The orally-active CYP17A1 inhibitor
abiraterone acetate (AA) decreases adrenal and intratumoral
androgen biosynthesis and is an effective agent for the treatment of
prostate cancer.
Abiraterone potently inhibits both reactions catalyzed by
CYP17, the 17α-hydroxylase (
hydroxylase) reaction as well as the
17,20-lyase (
lyase) transformation.
CYP17 hydroxylase inhibition prevents the synthesis of adrenal
glucocorticoids and causes an accumulation of circulating
mineralocorticoids. As a consequence of potent
CYP17 hydroxylase inhibition (i.e., lack of
lyase selectivity), AA must be co-administered with the
cortisol replacement
prednisone and patients may experience the effects of
mineralocorticoid excess syndrome (MES). Herein, we describe rationally-designed,
CYP17 lyase-selective inhibitors that could prove safer and more effective than
abiraterone. Using proprietary methodology, the high-affinity
pyridine or
imidazole metal-binding group found in current clinical
CYP17 inhibitors was replaced with novel, less avid,
metal-binding groups in concert with potency-enhancing molecular scaffold modifications. This process produced a unique series of
CYP17 lyase-selective inhibitors that included the oral agent 6 (VT-464), now in Phase 2
prostate cancer clinical trials. The chemical methodology described is potentially applicable to the design of new and more effective metalloenzyme inhibitor treatments for a broad array of diseases.