title: Phase I study of nelfinavir in liposarcoma.
abstract: OBJECTIVE
  HIV protease inhibitors are associated with HIV protease inhibitor-related lipodystrophy syndrome. We hypothesized that liposarcomas would be similarly susceptible to the apoptotic effects of an HIV protease inhibitor, nelfinavir.
  
  
  METHODS
  We conducted a phase I trial of nelfinavir for liposarcomas. There was no limit to prior chemotherapy. The starting dose was 1,250 mg twice daily (Level 1). Doses were escalated in cohorts of three to a maximally evaluated dose of 4,250 mg (Level 5). One cycle was 28 days. Steady-state pharmacokinetics (PKs) for nelfinavir and its primary active metabolite, M8, were determined at Levels 4 (3,000 mg) and 5.
  
  
  RESULTS
  Twenty subjects (13 males) were enrolled. Median (range) age was 64 years (37-81). One subject at Level 1 experienced reversible, grade 3 pancreatitis after 1 week and was replaced. No other dose-limiting toxicities were observed. Median (range) number of cycles was 3 (0.6-13.5). Overall best responses observed were 1 partial response, 1 minor response, 4 stable disease, and 13 progressive disease. Mean peak plasma levels and AUCs for nelfinavir were higher at Level 4 (7.3 mg/L; 60.9 mg/L × h) than 5 (6.3 mg/L; 37.7 mg/L × h). The mean ratio of M8:nelfinavir AUCs for both levels was ~1:3.
  
  
  CONCLUSIONS
  PKs demonstrate auto-induction of nelfinavir clearance at the doses studied, although the mechanism remains unclear. Peak plasma concentrations were within range where anticancer activity was demonstrated in vitro. M8 metabolite is present at ~1/3 the level of nelfinavir and may also contribute to the anticancer activity observed.
authors.affiliation: Department of Medical Oncology, City of Hope, Duarte, CA 91010, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Pan
authors.forename: Michelle
authors.initials: M
authors.lastname: Mott
authors.forename: Bixin
authors.initials: B
authors.lastname: Xi
authors.forename: Ernestine
authors.initials: E
authors.lastname: Hepner
authors.forename: Min
authors.initials: M
authors.lastname: Guan
authors.forename: Kristen
authors.initials: K
authors.lastname: Fousek
authors.forename: Rachel
authors.initials: R
authors.lastname: Magnusson
authors.forename: Raechelle
authors.initials: R
authors.lastname: Tinsley
authors.forename: Frances
authors.initials: F
authors.lastname: Valdes
authors.forename: Paul
authors.initials: P
authors.lastname: Frankel
authors.forename: Timothy
authors.initials: T
authors.lastname: Synold
authors.forename: Warren A
authors.initials: WA
authors.lastname: Chow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D004334:Drug Administration Schedule; D005260:Female; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000188:drug therapy; D006801:Humans; D008080:Liposarcoma / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D019888:Nelfinavir / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D012107:Research Design; D016896:Treatment Outcome
chemical_list: D017320:HIV Protease Inhibitors; D019888:Nelfinavir