A Phase 1 study of UCN-01 in combination with irinotecan in patients with resistant solid tumor malignancies.

Abstract

PURPOSE:

UCN-01 (7-hydroxystaurosporine) is a multi-targeted protein kinase inhibitor that exhibits synergistic activity with DNA-damaging agents in preclinical studies. We conducted a Phase I study to determine the maximum-tolerated dose (MTD), dose-limiting toxicity (DLT), pharmacokinetic, and pharmacodynamic effects of UCN-01 and irinotecan in patients with resistant solid tumors.

EXPERIMENTAL DESIGN:

Patients received irinotecan (75-125 mg/m(2) IV on days 1, 8, 15, 22) and UCN-01 (50-90 mg/m(2) IV on day 2 and 25-45 mg/m(2) on day 23 and subsequent doses) every 42 days. Blood for pharmacokinetics of UCN-01 and irinotecan, and blood, normal rectal mucosa, and tumor biopsies for pharmacodynamic studies were obtained.

RESULTS:

Twenty-five patients enrolled to 5 dose levels. The MTD was irinotecan 125 mg/m(2) on days 1, 8, 15, 22 and UCN-01 70 mg/m(2) on day 2 and 35 mg/m(2) on day 23. DLTs included grade 3 diarrhea/dehydration and dyspnea. UCN-01 had a prolonged half-life and a low clearance rate. There was a significant reduction in SN-38 C(max) and aminopentanocarboxylic acid (APC) and SN-38 glucuronide half-lives. Phosphorylated ribosomal protein S6 was reduced in blood, normal rectal mucosa, and tumor biopsies at 24 h post-UCN-01. Two partial responses were observed in women with ER, PgR, and HER2-negative breast cancers (TBNC). Both tumors were defective for p53. Twelve patients had stable disease (mean duration 18 weeks, range 7-30 weeks).

CONCLUSION:

UCN-01 and irinotecan demonstrated acceptable toxicity and target inhibition. Anti-tumor activity was observed and a study of this combination in women with TNBC is underway.

• Authors: Paula M Fracasso, Kerry J Williams, Ronald C Chen, Joel Picus, Cynthia X Ma, Matthew J Ellis, Benjamin R Tan, Timothy J Pluard, Douglas R Adkins, Michael J Naughton, Janet S Rader, Matthew A Arquette, James W Fleshman, Allison N Creekmore, Sherry A Goodner, Lisa P Wright, Zhanfang Guo, Christine E Ryan, Yu Tao, Eliane M Soares, Shi-Rong Cai, Li Lin, Janet Dancey, Michelle A Rudek, Howard L McLeod, Helen Piwnica-Worms
• Journal: Cancer chemotherapy and pharmacology (Cancer Chemother Pharmacol) Vol. 67 Issue 6 Pg. 1225-37 (Jun 2011) ISSN: 1432-0843 [Electronic] Germany
• PMID: 20694727 (Publication Type: Clinical Trial, Phase I, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Irinotecan
• 7-hydroxystaurosporine
• Staurosporine
• Camptothecin

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (pharmacokinetics, pharmacology, therapeutic use)
• Camptothecin (administration & dosage, analogs & derivatives, pharmacokinetics)
• Drug Resistance, Neoplasm
• Female
• Humans
• Irinotecan
• Male
• Maximum Tolerated Dose
• Middle Aged
• Neoplasms (drug therapy, pathology)
• Staurosporine (administration & dosage, analogs & derivatives, pharmacokinetics, pharmacology)
• Young Adult