title: Troxacitabine, a novel dioxolane nucleoside analog, has activity in patients with advanced leukemia.
abstract: OBJECTIVE
  To investigate the toxicity profile, activity, and pharmacokinetics of a novel L-nucleoside analog, troxacitabine (BCH-4556), in patients with advanced leukemia.
  
  
  METHODS
  Patients with refractory or relapsed acute myeloid (AML) or lymphocytic (ALL) leukemia, myelodysplastic syndromes (MDS), or chronic myelogenous leukemia in blastic phase (CML-BP). Troxacitabine was given as an intravenous infusion over 30 minutes daily for 5 days. The starting dose was 0.72 mg/m(2)/d (3.6 mg/m(2)/course). Courses were given every 3 to 4 weeks according to toxicity and antileukemic efficacy. The dose was escalated by 50% until grade 2 toxicity was observed, and then by 30% to 35% until the dose-limiting toxicity (DLT) was defined.
  
  
  RESULTS
  Forty-two patients (AML: 31 patients; MDS: six patients [five MDS + one CMML]; ALL: four patients; CML-BP: one patient) were treated. Median age was 61 years (range, 23 to 79 years), and 29 patients were males. Stomatitis and hand-foot syndrome were the DLTs. The MTD was defined as 8 mg/m(2)/d. The pharmacokinetic behavior of troxacitabine is linear over the dose range of 0.72 to 10.0 m/m(2). Approximately 69% of troxacitabine was excreted as unchanged drug in the urine. Marrow hypoplasia occurred between days 14 and 28 in 73% of AML patients. Three complete remissions and one partial remission were observed in 30 assessable AML patients. One MDS patient achieved a hematologic improvement. A patient with CML-BP achieved a return to chronic phase disease.
  
  
  CONCLUSIONS
  Troxacitabine has a unique metabolic and pharmacokinetic profile and significant antileukemic activity. DLTs were stomatitis and hand-foot syndrome. Troxacitabine merits further study in hematologic malignancies.
authors.affiliation: Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA. frankgiles@aol.com
authors.forename: F J
authors.initials: FJ
authors.lastname: Giles
authors.forename: J E
authors.initials: JE
authors.lastname: Cortes
authors.forename: S D
authors.initials: SD
authors.lastname: Baker
authors.forename: D A
authors.initials: DA
authors.lastname: Thomas
authors.forename: S
authors.initials: S
authors.lastname: O'Brien
authors.forename: T L
authors.initials: TL
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Beran
authors.forename: C
authors.initials: C
authors.lastname: Bivins
authors.forename: J
authors.initials: J
authors.lastname: Jolivet
authors.forename: H M
authors.initials: HM
authors.lastname: Kantarjian
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001752:Blast Crisis / Q000188:drug therapy / Q000378:metabolism; D003596:Cytosine / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004148:Dioxolanes / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007938:Leukemia / Q000188:drug therapy* / Q000378:metabolism; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000378:metabolism; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D004148:Dioxolanes; C074908:troxacitabine; D003596:Cytosine