The development of therapies for the treatment of neurological cancer
faces a number of major challenges including the synthesis of small molecule
agents that can penetrate the blood brain barrier (BBB). Given the likelihood
that in many cases drug exposure will be lower in the CNS than in systemic
circulation, it follows that strategies should be employed that can sustain
target engagement at low drug concentration. Time dependent target occupancy is
a function of both the drug and target concentration as well as the
thermodynamic and kinetic parameters that describe the binding reaction
coordinate, and sustained target occupancy can be achieved through structural
modifications that increase target (re)binding and/or that decrease the rate of
drug dissociation. The discovery and deployment of compounds with optimized
kinetic effects requires information on the structure-kinetic relationships that
modulate the kinetics of binding, and the molecular factors that control the
translation of drug-target kinetics to time-dependent drug activity in the
disease state. This review first introduces the potential benefits of
drug-target kinetics, such as the ability to delineate both thermodynamic and
kinetic selectivity, and then describes factors, such as target vulnerability,
that impact the utility of kinetic selectivity. The review concludes with a
description of a mechanistic PK/PD model that integrates drug-target kinetics
into predictions of drug activity.