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Phase I pharmacological and bioavailability study of oral diflomotecan (BN80915), a novel E-ring-modified camptothecin analogue in adults with solid tumors.
Clin Cancer Res. 2003 Sep 15; 9(11):4101-7.CC

Abstract

PURPOSE

Diflomotecan (BN80915) is an E-ring modified camptothecin analogue that possesses greater lactone stability in plasma compared with other topoisomerase I inhibitors, a potential advantage for antitumor activity. As with other camptothecins, oral administration has pharmacological and clinical advantages. This Phase I study was performed to assess the feasibility of the administration of oral diflomotecan, to determine the maximum-tolerated, dose its bioavailability, and to explore the pharmacokinetics.

EXPERIMENTAL DESIGN

An initial i.v. bolus was administered to assess the bioavailability of diflomotecan. Fourteen days later, diflomotecan was administered p.o. once daily for 5 days to adult patients with solid malignant tumors and repeated every 3 weeks. BN80915 and its open lactone form BN80942 were measured.

RESULTS

Twenty-two patients entered the study and received a total of 57 cycles of oral diflomotecan at flat dose levels of 0.10, 0.20, 0.27, and 0.35 mg. The main toxicity was hematological, but some patients experienced alopecia, mild gastrointestinal toxicity, and fatigue. At the 0.35-mg dose level, 2 of 4 patients experienced dose-limiting toxicity comprising grade 3 thrombocytopenia with epistaxis and febrile neutropenia in 1 patient and uncomplicated grade 4 neutropenia lasting for >7 days in another. Toxicity was acceptable at the 0.27-mg dose level at which dose-limiting toxicities were observed in 3 of 12 patients (grade 4 neutropenia > 7 days, complicated by fever in 1 patient but without other signs of infection). After two cycles of diflomotecan, 6 patients had disease stabilization, which was maintained in 2 patients for 9 months and >1 year, respectively. Diflomotecan pharmacokinetics were linear over the dose range studied. Systemic exposure correlated with the fall in WBC counts. The mean oral bioavailability (+/-SD) was 72.24 +/- 59.2% across all dose levels. Urinary excretion of BN80915 was very low.

CONCLUSIONS

The recommended oral diflomotecan dose for Phase II studies is 0.27 mg/day x 5 every 3 weeks. This regimen is convenient and generally well tolerated with a favorable pharmacokinetic profile and high but variable bioavailability.

Authors+Show Affiliations

Department of Medical Oncology, Erasmus MC-Daniel den Hoed, 3008 AE Rotterdam, the Netherlands. a.j.gelderblom@lumc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Clinical Trial, Phase I
Journal Article

Language

eng

PubMed ID

14519632

Citation

Gelderblom, Hans, et al. "Phase I Pharmacological and Bioavailability Study of Oral Diflomotecan (BN80915), a Novel E-ring-modified Camptothecin Analogue in Adults With Solid Tumors." Clinical Cancer Research : an Official Journal of the American Association for Cancer Research, vol. 9, no. 11, 2003, pp. 4101-7.
Gelderblom H, Salazar R, Verweij J, et al. Phase I pharmacological and bioavailability study of oral diflomotecan (BN80915), a novel E-ring-modified camptothecin analogue in adults with solid tumors. Clin Cancer Res. 2003;9(11):4101-7.
Gelderblom, H., Salazar, R., Verweij, J., Pentheroudakis, G., de Jonge, M. J., Devlin, M., van Hooije, C., Seguy, F., Obach, R., Pruñonosa, J., Principe, P., & Twelves, C. (2003). Phase I pharmacological and bioavailability study of oral diflomotecan (BN80915), a novel E-ring-modified camptothecin analogue in adults with solid tumors. Clinical Cancer Research : an Official Journal of the American Association for Cancer Research, 9(11), 4101-7.
Gelderblom H, et al. Phase I Pharmacological and Bioavailability Study of Oral Diflomotecan (BN80915), a Novel E-ring-modified Camptothecin Analogue in Adults With Solid Tumors. Clin Cancer Res. 2003 Sep 15;9(11):4101-7. PubMed PMID: 14519632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Phase I pharmacological and bioavailability study of oral diflomotecan (BN80915), a novel E-ring-modified camptothecin analogue in adults with solid tumors. AU - Gelderblom,Hans, AU - Salazar,Ramon, AU - Verweij,Jaap, AU - Pentheroudakis,George, AU - de Jonge,Maja J A, AU - Devlin,Martin, AU - van Hooije,Christel, AU - Seguy,Francis, AU - Obach,Rosendo, AU - Pruñonosa,Joan, AU - Principe,Paola, AU - Twelves,Chris, PY - 2003/10/2/pubmed PY - 2004/8/18/medline PY - 2003/10/2/entrez SP - 4101 EP - 7 JF - Clinical cancer research : an official journal of the American Association for Cancer Research JO - Clin Cancer Res VL - 9 IS - 11 N2 - PURPOSE: Diflomotecan (BN80915) is an E-ring modified camptothecin analogue that possesses greater lactone stability in plasma compared with other topoisomerase I inhibitors, a potential advantage for antitumor activity. As with other camptothecins, oral administration has pharmacological and clinical advantages. This Phase I study was performed to assess the feasibility of the administration of oral diflomotecan, to determine the maximum-tolerated, dose its bioavailability, and to explore the pharmacokinetics. EXPERIMENTAL DESIGN: An initial i.v. bolus was administered to assess the bioavailability of diflomotecan. Fourteen days later, diflomotecan was administered p.o. once daily for 5 days to adult patients with solid malignant tumors and repeated every 3 weeks. BN80915 and its open lactone form BN80942 were measured. RESULTS: Twenty-two patients entered the study and received a total of 57 cycles of oral diflomotecan at flat dose levels of 0.10, 0.20, 0.27, and 0.35 mg. The main toxicity was hematological, but some patients experienced alopecia, mild gastrointestinal toxicity, and fatigue. At the 0.35-mg dose level, 2 of 4 patients experienced dose-limiting toxicity comprising grade 3 thrombocytopenia with epistaxis and febrile neutropenia in 1 patient and uncomplicated grade 4 neutropenia lasting for >7 days in another. Toxicity was acceptable at the 0.27-mg dose level at which dose-limiting toxicities were observed in 3 of 12 patients (grade 4 neutropenia > 7 days, complicated by fever in 1 patient but without other signs of infection). After two cycles of diflomotecan, 6 patients had disease stabilization, which was maintained in 2 patients for 9 months and >1 year, respectively. Diflomotecan pharmacokinetics were linear over the dose range studied. Systemic exposure correlated with the fall in WBC counts. The mean oral bioavailability (+/-SD) was 72.24 +/- 59.2% across all dose levels. Urinary excretion of BN80915 was very low. CONCLUSIONS: The recommended oral diflomotecan dose for Phase II studies is 0.27 mg/day x 5 every 3 weeks. This regimen is convenient and generally well tolerated with a favorable pharmacokinetic profile and high but variable bioavailability. SN - 1078-0432 UR - https://www.unboundmedicine.com/medline/citation/14519632/Phase_I_pharmacological_and_bioavailability_study_of_oral_diflomotecan__BN80915__a_novel_E_ring_modified_camptothecin_analogue_in_adults_with_solid_tumors_ L2 - http://clincancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=14519632 DB - PRIME DP - Unbound Medicine ER -