Zoptarelin doxorubicin

Last updated
Zoptarelin doxorubicin
Zoptarelin doxorubicin.svg
Clinical data
Other namesAEZS-108; AN-152
ATC code
  • None
Legal status
Legal status
  • Investigational
Identifiers
  • [2-[(2S,4S)-4-[(2R,4S,5S,6S)-4-amino-5-hydroxy-6-methyl-tetrahydropyran-2-yl]oxy-2,5,12-trihydroxy-7-methoxy-6,11-dioxo-3,4-dihydro-1H-tetracen-2-yl]-2-oxo-ethyl] 5-[[(5R)-6-[[(1S)-1-[[(1S)-1-[(2S)-2-[(2-amino-2-oxo-ethyl)carbamoyl]pyrrolidine-1-carbonyl]-4-guanidino-butyl]carbamoyl]-3-methyl-butyl]amino]-5-[[(2S)-2-[[(2S)-3-hydroxy-2-[[(2S)-2-[[(2S)-3-(1H-imidazol-5-yl)-2-[[(2S)-5-oxopyrrolidine-2-carbonyl]amino]propanoyl]amino]-3-(1H-indol-3-yl)propanoyl]amino]propanoyl]amino]-3-(4-hydroxyphenyl)propanoyl]amino]-6-oxo-hexyl]amino]-5-oxo-pentanoate
PubChem CID
ChemSpider
CompTox Dashboard (EPA)
ECHA InfoCard 100.244.989 OOjs UI icon edit-ltr-progressive.svg
Chemical and physical data
Formula C91H117N19O26
Molar mass 1893.044 g·mol−1
3D model (JSmol)
  • CC1C(C(CC(O1)OC2CC(Cc3c2c(c4c(c3O)C(=O)c5cccc(c5C4=O)OC)O)(C(=O)COC(=O)CCCC(=O)NCCCCC(C(=O)NC(CC(C)C)C(=O)NC(CCCNC(=N)N)C(=O)N6CCCC6C(=O)NCC(=O)N)NC(=O)C(Cc7ccc(cc7)O)NC(=O)C(CO)NC(=O)C(Cc8c[nH]c9c8cccc9)NC(=O)C(Cc1cnc[nH]1)NC(=O)C1CCC(=O)N1)O)N)O
  • InChI=1S/C91H117N19O26/c1-44(2)31-58(83(125)104-57(17-11-29-98-90(94)95)89(131)110-30-12-18-63(110)88(130)100-40-67(93)114)105-81(123)55(16-7-8-28-97-68(115)20-10-21-70(117)134-42-66(113)91(132)36-52-73(65(37-91)136-71-35-53(92)76(118)45(3)135-71)80(122)75-74(78(52)120)77(119)51-14-9-19-64(133-4)72(51)79(75)121)103-84(126)59(32-46-22-24-49(112)25-23-46)106-87(129)62(41-111)109-85(127)60(33-47-38-99-54-15-6-5-13-50(47)54)107-86(128)61(34-48-39-96-43-101-48)108-82(124)56-26-27-69(116)102-56/h5-6,9,13-15,19,22-25,38-39,43-45,53,55-63,65,71,76,99,111-112,118,120,122,132H,7-8,10-12,16-18,20-21,26-37,40-42,92H2,1-4H3,(H2,93,114)(H,96,101)(H,97,115)(H,100,130)(H,102,116)(H,103,126)(H,104,125)(H,105,123)(H,106,129)(H,107,128)(H,108,124)(H,109,127)(H4,94,95,98)/t45-,53-,55+,56-,57-,58-,59-,60-,61-,62-,63-,65-,71-,76+,91-/m0/s1
  • Key:OOUACICUAVTCEC-LZHWUUGESA-N

Zoptarelin doxorubicin (developmental code names AEZS-108, AN-152) consists of doxorubicin linked to a small peptide agonist to the luteinizing hormone-releasing hormone (LHRH) receptor. [1] It has been developed as a potential treatment for a number of human cancers. The LHRH receptor is aberrantly present on the cell surface of approximately 80% of endometrial and ovarian cancers, 86% of prostate cancers and about 50% of breast cancers. Whereas in normal tissues, expression of this receptor is mainly confined to the pituitary gland, reproductive organs and hematopoietic stem cells. To a lesser extent the LHRH receptor is also found on the surface of bladder, colorectal, and pancreatic cancers, sarcomas, lymphomas, melanomas, and renal cell carcinomas. [2]

The proposed method of action is that upon administration zoptarelin doxorubicin binds to the LHRH receptor and is subsequently internalized, concentrating the toxic doxorubicin within cancer cells and the small subset of normal tissues, as opposed to the completely systemic distribution observed with untargeted chemotherapeutics. The specific targeting of the doxorubicin to LHRH receptor bearing cells is also proposed to reduce the cardiotoxicity observed in the administration of unconjugated doxorubicin.

Zoptarelin doxorubicin was invented by Andrew V. Schally while at the Tulane University School of Medicine, New Orleans and subsequently at the Sylvester Comprehensive Cancer Center, University of Miami. It has been subsequently developed by AEterna Zentaris Inc. In June 2016, Aeterna stated that it plans to submit an NDA to the FDA by mid 2017. [3] Zoptarelin doxorubicin was discontinued for all indications under development in May 2017. [4]

The U.S. Food and Drug Administration (FDA) has granted it orphan drug status for ovarian cancer and endometrial cancer.

Clinical trials

Promising results have been reported from a phase II clinical trial for ovarian cancer [5] and endometrial cancer. [6] Phase II trials have also been undertaken for prostate, breast and bladder cancer, although no results for these trials have been reported in peer-reviewed literature. A phase I trial in prostate cancer indicated that nine out ten evaluable patients achieved disease stabilization through administration of zoptarelin doxorubicin. [7]

A phase III trial for endometrial cancer was initiated in April 2013 and it the primary completion date is estimated to be December 2016. [8] In May 2017 the results were disclosed, showing that the drug did not extend overall survival nor did it improve the safety profile compared to doxorubicin. [9]

Related Research Articles

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Gonadotropin-releasing hormone (GnRH) is a releasing hormone responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. GnRH is a tropic peptide hormone synthesized and released from GnRH neurons within the hypothalamus. The peptide belongs to gonadotropin-releasing hormone family. It constitutes the initial step in the hypothalamic–pituitary–gonadal axis.

This is a list of terms related to oncology. The original source for this list was the US National Cancer Institute's public domain Dictionary of Cancer Terms.

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

Goserelin, sold under the brand name Zoladex among others, is a medication which is used to suppress production of the sex hormones, particularly in the treatment of breast and prostate cancer. It is an injectable gonadotropin releasing hormone agonist.

<span class="mw-page-title-main">2-Methoxyestradiol</span> Chemical compound

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<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">Triptorelin</span> GnRH-agonist

Triptorelin, sold under the brand name Decapeptyl among others, is a medication that acts as an agonist analog of gonadotropin-releasing hormone, repressing expression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

<span class="mw-page-title-main">Gonadotropin-releasing hormone agonist</span> Drug class affecting sex hormones

A gonadotropin-releasing hormone agonist is a type of medication which affects gonadotropins and sex hormones. They are used for a variety of indications including in fertility medicine and to lower sex hormone levels in the treatment of hormone-sensitive cancers such as prostate cancer and breast cancer, certain gynecological disorders like heavy periods and endometriosis, high testosterone levels in women, early puberty in children, as a part of transgender hormone therapy, and to delay puberty in transgender youth among other uses. It is also used in the suppression of spontaneous ovulation as part of controlled ovarian hyperstimulation, an essential component in IVF. GnRH agonists are given by injections into fat, as implants placed into fat, and as nasal sprays.

<span class="mw-page-title-main">Gonadotropin-releasing hormone antagonist</span> Class of medications

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References

  1. Rékási Z, Szöke B, Nagy A, Groot K, Rékási ES, Schally AV (May 1993). "Effect of luteinizing hormone-releasing hormone analogs containing cytotoxic radicals on the function of rat pituitary cells: tests in a long term superfusion system". Endocrinology. 132 (5): 1991–2000. doi:10.1210/endo.132.5.8477650. PMID   8477650.
  2. Engel J, Emons G, Pinski J, Schally AV (June 2012). "AEZS-108 : a targeted cytotoxic analog of LHRH for the treatment of cancers positive for LHRH receptors". Expert Opinion on Investigational Drugs. 21 (6): 891–9. doi:10.1517/13543784.2012.685128. PMID   22577891. S2CID   37548203.
  3. "Aeterna Zentaris Reconfirms Commitment to LHRH-receptor Targeting Zoptrex™ During 2016 ASCO Annual Meeting Pivotal Phase III Trial for Endometrial Cancer Expected to be Completed in Q3 2016". Aeterna Zentaris. 6 June 2016. Archived from the original on 4 February 2017.
  4. "Zoptarelin doxorubicin". Adis Insight. Springer Nature Switzerland AG. Archived from the original on 2019-07-27. Retrieved 2017-12-24.
  5. Emons G, Gorchev G, Sehouli J, Wimberger P, Stähle A, Hanker L, et al. (June 2014). "Efficacy and safety of AEZS-108 (INN: zoptarelin doxorubicin acetate) an LHRH agonist linked to doxorubicin in women with platinum refractory or resistant ovarian cancer expressing LHRH receptors: a multicenter phase II trial of the ago-study group (AGO GYN 5)". Gynecologic Oncology. 133 (3): 427–32. doi:10.1016/j.ygyno.2014.03.576. PMID   24713545.
  6. Emons G, Gorchev G, Harter P, Wimberger P, Stähle A, Hanker L, et al. (February 2014). "Efficacy and safety of AEZS-108 (LHRH agonist linked to doxorubicin) in women with advanced or recurrent endometrial cancer expressing LHRH receptors: a multicenter phase 2 trial (AGO-GYN5)". International Journal of Gynecological Cancer. 24 (2): 260–5. doi:10.1097/IGC.0000000000000044. PMC   3921259 . PMID   24418927.
  7. Liu SV, Tsao-Wei DD, Xiong S, Groshen S, Dorff TB, Quinn DI, et al. (December 2014). "Phase I, dose-escalation study of the targeted cytotoxic LHRH analog AEZS-108 in patients with castration- and taxane-resistant prostate cancer". Clinical Cancer Research. 20 (24): 6277–83. doi: 10.1158/1078-0432.CCR-14-0489 . PMID   25278449.
  8. Clinical trial number NCT01767155 for "Zoptarelin Doxorubicin (AEZS 108) as Second Line Therapy for Endometrial Cancer (ZoptEC)" at ClinicalTrials.gov
  9. "Zoptarelin doxorubicin fails to extend survival in advanced endometrial cancer". Healio.com. 2 May 2017.