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Angiogenesis (formation of new vessels from pre-existing ones) is a crucial early event in the process of tumor development. New vessels supply the tumor with nutrients that are needed for further local growth and enable distant metastases (Folkman 1995). Judah Folkman (1971) highlighted the potential therapeutic imp- cations of tumor angiogenesis. He hypothesized that if tumor angiogenesis is inhibited, then tumor growth and metastasis will be impaired greatly or even impossible. The subsequent quest for endogenous and exogenous inhibitors of angiogenesis has yielded a variety of promising therapeutic agents that block one or more angiogenic pathways, a few of which have been approved by the FDA (e. g. , bevacizumab, sorafenib, sunitinib) for use as single agents or in combination with chemotherapy in specific populations of cancer patients (Sessa et al. 2008). There has also been a dramatic expansion in the exploration of novel anti-angiogenic agents pre-clinically and in clinical trials (Ferrara 2002). Some of the most promising data comes from the development of agents that inhibit one of the key growth factors involved in tumor angiogenesis – vascular endothelial growth factor (VEGF) (Ferrara et al. 2003). Bevacizumab is a monoclonal antibody against VEGF that was the first an- angiogenic agent that improved significantly the overall survival of patients with colorectal and non-squamous non-small cell lung cancer (Ferrara et al. 2005). Various agents that target tumor angiogenesis are currently under investigation in different cancer types in many clinical trials (Ferrara and Kerbel 2005).
Vascular-Targeted Therapies in Oncology provides an interesting insight to the current status and future potential of vascular-disrupting approaches in cancer management. Emphasis is placed on target development, preclinical assessment, and the use of such targeted approaches in combination with conventional treatment regimens and the current clinical status of these therapies.
Beverly Teicher and a panel of distinguished investigators survey the state-of-the-art of antiangiogenesis research from the lab bench to clinical trials. Timely and authoritative, the contributors summarize our current understanding of tumor growth and its dependence on vascular development, as well as the present status of antiangiogenic agents in preclinical and clinical development. In addition, the book also examines what is known about the mechanisms by which these therapeutic agents interfere with tumor vasculature and grapples with the problem of establishing criteria by which to assess their clinical efficacy. Antiangiogenic Agents in Cancer Therapy offers a unique cutting-edge compendium of antiangiogenic research, taking stock of what has been accomplished , where the experimental therapeutics of antiangiogenic agents is going, and the continuing evolution of their role in cancer treatment and novel drug development.
Cancer is the second leading cause of death in the United States with over 550,000 deaths in 2009 and a devastating 7.9 million deaths worldwide in 2007. Vascular disrupting agents (VDAs) represent a novel method developed for the treatment of cancer. VDAs, such as combretastatin A1 phosphate (CA1P, Oxi4503) and combretastatin A4 phosphate (CA4P, ZybrestatTM, fosbretabulin), after undergoing phosphate cleavage by non-specific phosphatase enzymes, selectively bind to the colchicine site on tubulin, disrupting tubulin polymerization. The integrity of the microtubules that form the cytoskeleton of the endothelial cells that line the tumorvasculature is altered, causing tumor vasculature occlusion and collapse, thus preventing nutrients and oxygen from reaching the tumor. This leads to severe tumor hypoxia, tumor perfusion regression and tumor necrosis. A series of anticancer agents were designed to incorporate a VDA or cytotoxic agent linked to a bioreductive drug to form a bioreductive prodrug conjugate. When the bioreductive portion of the molecular conjugate is reduced, the linkage between the VDA and the bioreductive drug is broken, releasing the VDA in its active form to act upon the tumor vasculature. The reduced bioreductive drug becomes a chemotherapeutic agent that can damage the tumor cells. CA1 is a potent inhibitor of tubulin polymerization and it has been shown that CA1 undergoes a second mechanism of action against tumors. CA1 incorporates an ortho diphenolic moiety that can be oxidized to form an ortho quinone that can damage DNA. To further elucidate the biological mechanism of action of CA1, a synthetic methodology was developed to incorporate a radioisotope at a metabolically stable position. In addition, a total synthesis was designed to prepare each of the combretastatin A1 monophosphates in regioisomeric pure form.
Medicinal Chemistry of Anticancer Drugs, Second Edition, provides an updated treatment from the point of view of medicinal chemistry and drug design, focusing on the mechanism of action of antitumor drugs from the molecular level, and on the relationship between chemical structure and chemical and biochemical reactivity of antitumor agents. Antitumor chemotherapy is a very active field of research, and a huge amount of information on the topic is generated every year. Cytotoxic chemotherapy is gradually being supplemented by a new generation of drugs that recognize specific targets on the surface or inside cancer cells, and resistance to antitumor drugs continues to be investigated. While these therapies are in their infancy, they hold promise of more effective therapies with fewer side effects. Although many books are available that deal with clinical aspects of cancer chemotherapy, this book provides a sorely needed update from the point of view of medicinal chemistry and drug design. Presents information in a clear and concise way using a large number of figures Historical background provides insights on how the process of drug discovery in the anticancer field has evolved Extensive references to primary literature
This dissertation, "Antitumor and Vascular Disrupting Effects of Ombrabulin in Hepatocellular Carcinoma" by Tsz-ching, Chan, 陳子楨, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Hepatocellular Carcinoma (HCC) the fifth most common cancer and the third leading cause of death among cancer worldwide. Curative treatments such as liver resection and liver transplantation are generally used in treating early-stage HCC patients. However, only 10% to 30% of HCC patients are eligible for the surgery, which is due to the asymptomatic characteristic of HCC, most HCC patients are diagnosed at late stage. Palliative treatment such as TAE, TACE and Sorafenib provide them options to maintain their quality of life and extend their survival. Nevertheless, current treatments provides limited benefits to them as efficacy remains unsatisfactory. Therefore, there is a great need to develop new palliative treatments and explore new agents for the treatment of HCC. The aim of this study is to investigate the efficacy of a new therapeutic agent, Ombrabulin, in the treatment of HCC. Angiogenesis in HCC has been well-studied for many years as many studies proved that angiogeneisis plays an important role in the progression and development of HCC. Angiogenesis can also affect the prognosis and efficacy of treatments in HCC. As a result, antiangiogenesis and vascular disrupting agents have become new target in the therapaies of HCC. Ombrabulin is a synthetic vascular disrupting agent, which can inhibit tubulin polymerization in endothelial cells, causing cytoskeleton disorganization in endothelial cells. Endothelial cells will then detach from the basement membrane and eventually lead to vascular shutdown. This study demonstrated for the first time that Ombrabulin could selectively inhibit human umbilical vein endothelial cell (HUVEC) growth in vitro; particularly the early-form of HUVEC, which represent immature endothelial cell in neovasculature. Furthermore, this study also demonstrated the antiangiogenic effect of Ombrabulin on endothelial cells. By F-actin staining, it was shown that Ombrabulin caused changes in HUVECs morphology, which supported that Ombrabulin could lead to distortion in cytoskeleton. In vivo study demonstrated the early effect and long term effect of Ombrabulin. For the first part of the in vivo study, Nude mice were treated with single-dose of Ombrabulin for one week. Hoechst 33342, anti-CD34 staining and PCNA staining were carried out to study the functional effect of Ombrabulin and the combination effect with Sorafenib in vivo. Mice treated with Ombrabulin resulted in decreased blood perfusion, microvessel density and tumor cell proliferation, and tumor necrosis was also observed. In the combination with Sorafenib, it did not show synergistic effect in both tumor cell proliferation and microvessel density. For the second part of the in vivo study, nod scid mice were treated with multiple doses of Ombrabulin for three weeks to study the long term effect of Ombrabulin. Mice treated with Ombrabulin resulted in significantly smaller tumor size, demonstrating its antitumor efficacy in HCC. Furthermore, combination treatment of Sorafenib and Ombrabulin in vivo could enhance the efficacy of the treatment of HCC. In conclusion, Ombrabulin has vascular disrupting and antitumor effects, which could efficiently suppress HCC tumor growth in vivo. These results suggest that Ombrabulin could be a promising vascular disrupting agent in treating HCC. Combination with sorafenib should be further explored in clinical studies to demonstrate t