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Pegamotecan is a pegylated derivative of camptothecin and acts as a DNA topoisomerase I inhibitor. The pegylation (attachment of polyethylene glycol) increases its water solubility, prolongs circulating half-life, improves tolerability, and allows for passive tumor accumulation. It was developed by Enzon Pharmaceuticals for the treatment of various cancers including gastric cancer, soft tissue sarcoma, and gastroesophageal cancer. Clinical trials showed some activity in advanced gastric and gastroesophageal adenocarcinoma with manageable toxicity; however, development was discontinued after phase II studies due to strategic considerations regarding investment return versus required resources[1][2][3][5].
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