Concentrations of the DNA methyltransferase inhibitor 5-fluoro-2'-deoxycytidine (FdCyd) and its cytotoxic metabolites in plasma of patients treated with FdCyd and tetrahydrouridine (THU).
OBJECTIVE
Although the DNA methyltransferase inhibitor 5-fluoro-2'-deoxycytidine (FdCyd), is being evaluated clinically, it must be combined with the cytidine deaminase inhibitor tetrahydrouridine (THU) to prevent rapid metabolism of FdCyd to the pharmacologically active, yet unwanted, metabolites 5-fluoro-2'-deoxyuridine (FdUrd), 5-fluorouracil (FU), and 5-fluorouridine (FUrd). We assessed plasma concentrations of FdCyd and metabolites in patients receiving FdCyd and THU.


METHODS
We validated an LC-MS/MS assay, developed for a preclinical study, to quantitate FdCyd and metabolites in human plasma. Patients were treated with five daily, 3-h infusions of FdCyd at doses of 5-80 mg/m(2) with 350 mg/m(2) THU. Plasma was obtained during, and before the end of infusions on days 1 and 5.


RESULTS
The lower limits of quantitation for FU, FdUrd, FUrd, FC and FdCyd were 1, 1.5, 10, 3, and 10 ng/ml, respectively. Plasma FdCyd increased with dose, from 19-96 ng/ml at 5 mg/m(2) to 1,600-1,728 ng/ml at 80 mg/m(2). FdUrd was undetectable in patients treated with FdCyd doses <20 mg/m(2), and increased from 2.3 ng/ml at 20 mg/m(2) to 3.5-5.7 ng/ml at 80 mg/m(2). FU increased from 1.2-5.5 ng/ml at 5 mg/m(2) to 6.0-12 ng/ml at 80 mg/m(2).


CONCLUSIONS
By co-administering FdCyd with THU, FdCyd plasma concentrations were achieved that are known to inhibit DNA methylation in vitro. The accompanying plasma FU and FdUrd concentrations are <10% those observed after therapeutic infusions of FU or FdUrd, while FdCyd levels are well above those required to inhibit methylation in vitro. Therefore, inhibition of DNA methylation with FdCyd and THU appears feasible.
Beumer
Jan H
JH
Molecular Therapeutics/Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, 15213, USA. beumerjh@upmc.edu
Parise
Robert A
RA
Newman
Edward M
EM
Doroshow
James H
JH
Synold
Timothy W
TW
Lenz
Heinz-Josef
HJ
Egorin
Merrill J
MJ
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism; D002851:Chromatography, High Pressure Liquid; D015254:DNA Modification Methylases / Q000037:antagonists & inhibitors*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005467:Floxuridine / Q000097:blood; D005472:Fluorouracil / Q000097:blood; D006801:Humans; D007262:Infusions, Intravenous; D015203:Reproducibility of Results; D053719:Tandem Mass Spectrometry; D013767:Tetrahydrouridine / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism; D014529:Uridine / Q000031:analogs & derivatives / Q000097:blood
D000970:Antineoplastic Agents; D005467:Floxuridine; D003841:Deoxycytidine; D013767:Tetrahydrouridine; C001943:5-fluorouridine; D015254:DNA Modification Methylases; C007746:5-fluoro-2'-deoxycytidine; D005472:Fluorouracil; D014529:Uridine