title: A phase 1/2 trial of arginine butyrate and ganciclovir in patients with Epstein-Barr virus-associated lymphoid malignancies.
abstract: Malignancies associated with latent Epstein-Barr virus (EBV) are resistant to nucleoside-type antiviral agents because the viral enzyme target of these antiviral drugs, thymidine kinase (TK), is not expressed. Short-chain fatty acids, such as butyrate, induce EBV-TK expression in latently infected B cells. As butyrate has been shown to sensitize EBV(+) lymphoma cells in vitro to apoptosis induced by ganciclovir, arginine butyrate in combination with ganciclovir was administered in 15 patients with refractory EBV(+) lymphoid malignancies to evaluate the drug combination for toxicity, pharmacokinetics, and clinical responses. Ganciclovir was administered twice daily at standard doses, and arginine butyrate was administered by continuous infusion in an intrapatient dose escalation, from 500 mg/(kg/day) escalating to 2000 mg/(kg/day), as tolerated, for a 21-day cycle. The MTD for arginine butyrate in combination with ganciclovir was established as 1000 mg/(kg/day). Ten of 15 patients showed significant antitumor responses, with 4 CRs and 6 PRs within one treatment cycle. Complications from rapid tumor lysis occurred in 3 patients. Reversible somnolence or stupor occurred in 3 patients at arginine butyrate doses of greater than 1000 mg/(kg/day). The combination of arginine butyrate and ganciclovir was reasonably well-tolerated and appears to have significant biologic activity in vivo in EBV(+) lymphoid malignancies which are refractory to other regimens.
authors.affiliation: Cancer Research Center, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Perrine
authors.forename: Olivier
authors.initials: O
authors.lastname: Hermine
authors.forename: Trudy
authors.initials: T
authors.lastname: Small
authors.forename: Felipe
authors.initials: F
authors.lastname: Suarez
authors.forename: Richard
authors.initials: R
authors.lastname: O'Reilly
authors.forename: Farid
authors.initials: F
authors.lastname: Boulad
authors.forename: Joyce
authors.initials: J
authors.lastname: Fingeroth
authors.forename: Melissa
authors.initials: M
authors.lastname: Askin
authors.forename: Arthur
authors.initials: A
authors.lastname: Levy
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Mentzer
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Nicola
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Gianni
authors.forename: Christoph
authors.initials: C
authors.lastname: Klein
authors.forename: Steven
authors.initials: S
authors.lastname: Horwitz
authors.forename: Douglas V
authors.initials: DV
authors.lastname: Faller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001120:Arginine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002087:Butyrates / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000821:virology*; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents; D002087:Butyrates; D001120:Arginine; C033018:arginine butyrate; D015774:Ganciclovir