The calcium channel blocker verapamil and cancer chemotherapy

Verapamil is an agent which inhibits the transmembrane flux of calcium ions and is used clinically in the management of cardiac arrhythmias. Combination of this calcium antagonist with antineoplastic agents results in the establishment of chemosensitivity in tumor cells resistant to accepted chemotherapeutic agents and, to a lesser degree, potentiates the efficacy of such compounds in drug-sensitive malignancies. Preliminary indications are that the clinical role of such a potentiation of efficacy would not be limited by an increase in generalized toxicity in non-malignant tissues. Data accumulated indicates a verapamil-induced inhibition of the ability of resistant cells to actively extrude chemotherapeutic agents, possibly due to a decrease in calmodulin activity as a result of a drug-induced alteration of the intracellular calcium environment. The results of preclinical trials to date indicate a role for verapamil in augmenting currently accepted chemotherapeutic regimens.