Bid truncation mediated by caspases-3 and -9 in vinorelbine-induced apoptosis

Vinorelbine is a chemotherapeutic vinca alkaloid clinically prescribed for non-small cell lung cancer and breast cancer. Here we studied the mechanism for vinorelbine-induced apoptosis in a human T-cell lymphoma. Although vinorelbine induces DNA fragmentation that is inhibited by specific peptide inhibitors for caspases-9 and -3 in Jurkat cells, caspase-8 deficiency retards vinorelbine-induced apoptosis. Activation of caspase-8 is also observed in vinorelbine-treated cells, and the activity is diminished when the caspase-3 activity is blocked by a specific peptide inhibitor, Ac-DNLC-CHO. Blocking of the Fas receptor with an antagonistic anti-Fas antibody does not affect vinorelbine-induced DNA fragmentation. These results suggest that vinorelbine-induced apoptosis is enhanced by the activation of caspase-8 via caspase-9-mediated activation of caspase-3, but not through a Fas-triggered signal. Western blotting suggests that vinorelbine cleaves caspase-3, -9 and -8 and reduces the amount of mitochondrial cytochrome c. Caspase-8 deficiency suppresses all of these events. A downstream substrate for caspase-8, Bid, is also cleaved in vinorelbine-treated cells, but the Bid truncation is also observed in caspase-8-deficient Jurkat cells. Importantly, recombinant caspases-3 and -9, as well as caspase-8, directly cleaves recombinant Bid in vitro. These results suggest that caspases-3 and -9 participate in Bid truncation, indicating a new mechanism for vinorelbine-induces apoptosis.     

Pharmacological effects of vinorelbine on body temperature and locomotor activity circadian rhythms in mice

The effects of vinorelbine (VRL) on the circadian rhythms in body temperature and locomotor activity were investigated in unrestrained B6D2F₁ mice implanted with radio-telemetry transmitters. A single intravenous VRL dose (24 or 12 mg/kg) was given at 7 h after light onset (HALO), a time of high VRL toxicity, and resulted in transient suppression of temperature and activity circadian rhythms in mice kept in light-dark (LD) 12h:12h. Such suppression was dose-dependent. It occurred within 1-5 d after VRL dosing. Recovery of both rhythms was partially complete within 5 d following the high dose and within 2 or 3 d after the low dose and was not influenced by suppression of photoperiodic synchronization by housing in continuous darkness. Moreover, VRL induced a dose-dependent relative decrease in amplitude and phase shift of the temperature circadian rhythm. The mesor and amplitude of the activity rhythm were markedly reduced following the VRL administration. The relevance of VRL dosing time was studied in mice housed in LD 12h:12h. Vinorelbine was injected weekly (20 mg/kg/injection) for 3 wk at 6 or 18 HALO. Vinorelbine treatment ablated the rest-activity and temperature rhythms 3-6 d after each dose, with fewer alterations after VRL dosing at 18 HALO compared to 6 HALO, especially for the body temperature rhythm. There was at least partial recovery 1 wk after dosing, suggesting the weekly schedule of drug treatment is acceptable for therapeutic purposes. Our findings demonstrate that VRL can transiently, yet profoundly, alter circadian clock function. Vinorelbine-induced circadian dysfunction may contribute to the toxicokinetics of this and possibly other anticancer drugs.     

High-performance liquid chromatographic determination of vinorelbine in human plasma and blood: application to a pharmacokinetic study

A sensitive and specific high-performance liquid chromatographic method with fluorescence detection (excitation wavelength: 280 nm; emission wavelength: 360 nm) was developed and validated for the determination of vinorelbine in plasma and blood samples. The sample pretreatment procedure involved two liquid–liquid extraction steps. Vinblastine served as the internal standard. The system uses a Spherisorb cyano analytical column (250×4.6 mm I.D.) packed with 5 μm diameter particles as the stationary phase and a mobile phase of acetonitrile–80 mM ammonium acetate (50:50, v/v) adjusted to pH 2.5 with hydrochloric acid. The assay showed linearity from 1 to 100 ng/ml in plasma and from 2.5 to 100 ng/ml in blood. The limits of quantitation were 1 ng/ml and 2.5 ng/ml, respectively. Precision expressed as RSD was in the range 3.9 to 20% (limit of quantitation). Accuracy ranged from 92 to 120%. Extraction recoveries from plasma and blood averaged 101 and 75%, respectively. This method was used to follow the time course of the concentration of vinorelbine in human plasma and blood samples after a 10-min infusion period of 20 mg/m² of this drug in patients with metastatic cancer.     

培美曲塞联合长春瑞滨治疗复发转移性宫颈癌患者对疾病控制及预后随访研究

摘要 目的：探讨培美曲塞联合长春瑞滨治疗复发转移性宫颈癌对疾病控制及预后的影响。方法：选择2018年5月~2019年6月收治的100例复发转移性宫颈癌患者,按照随机数表法分观察组和对照组,每组50例。对照组采用紫杉醇联合顺铂化疗,观察组则采用培美曲塞联合长春瑞滨治疗。比较2组疾病控制效果,记录患者化疗前后Karnofsky评分变化,统计2组患者毒副反应及生存率、生存期。结果：观察组的疾病控制率为84.00%,明显高于对照组的62.00%,差异显著（P<0.05）;治疗后,2组患者的Karnofsky评分均升高,且观察组[（86.25±3.02）分]明显高于对照组[（81.15±3.11）分],差异显著（P<0.05）; 2组患者胃肠道反应、骨髓抑制、血小板计数减少、恶心呕吐等毒副反应发生率比较,无明显差异（P>0.05）;观察组患者的1年生存率70.00%、2年生存率58.00%、3年生存率26.00%均高于对照组的50.00%、38.00%、10.00%,观察组的生存期[（18.12±3.21）月]长于对照组[（14.18±2.81）月],差异显著（P<0.05）。结论：培美曲塞联合长春瑞滨治疗复发转移性宫颈癌效果显著,可有效提高患者的生存质量及生存率,延长生存期,毒副反应低,患者耐受性好,可在临床推广运用。     

Sensitive determination of vinorelbine and its metabolites in human serum using liquid chromatography-electrospray mass spectrometry

A liquid chromatography-electrospray mass spectrometry method was developed for the quantitation of vinorelbine (VNB) and two metabolites, vinorelbine N-oxide (VNO) and deacetyl vinorelbine (DAV) in human serum. The limits of quantitation (LOQ) reached 0.5 ng/ml for both VNB and VNO and 1 ng/ml for DAV. The method was proved linear in the range of LOQs up to 1000 ng/ml, and extraction recovery was 80% on average for the three compounds. It was applied to the pharmacokinetic monitoring of vinorelbine and, for the first time, to the detection of VNO in the serum of patients suffering from non-small-cell lung cancer.     

清肺散结丸与长春瑞滨和顺铂联用对晚期非小细胞肺癌的疗效观察

目的:观察清肺散结丸与长春瑞滨(vinorelbine,NVB)和顺铂(cisplatin,DDP)联合治疗晚期非小细胞肺癌的近期疗效及毒副作用,为临床用药提供参考。方法:选取2010年11月-2012年3月我院收治的晚期非小细胞肺癌患者146例,随机分为对照组和联合组,每组各73例。对照组常规给予长春瑞滨和顺铂(NP方案)治疗,联合组在对照组基础上加以清肺散结丸治疗。观察两组患者的客观有效率、疾病控制率、生活质量改善率和毒副反应的发生情况。结果:对照组患者的客观有效率为42.5%,联合组为46.6%,差异无统计学意义(P0.05);联合组疾病控制率为85.0%,明显高于对照组的65.8%(P0.05);联合组生活质量改善情况为68.5%,明显高于对照组的41.1%(P0.05);联合组Ⅱ度以上白细胞减少的发生率为54.8%,对照组为75.3%;联合组Ⅲ度以上白细胞减少的发生率为17.8%,对照组为37.0%,差异显著具有统计学意义(P0.05);联合组恶心呕吐的发生率为24.7%,显著优于对照组的49.3%(P0.05)。结论:NP方案联用清肺散结丸治疗晚期NSCLC能够使患者获益并提高患病期间生活质量,降低骨髓移植和消化系统毒副反应发生。     

The role of the anticancer drug vinorelbine in lipid bilayers using differential scanning calorimetry and molecular modeling

Differential scanning calorimetry (DSC) has been employed to investigate the thermal changes caused by the anticancer alkaloid drug vinorelbine in dipalmytoylphosphatidylcholine (DPPC) bilayers. The total enthalpy change was increased by the presence of the drug molecule, indicating a partial interdigitation of the lipid alkyl chains. The presence of cholesterol in DPPC bilayers including vinorelbine induced an obstruction of the interdigitation, since cholesterol interrupts the upraise of enthalpy change. Vinorelbine's interdigitation ability and stabilizing properties with the active site of the receptor have been compared with those of similar in structure amphipathic and bulky alkaloid vinblastine. The obtained results may in part explain their similar mechanism of action but different bioactivity.     

A Randomized Multicenter Study of Optimal Circadian Time of Vinorelbine Combined with Chronomodulated 5‐Fluorouracil in Pretreated Metastatic Breast Cancer Patients: EORTC Trial 05971

Studies in animals synchronized with an alternation of 12 h of light and 12 h of darkness have showed that hematological and systemic toxicities could be reduced if vinorelbine were administered 19 or 23 hours after light onset (HALO), corresponding to 17:00 and 21:00 h in diurnally active humans. This trial aimed to define the least toxic time of vinorelbine administration in metastatic breast cancer patients. Initially, the study treatment consisted of three courses of vinorelbine of 30 mg/m²/d on D1 and D6 and chronomodulated 5‐fluorouracil of 850 mg/m² from D2 to D5 every 21 days. Ninety metastatic breast cancer patients were randomized to receive vinorelbine at one of the eight possible dosing times. Further to the recommendations of the Independent Data Monitoring Committee, the vinorelbine dose was reduced to 25 mg/m²/d midway through the study. The primary objective of the study was detection of the least toxic time based on the incidence of grade 3–4 (G3–4) neutropenia. To show a significant result, the 90% confidence interval width of the least toxic time had to be<6 h. The least toxic time detection based on the incidence of other toxicities was also analyzed. The time of least drug toxic was estimated using a logistic regression model assuming that the logit transformation of the toxicity rate follows a sinusoidal distribution over 24 h. The bootstrap technique was used to obtain the 90% confidence interval. The least toxic time of G3–4 neutropenia was observed at 21:00 h with a non‐significant 90% CI. Secondary endpoint analyses indicated the least toxic time could differ when based on other toxicity parameters (e.g., a significant least toxic time of 17:00 h was observed for G3–4 leucopenia), in agreement with animal data. The least toxic time of 10:30 h was estimated for any G3–4 gastrointestinal toxicity. This results of this study do not allow us to recommend an optimal time for vinorelbine administration. It has highlighted, however, the inherent methodological difficulties in the conduct of such a trial in the human setting. It indicates that future optimal time‐finding trials should have tolerability and/or activity as the primary endpoint in place of a particular toxicity. The randomized optimal time‐finding design may be used to identify the best time of chemotherapy administration. (Author correspondence: bcoudert@dijon.fnclcc.fr)     

紫杉醇、长春瑞滨联合顺铂方案治疗晚期乳腺癌的临床疗效

目的:探讨紫杉醇(PTX)、长春瑞滨(NVB)两药与顺铂(DDP)联用方案对晚期乳腺癌的临床疗效及副反应。方法:将2009年2月至2014年2月于我院就诊的60例晚期乳腺癌患者随机分为TP方案和NP方案两组,每组30例。TP方案组:顺铂25mg/m2,d1~d3,紫杉醇175 mg/m2,d1;NP方案组:顺铂25 mg/m2,d1~d3,长春瑞滨25 mg/m2,d1和d8。比较两组患者的临床有效率并记录相关不良反应。结果:TP方案有效率56.7%(17/30),中位缓解期7.5个月。NP方案有效率53.3%(14/30),中位缓解期7.7个月。组间疗效及缓解期差异无统计学意义(P0.05)。TP与NP方案组出现血小板减少、白细胞减少、贫血、恶心呕吐的发生率分别为26.7%、76.7%、56.7%、43.3%和26.7%、76.7%、56.7%、43.3%,两方案血液毒性差异无统计学意义(P0.05)。静脉炎及关节肌肉反应的发生率分别为30.0%、13.3%和16.7%53.3%,差异有统计学意义(P0.05)。结论:紫杉醇、长春瑞滨与顺铂联用治疗晚期乳腺癌疗效相当,不良反应可耐受,都可做为晚期乳腺癌治疗的一线用药方案。     

Curcumin enhances Vinorelbine mediated apoptosis in NSCLC cells by the mitochondrial pathway

Elderly lung cancer patients and those with poor performance status/co-morbid conditions are deprived of chemotherapy because of high toxicity of multidrug regimens. Human squamous cell lung carcinoma H520 cells treated with Curcumin were sensitized to the cytotoxicity caused by chemotherapeutic agent, Vinorelbine. Both caused apoptosis by increasing the protein expression of Bax and Bcl-xs while decreasing Bcl-2 and Bcl-X(L), releasing apoptogenic cytochrome c, and augmenting the activity of caspase-9 and caspase-3. Expression of Cox-2, NF-kappaB, and AP-1 was also affected. 23.7% apoptosis was induced in the H520 cells by treatment with Curcumin while Vinorelbine caused 38% apoptosis. Pre-treatment with Curcumin enhanced the Vinorelbine induced apoptosis to 61.3%. The findings suggest that Curcumin has the potential to act as an adjuvant chemotherapeutic agent and enhance chemotherapeutic efficacy of Vinorelbine in H520 cells in vitro. Thus, Curcumin offers the prospect of being beneficial in the above-mentioned patient groups.