Cytarabine

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Cytarabine
Cytarabin.svg
Cytarabine ball-and-stick.png
Clinical data
Trade names Cytosar-U, Depocyt, others
AHFS/Drugs.com Monograph
MedlinePlus a682222
Pregnancy
category
  • AU: D
  • US: D (Evidence of risk)
Routes of
administration
injectable (intravenous injection or infusion, intrathecal, or subcutaneously)
ATC code L01BC01 (WHO)
Legal status
Legal status
  • ℞ (Prescription only)
Pharmacokinetic data
Bioavailability 20% by mouth
Protein binding 13%
Metabolism liver
Biological half-life biphasic: 10 min, 1–3 hr
Excretion kidney
Identifiers
CAS Number 147-94-4 YesY
PubChem (CID) 6253
IUPHAR/BPS 4827
DrugBank DB00987 YesY
ChemSpider 6017 YesY
UNII 04079A1RDZ YesY
KEGG D00168 YesY
ChEBI CHEBI:28680 YesY
ChEMBL CHEMBL803 YesY
PDB ligand ID AR3 (PDBe, RCSB PDB)
ECHA InfoCard 100.005.188
Chemical and physical data
Formula C9H13N3O5
Molar mass 243.217 g/mol
3D model (Jmol) Interactive image
  (verify)

Cytarabine, also known as cytosine arabinoside, is a chemotherapy medication used to treat acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), chronic myelogenous leukemia (CML), and non-Hodgkin's lymphoma. It is given by injection into a vein, under the skin, or into the cerebrospinal fluid. There is a liposomal formulation for which there is tentative evidence of better outcomes in lymphoma involving the meninges.[1]

Common side effects include bone marrow suppression, vomiting, diarrhea, liver problems, rash, ulcer formation in the mouth, and bleeding. Other serious side effects include loss of consciousness, lung disease, and allergic reactions. Use during pregnancy may harm the baby.[1] Cytarabine is in the antimetabolite family of medication.[2] It works by blocking the function of DNA polymerase.[1]

Cytarabine was patented in 1960 and approved for medical use in 1969.[3] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[4] The wholesale cost in the developing world is about 4.27 to 5.7 USD per 500 mg vial.[5] This dose in the United Kingdom costs the NHS about 50.00 pounds while the liposomal form is 1,223.75 pounds per 50 mg vial.[2]

Medical uses[edit]

Cytarabine is mainly used in the treatment of acute myeloid leukaemia, acute lymphocytic leukaemia (ALL) and in lymphomas,[6] where it is the backbone of induction chemotherapy.

Cytarabine also possesses antiviral activity, and it has been used for the treatment of generalised herpesvirus infection. However, cytarabine is not very selective in this setting and causes bone marrow suppression and other severe side effects. Therefore, ara-C is not a useful antiviral agent in humans because of its toxic profile[7] and actually it is used mainly for the chemotherapy of hematologic cancers.

Cytarabine is also used in the study of the nervous system to control the proliferation of glial cells in cultures, the amount of glial cells having an important impact on neurons.[citation needed]

Side effects[edit]

One of the unique toxicities of cytarabine is cerebellar toxicity when given in high doses, which may lead to ataxia. Cytarabine may cause granulocytopenia and other impaired body defenses, which may lead to infection, and thrombocytopenia, which may lead to hemorrhage.

Toxicity: leukopenia, thrombocytopenia, anemia, GI disturbances, stomatitis, conjunctivitis, pneumonitis, fever, and dermatitis, palmar-plantar erythrodysesthesia. Rarely, myelopathy has been reported after high dose or frequent intrathecal Ara-C administration.[8]

When used in protocols designated as high dose, cytarabine can cause cerebral and cerebellar dysfunction, ocular toxicity, pulmonary toxicity, severe GI ulceration and peripheral neuropathy (rare).

To prevent the side effects and improve the therapeutic efficiency, various derivatives of these drugs (including amino acid, peptide, fatty acid and phosphates) have been evaluated, as well as different delivery systems.[9]

Mechanism of action[edit]

It is called cytosine arabinoside because it combines a cytosine base with an arabinose sugar. Cytosine normally combines with a different sugar, deoxyribose, to form deoxycytidine, a component of DNA. Certain sponges, where it was originally found, use arabinoside sugars to form a different compound (not part of DNA). Cytosine arabinoside is similar enough to human cytosine deoxyribose (deoxycytidine) to be incorporated into human DNA, but different enough that it kills the cell. This mechanism is used to kill cancer cells. Cytarabine is the first of a series of cancer drugs that altered the sugar component of nucleosides. Other cancer drugs modify the base.[10]

Cytosine arabinoside interferes with the synthesis of DNA. It is an antimetabolic agent with the chemical name of 1β-arabinofuranosylcytosine. Its mode of action is due to its rapid conversion into cytosine arabinoside triphosphate, which damages DNA when the cell cycle holds in the S phase (synthesis of DNA). Rapidly dividing cells, which require DNA replication for mitosis, are therefore most affected. Cytosine arabinoside also inhibits both DNA[11] and RNA polymerases and nucleotide reductase enzymes needed for DNA synthesis.

When used as an antiviral, cytarabine functions by inhibiting deoxycytidine use.[12]

Cytarabine is rapidly deaminated in the body into the inactive uracil derivative and therefore is often given by continuous intravenous infusion.

History[edit]

Cytarabine was first synthesized in 1959 by Richard Walwick, Walden Roberts, and Charles Dekker at the University of California, Berkeley.[13]

It was approved by the United States Food and Drug Administration in June 1969, and was initially marketed in the U.S. by Upjohn under the trade name Cytosar-U.

Names[edit]

It is also known as ara-C (arabinofuranosyl cytidine).[14]

  • Cytosar-U
  • Tarabine PFS (Pfizer)
  • Depocyt (longer-lasting liposomal formulation)
  • AraC

References[edit]

  1. ^ a b c "Cytarabine". The American Society of Health-System Pharmacists. Retrieved 8 December 2016. 
  2. ^ a b British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 589. ISBN 9780857111562. 
  3. ^ Fischer, Janos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 511. ISBN 9783527607495. 
  4. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016. 
  5. ^ "Cytarabine". International Drug Price Indicator Guide. Retrieved 8 December 2016. 
  6. ^ Pigneux A, Perreau V, Jourdan E, et al. (October 2007). "Adding lomustine to idarubicin and cytarabine for induction chemotherapy in older patients with acute myeloid leukemia: the BGMT 95 trial results". Haematologica. 92 (10): 1327–34. doi:10.3324/haematol.11068. PMID 18024370. 
  7. ^ Lauter, CB.; Bailey, EJ.; Lerner, AM. (Nov 1974). "Assessment of cytosine arabinoside as an antiviral agent in humans.". Antimicrob Agents Chemother. 6 (5): 598–602. doi:10.1128/aac.6.5.598. PMID 15825312. 
  8. ^ Watterson J, Toogood I, Nieder M, et al. (December 1994). "Excessive spinal cord toxicity from intensive central nervous system-directed therapies". Cancer. 74 (11): 3034–41. doi:10.1002/1097-0142(19941201)74:11<3034::AID-CNCR2820741122>3.0.CO;2-O. PMID 7954266. 
  9. ^ Chhikara BS, Parang K (2010). "Development of cytarabine prodrugs and delivery systems for leukemia treatment". Expert Opinion on Drug Delivery. 7 (12): 1399–1414. doi:10.1517/17425247.2010.527330. 
  10. ^ Feist, Patty (April 2005). "A Tale from the Sea to Ara C". 
  11. ^ Perry, Michael J. (2008). The Chemotherapy source book. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 80. ISBN 0-7817-7328-8. 
  12. ^ Lemke, Thomas L.; Williams, David H.; Foye, William O. (2002). Foye's principles of medicinal chemistry. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 963. ISBN 0-683-30737-1. 
  13. ^ Sneader, Walter (2005). Drug discovery: a history. New York: Wiley. p. 258. ISBN 0-471-89979-8. 
  14. ^ Ogbomo H, Michaelis M, Klassert D, Doerr HW, Cinatl J (December 2008). "Resistance to cytarabine induces the up-regulation of NKG2D ligands and enhances natural killer cell lysis of leukemic cells". Neoplasia. 10 (12): 1402–10. PMC 2586691Freely accessible. PMID 19048119. [permanent dead link]

External links[edit]