Phase I and clinical evaluation of a pharmacologically guided regimen of suramin in patients with hormone-refractory prostate cancer

Mario Eisenberger, Victoria Sinibaldi, L. M. Reyno, R. Sridhara, D. I. Jodrell, E. G. Zuhowski, K. H. Tkaczuk, M. H. Lowitt, R. K. Hemady, S. C. Jacobs, D. VanEcho, M. J. Egorin

Research output: Contribution to journalArticle

Abstract

Purpose: This phase I study was designed with the following objectives: (1) to describe the overall and dose-limiting toxicity (DLT) of suramin administered by intermittent short intravenous infusions until DLT or disease progression; (2) to determine the ability of an adaptive control with feedback (ACF) dosing strategy to maintain suramin plasma concentrations within a preselected range; (3) to develop a population model of suramin pharmacokinetics; and (4) to identify preliminary evidence of antitumor activity. Patients and Methods: Seventy-three patients with advanced, incurable, solid tumors (including 69 with hormone-refractory prostate cancer) received an initial 5- to 7-day daily loading treatment followed by intermittent infusions individually determined by ACF using a Bayesian algorithm and relying on population models of suramin pharmacokinetics. Treatment was given to three cohorts of patients based on target plasma suramin concentration ranges (peak, 30 minutes postsuramin, and trough on morning of the treatment day), as follows: cohort 1, 175 to 300 μg/mL (27 patients); cohort 2, 150 to 250 μg/mL (23 patients); and cohort 3, 100 to 200 μg/mL (23 patients). All patients were to receive suramin until DLT or disease progression. Results: The DLT was mast commonly seen in cohort 1 and included a syndrome of malaise and fatigue, associated with weight loss, anorexia, and changes in taste. Other reversible toxicities were neurologic, renal, cutaneous, edema, lymphopenia and anemia, ophthalmologic, and alopecia. Forty of 67 assessable patients (60%) had a 50% reduction and 25 of 67 (37%) a 75% reduction in prostate-specific antigen (PSA) levels that lasted more than 4 weeks, seven of 18 (40%) had measurable responses, and 18 of 37 (49%) demonstrated major pain improvement. The overall times to disease progression and survival were 170 and 492 days, respectively. Conclusion: We have characterized all toxicities with suramin in a pharmacologically guided phase I study designed to maintain plasma suramin concentrations of 100 to 300 μg/mL (cohorts 1 to 3). The incidence of grade 3 to 4 neurologic abnormalities was relatively low, particularly in cohorts 2 and 3 (100 to 250 μg/mL). Evidence of significant and durable antitumor activity was seen in all three cohorts.

Original languageEnglish (US)
Pages (from-to)2174-2186
Number of pages13
JournalJournal of Clinical Oncology
Volume13
Issue number9
StatePublished - 1995

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Suramin
Prostatic Neoplasms
Hormones
Disease Progression
Pharmacokinetics
Nervous System Malformations
Lymphopenia
Aptitude
Alopecia
Anorexia
Prostate-Specific Antigen
Intravenous Infusions
Nervous System
Population
Fatigue
Anemia
Weight Loss
Edema
Therapeutics
Kidney

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Phase I and clinical evaluation of a pharmacologically guided regimen of suramin in patients with hormone-refractory prostate cancer. / Eisenberger, Mario; Sinibaldi, Victoria; Reyno, L. M.; Sridhara, R.; Jodrell, D. I.; Zuhowski, E. G.; Tkaczuk, K. H.; Lowitt, M. H.; Hemady, R. K.; Jacobs, S. C.; VanEcho, D.; Egorin, M. J.

In: Journal of Clinical Oncology, Vol. 13, No. 9, 1995, p. 2174-2186.

Research output: Contribution to journalArticle

Eisenberger, M, Sinibaldi, V, Reyno, LM, Sridhara, R, Jodrell, DI, Zuhowski, EG, Tkaczuk, KH, Lowitt, MH, Hemady, RK, Jacobs, SC, VanEcho, D & Egorin, MJ 1995, 'Phase I and clinical evaluation of a pharmacologically guided regimen of suramin in patients with hormone-refractory prostate cancer', Journal of Clinical Oncology, vol. 13, no. 9, pp. 2174-2186.
Eisenberger, Mario ; Sinibaldi, Victoria ; Reyno, L. M. ; Sridhara, R. ; Jodrell, D. I. ; Zuhowski, E. G. ; Tkaczuk, K. H. ; Lowitt, M. H. ; Hemady, R. K. ; Jacobs, S. C. ; VanEcho, D. ; Egorin, M. J. / Phase I and clinical evaluation of a pharmacologically guided regimen of suramin in patients with hormone-refractory prostate cancer. In: Journal of Clinical Oncology. 1995 ; Vol. 13, No. 9. pp. 2174-2186.
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abstract = "Purpose: This phase I study was designed with the following objectives: (1) to describe the overall and dose-limiting toxicity (DLT) of suramin administered by intermittent short intravenous infusions until DLT or disease progression; (2) to determine the ability of an adaptive control with feedback (ACF) dosing strategy to maintain suramin plasma concentrations within a preselected range; (3) to develop a population model of suramin pharmacokinetics; and (4) to identify preliminary evidence of antitumor activity. Patients and Methods: Seventy-three patients with advanced, incurable, solid tumors (including 69 with hormone-refractory prostate cancer) received an initial 5- to 7-day daily loading treatment followed by intermittent infusions individually determined by ACF using a Bayesian algorithm and relying on population models of suramin pharmacokinetics. Treatment was given to three cohorts of patients based on target plasma suramin concentration ranges (peak, 30 minutes postsuramin, and trough on morning of the treatment day), as follows: cohort 1, 175 to 300 μg/mL (27 patients); cohort 2, 150 to 250 μg/mL (23 patients); and cohort 3, 100 to 200 μg/mL (23 patients). All patients were to receive suramin until DLT or disease progression. Results: The DLT was mast commonly seen in cohort 1 and included a syndrome of malaise and fatigue, associated with weight loss, anorexia, and changes in taste. Other reversible toxicities were neurologic, renal, cutaneous, edema, lymphopenia and anemia, ophthalmologic, and alopecia. Forty of 67 assessable patients (60{\%}) had a 50{\%} reduction and 25 of 67 (37{\%}) a 75{\%} reduction in prostate-specific antigen (PSA) levels that lasted more than 4 weeks, seven of 18 (40{\%}) had measurable responses, and 18 of 37 (49{\%}) demonstrated major pain improvement. The overall times to disease progression and survival were 170 and 492 days, respectively. Conclusion: We have characterized all toxicities with suramin in a pharmacologically guided phase I study designed to maintain plasma suramin concentrations of 100 to 300 μg/mL (cohorts 1 to 3). The incidence of grade 3 to 4 neurologic abnormalities was relatively low, particularly in cohorts 2 and 3 (100 to 250 μg/mL). Evidence of significant and durable antitumor activity was seen in all three cohorts.",
author = "Mario Eisenberger and Victoria Sinibaldi and Reyno, {L. M.} and R. Sridhara and Jodrell, {D. I.} and Zuhowski, {E. G.} and Tkaczuk, {K. H.} and Lowitt, {M. H.} and Hemady, {R. K.} and Jacobs, {S. C.} and D. VanEcho and Egorin, {M. J.}",
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T1 - Phase I and clinical evaluation of a pharmacologically guided regimen of suramin in patients with hormone-refractory prostate cancer

AU - Eisenberger, Mario

AU - Sinibaldi, Victoria

AU - Reyno, L. M.

AU - Sridhara, R.

AU - Jodrell, D. I.

AU - Zuhowski, E. G.

AU - Tkaczuk, K. H.

AU - Lowitt, M. H.

AU - Hemady, R. K.

AU - Jacobs, S. C.

AU - VanEcho, D.

AU - Egorin, M. J.

PY - 1995

Y1 - 1995

N2 - Purpose: This phase I study was designed with the following objectives: (1) to describe the overall and dose-limiting toxicity (DLT) of suramin administered by intermittent short intravenous infusions until DLT or disease progression; (2) to determine the ability of an adaptive control with feedback (ACF) dosing strategy to maintain suramin plasma concentrations within a preselected range; (3) to develop a population model of suramin pharmacokinetics; and (4) to identify preliminary evidence of antitumor activity. Patients and Methods: Seventy-three patients with advanced, incurable, solid tumors (including 69 with hormone-refractory prostate cancer) received an initial 5- to 7-day daily loading treatment followed by intermittent infusions individually determined by ACF using a Bayesian algorithm and relying on population models of suramin pharmacokinetics. Treatment was given to three cohorts of patients based on target plasma suramin concentration ranges (peak, 30 minutes postsuramin, and trough on morning of the treatment day), as follows: cohort 1, 175 to 300 μg/mL (27 patients); cohort 2, 150 to 250 μg/mL (23 patients); and cohort 3, 100 to 200 μg/mL (23 patients). All patients were to receive suramin until DLT or disease progression. Results: The DLT was mast commonly seen in cohort 1 and included a syndrome of malaise and fatigue, associated with weight loss, anorexia, and changes in taste. Other reversible toxicities were neurologic, renal, cutaneous, edema, lymphopenia and anemia, ophthalmologic, and alopecia. Forty of 67 assessable patients (60%) had a 50% reduction and 25 of 67 (37%) a 75% reduction in prostate-specific antigen (PSA) levels that lasted more than 4 weeks, seven of 18 (40%) had measurable responses, and 18 of 37 (49%) demonstrated major pain improvement. The overall times to disease progression and survival were 170 and 492 days, respectively. Conclusion: We have characterized all toxicities with suramin in a pharmacologically guided phase I study designed to maintain plasma suramin concentrations of 100 to 300 μg/mL (cohorts 1 to 3). The incidence of grade 3 to 4 neurologic abnormalities was relatively low, particularly in cohorts 2 and 3 (100 to 250 μg/mL). Evidence of significant and durable antitumor activity was seen in all three cohorts.

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