Two members of the superfamily of ABC transport proteins, Mr 170.000 PGP and Mr 190.000 MRP, have been identified as multidrug resistance genes. Both genes can act as cellular efflux pumps for natural product anticancer drugs, like anthracyclines, Vinca alkaloids, and epipodophyl-lotoxins. Pgp and MRP are expressed in a variety of tumours, including haematological malignancies. Pharmacological intervention by competitive inhibition of PGP and MRP has been studied in vitro, and clinical studies have been performed with the aim to circumvent (primarily PGP-mediated) MDR. In summary, these attempts have not been very successful, so far, in solid tumours (e.g. kidney and colon cancer) with de novo expression of PGP. For haematological malignancies the results obtained encouraged randomized phase III trials (which are ongoing). The effects of the so-called reversal agents on clinical tumour responses seen in pilot studies, are likely due to specific inhibition of PGP in tumour cells and to altered pharmacokinetics of the cytotoxic drugs. The general idea is that more effective and less toxic reversal agents are needed for clinical trials. However, mdr-knockout mice appeared to be extremely sensitive for xenobiotics. Thus, upon clinical use of highly effective, second generation reversal agents, altered (life-threatening) toxicity profiles should be anticipated. Two members of the superfamily of ABC transport proteins, Mr 170.000 PGP and Mr 190.000 MRP, have been identified as multidrug resistance genes. Both genes can act as cellular efflux pumps for natural product anticancer drugs, like anthracyclines, Vinca alkaloids, and epipodophyl-lotoxins. Pgp and MRP are expressed in a variety of tumours, including haematological malignancies. Pharmacological intervention by competitive inhibition of PGP and MRP has been studied in vitro, and clinical studies have been performed with the aim to circumvent (primarily PGP-mediated) MDR. In summary, these attempts have not been very successful, so far, in solid tumours (e.g. kidney and colon cancer) with de novo expression of PGP. For haematological malignancies the results obtained encouraged randomized phase III trials (which are ongoing). The effects of the so-called reversal agents on clinical tumour responses seen in pilot studies, are likely due to specific inhibition of PGP in tumour cells and to altered pharmacokinetics of the cytotoxic drugs. The general idea is that more effective and less toxic reversal agents are needed for clinical trials. However, mdr-knockout mice appeared to be extremely sensitive for xenobiotics. Thus, upon clinical use of highly effective, second generation reversal agents, altered (life-threatening) toxicity profiles should be anticipated.
Read full abstract