Omacetaxine mepesuccinate

Omacetaxine mepesuccinate (INN, trade names Synribo ), formerly named as homoharringtonine or HHT, is a pharmaceutical drug substance that is indicated for treatment of chronic myeloid leukemia (CML).

Omacetaxine mepesuccinate
Clinical data
Trade namesSynribo
AHFS/Drugs.comMonograph
License data
Pregnancy
category
  • US: D (Evidence of risk)
    Routes of
    administration    		Subcutaneous, intravenous infusion
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Protein binding50%
    MetabolismMostly via plasma esterases
    Elimination half-life6 hours
    ExcretionUrine (≤15% unchanged)
    Identifiers
    CAS Number
    PubChem CID
    IUPHAR/BPS
    ChemSpider
    UNII
    KEGG
    ChEBI
    ECHA InfoCard100.164.439
    Chemical and physical data
    FormulaC29H39NO9
    Molar mass545.62 g/mol g·mol−1
    3D model (JSmol)

    HHT is a natural plant alkaloid derived from Cephalotoxus fortune . HHT and related compound esters of cephalotaxine were described first in 1970, and were the subject of intensive research efforts by Chinese investigators to clarify their role as anticancer and antileukemic agents from the 1970s until the present.[1] It was approved by the US FDA in October 2012 for the treatment of adult patients with CML with resistance and/or intolerance to two or more tyrosine kinase inhibitors (TKIs).[2]

    Medical uses

    Omacetaxine/homoharringtonine is indicated for use as a treatment for patients with chronic myeloid leukaemia who are resistant or intolerant of tyrosine kinase inhibitors.[3][4][5]

    In June 2009, results of a long-term open label Phase II study were published, which investigated the use of omacetaxine infusions in CML patients. After twelve months of treatment, about one third of patients showed a cytogenetic response.[6] A study in patients who had failed imatinib and who had the drug resistant T315I mutation achieved cytogenetic response in 28% of patients and hematologic response in 80% of patients, according to preliminary data.[7]

    Phase I studies including a small number of patients have shown benefit in treating myelodysplastic syndrome (MDS, 25 patients)[8] and acute myelogenous leukaemia (AML, 76 patients).[9] Patients with solid tumors did not benefit from omacetaxine.[10]

    Adverse effects

    By frequency:[2][3]
    Very common (>10% frequency):

    • Diarrhoea
    • Myelosuppression†
    • Injection site reactions
    • Nausea
    • Fatigue
    • Fever
    • Muscle weakness
    • Joint pain
    • Headache
    • Cough
    • Hair loss
    • Constipation
    • Nosebleeds
    • Upper abdominal pain
    • Pain in the extremities
    • Oedema
    • Vomiting
    • Back pain
    • Hyperglycemia, sometimes extreme
    • Gout
    • Rash
    • Insomnia

    Common (1–10% frequency):

    • Seizures
    • Haemorrhage

    † Myelosuppression, including: thrombocytopenia, anaemia, neutropenia and lymphopenia, in descending order of frequency.

    omacetaxine mepesuccinate can cause fetal harm when administered to a pregnant woman. females that are using HHT should avoid to becoming pregnant and also Advise females to avoid nursing while receiving HHT.[11]

    Mechanism of action

    Omacetaxine is a protein translation inhibitor. It inhibits protein translation by preventing the initial elongation step of protein synthesis. It interacts with the ribosomal A-site and prevents the correct positioning of amino acid side chains of incoming aminoacyl-tRNAs. Omacetaxine acts only on the initial step of protein translation and does not inhibit protein synthesis from mRNAs that have already commenced translation.[12]

    References
    1. Kantarjian, Hagop M.; O'Brien, Susan; Cortes, Jorge (October 2013). "Homoharringtonine/Omacetaxine Mepesuccinate: The Long and Winding Road to Food and Drug Administration Approval". Clinical Lymphoma Myeloma and Leukemia. 13 (5): 530–533. doi:10.1016/j.clml.2013.03.017. ISSN 2152-2650. PMC 3775965. PMID 23790799.
    2. "Synribo (omacetaxine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 18 February 2014.
    3. "SYNRIBO (omacetaxine mepesuccinate) injection, powder, lyophilized, for solution [Cephalon, Inc.]". DailyMed. Cephalon, Inc. October 2012. Retrieved 18 February 2014.
    4. Sweetman, S, ed. (14 November 2012). "Omacetaxine Mepesuccinate". Martindale: The Complete Drug Reference. Medicines Complete. Pharmaceutical Press.
    5. Lacroix, Marc (2014). Targeted Therapies in Cancer. Hauppauge , NY: Nova Sciences Publishers. ISBN 978-1-63321-687-7.
    6. Li, Y. F.; Deng, Z. K.; Xuan, H. B.; Zhu, J. B.; Ding, B. H.; Liu, X. N.; Chen, B. A. (2009). "Prolonged chronic phase in chronic myelogenous leukemia after homoharringtonine therapy". Chinese Medical Journal. 122 (12): 1413–1417. PMID 19567163.
    7. Quintás-Cardama, A.; Kantarjian, H.; Cortes, J. (2009). "Homoharringtonine, omacetaxine mepesuccinate, and chronic myeloid leukemia circa 2009". Cancer. 115 (23): 5382–5393. doi:10.1002/cncr.24601. PMID 19739234.
    8. Wu, L.; Li, X.; Su, J.; Chang, C.; He, Q.; Zhang, X.; Xu, L.; Song, L.; Pu, Q. (2009). "Effect of low-dose cytarabine, homoharringtonine and granulocyte colony-stimulating factor priming regimen on patients with advanced myelodysplastic syndrome or acute myeloid leukemia transformed from myelodysplastic syndrome". Leukemia & Lymphoma. 50 (9): 1461–7. doi:10.1080/10428190903096719. PMID 19672772.
    9. Gu, L. F.; Zhang, W. G.; Wang, F. X.; Cao, X. M.; Chen, Y. X.; He, A. L.; Liu, J.; Ma, X. R. (2010). "Low dose of homoharringtonine and cytarabine combined with granulocyte colony-stimulating factor priming on the outcome of relapsed or refractory acute myeloid leukemia". Journal of Cancer Research and Clinical Oncology. 137 (6): 997–1003. doi:10.1007/s00432-010-0947-z. PMID 21152934.
    10. Kantarjian, H. M.; Talpaz, M.; Santini, V.; Murgo, A.; Cheson, B.; O'Brien, S. M. (2001). "Homoharringtonine". Cancer. 92 (6): 1591–1605. doi:10.1002/1097-0142(20010915)92:6<1591::AID-CNCR1485>3.0.CO;2-U. PMID 11745238.
    11. "FDA" (PDF).
    12. Wetzler M, Segal D. Omacetaxine as an Anticancer Therapeutic: What is Old is New Again. Current Pharmaceutical Design 2011;17:59–64
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