Page last updated: 2024-12-07

combretastatin

Description Research Excerpts Clinical Trials Roles Classes Pathways Study Profile Bioassays Related Drugs Related Conditions Protein Interactions Research Growth Market Indicators

Description

Combretastatins are a class of natural products isolated from the South African tree Combretum caffrum. They exhibit potent anti-cancer activity, particularly against tumor angiogenesis, which is the formation of new blood vessels that supply tumors with oxygen and nutrients. Combretastatins work by inhibiting tubulin polymerization, a crucial process in microtubule formation. Microtubules are essential for cell division, and their disruption leads to cell death. Combretastatin A-4 (CA-4) is a potent anti-cancer agent that has shown promise in clinical trials. However, its clinical use is limited by its poor water solubility and short half-life. Several synthetic analogues of combretastatin A-4 have been developed to overcome these limitations, including CA-4P, which has improved pharmacokinetic properties and is currently in clinical trials for the treatment of various cancers. Combretastatins continue to be studied extensively for their potential as anticancer agents. Researchers are actively exploring novel synthetic approaches to produce more effective and less toxic combretastatin analogues.'

combretastatin: cytotoxic principle from South African tree COMBRETUM caffrum; structure given in first source; acts at COLCHICINE site of TUBULIN [Medical Subject Headings (MeSH), National Library of Medicine, extracted Dec-2023]

Cross-References

ID SourceID
PubMed CID100154
MeSH IDM0119605

Synonyms (8)

Synonym
ca4p
combretastatin
5-[(2s)-2-hydroxy-2-(3,4,5-trimethoxyphenyl)ethyl]-2-methoxyphenol
AKOS015967221
DB05284
LGZKGOGODCLQHG-ZDUSSCGKSA-N
Q27095579
(r,s)-5-[2-hydroxy-2-(3,4,5-trimethoxy-phenyl)-ethyl]-2-methoxy-phenol

Research Excerpts

Overview

Combretastatin A4 (CA4) is a natural product characterized by a powerful inhibition of tubulin polymerization and a potential anticancer activity. The combretastatins are a group of anti-mitotic agents isolated from the bark of the South African tree Combretum caffrum.

ExcerptReferenceRelevance
"Combretastatin is a naturally occurring small stilbenoid."( Suppression of angiogenesis and tumour progression by combretastatin and derivatives.
Sherbet, GV, 2017
)
1.42
"Combretastatin A4 (CA4) is a natural product characterized by a powerful inhibition of tubulin polymerization and a potential anticancer activity. "( Synthesis, antiproliferative, anti-tubulin activity, and docking study of new 1,2,4-triazoles as potential combretastatin analogues.
Abdelhafez, EMN; Abdelhamid, D; Aly, OM; Gamal-Eldeen, AM; Ibrahim, MAA; Mustafa, M, 2017
)
2.11
"Combretastatin (CA)-4 is a MT-destabilising agent that possesses potent anti-tumour properties."( Combretastatin (CA)-4 and its novel analogue CA-432 impair T-cell migration through the Rho/ROCK signalling pathway.
Carr, M; Meegan, MJ; O'Boyle, NM; Pollock, JK; Verma, NK; Zisterer, DM, 2014
)
2.57
"The combretastatins are a group of anti-mitotic agents isolated from the bark of the South African tree Combretum caffrum. "( Combretastatins: from natural products to drug discovery.
Cirla, A; Mann, J, 2003
)
2.32

Effects

ExcerptReferenceRelevance
"Combretastatin has shown activity in phase 1 and phase II trials; although the registration phase III study failed to meet its accrual goals, it did appear to show some benefit, especially in younger patients."( New targeted therapies and other advances in the management of anaplastic thyroid cancer.
Deshpande, HA; Roman, S; Sosa, JA, 2013
)
1.11

Actions

ExcerptReferenceRelevance
"Combretastatins activate mitotic checkpoints that lead to mitotic catastrophe and apoptosis."( Suppression of angiogenesis and tumour progression by combretastatin and derivatives.
Sherbet, GV, 2017
)
1.42

Toxicity

ExcerptReferenceRelevance
" Close collaboration with cardiology colleagues for early indicators of serious cardiac adverse events will likely minimize toxicity while optimizing the therapeutic potential of VDAs and ultimately enhancing patient outcomes."( Cardiovascular toxicity profiles of vascular-disrupting agents.
Lenihan, DJ; Subbiah, IM; Tsimberidou, AM, 2011
)
0.37

Pharmacokinetics

ExcerptReferenceRelevance
"Although in vitro studies suggest that variable rates of tumor-specific prodrug dephosphorylation may explain these differences in pharmacokinetics profiles, the improved antitumor activity and altered pharmacokinetic profile of CA1 may be due to the formation of a more reactive metabolite."( Comparative preclinical pharmacokinetic and metabolic studies of the combretastatin prodrugs combretastatin A4 phosphate and A1 phosphate.
Anthoney, DA; Bibby, MC; Cooper, PA; Kirwan, IG; Lippert, JW; Loadman, PM; Pettit, GR; Shnyder, SD; Swaine, DJ, 2004
)
0.56

Bioavailability

ExcerptReferenceRelevance
" Among the recently disclosed tubulin polymerization inhibitors, there are several interesting low molecular weight compounds with improved oral bioavailability and demonstrated activity against multi-drug resistance positive phenotypes."( Recent advances in the field of tubulin polymerization inhibitors.
Prinz, H, 2002
)
0.31
" The impediments of poor solubility and bioavailability and the spontaneous geometric isomerisation of combretastatin into an inactive form have led to intensive efforts towards evolving novel analogues to provide more efficacious biological outcome."( Combretastatin analogues in cancer biology: A prospective view.
Sherbet, GV, 2020
)
2.22

Dosage Studied

ExcerptRelevanceReference
" Single and fractionated dosing of radiation and/or CA4P was evaluated."( Radiation-guided targeting of combretastatin encapsulated immunoliposomes to mammary tumors.
Chong, PL; Del Valle, L; Donelson, FJ; Kiani, MF; Knight, LC; Pattillo, CB; Venegas, B, 2009
)
0.64
" This effect can be further potentiated using a fractionated irradiation dosing schedule combined with fractionated immunoliposome treatments."( Radiation-guided targeting of combretastatin encapsulated immunoliposomes to mammary tumors.
Chong, PL; Del Valle, L; Donelson, FJ; Kiani, MF; Knight, LC; Pattillo, CB; Venegas, B, 2009
)
0.64
" Second, the question of identifying an optimal dosing strategy for treating with an AI and a cytotoxic agent is addressed."( Microenvironment-Mediated Modeling of Tumor Response to Vascular-Targeting Drugs.
Gevertz, JL, 2016
)
0.43
"Radiation was applied locally to tissues in CDF1 mice to produce full radiation dose-response curves."( Enhancing the radiation response of tumors but not early or late responding normal tissues using a vascular disrupting agent.
Horsman, MR, 2017
)
0.46
"Ecust004 treatment decreased the growth and proliferation of MDA-MB-231 and MCF7 cells at a lower dosage than Erianin."( Ecust004 Suppresses Breast Cancer Cell Growth, Invasion, and Migration via EMT Regulation.
Hu, X; Huang, J; Huang, L; Liang, Y; Liu, Z; Nie, H; Sun, L; Wu, F, 2021
)
0.62
[information is derived through text-mining from research data collected from National Library of Medicine (NLM), extracted Dec-2023]

Research

Studies (221)

TimeframeStudies, This Drug (%)All Drugs %
pre-19902 (0.90)18.7374
1990's14 (6.33)18.2507
2000's70 (31.67)29.6817
2010's115 (52.04)24.3611
2020's20 (9.05)2.80
[information is prepared from research data collected from National Library of Medicine (NLM), extracted Dec-2023]

Market Indicators

Research Demand Index: 41.47

According to the monthly volume, diversity, and competition of internet searches for this compound, as well the volume and growth of publications, there is estimated to be strong demand-to-supply ratio for research on this compound.

MetricThis Compound (vs All)
Research Demand Index41.47 (24.57)
Research Supply Index5.42 (2.92)
Research Growth Index5.66 (4.65)
Search Engine Demand Index58.96 (26.88)
Search Engine Supply Index2.00 (0.95)

This Compound (41.47)

All Compounds (24.57)

Study Types

Publication TypeThis drug (%)All Drugs (%)
Trials1 (0.45%)5.53%
Reviews31 (13.90%)6.00%
Case Studies1 (0.45%)4.05%
Observational0 (0.00%)0.25%
Other190 (85.20%)84.16%
[information is prepared from research data collected from National Library of Medicine (NLM), extracted Dec-2023]

Clinical Trials (16)

Trial Overview

TrialPhaseEnrollmentStudy TypeStart DateStatus
A Phase II, Dose Ranging, Multi-Center Study to Evaluate the Safety and Efficacy of Combretastatin A4 Phosphate for Treating Subfoveal Choroidal Neovascularization in Subjects With Pathologic Myopia [NCT01423149]Phase 223 participants (Actual)Interventional2005-03-31Completed
A Randomized Open-Labeled Phase II Study of Combretastatin A-4 Phosphate in Combination With Paclitaxel and Carboplatin to Evaluate the Safety and Efficacy in Subjects With Advanced Imageable Malignancies [NCT00113438]Phase 213 participants (Actual)Interventional2005-03-31Completed
OXiGENE OXC402-201: A Phase 2, Randomized, Double-Masked, Placebo-Controlled Study of the Safety, Pharmacokinetics, and Biological Effects of Intravenous Fosbretabulin in Asian Subjects With Polypoidal Choroidal Vasculopathy (PCV) [NCT01023295]Phase 220 participants (Actual)Interventional2009-07-31Completed
A Phase II/III Study to Evaluate the Safety and Efficacy of Combretastatin A-4 Phosphate in Combination With Paclitaxel and Carboplatin in Comparison With Paclitaxel and Carboplatin Against Anaplastic Thyroid Carcinoma [FACT] [NCT00507429]Phase 2/Phase 380 participants (Actual)Interventional2007-08-31Terminated(stopped due to Low rate of subject accrual)
A Phase II Study to Assess the Safety and Efficacy of the Combination of Carboplatin, Paclitaxel, and Bevacizumab ± Combretastatin A4 Phosphate (CA4P) Followed by Bevacizumab ± CA4P in Subjects With Chemotherapy Naïve Stage IIIB/IV Non-Squamous Cell Histo [NCT00653939]Phase 263 participants (Actual)Interventional2008-03-31Completed
A Multicenter, Open-label Phase 1b/2 Study to Assess the Safety and Clinical Activity of Intravenous Combretastatin A1 Diphosphate (OXi4503) as Monotherapy in Subjects With Primary or Secondary Hepatic Tumor Burden [NCT00960557]Phase 116 participants (Actual)Interventional2009-07-31Completed
Ph 1b Dose Escalation Study of OXi4503 as a Single Agent and in Combination With Cytarabine With Subsequent Phase 2 Cohorts for Subjects With Relapsed/Refractory Acute AML and MDS [NCT02576301]Phase 1/Phase 2105 participants (Anticipated)Interventional2015-10-31Recruiting
FOCUS: A Multicenter, Multinational, Double-Blind, 2-Arm, Randomized, Phase 2/3, Study of Physician's Choice Chemotherapy ([PCC] Weekly Paclitaxel or Pegylated Liposomal Doxorubicin [PLD]) Plus Bevacizumab and CA4P Versus PCC Plus Bevacizumab and Placebo [NCT02641639]Phase 2/Phase 391 participants (Actual)Interventional2016-06-30Terminated(stopped due to Interim analysis failed to show efficacy benefit)
An Open Label, Pilot (Phase I/II), Dose-Escalation Safety and Tolerability Study of Combretastatin A4 Phosphate in Patients With Neovascular Age-Related Macular Degeneration. [NCT01570790]Phase 1/Phase 28 participants (Actual)Interventional2003-05-31Completed
A Phase I Clinical Trial of OXi4503 for Relapsed and Refractory Acute Myelogenous Leukemia (AML) and Myelodysplastic Syndromes (MDS) [NCT01085656]Phase 118 participants (Actual)Interventional2011-02-28Terminated
Phase II Trial of Combined Modality Combretastatin A-4 Phosphate (CA4P)-Based Therapy for Patients With Newly Diagnosed Anaplastic Thyroid Cancer [Induction Chemotherapy With Doxorubicin/Cisplatin; Combined Modality Therapy With CA4P and Radiation; Follow [NCT00077103]Phase 1/Phase 24 participants (Actual)Interventional2003-11-30Terminated(stopped due to slow accrual)
OXC4P1-105: A Phase I Study of the Safety, Tolerability, and Antitumor Activity of Escalating Doses of Combretastatin A4 Phosphate Given in Combination With Bevacizumab to Subjects With Advanced Solid Tumors [NCT00395434]Phase 120 participants (Anticipated)Interventional2006-09-30Completed
Phase II Trial Of Combretastatin A-4 Phosphate (CA4P) In Advanced Anaplastic Carcinoma Of The Thyroid [NCT00060242]Phase 226 participants (Actual)Interventional2003-02-28Completed
Rollover for Study OX4218s, A P2 Study to Investigate Safety and Activity of Fosbretabulin Tromethamine in the Treatment of Well-Differentiated, Low-to-Intermediate-Grade Unresectable, Recurrent or Metastatic PNET or GI-NET With Elevated Biomarkers [NCT02279602]Phase 27 participants (Actual)Interventional2014-12-31Completed
A Ph 2 Study to Investigate the Safety and Activity of Fosbretabulin Tromethamine (CA4P) in the Treatment of Well-Differentiated, Low-to-Intermediate-Grade Unresectable, Recurrent or Metastatic PNET or GI-NET Neuroendocrine Tumors/Carcinoid With Elevated [NCT02132468]Phase 218 participants (Actual)Interventional2014-09-30Completed
A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Safety and Efficacy of Fosbretabulin Tromethamine (CA4P) in Combination With Paclitaxel and Carboplatin in Anaplastic Thyroid Carcinoma (FACT2) [NCT01701349]Phase 30 participants (Actual)Interventional2015-03-31Withdrawn(stopped due to Expected inability to recruit study participants in a reasonable amount of time.)
[information is prepared from clinicaltrials.gov, extracted Sep-2024]

Trial Outcomes

TrialOutcome
NCT00507429 (2) [back to overview]Overall Survival
NCT00507429 (2) [back to overview]To Determine Percentage of 1 Year Survival
NCT00653939 (6) [back to overview]Overall Survival (OS) Using a Multivariate Cox Regression Model in the Intent-to-Treat Population
NCT00653939 (6) [back to overview]Progression Free Survival (PFS) in the Intent-to-Treat Population
NCT00653939 (6) [back to overview]Best Overall Tumor Response Rate (RR) in the Intent-to-Treat Population
NCT00653939 (6) [back to overview]Chemistry NCI-CTCAE Toxicity Grade of 3 or 4 (Safety Population)
NCT00653939 (6) [back to overview]Coagulation NCI-CTCAE Grade 3 or 4 (Safety Population)
NCT00653939 (6) [back to overview]Hematology NCI-CTCAE Grade 3 or 4 (Safety Population)

Overall Survival

(NCT00507429)
Timeframe: From randomization to date last known alive

Interventionmonths (Median)
Arm 1, Active: CA4P + Carboplatin + Paclitaxel5.2
Arm 2, Comparator: Carboplatin + Paclitaxel4.0

[back to top]

To Determine Percentage of 1 Year Survival

(NCT00507429)
Timeframe: from randomization through end of study visit

Interventionpercentage of participants (Number)
Arm 1, Active: CA4P + Carboplatin + Paclitaxel26
Arm 2, Control: Carboplatin + Paclitaxel9

[back to top]

Overall Survival (OS) Using a Multivariate Cox Regression Model in the Intent-to-Treat Population

(NCT00653939)
Timeframe: Until death or lost to follow-up, up to 12 months since randomization

InterventionMonths (Median)
Arm 1: Chemotherapy+Bevacizumab16.2
Arm 2: Active Comparator+Fosbretabulin13.6

[back to top]

Progression Free Survival (PFS) in the Intent-to-Treat Population

Progression was defined using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.0. Based on 20% increase of the longest diameter of target lesions or appearance of one or more new non-target lesions or/and progression of non-target lesions since the treatment started. (NCT00653939)
Timeframe: Six 21-day cycles

Interventionmonths (Median)
Arm 1: Chemotherapy+Bevacizumab9.3
Arm 2: Active Comparator+Fosbretabulin8.6

[back to top]

Best Overall Tumor Response Rate (RR) in the Intent-to-Treat Population

Based on Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.0 for target lesions (assessed by MRI or CT scan): Complete Response (CR) is defined as the disappearance of all target lesions, Partial Response (PR) is defined as at least a 30% decrease in the sum of the longest diameter of target lesions, Progressive Disease is defined as at least 20% increase in the sum of the longest diameter of target lesions, Stable Disease (SD) is defined as neither shrinkage to qualify for a PR or increase to qualify for a PD. (NCT00653939)
Timeframe: Six 21-day cycles

,
Interventionparticipants (Number)
Complete ResponsePartial ResponseStable DiseaseProgressive DiseaseUnknown
Arm 1: Chemotherapy+Bevacizumab0111334
Arm 2: Active Comparator+Fosbretabulin018815

[back to top]

Chemistry NCI-CTCAE Toxicity Grade of 3 or 4 (Safety Population)

(NCT00653939)
Timeframe: Days 1 (pretreatment) per 21-day Cycle (6 Cycles)

,
Interventionparticipants (Number)
ALT - Grade 3ALT - Grade 4AST - Grade 3AST - Grade 4ALP - Grade 3ALP - Grade 4Total Bilirubin - Grade 3Total Bilirubin - Grade 4Glucose - Grade 3Glucose - Grade 4Creatinine - Grade 3Creatinine - Grade 4Calcium - Grade 3Calcium - Grade 4Magnesium - Grade 3Magnesium - Grade 4Phosphorus - Grade 3Phosphorus - Grade 4Potassium - Grade 3Potassium - Grade 4Sodium - Grade 3Sodium - Grade 4
Arm 1: Chemotherapy+Bevacizumab1000000001013122005150
Arm 2: Active Comparator+Fosbretabulin1010000000010111100020

[back to top]

Coagulation NCI-CTCAE Grade 3 or 4 (Safety Population)

(NCT00653939)
Timeframe: Day 1 (pretreatment) per 21-day Cycle (6 Cycles)

,
Interventionparticipants (Number)
INR - Grade 3INR - Grade 4PTT - Grade 3PTT - Grade 4
Arm 1: Chemotherapy+Bevacizumab2030
Arm 2: Active Comparator+Fosbretabulin3050

[back to top]

Hematology NCI-CTCAE Grade 3 or 4 (Safety Population)

(NCT00653939)
Timeframe: Days 1 (pretreatment), 7, 14, and 21 per 21-day Cycle (6 Cycles)

,
Interventionparticipants (Number)
Hemoglobin - Grade 3Hemoglobin - Grade 4White Blood Cell - Grade 3White Blood Cell - Grade 4Absolute Neutrophils - Grade 3Absolute Neutrophils - Grade 4Platelets - Grade 3Platelets - Grade 4
Arm 1: Chemotherapy+Bevacizumab7414242036
Arm 2: Active Comparator+Fosbretabulin0112152053

[back to top]