Vorolanib, sunitinib, and axitinib: A comparative study of vascular endothelial growth factor receptor inhibitors and their anti-angiogenic effects.

PURPOSE: Pathological angiogenesis and vascular instability are observed in diabetic retinopathy (DR), diabetic macular edema (DME), and wet age-related macular degeneration (wAMD). Many receptor tyrosine kinases (RTKs) including vascular endothelial growth factor receptors (VEGFRs) contribute to angiogenesis, whereas the RTK TIE2 is important for vascular stability. Pan-VEGFR tyrosine kinase inhibitors (TKIs) such as vorolanib, sunitinib, and axitinib are of therapeutic interest over current antibody treatments that target only one or two ligands. This study compared the anti-angiogenic potential of these TKIs. METHODS: A kinase HotSpot™ assay was conducted to identify TKIs inhibiting RTKs associated with angiogenesis and vascular stability. Half-maximal inhibitory concentration (IC50) for VEGFRs and TIE2 was determined for each TKI. In vitro angiogenesis inhibition was investigated using a human umbilical vein endothelial cell sprouting assay, and in vivo angiogenesis was studied using the chorioallantoic membrane assay. Melanin binding was assessed using a melanin-binding assay. Computer modeling was conducted to understand the TIE2-axitinib complex as well as interactions between vorolanib and VEGFRs. RESULTS: Vorolanib, sunitinib, and axitinib inhibited RTKs of interest in angiogenesis and exhibited pan-VEGFR inhibition. HotSpot™ assay and TIE2 IC50 values showed that only axitinib potently inhibited TIE2 (up to 89%). All three TKIs effectively inhibited angiogenesis in vitro. In vivo, TKIs were more effective at inhibiting VEGF-induced angiogenesis than the anti-VEGF antibody bevacizumab. Of the three TKIs, only sunitinib bound melanin. TKIs differ in their classification and binding to VEGFRs, which is important because type II inhibitors have greater selectivity than type I TKIs. CONCLUSIONS: Vorolanib, sunitinib, and axitinib exhibited pan-VEGFR inhibition and inhibited RTKs associated with pathological angiogenesis. Of the three TKIs, only axitinib potently inhibited TIE2 which is an undesired trait as TIE2 is essential for vascular stability. The findings support the use of vorolanib for therapeutic inhibition of angiogenesis observed in DR, DME, and wAMD.

A novel chemical delivery system comprising an ocular sustained release formulation of a 3alpha, 17alpha, 21-trihydroxy-5beta-pregnan-20-one-BIS-5-fluorouracil [correction of flourouracil] codrug.

Directly compressed sustained release pellets were prepared from material consisting of a molecule of 3alpha, 17alpha, 21-trihydroxy-5beta-pregnan-20-one (trihydroxy steroid, THS) covalently linked via carbonate moieties to two molecules of 5-flourouracil (5FU) to form a novel THS-BIS-5FU codrug for the treatment of angiogenesis. Dissolution and drug release was tested in vitro in 0.1M phosphate buffer (pH 7.4), human serum, and vitreous humor. The results suggest that neat THS-BIS-5FU codrug pellets are useful for sustained release ocular delivery of the parent compounds, and that the unique physicochemical properties of the codrug allow slow dissolution and rapid release of the two parent drugs. This codrug formulation is regarded as a "chemical delivery" system that involves dissolution of the codrug as the rate-limiting step followed by rapid hydrolysis of the carbonate ester linkages to release the parent drugs via sustained delivery.

Evaluation of O(3alpha)-, O(21)-di-(N(1)-methyloxycarbonyl-2, 4-dioxo-5-fluoropyrimidinyl) 17alpha-hydroxy-5beta-pregnan-20-one as a novel potential antiangiogenic codrug.

Intraocular neovascularization is a complication in a variety of eye diseases, and is a leading cause of visual loss. The purpose of this study was to design and synthesize three novel codrugs of the antiangiostatic steroid, 3alpha, 17alpha, 21-trihydroxy-5beta-pregnan-20-one (trihydroxy steroid, THS) with the cytotoxic agent 5-fluorouracil (5FU) which incorporates either one or two molecules of 5FU attached through carbonate ester linkages at positions O(3), and/or O(21) of the THS molecule. Furthermore, a kinetic study of the O(3alpha)-, O(21)-di-(N(1)-methyloxycarbonyl-2, 4-dioxo-5-fluoropyrimidinyL) 17alpha-hydroxy-5beta-pregnan-20-one (THS-BIS-5FU) codrug was carried out. The overall goal of this codrug strategy was to improve sustained drug delivery of both compounds by overcoming their individual solubility problems, and to thus enhance their bioavailability. The codrug was found to be optimal with superior angiostatic activity using the CAM assay compared to the activity of the parent compounds alone. In the hydrolysis studies 5FU was released at a faster rate than THS with an unknown intermediate observed by HPLC, a rationale and proposed structure and mechanism of the unknown THS derivative is provided.

Evaluation of blend uniformity and content uniformity based on 2003 stratified sampling guidance and 1999 blend uniformity analysis guidance: product A.

In August 1999 the FDA issued a Draft Abbreviated New Drug Application (ANDA) Guidance for Industry titled "ANDA's: Blend Uniformity Analysis" that detailed blend uniformity sampling and acceptance criteria for the determination of final blend uniformity for generic drug products. Although this guidance was written specifically to address ANDA's, the guidance was also adopted as standard practice in the development of NDA's (New Drug Applications). The proposed release criteria established for blend uniformity were to be used in addition to, and independent from, the USP finished product uniformity release requirements. Based on the Blend Uniformity Guidance, batches that failed to meet the blend uniformity acceptance criteria should be rejected regardless of the products ability to demonstrate final product uniformity. In March 2002, the Product Quality Research Institute (PQRI) issued a proposal to the FDA with respect to both ANDA's and NDA's recommending the use of stratified sampling for final blend and in-process dosage units. The proposal recommended the use of final blend uniformity and dosage unit uniformity to demonstrate overall batch uniformity, with the possibility of using dosage unit uniformity in lieu of blend uniformity during routine commercial production. Consequently, in October 2003, the FDA issued a Draft Guidance for Industry titled "Powder Blends and Finished Dosage Units-Stratified In-Process Dosage Unit Sampling Assessment" that detailed the criteria for the use of stratified sampling and acceptance criteria to demonstrate batch uniformity. In response to the PQRI proposal, Endo Pharmaceuticals conducted an impact evaluation of the proposed PQRI sampling procedures and acceptance criteria on a product-by-product basis as compared to the 1999 Draft Guidance and current USP requirements. The evaluation of Product A demonstrates the benefit of implementing the 2003 Guidance for products that demonstrate questionable blend uniformity but acceptable finished product uniformity.