title: First-into-man phase I and pharmacokinetic study of XR5944.14, a novel agent with a unique mechanism of action.
abstract: The bis-phenazine XR5944.14 is a novel cytotoxic agent which intercalates into DNA and inhibits transcription. The objectives of this study were to determine the dose-limiting toxicity (DLT), the maximum tolerated dose (MTD) and to describe the pharmacokinetics (PKs) of XR5944.14 when given at doses ranging from 3.6 to 36 mg m(-2) every 3 weeks to patients with advanced tumours. Twenty-seven patients were treated with a total of 77 cycles. Dose-limiting toxicities occurred at doses > or =24 mg m(-2). Oral mucositis was the most common DLT. Two patients developed acute renal failure possibly related to the study drug. Other less-severe toxicities were diarrhoea, nausea, vomiting and fatigue. Haematological toxicity was mild. One patient showed an objective partial response. Pharmacokinetic analysis was performed during the first cycle of treatment and plasma was assayed for XR5944.14 using a validated liquid chromatography tandem mass spectrometry. The systemic exposure of XR5944.14 increased more than proportionally with increasing dose, with inter-patient variability increasing from dose level 24 mg m(-2) onwards. The lack of correlation between toxicity and PK values makes it difficult to recommend a dose for further study in phase 2 trials. More work is needed to explain the inter- and intra-individual variation in PKs and pharmacodynamics.
authors.affiliation: Division of Cancer Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
authors.forename: W
authors.initials: W
authors.lastname: Verborg
authors.forename: H
authors.initials: H
authors.lastname: Thomas
authors.forename: D
authors.initials: D
authors.lastname: Bissett
authors.forename: J
authors.initials: J
authors.lastname: Waterfall
authors.forename: J
authors.initials: J
authors.lastname: Steiner
authors.forename: M
authors.initials: M
authors.lastname: Cooper
authors.forename: E M
authors.initials: EM
authors.lastname: Rankin
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010619:Phenazines / Q000493:pharmacokinetics* / Q000633:toxicity
chemical_list: D010619:Phenazines; C434883:XR5944