title: Selective intraperitoneal biochemical modulation of methotrexate by dipyridamole.
abstract: Dipyridamole increases the toxicity of methotrexate in a concentration-dependent manner. We hypothesized that concurrent intraperitoneal administration of both drugs would result in high peritoneal concentrations with much lower plasma concentrations, permitting a selective increase in the activity of methotrexate against intraperitoneal tumors without enhancing systemic toxicity. Initially, 2.16 mg/m2/d methotrexate and 12 mg/m2/d dipyridamole were delivered together as a constant intraperitoneal infusion for 48 hours. With escalation of chemotherapy, eventually 4.32 mg/m2/d methotrexate was administered for 168 hours. Forty-seven courses were administered to 18 patients. The mean peritoneal to plasma concentration ratios of methotrexate and non-protein bound dipyridamole were 71.6 +/- 34.8 and over 2,300, respectively. Chemical peritonitis was the dose-limiting toxicity. Three patients had some evidence of a response (two with decreasing tumor markers, and the third with a reduction in ascites). We conclude that the drug concentrations are in an appropriate range for selective intraperitoneal biochemical modulation of methotrexate, and that it is feasible to expose tumors confined to the peritoneal cavity to these drugs for long periods of time.
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla 92093.
authors.forename: R
authors.initials: R
authors.lastname: Goel
authors.forename: S M
authors.initials: SM
authors.lastname: Cleary
authors.forename: C
authors.initials: C
authors.lastname: Horton
authors.forename: F M
authors.initials: FM
authors.lastname: Balis
authors.forename: S
authors.initials: S
authors.lastname: Zimm
authors.forename: S
authors.initials: S
authors.lastname: Kirmani
authors.forename: S B
authors.initials: SB
authors.lastname: Howell
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004176:Dipyridamole / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D004347:Drug Interactions; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy*; D010538:Peritonitis / Q000139:chemically induced; D011379:Prognosis
chemical_list: D004176:Dipyridamole; D008727:Methotrexate