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CBT-1 is an orally bioavailable small molecule bisbenzylisoquinoline alkaloid, specifically a purified form of d-tetrandrine, that acts as a potent inhibitor of the P-glycoprotein (P-gp) efflux pump. P-gp, encoded by the ABCB1 (MDR1) gene, is an ATP-binding cassette transporter that frequently mediates multidrug resistance in cancer by actively extruding various chemotherapeutic agents from tumor cells. CBT-1 is designed to be administered in combination with cytotoxic drugs, such as paclitaxel or doxorubicin, to enhance their intracellular accumulation and therapeutic efficacy. Developed in collaboration with the National Cancer Institute (NCI), CBT-1 has been evaluated in clinical trials for the treatment of relapsed or refractory solid tumors and anthracycline-refractory sarcomas. It has demonstrated the ability to inhibit P-gp-mediated drug efflux in both tumor and normal tissues without significantly altering the systemic pharmacokinetics of co-administered chemotherapy.
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