5-Fluorouracil antimetabolite

Uracil is used more effectively, in nucleic acid synthesis within a rat hepatoma than in normal liver. This observation appears to have stimulated the synthesis of 5-fluorouracil (1027) as an antimetabolite mainly because the introduction of a fluorine atom involves a minimal increase in size. In the event, 5-fluorouracil did prove to have antineoplastic activity and it is now a valuable drug for treatment of tumors of the breast, colon or rectum, and to a lesser extent, gastric, hepatic, pancreatic, uterine, ovarian and bladder carcinomas. As with other drugs which interfere with DNA synthesis, the therapeutic index is quite low and great care is required during treatment (69MI21301). 

One commonly used agent is the antimetabolite 5-fluorouracil (5-FU), which is frequently used as an adjuvant therapy in conjunction with surgical excision in the treatment of solid tumors. p53 can directly trigger apoptosis in cells exposed to 5-FU in vitro [1]. In addition, there is a substantial amount of clinical... 

The antimetabolites interfere with various metabolic functions of cells, thereby disrupting normal cell functions. They inactivate enzymes or alter the structure of DNA, changing the DNA s ability to replicate These drag are most effective in the treatment of rapidly dividing neoplastic cells. Examples of the antimetabolites include methotrexate and fluorouracil (Adrucil). 

Antimetabolites (inhibition of purine and pyrimidine nucleotide synthesis) Methotrexate Folic acid antagonist, inhibits tetrahydrofolate reductase and therefore dTMP synthesis 6-Mercaptopurine Interferes with purine synthesis 5-Fluorouracil Inhibits dTMP synthesis ... 

Ciclosporin, a calcineurin inhibitor, is a potent immunosuppressant useful in the prevention of rejection in organ transplants and grafting procedures. Ciclosporin is markedly nephrotoxic. Vincristine is a vinca alkaloid cytotoxic agent fluorouracil and methotrexate are both antimetabolite cytotoxic agents and bleomycin is a cytotoxic antibiotic. 

Flucytosine is converted in Candida fungi to 5-fluorouracil by the action of a specific cytosine deaminase. As an antimetabolite, this compound disrupts DNA and RNA synthesis (p. 298), resulting in a fungicidal effect Given orally, flucytosine is rapidly absorbed. It is well tolerated and often combined with amphotericin B to allow dose reduction of the lattet... 

Incorporation of false building blocks (3). Unnatural nucleobases (6-mercaptopurine 5-fluorouracil) or nucleosides with incorrect sugars (cytara-bine) act as antimetabolites. They inhibit DNA/RNA synthesis or lead to synthesis of missense nucleic acids. 

The pyrimidine 5-fluorouracil (64) is used extensively in the clinic as an antimetabolite antitumor agent. As a consequence of poor absorption by the oral route, the drug is usually administered by the intravenous route. A rather simple latent ated derivative, tegafur (66), has overcome this limitation by providing good oral absorption. Reaction of 5-fluorouracil with trimethylsilyl chloride in the presence of base gives the disilylated derivative (65). Reaction of this with dihydrofuran (obtained by dehydro-... 

Fluorouracil (Efudex, Fluoroplex) is an antimetabolite used for the topical treatment of actinic keratoses. It is also useful for the treatment of superficial basal cell carcinomas when conventional surgical modalities are impractical. Local inflammatory reactions characterized by erythema, edema, crusting, burning, and pain are common (and, some would argue, desirable) but may be minimized by reduced frequency of application or use in combination with a topical corticosteroid. 

Drugs that require metabolic activation for antitumor activity, such as the antimetabolites 5-fluorouracil and 6-mercaptopurine, may be ineffective if a tumor is deficient in the required activating enzymes. Alter-... 

Drug-induced niacin deficiency has resulted from the use of isonicotinic acid hydrazide, which interferes with the conversion of niacin from tryptophan. Administration of ethanol or the antimetabolites 6-mercaptop-urine and 5-fluorouracil also may lead to niacin deficiency. The uricosuric effects of sulfinpyrazone and probenecid may be inhibited by nicotinic acid. 

Thymidylate synthase (E.C. 2.1.1.45) is the enzyme that methylates UMP to thymidine, using methylene tetrahydrofolate as the carbon carrier. The enzyme can be inhibited directly by analogues of uracil such as 5-fluorouracil (8.34, 5-FU). The antimetabolite must be in the 5-fluorodeoxyuridine monophosphate (FdUMP) form to become active, and the capability of cells to achieve this transformation is a major determinant of their sensitivity to such drugs. 

It was previously thought that 5-FU inhibits the enzyme by classical competitive inhibition. However, it was found that 5-FU is a transition-state substrate, and it forms a covalent complex with tetrahydrofolate and the enzyme in the same way that the natural substrate does. The reaction, however, will not go to completion, since the fluoro-uridine derived from the antimetabolite remains attached to the enzyme, and the latter becomes irreversibly deactivated. Recovery can occur only through the synthesis of new enzyme. Fluorouracil is used in the treatment of breast cancer and has found limited use in some intestinal carcinomas. Unfortunately, this drug has the side effects usually associated with antimetabolites. Its prodrug, fluorocytosine (8.35, which is also an antifungal agent) is better tolerated. 

Nucleic-acid-related molecules (nucleotides, nucleosides, purines, pyrimidines) may also be used as dmgs themselves (and not only as dmg receptors). Once again, as discussed in chapters 7 and 9, this is most relevant in the areas of cancer and infectious disease, with purine/pyrimidine analogs being exploited as antimetabolites. 5-Fluorouracil is a well-described antineoplastic agent. Analogously, 5-fluorocytosine is used as an antifungal... 

Fluorouracil, a fluorinated pyrimidine antimetabolite is used topically for the treatment of multiple actinic keratoses and intralesionally for keratoacanthomas. 

Fluorouracil is a fluorinated pyrimidine antimetabolite that resembles uracil, with a fluorine atom substituted for the 5-methyl group. Its systemic pharmacology is described in Chapter 54. Fluorouracil is used topically for the treatment of multiple actinic keratoses. 

Fluorouracil/ Topical [5-FU] (Efudex) [Anrineoplasric/ Antimetabolite] Uses Basal cell carcinoma acdnic/solar keratosis Action Inhibits thymidylate synthetase (X DNA synth, S-phase specific) Dose 5% cream bid x 2-6 wk Caution [D, ] Irritant chemo Contra Component sensitivity Disp Cream, soln SE Rash, dry skin, photosens EMS See Fluorouracil OD See Fluorouracil... 

Advantage is taken of the properties of antimctabolitcs in chemotherapy. In cancer chemotherapy, several antimetabolites are used. These include methotrexate, 6-mercaptopunne, 6-thioguanine, 5-fluorouracil, and cystine arabinoside. In the chemotherapy of metastatic breast cancer, 5-fluorouracil and methotrexate, in combination with cyclophosphamide, have been used. Antimetabolites, sometimes along with corticosteroids, are used in the therapy of various autoimmune diseases, such as thrombocytenic purpura, thyroiditis, Goodpasture s syndrome, among others. 

Antimetabolites include 5-fluorouracil [51-21-8] (153) and amethopterin [59-05-2] (154), a folic acid antagonist, which produce sterility in female flies when fed at 0.01—0.05% in the diet. 

Mechanism of Action. Flucytosine is incorporated into susceptible fungi, where it undergoes enzymatic conversion to fluorouracil,7 which acts as an antimetabolite during RNA synthesis in the fungus. Fluorouracil is incorporated into RNA chains but acts as a false nucleic acid. This event ultimately impairs protein synthesis, thus disrupting the normal function of the fungus. 

Flucytosine (Ancobon) possesses clinically useful activity against Cryptococcus neoformans, Candida species, Torulopsis glabrata, and the agents of chromomycosis. Susceptible fungi deam-inate flucytosine to 5-fluorouracil, which becomes an antimetabolite. Flucytosine, which is excreted by the kidney, should be used cautiously in the setting of renal impairment. Flucytosine is a bone marrow depressant. Flucytosine is used in combination with amphotericin B. 

Many drugs have been developed to intervene in the synthesis of TMP (Figure 6.24). For example, methotrexate (6.66) inhibits DHFR by blocking the binding site of DHF. Another antimetabolite, 5-fluorouracil (5-FU, 6.67), is converted in the body to 5-fluoro-2 -deoxyuridine 5 -monophosphate (F-dUMP, 6.68), a potent inhibitor of TS.26... 

In summary, capecitabine (1), an A -carbamate pyrimidine nucleoside prodrug of cytotoxic antimetabolite 5-fluorouracil, is an FDA-approved anticancer drug that can be administered orally. This compound uses a multilayer of prodrug strategies that not only avoids side effects arising from exposure of toxic metabolites to healthy tissue but is converted to 5-fluorouracil only by enzymes preferentially expressed in many cancer cell types, thus resulting in selective delivery of the drug to tumors. Capecitabine is marketed under the trade name of Xeloda for use in the treatment of metastatic colorectal and breast cancers and metastatic breast cancer that is resistant to paclitaxel or anthracycline therapies. 

Chemotherapeutic agents are grouped by cytotoxic mechanism. The alkylating agents, such as cyclophosphamide [50-18-0] and melphalan [148-82-5], interfere with normal cellular activity by alkylation deoxyribonucleic acid (DNA). Antimetabolites, interfering with complex metabolic pathways in the cell, include methotrexate [59-05-2], 5-fluorouracil [51-21-8], and cytosine arabinoside hydrochloride [69-74-9]. Antibiotics such as bleomycin [11056-06-7] and doxorubicin [23214-92-8] have been used, as have the plant alkaloids vincristine [57-22-7] and vinblastine [865-21-4]. 

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