title: Phase I study of the novel cyclic AMP (cAMP) analogue 8-chloro-cAMP in patients with cancer: toxicity, hormonal, and immunological effects.
abstract: The cyclic AMP (cAMP)-dependent protein kinase regulatory subunit RI is overexpressed in cancer cells. 8-Chloro-cAMP (8-Cl-cAMP) is an RII site-specific analogue that down-regulates RI and inhibits the growth of a wide range of cancer cells in vitro and in vivo. We performed a Phase I trial of 8-Cl-cAMP in 32 patients with malignancies that were refractory to standard treatments. 8-Cl-cAMP was initially given in a 1-month cycle by constant infusion at 0.005 mg/kg/h for 21 days, followed by 1 week of rest. The dose was escalated to 0.045 mg/kg/h, but hypercalcemia became the dose-limiting toxicity. The length of drug administration was, therefore, reduced to 5 days per week for the first 3 weeks of the cycle, but it was not possible to increase the drug dose without producing hypercalcemia. Hence, the length of drug administration was reduced to 3 days per week for the first 3 weeks of the cycle. The maximum tolerated dose for this regimen was 0.15 mg/kg/h, and the dose-limiting toxicities were reversible hypercalcemia and hepatotoxicity. Stable disease for > or =4 months was observed in two patients treated at > or =0.045 mg/kg. cAMP-dependent protein kinase is involved in hormone- and cytokine-mediated signaling, and so representative hormone, cytokine, and peripheral lymphocyte subsets were measured. The drug had a parathyroid hormone-like effect on calcium homeostasis and significantly increased circulating luteinizing hormone and 17-hydoxyprogesterone levels (P < 0.02 and P < 0.0006, respectively). We conclude that 8-Cl-cAMP is well tolerated without attendant myelotoxicity, and in this study, it was associated with biological effects. In Phase II studies, a dose of 0.11 mg/kg/h for 3 days per week would be appropriate.
authors.affiliation: Imperial Cancer Research Fund Medical Oncology Unit, University of Oxford, Churchill Hospital, United Kingdom.
authors.forename: D J
authors.initials: DJ
authors.lastname: Propper
authors.forename: M P
authors.initials: MP
authors.lastname: Saunders
authors.forename: A J
authors.initials: AJ
authors.lastname: Salisbury
authors.forename: L
authors.initials: L
authors.lastname: Long
authors.forename: K J
authors.initials: KJ
authors.lastname: O'Byrne
authors.forename: J P
authors.initials: JP
authors.lastname: Braybrooke
authors.forename: M
authors.initials: M
authors.lastname: Dowsett
authors.forename: M
authors.initials: M
authors.lastname: Taylor
authors.forename: D C
authors.initials: DC
authors.lastname: Talbot
authors.forename: T S
authors.initials: TS
authors.lastname: Ganesan
authors.forename: A L
authors.initials: AL
authors.lastname: Harris
mesh_terms: D015124:8-Bromo Cyclic Adenosine Monophosphate / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006728:Hormones / Q000378:metabolism; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced; D007668:Kidney / Q000187:drug effects; D008099:Liver / Q000187:drug effects; D016131:Lymphocyte Subsets / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D009369:Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000970:Antineoplastic Agents; D016207:Cytokines; D006728:Hormones; D015124:8-Bromo Cyclic Adenosine Monophosphate; C044258:8-chloro-cyclic adenosine monophosphate