癌症化疗中的前体药物。
Prodrugs in cancer chemotherapy.
作者信息
Connors T A, Knox R J
机构信息
School of Pharmacy, Centre for Polymer Therapeutics, London, UK.
出版信息
Stem Cells. 1995 Sep;13(5):501-11. doi: 10.1002/stem.5530130507.
At present, chemotherapy is not very effective against common solid cancers, especially once they have metastasized. However, laboratory experiments and studies on dose intensification in humans have indicated that some anticancer agents might be curative, but only if the dose given was very much higher than that attainable clinically. Prodrugs activated by enzymes expressed at a high level in tumors can deliver at least 50-fold the normal dose and can cure animals with tumors normally resistant to chemotherapy. The approach is not practicable clinically because of the rarity of human tumors expressing a high level of an activating enzyme. However, new therapies have been proposed that overcome this limitation of prodrug therapy. Enzymes that activate prodrugs can be directed to human tumor xenografts by conjugating them to tumor-associated antibodies. After allowing for the conjugate to clear from the blood a prodrug is administered which is normally inert, but which is activated by the enzyme delivered to the tumor. This procedure is referred to as ADEPT (antibody-directed enzyme prodrug therapy). Using different combinations of antibody, enzyme and prodrug, many classes of human tumor xenograft have been shown to be very sensitive to this procedure although in most cases they are quite resistant to conventional chemotherapy. Early clinical trials are promising and indicate that ADEPT may become an effective treatment for all solid cancers for which tumor-associated or tumor-specific antibodies are known. Tumors have also been targeted with the genes encoding for prodrug activating enzymes. This approach has been called virus-directed enzyme prodrug therapy (VDEPT) or more generally GDEPT (gene-directed enzyme prodrug therapy) and has shown good results in laboratory systems. These new therapies may finally realize the potential of prodrugs in cancer chemotherapy.
目前,化疗对常见实体癌的效果并不理想,尤其是在癌症发生转移之后。然而,实验室实验以及针对人类的剂量强化研究表明,某些抗癌药物可能具有治愈效果,但前提是给予的剂量要比临床可达到的剂量高得多。由肿瘤中高表达的酶激活的前药,其给药剂量至少可为正常剂量的50倍,并且能够治愈那些通常对化疗耐药的荷瘤动物。由于人类肿瘤中高表达激活酶的情况罕见,所以这种方法在临床上并不实用。不过,已经有人提出了新的疗法来克服前药疗法的这一局限性。通过将激活前药的酶与肿瘤相关抗体偶联,可以使其靶向人类肿瘤异种移植模型。待偶联物从血液中清除后,给予一种通常无活性的前药,该前药可被输送到肿瘤部位的酶激活。这个过程被称为抗体导向酶前药疗法(ADEPT)。使用不同的抗体、酶和前药组合,已证明许多类型的人类肿瘤异种移植模型对该方法非常敏感,尽管在大多数情况下它们对传统化疗相当耐药。早期临床试验前景良好,表明ADEPT可能成为已知肿瘤相关或肿瘤特异性抗体的所有实体癌的有效治疗方法。编码前药激活酶的基因也已被用于靶向肿瘤。这种方法被称为病毒导向酶前药疗法(VDEPT),更一般地称为基因导向酶前药疗法(GDEPT),并且在实验室系统中已显示出良好的效果。这些新疗法最终可能会实现前药在癌症化疗中的潜力。