Irofulven: Difference between revisions

{{Update|date=February 2018}}

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| ImageFile=Irofulven.svg

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| PIN=(6′''R'')-6′-Hydroxy-3′-(hydroxymethyl)-2′,4′,6′-trimethylspiro[cyclopropane-1,5′-inden]-7′(6′''H'')-one

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| PubChem=148189

| SMILES = O=C1C/3=C/C(=C(C\3=C(/C2([C@]1(O)C)CC2)C)CO)C

|Section2={{Chembox Properties

| Formula=C₁₅H₁₈O₃

| MolarMass=246.302 g/mol

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| Density=1.285 g/mL

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'''Irofulven''' or '''6-hydroxymethylacylfulvene''' (also known as '''HMAF''' of '''MGI-114''') is an experimental antitumor agent.<ref name="pmid18388315">{{ cite journal |author1=Escargueil, A. E. |author2=Poindessous, V. |author3=Soares, D. G. |author4=Sarasin, A. |author5=Cook, P. R. |author6=Larsen, A. K. | title = Influence of Irofulven, a Transcription-Coupled Repair-Specific Antitumor Agent, on RNA Polymerase Activity, Stability and Dynamics in Living Mammalian Cells | journal = Journal of Cell Science | volume = 121 | issue = Pt 8 | pages = 1275–1283 |date=April 2008 | pmid = 18388315 | doi = 10.1242/jcs.023259 |doi-access= |s2cid=9282024 }}</ref><ref name="pmid8913837">{{ cite journal |author1=Kelner, M. J. |author2=McMorris, T. C. |author3=Estes, L. |author4=Wang, W. |author5=Samson, K. M. |author6=Taetle, R. | title = Efficacy of HMAF (MGI-114) in the MV522 Metastatic Lung Carcinoma Xenograft Model Nonresponsive to Traditional Anticancer Agents | journal = Investigational New Drugs | volume = 14 | issue = 2 | pages = 161–167 | year = 1996 | pmid = 8913837 | doi = 10.1007/BF00210787 |s2cid=8439510 }}</ref> It belongs to the family of [[medication|drugs]] called [[alkylating antineoplastic agent|alkylating agent]]s.

It inhibits the DNA replication of cells deficient in [[nucleotide excision repair]] in culture.<ref name="pmid17118344">{{ cite journal |author1=Wang, Y. |author2=Wiltshire, T. |author3=Senft, J. |author4=Reed, E. |author5=Wang, W. | title = Irofulven Induces Replication-Dependent CHK2 Activation Related to p53 Status | journal = [[Biochemical Pharmacology (journal)|Biochemical Pharmacology]] | volume = 73 | issue = 4 | pages = 469–480 |date=February 2007 | pmid = 17118344 | pmc = 1800887 | doi = 10.1016/j.bcp.2006.10.023 }}</ref><ref name=":0">{{Cite journal |last1=Börcsök |first1=Judit |last2=Sztupinszki |first2=Zsofia |last3=Bekele |first3=Raie |last4=Gao |first4=Sizhi P. |last5=Diossy |first5=Miklos |last6=Samant |first6=Amruta S. |last7=Dillon |first7=Kasia M. |last8=Tisza |first8=Viktoria |last9=Spisák |first9=Sándor |last10=Rusz |first10=Orsolya |last11=Csabai |first11=Istvan |last12=Pappot |first12=Helle |last13=Frazier |first13=Zoë J. |last14=Konieczkowski |first14=David J. |last15=Liu |first15=David |date=2021-04-01 |title=Identification of a Synthetic Lethal Relationship between Nucleotide Excision Repair Deficiency and Irofulven Sensitivity in Urothelial Cancer |journal=Clinical Cancer Research|volume=27 |issue=7 |pages=2011–2022 |doi=10.1158/1078-0432.CCR-20-3316 |issn=1557-3265 |pmc=8026514 |pmid=33208343}}</ref>

Irofulven is an [[analog (chemistry)|analogue]] of [[illudin S]], a [[sesquiterpene]] toxin found in the Jack 'o' Lantern mushroom (''[[Omphalotus illudens]]''). The compound was originally synthesized by Dr. Trevor McMorris and found to have anticancer properties in mice by Dr. Michael J Kelner.<ref>{{ cite journal |author1=MacDonald, J. R. |author2=Muscoplat, C. C. |author3=Dexter, D. L. |author4=Mangold, G. L. |author5=Chen, S. F. |author6=Kelner, M. J. |author7=McMorris, T. C. |author8=Von Hoff, D. D. | title = Preclinical Antitumor Activity of 6-hydroxymethylacylfulvene, a Semisynthetic Derivative of the Mushroom Toxin Illudin S | journal = Cancer Research | volume = 57 | issue = 2 | pages = 279–283 | year = 1997 | pmid = 9000568 | url = http://cancerres.aacrjournals.org/content/57/2/279.full.pdf }}</ref>

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==Licensing and Clinical development==

The drug was created and patented by the [[University of California]], San Diego (UCSD), and subsequently licensed to the US biotech company MGI Pharma. [[Eisai]] acquired MGI in 2007, and the license was returned to UCSD, which then re-licensed the potential cancer drug to Lantern Pharma in 2015. Soon after, the drug was again sub-licensed to Oncology Venture, now known as Allarty Therapeutics A/S.

The drug has undergone a number of clinical trials, mostly for late-stage tumors as well as ovarian and prostate cancers, usually preceded by treatment with [[carboplatin]] and [[paclitaxel]]. A multi-center phase 2 trial involving patients with Recurrent or Persistent Ovarian Epithelial or Primary Peritoneal Cancer was well tolerated but irofluven demonstrated modest activity as a single agent.<ref>Schilder RJ et al. (2010 Oct). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079178/ "A phase II evaluation of Irofulven (IND#55804, NSC#683863) as second-line treatment of recurrent or persistent intermediately platinum-sensitive ovarian or primary peritoneal cancer: A Gynecologic Oncology Group trial"]. J Gynecol Cancer. 20(7):1137-41. {{PMC|3079178}}.</ref> Previously, a European Phase I study in combination with [[cisplatin]] showed substantial evidence for anti-tumor activity. In that study, irofulven showed rapid elimination and high interpatient variability. Platinum and irofulven pharmacokinetics did not suggest drug-drug interactions.<ref>Hilger W et al.(July 2006),[https://www.ncbi.nlm.nih.gov/pubmed/16683074 A phase I and pharmacokinetic study of irofulven and cisplatin administered in a 30-min infusion every two weeks to patients with advanced solid tumors]. Invest New Drugs. 24(4):311-9. {{doi|10.1007/s10637-005-5055-6}}.</ref>

Despite modest successes demonstrating limited efficacy for late stage tumors that were statistically not significant enough to support broader clinical trials, Allarty decided to stratify patient populations with companion diagnostic tools ([[biomarkers]]) to predict outcomes, and thus select that sub-set of patients through DRP (Drug Response Predictors), for whom treatment with irofulven would be most effective. Allarty initiated two Phase 2 drug-screening studies at two Danish University Hospitals for late-stage prostate cancers, wherein 300 patients have been included to be screened, of which only 27 are to be selected for the Phase 2 trial.<ref>[http://www.pharmacychoice.com/news/article.cfm?Article_ID=1610062 Both Danish sites now open in the Screening Study of prostate cancer patients for OV's Irofulven] Pharmacy Choice - Pharmaceutical News. Retrieved 12 May 2017.</ref>In 2021, Lantern Pharma reacquired the rights to the development and commercialization of irofulven. At that time, 9 of the intended 27 patients had been a part of the study which saw an increase of median overall survival from 2.6 to 5.4 months.<ref>{{Cite web |date=2021-07-27 |title=Lantern Pharma Reacquires Rights to Phase 2 Clinical Trial in Metastatic Prostate Cancer and Global Development & Commercialization of Irofulven (LP-100) from Allarity Therapeutics A/S |url=https://ir.lanternpharma.com/news-events/press-releases/detail/54/lantern-pharma-reacquires-rights-to-phase-2-clinical-trial |access-date=2024-07-26 |website=Lantern Pharma Inc. |language=en}}</ref> The study is estimated to be complete in late 2024.<ref name=":1">{{Cite web |title=ClinicalTrials.gov |url=https://clinicaltrials.gov/study/NCT03643107 |access-date=2024-01-26 |website=clinicaltrials.gov}}</ref>

Since it was first synthesized, research with irofulven has decreased dramatically over the past decade with only one clinical trial currently being run.<ref name=":1" /> A study published in 2021 showed cells with nucleotide excision repair (NER) deficiencies were susceptible to iroflaven while cells without these NER deficiencies were not overly affected. The deficiency of tumors in NER was seen as a potential identifier for patient candidates.<ref name=":0" /> Since this discovery, research has increased with researchers calling irofulven a "previously abandoned" anticancer drug.<ref>{{Cite journal |last1=Prosz |first1=Aurel |last2=Duan |first2=Haohui |last3=Tisza |first3=Viktoria |last4=Sahgal |first4=Pranshu |last5=Topka |first5=Sabine |last6=Klus |first6=Gregory T. |last7=Börcsök |first7=Judit |last8=Sztupinszki |first8=Zsofia |last9=Hanlon |first9=Timothy |last10=Diossy |first10=Miklos |last11=Vizkeleti |first11=Laura |last12=Stormoen |first12=Dag Rune |last13=Csabai |first13=Istvan |last14=Pappot |first14=Helle |last15=Vijai |first15=Joseph |date=2023-11-23 |title=Nucleotide excision repair deficiency is a targetable therapeutic vulnerability in clear cell renal cell carcinoma |journal=Scientific Reports |language=en |volume=13 |issue=1 |pages=20567 |doi=10.1038/s41598-023-47946-4 |pmid=37996508 |issn=2045-2322|pmc=10667362 |bibcode=2023NatSR..1320567P }}</ref><ref name=":0" /><ref>{{Cite web |date=2021-01-11 |title=Repairing DNA Damage in Cancer Cells {{!}} Memorial Sloan Kettering Cancer Center |url=https://www.mskcc.org/news/repairing-dna-damage-cancer-cells |access-date=2024-01-26 |website=www.mskcc.org |language=en}}</ref>

A synthesis of irofulven has been reported.<ref>{{ Cite journal | doi = 10.1021/jo035084j | pmid = 14750783 | title = Synthesis and Biological Activity of Enantiomers of Antitumor Irofulven | year = 2004 | last1 = McMorris | first1 = T. C. | last2 = Staake | first2 = M. D. | last3 = Kelner | first3 = M. J. | journal = The Journal of Organic Chemistry | volume = 69 | issue = 3 | pages = 619–23 }}</ref>

:[[File:Irofulven.png|500px]]{{clear left}}

{{reflist}}

[[Category:Diols]]

[[Category:Hydroxyketones]]

[[Category:Spiro compounds]]

[[Category:Sesquiterpenes]]

[[Category:Primary alcohols]]

[[Category:Tertiary alcohols]]