Edelfosine (ET-18-O-CH3; 1-octadecyl-2-O-methyl-glycero-3-phosphocholine)[1] is a synthetic alkyl-lysophospholipid (ALP). It has antineoplastic (anti-cancer) effects.[2]
Like all ALPs, it incorporates into the cell membrane and does not target the DNA. In many tumor cells, it causes selective apoptosis, sparing healthy cells.[3] Edelfosine can activate the Fas/CD95 cell death receptor,[4] can inhibit the MAPK/ERK mitogenic pathway and the Akt/protein kinase B (PKB) survival pathway.[3][5] Aside from these plasma-level effects, edelfosine also affects gene expression by modulating the expression and activity of transcription factors.[3][4]
It has immune modulating properties.[6]
These characteristics cause edelfosine also to affect HIV,[7] parasitic,[4][8] and autoimmune diseases.[4][9]
It can complement classic anti-cancer drugs such as cisplatin.[10]
It can be administered orally, intraperitoneally (IP) and intravenously (IV).
Edelfosine and other ALPs can be used for purging residual leukemic cells from bone marrow transplants.[4][11][12]
Edelfosine apoptosis-inducing abilities were studied with several types of cancer, among them multiple myeloma[13] and non-small and small cell lung carcinoma cell lines.[14]In vivo activity against human solid tumors in mice was shown against malignant gynecological tumor cells,[3] like ovarian cancer, and against breast cancer. In vivo biodistribution studies demonstrated a “considerably higher” accumulation of Edelfosine in tumor cells than in other analyzed organs. It remained undergraded for a long time.[3][15][16]
Clinical trials
Several clinical trials were conducted. Among them a phase I trials with solid tumors or leukemias and phase II with non-small-cell lung carcinomas (NSCLC).[3]
In a Phase II clinical trial for use of Edelfosine in treating leukemia with bone marrow transplants, it was found to be safe and 'possibly effective'.[17]
A phase II trial for the treatment of brain cancers was also reported.[18] It showed encouraging results in stopping the growth of the tumor and a considerable improvement in the “quality of life” of the patients.
A phase II trial on the effect of Edelfosine on advanced non-small-cell bronchogenic carcinoma had a “remarkable” “high proportion of patients with stationary tumor status” as result, stable disease after initial progression in 50% of the patients.[17][19]
Toxicity
In animal tests the main toxic effect was gastrointestinal irritation. There were no significant negative systemic side effects observed. It showed that edelfosine can be given over a long period safely. Most important, in contrast to many DNA-directed anti-cancer drugs, no bone marrow toxicity was in vivo observed. Those findings in animals were confirmed in clinical trials. No mutagenic or cytogenetic effects were observed.[3][20]
History
In the 1960s Herbert Fischer and Paul Gerhard in Freiburg, Germany, found that lysolecitin (2-lysophosphatidylcholine, LPC) increases the phagocytotic activity of macrophages.
Since LPC had a short half-life, synthetic LPC-analogues were tested by Fischer, Otto Westphal, Hans Ulrich Weltzien and Paul Gerhard Munder. Unexpectedly, some of the substances showed strong anti-tumor activity and among them Edelfosine was the most effective. It is therefore considered to be the prototype of synthetic anti-cancer lipids.[20][21]
^Vogler, William R.; Liu, Jianguo; Volpert, Olga; Ades, Edwin W.; Bouck, Noel (1998). "The anticancer drug edelfosine is a potent inhibitor of neovascularization in vivo". Cancer Invest. 16 (8): 549–53. doi:10.3109/07357909809032884. PMID9844614.
^ abcdefgGajate, C; Mollinedo F (2002). "Biological Activities, Mechanisms of Action and Biomedical Prospect of the Antitumor Ether Phospholipid ET-18-OCH3 (Edelfosine), A Proapoptotic Agent in Tumor Cells". Current Drug Metabolism. 5 (3): 491–525. doi:10.2174/1389200023337225. hdl:10261/59536. PMID12369895.
^ abcdeMollinedo, F; Gajate C; Martín-Santamaria S; Gago F (2004). "ET-18-OCH3 (edelfosine): a selective antitumour lipid targeting apoptosis through intracellular activation of Fas/CD95 death receptor". Current Medicinal Chemistry. 11 (24): 3163–84. doi:10.2174/0929867043363703. PMID15579006.
^Munder, PG; Modolell M; Andreesen R; Weltzien HU; Westphal O (1979). "Lysophosphatidylcholine ( Lysolecithin ) and its Synthetic Analogues. Immunemodulating and Other Biologic Effects". Springer Seminars in Immunopathology. 203 (2): 187–203. doi:10.1007/bf01891668. S2CID42907729.
^Klein-Franke, A; Munder PG (1992). "Alkyllysophospholipid prevents induction of experimental allergic encephalomyelitis". Journal of Autoimmunity. 5 (1): 83–91. doi:10.1016/s0896-8411(05)80053-8. PMID1373062.
^Noseda, A; Berens ME; White JG; Modest EJ (1988). "In vitro antiproliferative activity of combinations of ether lipid analogues and DNA-interactive agents against human tumor cells". Cancer Research. 48 (7): 1788–91. PMID3349458.
^Berdel, WE (1990). "Ether lipids and derivatives as investigational anticancer drugs. A brief review". Onkologie. 13 (4): 245–50. doi:10.1159/000216771. PMID2234777.
^Vogler, WR; Berdel WE (1993). "Autologous bone marrow transplantation with alkyl-lysophospholipid-purged marrow". Journal of Hematotherapy. 2 (1): 93–102. doi:10.1089/scd.1.1993.2.93. PMID7921970.
^Shafer, SH; Williams CL (2003). "Non-small and small cell lung carcinoma cell lines exhibit cell type-specific sensitivity to edelfosine-induced cell death and different cell line-specific responses to edelfosine treatment". International Journal of Oncology. 23 (2): 389–400. doi:10.3892/ijo.23.2.389. PMID12851688.
^Arnold, B; Reuther R; Weltzien HU (1978). "Distribution and metabolism of synthetic alkyl analogs of lysophosphatidylcholine in mice". Biochimica et Biophysica Acta (BBA) - Lipids and Lipid Metabolism. 530 (1): 47–55. doi:10.1016/0005-2760(78)90125-x. PMID687654.
^Drings, P; Günther I; Gatzmeier U; ulbrich F; et al. (1992). "Final Evaluation of a Phase II Study on the Effect of Edelfosine (an Ether Lipid) in Advanced Non-Small-Cell Bronchogenic Carcinoma". Onkologie. 15 (5): 375–382. doi:10.1159/000217391.
^Munder, PG; Ferber E; Modolell M; Fischer H. (1969). "The influence of various adjuvants on the metabolism of phospholipids in macrophages". International Archives of Allergy and Applied Immunology. 36 (1): 117–28. doi:10.1159/000230731. PMID4980286.