Clinical potency of methotrexate, aminopterin, talotrexin and pemetrexed in childhood leukemias.
OBJECTIVE
Renewed interest in antifols for the treatment of childhood cancers has resulted from identification of novel antifols with broad spectrums of anti-cancer activity and from re-evaluation of the original clinical antifol, aminopterin. In this pre-clinical study we evaluated the in vitro activity of both traditional antifols (methotrexate, aminopterin) and novel antifols (pemetrexed, talotrexin) in childhood acute leukemias and lymphomas.


METHODS
We compared the in vitro cytotoxicity of methotrexate, aminopterin, pemetrexed, and talotrexin in a panel of six pediatric leukemia and lymphoma cell lines using the sulforhodamine B assay. In addition to defining a 50% growth inhibitory concentration (IC50) for a 120-h drug exposure, we contrasted the activity of the drugs in the context of clinically achievable (tolerable) drug exposures using the area under the plasma concentration-time curve (AUC). We defined each agent's clinical potency index (CPI) as the AUC achieved with standard pediatric dosing regimens divided by the in vitro IC50.


RESULTS
Across all cell lines, talotrexin (median IC50 7 nM) and aminopterin (median IC50 17 nM) had lower IC50's than methotrexate (median IC50 78 nM) and pemetrexed (median IC50 155 nM). However, the CPI for methotrexate (median 0.9) was significantly greater than that for aminopterin (median 0.4). In contrast, pemetrexed had a significantly better CPI (median 13) than the traditional antifols.


CONCLUSIONS
Aminopterin does not appear to offer any advantage over methotrexate for the treatment of childhood ALL. Further study of pemetrexed in childhood leukemias is warranted.
Division of Clinical Pharmacology and Therapeutics, Children's Hospital of Philadelphia, Abramson Research Center, 3615 Civic Center Blvd., Suite 916, Philadelphia, PA 19104, USA. norrisr@email.chop.edu
Robin E
RE
Norris
Peter C
PC
Adamson
D000630:Aminopterin / Q000737:chemistry / Q000494:pharmacology; D000970:Antineoplastic Agents / Q000737:chemistry / Q000494:pharmacology*; D045744:Cell Line, Tumor; D049109:Cell Proliferation / Q000187:drug effects*; D002470:Cell Survival / Q000187:drug effects; D002648:Child; D004305:Dose-Response Relationship, Drug; D005493:Folic Acid Antagonists / Q000737:chemistry / Q000494:pharmacology*; D005971:Glutamates / Q000737:chemistry / Q000494:pharmacology; D006147:Guanine / Q000031:analogs & derivatives / Q000737:chemistry / Q000494:pharmacology; D006801:Humans; D020128:Inhibitory Concentration 50; D019169:Jurkat Cells; D007938:Leukemia / Q000473:pathology; D008223:Lymphoma / Q000473:pathology; D008727:Methotrexate / Q000737:chemistry / Q000494:pharmacology; D015394:Molecular Structure; D009952:Ornithine / Q000031:analogs & derivatives / Q000737:chemistry / Q000494:pharmacology; D000068437:Pemetrexed; D011622:Pterins / Q000737:chemistry / Q000494:pharmacology
D000970:Antineoplastic Agents; D005493:Folic Acid Antagonists; D005971:Glutamates; D011622:Pterins; D000068437:Pemetrexed; C085590:N(alpha)-(4-amino-4-deoxypteroyl)-N(delta)-hemiphthaloyl-L-ornithine; D006147:Guanine; D009952:Ornithine; D000630:Aminopterin; D008727:Methotrexate