© 1994 by Oxford University Press
Journal of the National Cancer Institute, Vol. 86, No. 12, 906-912,
June 15, 1994
© 1994 Oxford University Press
Phase I and Pharmacologic Study of the Novel Indoloquinone Bioreductive Alkylating Cytotoxic Drug E09
1Division of Experimcntal Chemotherapy and Pharmacology, Department of Medical Oncology, Rotterdam Cancer Institute, Dr. Daniel den Hoed Kliniek Rotterdam, The Netherlands
2Renal Unit, Academic Medical Center Amsterdam, The Netherlands
3 European Organization for Research and Treatment of Cancer (EORTC New Drug Development Office Amsterdam
*Correspondence to: J. H. M. Schellens, M.D., Ph.D., Division of Experimental Chemotherapy and Pharmacology, Department of Medical Oncology, Rotterdam Cancer Institute, Dr. Daniel den Hoed Kliniek, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands.
Background: A novel bioreductive alkylating indolo-quinone compound, E09 [3-hydroxy-5-aziridinyl-l-methyl-2-(lH-indole-4, 7-indione)-prop-F128b-en-a-ol], has been shown to have distinct antitumor activity against solid tumors, excellent activity under hypoxic conditions, but no notable bone marrow toxicity in preclinical models. Purpose: A phase I study was carried out to determine the toxicity, maximum tolerated dose (MTD), pharmacology, and antitumor response of E09. Methods: E09 was administered as a 5-minute intravenous infusion once every 3 weeks to 32 patients with solid tumors. The starting dose of 2.7 mg/m2 was one tenth of the mouse equivalent of lethal dose to 10% of animals (MELD10). Dose was escalated by 100% until the area under the curve (AUC) at the MELD10 was reached, following a Fibonacci-like schedule. The pharmacokinetics of E09 and its metabolite E05A with an open aziridine ring were determined using a new high-pressure liquid chromatographic method and noncom-partmental calculation of kinetic parameters. The sigmoid Emax model was used to fit pharmacokinetic parameters to toxicity. The renal function and proteinuria were quantitated and were further evaluated by determining renal clearance ratios of immunoglobulin G (IgG) to albumin and pancreatic amylase to salivary amylase. Results: The 32 patients were treated with a total of 85 assessable courses of E09. The dose-limiting toxicity was proteinuria, which was accompanied by sodium and water retention. All symptoms were reversible on day 15 except in two patients, who developed acute renal failure. The ratios of IgG to albumin and pancreatic amylase to salivary amylase suggested a loss of glomerular negative charge consistent with a minimal change glomerulopathy. The pharmacokinetics of E09 showed its rapid elimination from the central compartment but with wide interpatient variation in the overall disposition of the drug. Total plasma clearance of E09 ranged from 3.2 to 24 L/min. The AUC of E09 was linearly related to the administered dose. The relationship between the AUC and proteinuria was best fitted by the sigmoid Emax, model (r =.98). In two patients with adenocarcinoma of unknown primary site and in a third patient with bile duct cancer, a partial response was observed. Conclusions: The MTD of E09 was determined to be 27 mg/m2. The standard approach of drug administration is considered unsuitable because of potential renal toxicity and wide variability in the pharmacokinetics of E09. Individual dose adjustments based on plasma concentration measurements are recommended to combine maximally achievable exposure with tolerable toxicity. [J Natl Cancer Inst 86:906–912, 1994]
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