Dacarbazine Explained

Dacarbazine, also known as imidazole carboxamide and sold under the brand name DTIC-Dome, is a chemotherapy medication used in the treatment of melanoma and Hodgkin's lymphoma. For Hodgkin's lymphoma it is often used together with vinblastine, bleomycin, and doxorubicin. It is given by injection into a vein.[1]

Common side effects include loss of appetite, vomiting, low white blood cell count, and low platelets.[1] Other serious side effects include liver problems and allergic reactions.[1] It is unclear if use in pregnancy is safe for the baby.[1] Dacarbazine is in the alkylating agent and purine analog families of medication.[1]

Dacarbazine was approved for medical use in the United States in 1975.[1] It is on the World Health Organization's List of Essential Medicines.[2]

Medical uses

As of mid-2006, dacarbazine is commonly used as a single agent in the treatment of metastatic melanoma,[3] [4] and as part of the ABVD chemotherapy regimen to treat Hodgkin's lymphoma,[5] and in the MAID regimen for sarcoma.[6] [7] Dacarbazine was proven to be just as efficacious as procarbazine,[8] another drug with similar chemistry, in the German trial for paediatric Hodgkin's lymphoma, without the teratogenic effects. Thus COPDAC has replaced the former COPP regime in children for TG2 & 3 following OEPA.[9]

Side effects

Like many chemotherapy drugs, dacarbazine may have numerous serious side effects, because it interferes with normal cell growth as well as cancer cell growth. Among the most serious possible side effects are birth defects to children conceived or carried during treatment; sterility, possibly permanent; or immune suppression (reduced ability to fight infection or disease). Dacarbazine is considered to be highly emetogenic,[10] and most patients will be pre-medicated with dexamethasone and antiemetic drugs like 5-HT3 antagonist (e.g., ondansetron) and/or NK1 receptor antagonist (e.g., aprepitant). Other significant side effects include headache, fatigue and occasionally diarrhea.

The Swedish National Board of Health and Welfare has sent out a black box warning and suggests avoiding dacarbazine due to liver problems.[11]

Mechanism of action

Dacarbazine is activated by liver microsomal enzymes to monomethyl triazeno imidazole carboxamide (MTIC), which is an alkylating compound.[12] It causes methylation, modification and cross linking of DNA, thus inhibiting DNA, RNA and protein synthesis.[13]

Synthesis

Nitrous acid is added to 5-aminoimidazol-4-carboxamide to make 5-diazoimidazol-4-carboxamide. It reacts with dimethylamine to give dacarbazine.[14]

History

See also: History of cancer chemotherapy. In 1959, dacarbazine was first synthesized at Southern Research in Alabama.[15] The research was funded by a US federal grant. Dacarbazine gained FDA approval in May 1975 as DTIC-Dome. The drug was initially marketed by Bayer.

Society and culture

There are generic versions of dacarbazine available from APP, Bedford, Mayne Pharma (Hospira) and Teva.

Notes and References

  1. Web site: Dacarbazine. The American Society of Health-System Pharmacists. December 8, 2016. live. https://web.archive.org/web/20170911072711/https://www.drugs.com/monograph/dacarbazine.html. September 11, 2017.
  2. Book: ((World Health Organization)) . The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) . 2023 . 10665/371090 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2023.02 . free .
  3. Serrone L, Zeuli M, Sega FM, Cognetti F . Dacarbazine-based chemotherapy for metastatic melanoma: thirty-year experience overview . Journal of Experimental & Clinical Cancer Research . 19 . 1 . 21–34 . March 2000 . 10840932 .
  4. Bhatia S, Tykodi SS, Thompson JA . Treatment of metastatic melanoma: an overview . Oncology . 23 . 6 . 488–496 . May 2009 . 19544689 . 2737459 .
  5. Rueda Domínguez A, Márquez A, Gumá J, Llanos M, Herrero J, de Las Nieves MA, Miramón J, Alba E . Treatment of stage I and II Hodgkin's lymphoma with ABVD chemotherapy: results after 7 years of a prospective study . Annals of Oncology . 15 . 12 . 1798–1804 . December 2004 . 15550585 . 10.1093/annonc/mdh465 . free .
  6. Elias A, Ryan L, Aisner J, Antman KH . Mesna, doxorubicin, ifosfamide, dacarbazine (MAID) regimen for adults with advanced sarcoma . Seminars in Oncology . 17 . 2 Suppl 4 . 41–49 . April 1990 . 2110385 .
  7. Pearl ML, Inagami M, McCauley DL, Valea FA, Chalas E, Fischer M . Mesna, doxorubicin, ifosfamide, and dacarbazine (MAID) chemotherapy for gynecological sarcomas . International Journal of Gynecological Cancer . 12 . 6 . 745–748 . 2001 . 12445253 . 10.1046/j.1525-1438.2002.01139.x . 25246937 .
  8. Jelić S, Babovic N, Kovcin V, Milicevic N, Milanovic N, Popov I, Radosavljevic D . Comparison of the efficacy of two different dosage dacarbazine-based regimens and two regimens without dacarbazine in metastatic melanoma: a single-centre randomized four-arm study . Melanoma Research . 12 . 1 . 91–98 . February 2002 . 11828263 . 10.1097/00008390-200202000-00013 . 32031568 .
  9. Mauz-Körholz C, Hasenclever D, Dörffel W, Ruschke K, Pelz T, Voigt A, Stiefel M, Winkler M, Vilser C, Dieckmann K, Karlén J, Bergsträsser E, Fosså A, Mann G, Hummel M, Klapper W, Stein H, Vordermark D, Kluge R, Körholz D . Procarbazine-free OEPA-COPDAC chemotherapy in boys and standard OPPA-COPP in girls have comparable effectiveness in pediatric Hodgkin's lymphoma: the GPOH-HD-2002 study . Journal of Clinical Oncology . 28 . 23 . 3680–3686 . August 2010 . 20625128 . 10.1200/jco.2009.26.9381 . free .
  10. Aoki S, Iihara H, Nishigaki M, Imanishi Y, Yamauchi K, Ishihara M, Kitaichi K, Itoh Y . Difference in the emetic control among highly emetogenic chemotherapy regimens: Implementation for appropriate use of aprepitant . Molecular and Clinical Oncology . 1 . 1 . 41–46 . January 2013 . 24649120 . 3956247 . 10.3892/mco.2012.15 .
  11. Web site: Alla aktuella ändringar för Dacarbazine medac Pulver till infusionsvätska, lösning 500 mg, Medac . FASS.se . August 19, 2011 . dead . https://web.archive.org/web/20111001011425/http://www.fass.se/LIF/produktfakta/audit_page.jsp?_sourcePage=%2Fproduktfakta%2Fartikel_produkt.jsp&docType=7&nplId=19971212000080 . October 1, 2011 .
  12. Kewitz S, Stiefel M, Kramm CM, Staege MS . Impact of O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation and MGMT expression on dacarbazine resistance of Hodgkin's lymphoma cells . Leukemia Research . 38 . 1 . 138–143 . January 2014 . 24284332 . 10.1016/j.leukres.2013.11.001 .
  13. Book: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet] . National Institute of Diabetes and Digestive and Kidney Diseases . 2012 . Dacarbazine . 31644220.
  14. Book: Synthesis of Essential Drugs . Vardanyan RS, Hruby VJ . 2006 . 389–418 . 30 - Antineoplastics . 10.1016/B978-044452166-8/50030-3. 9780444521668 .
  15. Marchesi F, Turrizani M, Tortorelli G, Avvisati G, Torino F, De Vecchis L . October 2007 . Triazene compounds: Mechanism of action and related DNA repair systems . Pharmacological Research . 56 . 4 . 275–287 . 10.1016/j.phrs.2007.08.003. 17897837 .

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