title: Phase I and pharmacokinetic study of brequinar sodium (NSC 368390).
abstract: Brequinar sodium is a quinoline carboxylic acid derivative that has shown antitumor activity in a number of in vivo murine and human tumor xenograft models. Its mechanism of action is blockade of de novo pyrimidine biosynthesis by inhibition of dihydroorotic acid dehydrogenase. In vitro and in vivo studies demonstrate the superiority of prolonged drug exposure in achieving tumor growth inhibition. This phase I study evaluated the administration of brequinar sodium by short, daily i.v. infusion for 5 days repeated every 4 weeks. Fifty-four subjects were enrolled in the study and received drug in doses ranging from 36-300 mg/m2. The dose-limiting toxicities were mucositis and diffuse skin rash. Other toxicities included myelosuppression, nausea, vomiting, malaise, and burning at the infusion site. The maximum tolerated dose on the "daily times 5" schedule was 300 mg/m2. The recommended phase II dose is 250 mg/m2. Pharmacokinetic analysis of the day 1 drug clearance curves in 51 subjects showed slight nonlinearity in the relationship between dose and area under the clearance curve (AUC). The dose versus AUC relationship was well described using a Michaelis-Menten model of brequinar elimination kinetics with Vmax = 45 (micrograms/ml)/h and Km = 123 micrograms. Analysis of the day 5 drug clearance curves revealed a diminution in Vmax to 30 (micrograms/ml)/h. As a consequence of the reduction in Vmax brequinar plasma concentrations on day 5 were higher than predicted from day 1 drug kinetics. Pharmacodynamic analysis of the day 1 kinetic parameters and the toxicities occurring during the first cycle of drug therapy revealed significant correlations between mucositis and dose, AUC, and peak brequinar concentration; between leukopenia and AUC and peak drug concentration; and between thrombocytopenia and beta elimination rate.
authors.affiliation: Johns Hopkins Oncology Center, Baltimore, Maryland 21205.
authors.forename: D A
authors.initials: DA
authors.lastname: Noe
authors.forename: E K
authors.initials: EK
authors.lastname: Rowinsky
authors.forename: H S
authors.initials: HS
authors.lastname: Shen
authors.forename: B V
authors.initials: BV
authors.lastname: Clarke
authors.forename: L B
authors.initials: LB
authors.lastname: Grochow
authors.forename: W B
authors.initials: WB
authors.lastname: McGuire
authors.forename: A
authors.initials: A
authors.lastname: Hantel
authors.forename: D B
authors.initials: DB
authors.lastname: Adams
authors.forename: M D
authors.initials: MD
authors.lastname: Abeloff
authors.forename: D S
authors.initials: DS
authors.lastname: Ettinger
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001713:Biphenyl Compounds / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D005260:Female; D006207:Half-Life; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011798:Quinaldines
chemical_list: D000970:Antineoplastic Agents; D001713:Biphenyl Compounds; C046943:brequinar; D011798:Quinaldines