title: Suramin in adrenal cancer: modulation of steroid hormone production, cytotoxicity in vitro, and clinical antitumor effect.
abstract: Suramin, a drug known to have antiparasitic effects, has been previously shown to have adrenocorticolytic activity in primates. We now confirm preferential accumulation of this compound in the normal adrenal gland, evaluate its in vitro effect against two human adrenocortical carcinoma cell lines (SW-13 and NCI-H295), and report the clinical activity of suramin in 17 patients with metastatic adrenocortical carcinoma. Inhibition of colony formation occurred in both adrenal cell lines in vitro at concentrations that are clinically achievable in humans. In addition, suramin concentrations as low as 100 micrograms/mL were able to inhibit glucocorticoid, mineralocorticoid, and androgen production by the NCI-H295 cell line. Of 16 patients with adrenocortical carcinoma now evaluable for tumor response, 2 achieved a partial response, 2 had a minor response, and 5 remained with stable disease for periods ranging from 3-10 months; the remainder progressed. One of 7 patients with excessive steroid hormone production achieved a partial normalization of her steroid levels for the duration of suramin therapy in the setting of radiographic disease stabilization. An additional patient treated off-study for lack of radiographically measurable disease, achieved complete normalization of plasma aldosterone levels. We conclude that suramin preferentially accumulates in adrenal cells, induces cytotoxicity and significant down-regulation of steroid hormone production in vitro, and has some therapeutic efficacy as a single agent in patients with metastatic adrenocortical carcinoma.
authors.affiliation: Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892.
authors.forename: R V
authors.initials: RV
authors.lastname: La Rocca
authors.forename: C A
authors.initials: CA
authors.lastname: Stein
authors.forename: R
authors.initials: R
authors.lastname: Danesi
authors.forename: C A
authors.initials: CA
authors.lastname: Jamis-Dow
authors.forename: G H
authors.initials: GH
authors.lastname: Weiss
authors.forename: C E
authors.initials: CE
authors.lastname: Myers
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D000311:Adrenal Glands / Q000378:metabolism; D000328:Adult; D000368:Aged; D000818:Animals; D000970:Antineoplastic Agents; D002460:Cell Line; D005260:Female; D006728:Hormones / Q000378:metabolism; D006801:Humans; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008875:Middle Aged; D013256:Steroids / Q000378:metabolism; D013498:Suramin / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D014407:Tumor Cells, Cultured / Q000166:cytology* / Q000187:drug effects / Q000378:metabolism; D014410:Tumor Stem Cell Assay
chemical_list: D000970:Antineoplastic Agents; D006728:Hormones; D013256:Steroids; D013498:Suramin