Phase I dose-escalating study of PM02734 in a 24-hour infusion schedule every 21 days in advanced solid tumors

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Background: PM02734 is a chemically synthesized depsipeptide with a broad spectrum of activity against solid tumors in vitro (breast, colon, lung, neuroblastoma, prostate, sarcoma and thyroid) and in vivo (breast, prostate, melanoma); as well as an acceptable non-clinical toxicology profile. Methods: Patients (pts) with metastatic or advanced solid tumors were enrolled in a phase I, open-label, dose-escalating study to assess safety, tolerability, pharmacokinetics (PK), and to identify the dose limiting toxicity (DLT) and recommended dose (RD) of PM02734 infused over 24 hours every 21 days (d). The starting dose was 0.48 mg/m2. Cohorts of 1–6 pts were treated at different dose levels. Results: Thirty seven pts were treated in this study. The median age was 55 years (40–75), sex: males/females 20/19. The median PS was 1 (range 0–2). The most frequent cancer types were colon/ gastric/ sarcoma (n=8/5/5). Most patients were heavily pretreated, with a median of prior therapy lines of 4 (1–12). Patients were treated at 8 dose levels (0.48, 0.72, 1.0, 1.6, 2.4, 3.6, 5.4, and 6.8 mg/m2), the MTD was 6.8 mg/m2 and the RD was 5.4 mg/m2 (10 mg flat dose).Common toxicities grade ≤ 2 included asthenia, nausea/emesis, lymphopenia, injection site reactions and asymptomatic elevated transaminases (TAs). DLT were grade 3 asymptomatic, reversible TA elevations at 6.8 mg/m2. Preliminary PK data is characterized by long half life (>100 h), a wide distribution and high inter-patient variability. Clearance was not correlated with dose or body surface area (BSA), therefore, flat dose was implemented and the RD was explored with this schedule. Efficacy data showed one complete response (CR) of +28 months observed in a pt with metastatic large cell esophageal carcinoma, and five more showed stable disease (SD) for more than 3 months in different histologies. Conclusions: PM02734 shows to be safe, well tolerated and with evidence of activity (1 CR and 5 SD > 3 months) in pts with advanced solid tumors. The DLT was grade 3 asymptomatic and reversible TA elevations, and the RD for further phase II studies is 10 mg.

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Control of E1A under an E2F-1 promoter insulated with the myotonic dystrophy locus insulator reduces the toxicity of oncolytic adenovirus Ad-Δ24RGD

We previously described Ad-Delta24RGD as an enhanced-infectivity oncolytic adenovirus that targets tumors with an impaired RB pathway. The common alteration of this pathway in cancer eliminates the interaction of pRB with E2F and releases free E2F to activate E2F-responsive promoters, including the E2F-1 promoter. To improve the selectivity towards RB pathway-defective tumors and reduce the toxicity of Ad-Delta24RGD we aimed to control E1A-Delta24 expression under the E2F-1 promoter. A polyA signal was inserted upstream of the E2F-1 promoter to stop transcription initiated at the adenovirus ITR and packaging signal. The human myotonic dystropy locus insulator (DM-1) was also located between the E1a enhancers and the E2F-1 promoter to further insulate the promoter. The Ad-Delta24RGD derivative containing these insulation sequences expressed less E1a-Delta24 in normal cells and resulted less toxic while maintaining the potent oncolytic activity of the parental virus. These results demonstrate that the human DM-1 inslulator can function in an adenovirus context to maintain heterologous promoter selectivity. The new oncolytic adenovirus presented here may represent a valuable therapeutic option for a broad range of tumors with a deregulated E2F/pRB pathway.

Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial

OBJECTIVE

To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment.

DESIGN

Randomised controlled trial.

SETTING

Large teaching hospital.

PARTICIPANTS

87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer.

INTERVENTIONS

Treatment with fluorouracil (with or without folinic acid or levamisole) at outpatient clinic or at home.

MAIN OUTCOME MEASURES

Treatment toxicity; patients' compliance with treatment, quality of life, satisfaction with care, and use of health resources.

RESULTS

42 patients were treated at outpatient clinic and 45 at home. The two groups were balanced in terms of age, sex, site of cancer, and disease stage. Treatment related toxicity was similar in the two groups (difference 7% (95% confidence interval -12% to 26%)), but there were more voluntary withdrawals from treatment in the outpatient group than in the home group (14% v 2%, difference 12% (1% to 24%)). There were no differences between groups in terms of quality of life scores during and after treatment. Levels of patient satisfaction were higher in the home treatment group, specifically with regard to information received and nursing care. There were no significant differences in use of health services.

CONCLUSIONS

Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment.

Mortality in testicular cancer: 10 years' experience at a single centre

The aim of the present study was to investigate the causes of death in patients with germ cell testicular tumours (GCTTs), especially those due to persistent or recurrent tumours, and to determine potentially avoidable deaths. Among 299 patients with GCTTs there were 27 (9%) deaths: 21 (78%) had non-seminomatous GCTTs and 6 (22%) had seminomatous GCTTs. Sixteen deaths (59%) were due to progressive disease, 6 (22%) were treatment-related, 4 (15%) were due to incidental causes, and 1 was a sudden, unexplained death. The analysis of the data led us to the conclusion that some deaths are still potentially avoidable.

False elevations of human chorionic gonadotropin associated to iatrogenic hypogonadism in gonadal germ cell tumors

Radioimmunoassay (RIA) for fraction beta of the chorionic gonadotropin hormone (HCG-beta subunit) has a clinical value in the management of patients with gonadal germ cell tumors (GCT). Treatment of disease causes temporary or permanent iatrogenic hypogonadism and secondary plasmatic elevations of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Small but significant cross-reactions with LH have been observed, resulting in spurious elevations of HCG, as result, also in part, of the lack of specificity of the RIA. Twelve patients with complete response showed high HCG follow-up levels between 1.7 and 7.8 mIU/ml; simultaneous determination of LH and FSH resulted, also, in high levels: 79.9 to 24.9 mIU/ml and 80 to 19.2 mIU/ml, respectively, in females, and 78 to 18 mIU/ml and 65.1 to 5 mIU/ml, respectively, in males. Administration of exogenous hormones resulted in all cases in reduction of LH and FSH values and normalization of HCG. Therefore, relationship between spurious elevations of HCG and the iatrogenic hypogonadism is clarified through this simple technique that is of most importance as regards the adoption of the appropriate therapy.