Doxifluridine

Doxifluridine (5'-deoxy-5-fluorouridine) is a second generation nucleoside analog prodrug developed by Roche and used as a cytostatic agent in chemotherapy in several Asian countries including China and South Korea.^[1] Doxifluridine is not FDA-approved for use in the USA. It is currently being evaluated in several clinical trials as a stand-alone or combination therapy treatment.

Doxifluridine

Clinical data
Other names	Doxyfluridine; doxifluridine; 5'-deoxy-5-fluorouridine; 5'-deoxy-5'-fluorouridine; 5'-fluoro-5'-deoxyuridine; 5'-dFUrd; 5'-DFUR; Furtulon; Ro 21-9738
Identifiers
IUPAC name 1-[(2R,3R,4S,5R)-3,4-Dihydroxy-5-methyloxolan-2-yl]-5-fluoropyrimidine-2,4-dione
CAS Number	3094-09-5 Y
PubChem CID	18343
DrugBank	DB12947
ChemSpider	17322
UNII	V1JK16Y2JP
CompTox Dashboard (EPA)	DTXSID2022967
ECHA InfoCard	100.019.491
Chemical and physical data
Formula	C9H11FN2O5
Molar mass	246.194 g·mol−1
3D model (JSmol)	Interactive image
SMILES C[C@@H]1[C@H]([C@H]([C@@H](O1)N2C=C(C(=O)NC2=O)F)O)O
InChI InChI=1S/C9H11FN2O5/c1-3-5(13)6(14)8(17-3)12-2-4(10)7(15)11-9(12)16/h2-3,5-6,8,13-14H,1H3,(H,11,15,16)/t3-,5-,6-,8-/m1/s1 Key:ZWAOHEXOSAUJHY-ZIYNGMLESA-N

Biology

5-Fluorouracil (5-FU), the nucleobase of doxifluridine, is currently an FDA-approved antimetabolite.^[2] 5-FU is normally administered intravenously to prevent its degradation by dihydropyrimidine dehydrogenase in the gut wall. Doxifluridine is a fluoropyrimidine derivative of 5-FU, thus a second-generation nucleoside prodrug. Doxifluridine was designed to improve oral bioavailability in order to avoid dihydropyrimidine dehydrogenase degradation in the digestive system.^[3]

Within a cell, pyrimidine nucleoside phosphorylase or thymidine phosphorylase can metabolize doxifluridine into 5-FU.^[4][5] It is also a metabolite of capecitabine.^[4] High levels of pyrimidine-nucleoside phosphorylase and thymidine phosphorylase are expressed in esophageal, breast, cervical, pancreatic, and hepatic cancers.^[6][7] Liberation of 5-FU is the active metabolite and leads to inhibition of DNA synthesis and cell death.

Side effects

High thymidine phosphorylase expression is also found in the human intestinal tract, resulting in dose-limiting toxicity (diarrhea) in some individuals.^[8]

The most frequent adverse effects for doxifluridine were neurotoxicity and mucositis.^{[citation needed]}

Brand names

Doxifluridine is sold under many brand names:^[9]

Brand name	Company	Country
Didox[10]	Shin Poong Pharm. Co., Ltd.	South Korea
Doxyfluridine[9]	Kwang Dong
Doxifluridine cap	Myungmoon Pharma Co. Ltd.
Ai Feng[9]	Hengrui	China and Japan
Doxifluridine[9]	XinShiDai Pharmaceutical
Furtulon[9]	Roche, Chugai
Ke Fu[9]	Zhaohui
Ke Tuo[9]	Southwest
Qi Nuo Bi Tong[9]	Wanjie High-Tech
Shu Qi[9]	Team
Tan Nuo[9]	Xinchang Medicine & Chemical Co Ltd
Yi Di An[9]	Pacific

References

1. "Doxifluridine". drugs.com.
2. Shelton J, Lu X, Hollenbaugh JA, Cho JH, Amblard F, Schinazi RF (December 2016). "Metabolism, Biochemical Actions, and Chemical Synthesis of Anticancer Nucleosides, Nucleotides, and Base Analogs". Chemical Reviews. 116 (23): 14379–14455. doi:10.1021/acs.chemrev.6b00209. PMC 7717319. PMID 27960273.
3. Schöffski P (February 2004). "The modulated oral fluoropyrimidine prodrug S-1, and its use in gastrointestinal cancer and other solid tumors". Anti-Cancer Drugs. 15 (2): 85–106. doi:10.1097/00001813-200402000-00001. PMID 15075664.
4. Ishikawa T, Sekiguchi F, Fukase Y, Sawada N, Ishitsuka H (February 1998). "Positive correlation between the efficacy of capecitabine and doxifluridine and the ratio of thymidine phosphorylase to dihydropyrimidine dehydrogenase activities in tumors in human cancer xenografts". Cancer Research. 58 (4): 685–690. PMID 9485021.
5. "Definition of Doxifluridine". NCI Drug Dictionary. National Cancer Institute.
6. Mori K, Hasegawa M, Nishida M, Toma H, Fukuda M, Kubota T, et al. (July 2000). "Expression levels of thymidine phosphorylase and dihydropyrimidine dehydrogenase in various human tumor tissues". International Journal of Oncology. 17 (1): 33–38. doi:10.3892/ijo.17.1.33. PMID 10853015.
7. Ogata Y, Sasatomi T, Mori S, Matono K, Ishibashi N, Akagi Y, et al. (Jul 2007). "Significance of thymidine phosphorylase in metronomic chemotherapy using CPT-11 and doxifluridine for advanced colorectal carcinoma". Anticancer Research. 27 (4C): 2605–2611. PMID 17695422.
8. Lamont EB, Schilsky RL (September 1999). "The oral fluoropyrimidines in cancer chemotherapy". Clinical Cancer Research. 5 (9): 2289–2296. PMID 10499595.
9. "Medicine search - Doxifluridine". pillintrip.com. Retrieved 2022-02-12.
10. Kim M, Ahn S, Son B, Lee J, Koh B, Sohn G, Lee S, Kim HJ (2017-02-23). "Oncologic Effect of Oral Fluorouracil in Hormone Receptor-Negative T1a Node-Negative Breast Cancer Patients". Journal of Breast Disease. 4 (2): 116–121. doi:10.14449/jbd.2016.4.2.116. ISSN 2288-5560.