Description
Epirubicin hydrochloride is an antitumor antibiotic which is epimeric with
doxorubicin a t the 4’-position of the amino sugar moiety. It has shown utility in
the treatment of mammary, gastric, colorectal, pulmonary and ovarian carcinomas,
as well as malignant lymphoma and melanoma and soft tissue sarcoma. It is
reported to be less sardiotoxic than doxorubicin.
Description
Epirubicin is a stereoisomer of the antitumor anthracycline doxorubicin that undergoes β-
glucuronidation, which partially detoxifies the dose-
limiting side effects that are present with doxorubicin. Compared to doxorubicin, epirubicin is equally cytotoxic to HeLa cells (ID
50s = 9 μM). When used either alone or in combination therapies, epirubicin has been shown to demonstrate high rates of complete or partial remission in various cancers including advanced ovary, lymphomas, breast, pancreas, gastric, hepatocellular carcinoma, head and neck tumors, and colorectal.
Chemical Properties
Orange-Red Crystalline Solid
Originator
Erbamont (Italy)
Uses
Cell-permeable anthracycline anti-tumor antibiotic
Uses
Used as an antineoplastic
brand name
Ellence(Pfizer);FARMORUBICIN.
Biological Functions
This stereoisomer of doxorubicin has the 4′-hydroxy group of the daunosamine sugar oriented in the β-position . Epirubicin will be slowly reduced to the active C13 alcohol (epirubicinol), giving it a 30- to 38-hour half life, which is similar to that of doxorubicin. Unlike doxorubicinol, however, which was equally active with doxorubicin, epirubicinol has only one-tenth the activity of its parent drug and is not believed to contribute significantly to the therapeutic action of this agent.
Biological Activity
Antibiotic antitumor agent. Inhibits the synthesis and function of DNA (IC 50 = 62.7 μ M in rat glioblastoma cell lines) and inhibits the relaxing property of topoisomerase II.
Clinical Use
Epirubicin is indicated for use in breast cancer, and the starting dose is 100 to 120 mg/m2 (compared to a starting dose of 60–75 mg/m2 for doxorubicin).
Side effects
The side effects and precautions are as outlined previously for doxorubicin, although there is a lower risk of serious myocardial toxicity or myelotoxicity.
Drug interactions
Potentially hazardous interactions with other drugsAntipsychotics: avoid with clozapine - increased risk
of agranulocytosis.Ciclosporin: increased risk of neurotoxicityCytotoxics: possible increased risk of cardiotoxicity
with trastuzumab - avoid for up to 28 weeks after
stopping trastuzumab.Ulcer-healing drugs: concentration increased by
cimetidine. Vaccines: avoid with live vaccines
Metabolism
Cleavage of the epimerized sugar will occur before excretion, generating an aglycone that is indistinguishable from that generated by doxorubicin. Although excretion is primarily biliary, dosage reduction in severe renal impairment, as well as in hepatic dysfunction, is warranted.
References
1) Cersosimo?et al. (1986),?Epirubicin: a review of the pharmacology, clinical activity, and adverse effects of an adriamycin analogue; J. Clin. Oncol.,?4?425
2) Spadari?et al. (1986),?DNA polymerases and DNA topoisomerases as targets for the development of anticancer drugs; Anticancer Res.,?6?935
3) Minotti?et al. (2004),?Anthracyclines: molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity; Pharmacol. Rev.,?56?185
4) Mercuro?et al. (2007),?Early epirubicin-induced myocardial dysfunction revealed by serial tissue Doppler echocardiography: correlation with inflammatory and oxidative stress markers; Oncologist,?12?1124
