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ZD9331: discovery to clinical development
1Royal Marsden Hospital NHS Trust, Sutton, Surrey UK. tim.benepal@rmh.nthames.nhs.uk
Abstract:
Thymidylate synthase (TS) has been targeted in cancer therapy for many years. As a result of a prolonged and extensive drug development program specific TS inhibitors have come into clinical practice. Following on from the development of the polyglutamatable TS inhibitor raltitrexed (Tomudex, ZD1694), ZD9331 is a rationally designed third-generation specific inhibitor of TS that does not require polyglutamation for its activity. Its development was based on the dual rationale of increased efficacy, by overcoming the potential for resistance due to reduced expression of folylpolyglutamate synthetase (FPGS), whilst potentially reducing the toxicities associated with polyglutamation and drug retention in normal tissues. Preclinical studies have shown it to be transported by the ubiquitously expressed reduced folate carrier as well as the alpha-folate receptor which is overexpressed in some cancers, especially ovarian. In vivo studies demonstrated a broad range of activity, leading to an extensive phase I program with several administration schedules. Whilst not being targeted to any individual tumor type, a large number of phase I, II, monotherapy and combination studies have been undertaken, and overall activity has been most promising, particularly in platinum-refractory relapsed ovarian, pancreatic and gastric cancers. Its role in the treatment of these diseases may be important, especially if patients were to be selected on the basis of their folate transport and FPGS status. The true potential of the drug remains to be determined.
Insights
ZD9331, a novel thymidylate synthase inhibitor, shows promise in treating various cancers without polyglutamation. This cancer drug may reduce toxicity and overcome resistance, particularly in ovarian, pancreatic, and gastric cancers.
Area of Science:
- Oncology
- Pharmacology
- Cancer Therapeutics
Background:
- Thymidylate synthase (TS) is a validated target in cancer therapy.
- Previous TS inhibitors, like raltitrexed, require polyglutamation for activity.
- Reduced expression of folylpolyglutamate synthetase (FPGS) can lead to resistance against polyglutamatable drugs.
Purpose of the Study:
- To evaluate ZD9331, a third-generation TS inhibitor designed for non-polyglutamation.
- To overcome resistance mechanisms associated with FPGS.
- To potentially reduce toxicities linked to polyglutamation and drug retention.
Main Methods:
- Preclinical studies assessed ZD9331 transport via reduced folate carrier and alpha-folate receptor.
- In vivo studies demonstrated broad anti-cancer activity.
- Extensive Phase I clinical trials were conducted across various administration schedules.
Main Results:
- ZD9331 demonstrated promising activity in platinum-refractory relapsed ovarian, pancreatic, and gastric cancers.
- The drug is transported by both reduced folate carrier and alpha-folate receptor.
- Monotherapy and combination studies showed encouraging outcomes.
Conclusions:
- ZD9331 represents a novel approach to TS inhibition, potentially offering improved efficacy and safety.
- Patient selection based on folate transport and FPGS status may enhance therapeutic potential.
- Further investigation is warranted to determine the full clinical utility of ZD9331.
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