Platinum-based antineoplastic

Short description: Chemotherapeutic agents used to treat cancer

Platinum-based antineoplastic drugs (informally called platins) are chemotherapeutic agents used to treat cancer. Their active moieties are coordination complexes of platinum. These drugs are used to treat almost half of people receiving chemotherapy for cancer. In this form of chemotherapy, commonly used drugs include cisplatin, oxaliplatin, and carboplatin, but several have been proposed or are under development.[1] Addition of platinum-based chemotherapy drugs to chemoradiation in women with early cervical cancer seems to improve survival and reduce risk of recurrence.[2]

In total, these drugs can cause a combination of more than 40 specific side effects which include neurotoxicity, which is manifested by peripheral neuropathies including polyneuropathy.[3]

## Mechanism of action

As studied mainly on cisplatin, but presumably for other members as well, platinum-based antineoplastic agents cause crosslinking of DNA as monoadduct, interstrand crosslinks, intrastrand crosslinks or DNA protein crosslinks. Mostly they act on the adjacent N-7 position of guanine, forming a 1, 2 intrastrand crosslink.[4][5] The resultant crosslinking inhibits DNA repair and/or DNA synthesis. This mechanism leads to specific patterns of damage in DNA, which can kill cancer cells but can also increase the risk of secondary tumors developing.[6]

Platinum-based antineoplastic agents are sometimes described as "alkylating-like" due to similar effects as alkylating antineoplastic agents, although they do not have an alkyl group.[7]

## Examples

Strategies for improving platinum-based anticancer drugs usually involve changes in the neutral spectator ligands, changes in the nature of the anions (halides vs various carboxylates), or changes in the oxidation state of the metal (Pt(II) vs Pt(IV)). Nanotechnology has been explored to deliver platinum more efficiently in the case of lipoplatin, which is introduced into the tumor sites thereby reducing the chance of toxicity.[8]

Cisplatin was the first to be developed.[9] Cisplatin is particularly effective against testicular cancer; the cure rate was improved from 10% to 85%.[10] Similarly, the addition of cisplatin to adjuvant chemotherapy led to a marked increase in disease-free survival rates for patients with medulloblastoma \- again, up to around 85%.[11] This application of cisplatin was developed by pediatric oncologist Roger Packer in the early 1980s.[12]

* Approved platinum-based anticancer drugs
* cisplatin

* carboplatin

* oxaliplatin

* nedaplatin

* Dicycloplatin

* Platinum-based anticancer drugs in trials
* triplatin tetranitrate

* phenanthriplatin, a proposed new anticancer drug.[1]

* picoplatin, which remains in trials

* satraplatin

* Pyriplatin
* Lobaplatin

## References

1. ↑ 1.0 1.1 Johnstone, TC; Park, GY; Lippard, SJ (2014). "Understanding and improving platinum anticancer drugs--phenanthriplatin". Anticancer Res. 34 (1): 471–6. PMID 24403503.
2. ↑ Falcetta, FS; Medeiros, LR; Edelweiss, MI; Pohlmann, PR; Stein, AT; Rosa, DD (22 November 2016). "Adjuvant platinum-based chemotherapy for early stage cervical cancer.". The Cochrane Database of Systematic Reviews 11 (11). doi:10.1002/14651858.CD005342.pub4. PMID 27873308.
3. ↑ "The side effects of platinum-based chemotherapy drugs: a review for chemists". Dalton Transactions 47 (19): 6645–6653. 2018. doi:10.1039/c8dt00838h. PMID 29632935.
4. ↑ "Influence of cisplatin intrastrand crosslinking on the conformation, thermal stability, and energetics of a 20-mer DNA duplex". Proc. Natl. Acad. Sci. U.S.A. 93 (15): 7606–11. July 1996. doi:10.1073/pnas.93.15.7606. PMID 8755522. Bibcode: 1996PNAS...93.7606P.
5. ↑ "Persistence of cisplatin-induced DNA interstrand crosslinking in peripheral blood mononuclear cells from elderly and young individuals". Cancer Chemother. Pharmacol. 35 (4): 323–6. 1995. doi:10.1007/BF00689452. PMID 7828275.
6. ↑ Steele, Christopher D; Pillay, Nischalan; Alexandrov, Ludmil B (July 2022). "An overview of mutational and copy number signatures in human cancer". The Journal of Pathology 257 (4): 454–465. doi:10.1002/path.5912. ISSN 0022-3417. PMID 35420163.
7. ↑ "Enhanced DNA-PK-mediated RPA2 hyperphosphorylation in DNA polymerase eta-deficient human cells treated with cisplatin and oxaliplatin". DNA Repair 7 (4): 582–96. April 2008. doi:10.1016/j.dnarep.2007.12.012. PMID 18289945.
8. ↑ Johnstone, Timothy C.; Suntharalingam, Kogularamanan; Lippard, Stephen J. (2016). "The Next Generation of Platinum Drugs: Targeted Pt(II) Agents, Nanoparticle Delivery, and Pt(IV) Prodrugs". Chemical Reviews 116 (5): 3436–3486. doi:10.1021/acs.chemrev.5b00597. ISSN 0009-2665. PMID 26865551.
9. ↑ Kelland, L. (2007). "The resurgence of platinum-based cancer chemotherapy". Nature Reviews Cancer 7 (8): 573–584. doi:10.1038/nrc2167. PMID 17625587.
10. ↑ Einhorn LH. (1 November 1990). "Treatment of testicular cancer: a new and improved model". J. Clin. Oncol. 8 (11): 1777–81. doi:10.1200/JCO.1990.8.11.1777. PMID 1700077. http://jco.ascopubs.org/cgi/content/abstract/8/11/1777.
11. ↑ Packer, R. (1994). "Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU, and vincristine chemotherapy.". Journal of Neurosurgery 81 (5): 690–698. doi:10.3171/jns.1994.81.5.0690. PMID 7931615. https://www.researchgate.net/publication/237391614.
12. ↑ Packer, R. (1994). "Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU, and vincristine chemotherapy.". Journal of Neurosurgery 81 (5): 690–698. doi:10.3171/jns.1994.81.5.0690. PMID 7931615. https://www.researchgate.net/publication/237391614.

* v
* t
* e

Intracellular chemotherapeutic agents / antineoplastic agents (L01)

SPs/MIs
(M phase)|

| Block microtubule assembly|

* Vinca alkaloids (Vinblastine#
* Vincristine#
* Vinflunine§
* Vindesine
* Vinorelbine#)

|

Block microtubule disassembly|

* Taxanes (Cabazitaxel
* Docetaxel#
* Larotaxel
* Ortataxel†
* Paclitaxel#
* Tesetaxel)
* Epothilones (Ixabepilone)

DNA replication
inhibitor|

| DNA precursors/
antimetabolites
(S phase)|

| Folic acid|

* Dihydrofolate reductase inhibitor (Aminopterin
* Methotrexate#
* Pemetrexed
* Pralatrexate)
* Thymidylate synthase inhibitor (Raltitrexed
* Pemetrexed)

|

Purine|

* Adenosine deaminase inhibitor (Pentostatin)

* Halogenated/ribonucleotide reductase inhibitors (Cladribine
* Clofarabine
* Fludarabine)
* Nelarabine

* Thiopurine (Tioguanine#
* Mercaptopurine#)

Pyrimidine|

* Thymidylate synthase inhibitor (Fluorouracil#
* Capecitabine#
* Doxifluridine
* Tegafur (+gimeracil/oteracil)
* Carmofur
* Floxuridine)

* DNA polymerase inhibitor (Cytarabine#)

* Ribonucleotide reductase inhibitor (Gemcitabine#)

* Hypomethylating agent (Azacitidine
* Decitabine)

Deoxyribonucleotide|

* Ribonucleotide reductase inhibitor (Hydroxycarbamide#)

Topoisomerase inhibitors
(S phase)|

| I|

* Camptotheca (Camptothecin
* Cositecan†
* Belotecan
* Gimatecan
* Exatecan
* Irinotecan#
* Lurtotecan‡
* Silatecan§
* Topotecan
* Rubitecan‡)

|

II|

* Podophyllum (Etoposide#
* Teniposide)

II+Intercalation|

* Anthracyclines (Aclarubicin
* Daunorubicin#
* Doxorubicin#
* Epirubicin
* Idarubicin
* Amrubicin†
* Pirarubicin
* Valrubicin
* Zorubicin)
* Anthracenediones (Mitoxantrone
* Pixantrone)

Crosslinking of DNA
(CCNS)|

| Alkylating|

* Nitrogen mustards: Chlormethine
* Cyclophosphamide# (Ifosfamide#
* Trofosfamide)
* Chlorambucil# (Melphalan
* Prednimustine)
* Bendamustine#
* Uramustine

* Nitrosoureas: Carmustine
* Lomustine (Semustine)
* Fotemustine
* Nimustine
* Ranimustine
* Streptozocin

* Alkyl sulfonates: Busulfan (Mannosulfan
* Treosulfan)

* Aziridines: Carboquone
* Thiotepa
* Triaziquone
* Triethylenemelamine

|

Platinum-based|

* Carboplatin#
* Cisplatin#
* Dicycloplatin
* Nedaplatin
* Oxaliplatin#
* Satraplatin

Nonclassical|

* Hydrazines (Procarbazine#)
* Triazenes (Dacarbazine#
* Temozolomide)
* Altretamine
* Mitobronitol
* Pipobroman

Intercalation|

* Streptomyces (Actinomycin#
* Bleomycin#
* Mitomycins
* Plicamycin)

Photosensitizers/PDT|

* Aminolevulinic acid / Methyl aminolevulinate
* Efaproxiral
* Porphyrin derivatives (Porfimer sodium
* Talaporfin
* Temoporfin
* Verteporfin)

Other|

| Enzyme inhibitors|

* FI (Tipifarnib§)
* CDK inhibitors (Abemaciclib
* Alvocidib†
* Palbociclib
* Ribociclib
* Seliciclib†)
* PrI
* Bortezomib
* Carfilzomib
* Ixazomib
* PhI (Anagrelide)
* IMPDI (Tiazofurin§)
* LI (Masoprocol)
* PARP inhibitor (Niraparib
* Olaparib
* Rucaparib)
* HDAC (Belinostat
* Panobinostat
* Romidepsin
* Vorinostat)
* PIKI (Idelalisib)

|

Receptor antagonists|

* ERA (Atrasentan)
* Retinoid X receptor (Bexarotene)
* Sex steroid (Testolactone)

Other/ungrouped|

* Amsacrine
* Trabectedin
* Retinoids (Alitretinoin
* Tretinoin#)
* Arsenic trioxide
* Asparagine depleters (Asparaginase#/Pegaspargase)
* Celecoxib
* Demecolcine
* Elesclomol§
* Elsamitrucin
* Estramustine phosphate
* Etoglucid
* Lonidamine
* Lucanthone
* Mitoguazone
* Mitotane
* Oblimersen†
* Omacetaxine mepesuccinate
* Eribulin

* #WHO-EM
* ‡Withdrawn from market
* Clinical trials:
* †Phase III
* §Never to phase III

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