• Clinical and Experimental Pediatrics
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• 제56권3호
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• pp.130-134
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• 2013

Purpose: Anthracyclines have been utilized in the treatment of children with acute lymphoblastic leukemia (ALL). Recent studies have shown that anthracyclines may induce toxicity in the vascular endothelium. This study was performed using brachial artery reactivity (BAR) to evaluate vascular endothelial function in ALL patients who were treated with anthracycline chemotherapy. Methods: We included 21 children with ALL who received anthracycline chemotherapy and 20 healthy children. The cumulative dose of anthracyclines in the ALL patients was $142.5{\pm}18.2/m^2$. The last anthracycline dose was administered to the patients 2 to 85 months prior to their examination using BAR. The diameter of the brachial artery was measured in both groups using echocardiography, and BAR was calculated as the percentage change in the arterial diameter after release of the cuff relative to the baseline vessel diameter. Results: In the anthracycline-treated group, BAR was observed to be $3.4%{\pm}3.9%$, which was significantly lower than that observed in the control group ($12.1%{\pm}8.0%$, P<0.05). The time elapsed after the last anthracycline treatment and the age at the time of treatment did not affect the change in BAR (P =0.06 and P =0.13, respectively). Conclusion: These results provided evidence that treatment of ALL patients with anthracycline results in endothelial dysfunction. A larger cohort study and a longer follow-up period will be required to clarify the relationship between endothelial dysfunction resulting from anthracycline treatment for childhood ALL and occurrence of cardiovascular diseases later in life.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4223-4231
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• 2016

Background: Development of new apoptosis-inducing drugs is a promising trend in anticancer therapy. For this purpose several formamidinoderivatives of doxorubicin were synthesized. The aim of our study was to investigate effects of the five formamidinodoxorubicins in the ES-2 human ovarian clear cell carcinoma line, for comparison with data obtained previously for SKOV-3 human ovarian adenocarcinoma cells, to answer the question of whether and to what extent the histological cell type is a possible determinant of sensitivity to tested anthracyclines. Materials and Methods: In our experimental work the following methods were used: spectrophotometric assays with MTT; fluorimetric assays - double staining with Hoechst 33258 and propidium iodide (PI), measurement of caspase-3, -8, -9 activity, intracellular accumulation of DOX and analogues, estimation of drug uptake, mitochondrial transmembrane potential; flow cytometry - phosphatidylserine (PS) externalization with annexin V-FITC and PI fluorochromes. Results: Effects of the derivatives of doxorubicin were partially linked with the specific type of cancer cell although intracellular accumulation and cellular uptake of DOX and derivatives were similar in both. All of the investigated derivatives were considerably more cytotoxic than DOX. Formamidinodoxorubicins were able to induce caspase-dependent apoptotic cell death in both cell types. Conclusions: All new formamidine derivatives of DOX were able to induce caspase - dependent apoptosis in human ovarian cancer cell lines SKOV-3 and ES-2. Obtained results suggested that formamidine derivatives of DOX may be promising candidates for the prospective chemotherapeutic agents for the two different histological subtypes of ovarian cancer.

• 대한종양외과학회지
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• 제14권2호
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• pp.102-107
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• 2018

Purpose: Cardiotoxicity is a serious late complication of breast cancer treatment. Individual treatment risk of specific drugs has been investigated. However, studies on the evaluation of the composite risk of chemotherapeutic agents are limited. Methods: We retrospectively analyzed the medical records of breast cancer patients who received adjuvant treatment and had available serial echocardiography results. Patients were assigned to subgroups based on chemotherapy containing anthracyclines (A), anthracyclines and taxanes (A+T), and radiotherapy (RT). The development of cardiac disease and serial ejection fraction (EF) were reviewed. EF decline up to 10% from baseline was considered grade 1 cardiotoxicity and EF decline >20% or absolute value <50% was considered grade 2 cardiotoxicity. The most recent medical records and echocardiography results over 1 year of chemotherapy completion were also reviewed. Late cardiotoxicity was defined as a lack of recovery of EF decline or aggravated EF decline from baseline. Results: In total, 123 patients were evaluated. A small reduction in EF was observed after chemotherapy in both chemotherapy groups. There were no significant differences between groups A and A+T in EF decline following chemotherapy. We could not find any differences in composite risk between the chemotherapy groups and the RT group during follow-up. Late cardiotoxicity was seen in 15.45% of patients. During follow-up, three patients were diagnosed with dilated cardiomyopathy. Conclusion: There was no significant composite risk elevation following adjuvant treatment of breast cancer. However, late cardiotoxicity was considerable and further research in this direction is necessary.

• Clinical and Experimental Pediatrics
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• 제46권3호
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• pp.242-249
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• 2003

목 적 : 항암치료 중 anthracycline을 사용한 환아들에 대한 후향적 조사를 통해 anthracycline의 축적량과 anthracycline 심독성과의 관계를 알고자 했고 심독성 환아들에 대한 추적 조사를 통해 anthracycline 심독성 환아의 예후를 알고자 하였다. 방 법 : 1995년 1월부터 2000년 12월까지 서울대학교병원 소아과에서 anthracycline을 포함한 항암치료를 시작한 환아를 대상으로 과거 anthracycline 축적량과 심장 초음파 검사 소견, 심독성 발생 유무 등을 조사하였다. 심독성은 좌심실 수축분율이 26% 이하로 감소한 경우로 정하였고 이들을 다시 좌심실 수축분율이 20%가 넘는 경증 심독성과 20% 미만인 중증 심독성으로 분류하였다. Anthracycline 심독성이 발생한 환아들에게 운동 능력과 심장 초음파, 심전도 검사, 흉부 방사선 촬영 등의 추적 검사를 시행하였다. 결 과 : 총 조사대상 환아는 154명이었다. 이 중에서 40명(26.0%)의 anthracycline 심독성이 발생하였으며 경증 심독성이 27명(17.5%), 중증 심독성이 13명(8.4%)이었다. 심독성의 발생률은 anthracycline의 축적량이 증가함에 따라 서서히 증가하다가 축적량이 $300mg/m^2$ 이상부터 갑자기 지수적으로 증가하는 양상을 보였다. 심독성 환아 40명 중 12명이 추적조사 이전에 사망하였고 생존한 환아 중 23명에 대해 추적검사를 시행하였다. Anthracycline의 사용을 중단한 후 평균 $3.6{\pm}1.8$년의 추적검사 결과 심독성 환아들의 좌심실 수축분율은 유의하게 증가하였다(P<0.01). 흉부 방사선 촬영이나 심전도 검사는 심독성의 진단을 위해 민감도와 특이도가 매우 낮은 검사였다. 결 론 : 일반적으로 anthracycline 심독성 환아의 추적검사로 시행하는 심전도 검사나 흉부 방사선 촬영은 심독성의 추적 조사에 도움이 되지 않는다. 심독성 환아들은 일단 생존하여 항암치료를 마치고 약 2-5년 정도 경과하면 심부전 증상이나 심장초음파 검사상 대부분 호전을 보인다.

• 분석과학
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• 제20권4호
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• pp.308-314
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• 2007

방사흐름 전지를 연결한 고성능 액체 크로마토그래프를 사용하여 독소루비신, 에피루비신, 노갈라마이신, 다우노루비신 및 아이다루비신을 동시에 정량 할 수 있는 역상 크로마토그래피법을 개발하였다. 안트라사이클린계 항생제들은 이동상 용매 중에서 은/염화은 (0.01 M NaCl) 기준전극에 대하여 확산 전류를 나타내는 -0.74 V에서 검출되었다. 부피 흐름속도 ($V_f$)를 1.0 mL/min로 고정하였을 때 독소루비신, 에피루비신, 다우노루비신 및 아이다루비신은 각각 6.4 분, 7.4분, 12.7분 및 18.4분의 머무름 시간 ($t_r$)에서 나타났으며, $V_f$ 0.6 mL/min 에서는 독소루비신, 에피루비신, 노갈라마이신, 다우노루비신 및 아이다루비신의 $t_r$은 각각 9.9분, 11.5분, 13.5분, 19.6분 및 28.7분에서 나타났다. 주입된 각각의 안트라사이클린계 항생제의 농도 ($2.40{\times}10^{-7}M{\sim}1.42{\times}10^{-5}M$)에 대하여 봉우리 면적 (전하)를 도시하였을 때 상관계수의 제곱 ($R^2$)은 0.999 이상으로 직선 성이 우수하였다. 다섯 가지 안트라사이클린계 항생제의 검출한계는 $1.0{\times}10^{-8}M{\sim}1.5{\times}10^{-7}M$이었으며 정밀도는 $0.7{\mu}M$ 이하의 농도를 제외하고는 상대 표준편차3%($1.00{\times}10^{-6}M{\sim}1.42{\times}10^{-5}M$) 미만이었다. 사람의 혈청 중에 포함된 $1.00{\times}10^{-5}M$ 에피루비신, $0.48{\times}10^{-5}M$ 노갈라마이신 및 $1.52{\times}10^{-5}M$ 다우노루비신을 $C_{18}$ 카트리지로 고상 추출하였을 때 회수율은 각각 97%, 100% 및 90% 이었다.

• Clinical and Experimental Pediatrics
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• 제54권3호
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• pp.95-105
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• 2011

Since the successful introduction of all-trans-retinoic acid (ATRA) and its combination with anthracycline-containing chemotherapy, the prognosis for acute promyelocytic leukemia (APL) has markedly improved. With ATRA and anthracycline-based-chemotherapy, the complete remission rate is greater than 90%, and the long-term survival rate is 70-89%. Moreover, arsenic trioxide (ATO), which was introduced for APL treatment in 1994, resulted in excellent remission rates in relapsed patients with APL, and more recently, several clinical studies have been designed to explore its role in initial therapy either alone or in combination with ATRA. APL is a rare disease in children and is frequently associated with hyperleukocytosis, which is a marker for higher risk of relapse and an increased incidence of microgranular morphology. The frequency of occurrence of the promyelocytic leu-kemia/retinoic acid receptor-alpha (PML/$RAR{\alpha}$) isoforms bcr 2 and bcr 3 is higher in children than in adults. Although recent clinical studies have reported comparable long-term survival rates in patients with APL, therapy for APL in children is challenging because of the risk of early death and the potential long-term cardiac toxicity resulting from the need to use high doses of anthracyclines. Additional prospective, randomized, large clinical trials are needed to address several issues in pediatric APL and to possibly minimize or eliminate the need for chemotherapy by combining ATRA and ATO. In this review article, we discuss the molecular pathogenesis, diagnostic progress, and most recent therapeutic advances in the treatment of children with APL.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.697-702
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• 2016

Background: The Asia-Pacific Breast Initiatives (APBI) I and II registries were established to collect safety data for patients with early stage breast cancer receiving adjuvant docetaxel-based regimens in the Asia-Pacific region. Materials and Methods: Data from the two registries were combined to perform a safety analysis. Participants in the registry were women with early stage operable breast cancer with an intermediate or high risk of recurrence. These women received adjuvant chemotherapy that included docetaxel between 2006 and 2011. Adverse events (AEs) were recorded and analyzed. Results: Data were collected from 3,224 patients from 13 countries. The mean dose intensity of docetaxel was 24.1, 22.7, $25.1mg/m^2/week$ among patients receiving docetaxel-based monotherapy, combination therapy and sequential therapy, respectively. Granulocyte colony-stimulating factor (G-CSF) was given with docetaxel to 41.8% of women and 20.6% of women receiving prophylactic antibiotics. Adverse events were reported in 86% of patients (anthracycline-containing regimens vs. non-anthracycline regimens; 87% vs. 80%). The most common adverse events were alopecia, nausea, neutropenia, vomiting, and myalgia. Adverse events NCI CTCAE ${\geq}$Grade 3 were reported in 45.4% of patients. Serious adverse events were reported in 13% of patients, of which 2.5% led to study discontinuation. Forty-six deaths (1.4%) were reported, with no significant difference between regimens. Conclusions: The safety parameters of adjuvant docetaxel therapy used to treat sequential Asian women were comparable to those reported in clinical trials evaluating the role of adjuvant docetaxel. No unusual adverse events linked to Asia-Pacific region patients were observed.

• Archives of Pharmacal Research
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• 제29권2호
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• pp.123-130
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• 2006

1,4-Naphthoquinones are widely distributed in nature and many clinically important antitumor drugs containing a quinone moiety, such as anthracyclines, mitoxantrones and saintopin, show excellent anticancer activity. In this study, 2- or 6-substituted 5,8-dimethoxy-1,4-naphthoquinone (DMNQ) and 5,8-dihydroxy-1,4-naphthoquinone (DHNQ) derivatives were synthesized, and their cytotoxic activity against L1210 and P388 cancer cells was examined. Their antitumor activity was also assessed in mice bearing S-180 cells in the peritoneal cavity. In comparison with the DMNQ derivatives, the DHNQ derivatives exhibited more potent bioactivities than the DMNQ derivatives against both L1210 and P388 cells in vitro and S-180 cells in vivo. The $ED_{50}$ values of the DHNQ derivatives against P388 cells were in the range of 0.18-1.81 ${\mu}g/mL$ whereas those of the DMNQ derivatives were in the range of 0.26-40.41 ${\mu}g/mL$. The T/C ($\%$) values of the DHNQ derivatives, 8, 17, 18, 19, and 20, were found to be comparable to or even better than that of adriamycin. It was also observed that the 2-substituted derivatives (8, 19, 20) showed better antitumor activity than the 6-substituted derivatives (7, 17, 18) in the mice bearing S-180 cells in the peritoneal cavity.

• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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• pp.8503-8512
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• 2016

The purpose of this study was to provide a detailed explanation of the mechanism of bisanthracycline, WP 631 in comparison to doxorubicin (DOX), a first generation anthracycline, currently the most widely used pharmaceutical in clinical oncology. Experiments were performed in SKOV-3 ovarian cancer cells which are otherwise resistant to standard drugs such as cis-platinum and adriamycin. As attention was focused on the ability of WP 631 to induce apoptosis, this was examined using a double staining method with Annexin V and propidium iodide probes, with measurement of the level of intracellular calcium ions and cytosolic cytochrome c. The western blotting technique was performed to confirm PARP cleavage. We also investigated the involvement of caspase activation and DNA degradation (comet assay and immunocytochemical detection of phosphorylated H2AX histones) in the development of apoptotic events. WP 631 demonstrated significantly higher effectiveness as a pro-apoptotic drug than DOX. This was evident in the higher levels of markers of apoptosis, such as the externalization of phosphatidylserine and the elevated level of cytochrome c. An extension of incubation time led to an increase in intracellular calcium levels after treatment with DOX. Lower changes in the calcium content were associated with the influence of WP 631. DOX led to the activation of all tested caspases, 8, 9 and 3, whereas WP 631 only induced an increase in caspase 8 activity after 24h of treatment and consequently led to the cleavage of PARP. The lack of active caspase 3 had no outcome on the single and double-stranded DNA breaks. The obtained results show that WP 631 was considerably more genotoxic towards the investigated cell line than DOX. This effect was especially visible after longer times of incubation. The above detailed studies indicate that WP 631 generates early apoptosis and cell death independent of caspase-3, detected at relatively late time points. The observed differences in the mechanisms of the action of WP631 and DOX suggest that this bisanthracycline can be an effective alternative in ovarian cancer treatment.

• Asian Pacific Journal of Cancer Prevention
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• 제16권1호
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• pp.65-69
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• 2015

Background: To evaluate the impact of adding taxanes to anthracycline-based regimens in the adjuvant setting in localized young female breast cancer patients on the overall survival (OS) and the disease free survival (DFS). Materials and Methods: This retrospective study included all female breast cancer patients who were candidates for adjuvant chemotherapy presenting to Kasr Al Ainy centre of clinical oncology and Cairo oncology centre (Cairo Cure) in the period from January 2005 till December 2010. Results: Our study included 865 patients, 732 of whom received anthracycline based regimens and 133 taxane based regimens. The mean age of patients was 39 years. After a median follow up of 50 months the median DFS was 48.4 months. Survival analysis indicated that the tumor size (>5cm vs. <5cm) p=0.001), nodal involvement (Yes vs. No) p=0.0001) and pathology (invasive lobular vs. ductal) p=0.048) affected DFS. As regards hormonal status, ER, PR and HER 2neu positive patients had longer DFS (p=0.001, 0.003, 0.106). On multivariate analysis DFS was affected by tumor size and lymph node involvement (p=0.014, 0.007). Subgroup analysis showed improvement in arms treated with taxanes in terms of DFS with positive Her2neu, ER and PR, but this was not statistically significant. Conclusions: Adding adjuvant taxanes to anthracyclines is beneficial for treatment of localized breast cancer among all subgroups, especially higher risk groups. The type of adjuvant chemotherapy regimens and tumor characteristics have direct effects on DFS.