receptor antagonists for highly emetogenic chemotherapy in adults". The Cochrane Database of Systematic Reviews (1): CD006272. doi:10.1002/14651858.CD006272.pub2. PMID   20091591. (Retracted, see doi:10.1002/14651858.CD006272.pub3, PMID   24323437,  Retraction Watch)
  16. ↑ The Merck Index: An Encyclopedia of Chemicals, Drugs, and Biologicals (14 ed.). Merck & Co. 2006. p. 1206. ISBN   978-0-911910-00-1.
  17. 1 2 "Chemistry Revire – Aloxi (Palonosetron HCl) Capsules, 0.5 mg" (PDF). Center for Drug Evaluation and Research. 13 August 2008. Archived (PDF) from the original on 5 August 2019. Retrieved 13 July 2016.
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