[Chemotherapy of the malignancies from the viewpoint of pharmacology and biochemistry of cytosine arabinoside (ara-C) and its derivatives]

Abstract

Ara-C should be converted to ara-CTP to inhibit DNA polymerase in the malignant cells but is rapidly inactivated to uracil arabinoside (ara-U) by cytidine deaminase in human tissue. Therefore, production as well as maintenance of ara-CTP in the cells is a function of both phosphorylation and deamination of ara-C, but is more dependent on the latter, because the deamination is several times superior to the former in terms of enzymatic activities. In chemotherapy with ara-C, the rate of the inactivation should be estimated for evaluating antitumor effect of the agent. Determination of serum or plasma deaminase activity can be a useful parameter of the inactivation. Attempts have been made to enhance the antitumor activity of ara-C by preventing deamination and a number of ara-C derivatives resistant to the deamination such as cyclocytidine, ara-C-5'-ester and acyl ara-C have been introduced. Cyclo-C gradually receives non-enzymatic hydrolysis to produce ara-C in neutral medium, which is useful for maintaining plasma ara-C level. Acyl ara-C such as behenoyl-ara-C (BHAC) is well incorporated into the cells and is highly distributed to lipophilic components such as membrane, microsome and mitochondria in the cells. The extremely gradual conversion of BHAC to ara-C in the cells is considered to be useful for maintaining effective intracellular concentration. A part of BHAC could be phosphorylated before deacylation. After intravenous administration of BHAC, the plasma drug concentrations are maintained significantly longer than those after the administration of the equivalent dose of ara-C. Therefore, BHAC is more resistant to the deamination than cyclo-C and the antitumor effect of the former is suspected to be milder but prolonged than that of ara-C or cyclo-C.