Nita S. Brown

Oral uracil and Ftorafur plus leucovorin: pharmacokinetics and toxicity in patients with metastatic cancer.

Purpose: To assess the pharmacokinetics of Ftorafur (tegafur, FT), 5-fluorouracil (5-FU), and uracil in 31 cancer patients who were enrolled in phase I studies of oral uracil and FT (UFT). The correlation between pharmacokinetic parameters and toxic effects of UFT was evaluated. Methods: Uracil and FT were orally administered in a 4:1 molar ratio at FT doses of 200–400 mg/m2 per day. Patients also received leucovorin at 150 mg/day. Daily doses were divided into three doses and administered at 8-h intervals for 28 consecutive days. Plasma FT concentrations were measured by high-performance liquid chromatography, and plasma 5-FU and uracil concentrations were determined using gas chromatography-mass spectrometry. National Institutes of Health Common Toxicity Criteria were used for assessment of toxicity. Results: The concentrations of FT, 5-FU, and uracil showed wide interpatient variations. Maximum plasma concentrations (Cpmax) of all three compounds were achieved in 0.3 to 4.0 h. At the various study doses, the terminal half-life (t1/2β) of FT ranged from 3.9 to 5.9 h, the area under the concentration-versus-time curve (AUC0–6h) ranged from 16,220 to 52,446 (ng/ml)h, the total clearance (ClT) ranged from 100 to 175 ml/min, and the steady-state volume of distribution (Vdss) ranged from 18.3 to 28.7 l. The 5-FU generated from FT had an apparent distribution half-life (t1/2α) and an apparent elimination half-life (t1/2β) of 0.3–1.3 h and 4.9–7.0 h, respectively. The AUC0–6h of 5-FU ranged from 120 to 325 (ng/ml)h. Uracil had a t1/2α of 0.2–0.5 h and the level quickly returned to the endogenous level. The AUC0–6h for uracil ranged from 605 to 3764 (ng/ml)h, the ClT ranged from 3225 to 7748 ml/min, and the Vdss ranged from 341 to 1354 l. The Cpmax and AUC0–6h of both FT and uracil were significantly correlated with FT doses (P-values of 0.0244 and 0.0112) and with uracil doses (P-values of 0.0346 and 0.0083), respectively. In addition to interpatient variations, intrapatient variations were also observed in six patients who had pharmacology studies done on days 1 and 26 ± 2 at the same study dose. We found that the repeated treatment with UFT caused cumulative increases in the values of Cpmax, Ctrough, and AUC0–6h of FT and 5-FU. The major toxic effects observed were diarrhea and nausea and vomiting. The occurrence of these toxic effects correlated significantly with the Cpmax and AUC0–6h of 5-FU. Conclusions: The pharmacology studies showed that FT and uracil were readily absorbed orally and that FT was rapidly converted to 5-FU. The preliminary findings suggest that determination of plasma levels of 5-FU after oral administration of UFT may help predict subsequent toxic effects.

Radioimmunoassay for the detection and quantitation of bruceantin

Abstract A radioimmunoassay for a new anticancer drug, bruceantin, has been developed using [ 3 H]acetylbruceantin and antibody induced by immunizing rabbits with succinylbruceantin-bovine serum albumin conjugates. [ 3 H]Acetylbruceantin was synthesized by reacting bruceantin with [ 3 H]acetyl anhydride. The assay is simple and reproducible. The standard curve was linear on a logit-log plot, and the lower limit of sensitivity of the assay was 1 ng/ml. Using this assay, drug levels were easily determined in tissues of experimental animals following bruceantin administration. The assay procedure does not require sample extraction for plasma, urine, and bile. Bruceantin in other tissues can be extracted quantitatively with ethanol before being measured by the radioimmunoassay.

Determination of plicamycin in plasma by radioimmunoassay.

This article describes a method for the determination of plicamycin in plasma by radioimmunoassay. The anti-plicamycin antibody was produced against a plicamycin-bovine serum albumin conjugate prepared by using diazotized p-aminobenzoic acid as a cross-linker. The radiolabeled ligand, 125I-plicamycin, was prepared by the chloramine-T method. The linear plicamycin concentration range was 7–400 ng/ml. The coefficients of variation for intra-and interday variabilities were 7.5 and 15%, respectively. No interference was observed from either the structurally related chromomycin A or concomitantly used drugs hydroxyurea or allopurinol. With this method of testing, plicamycin levels in plasma could be determined in patients receiving small (0.85–1.0 mg/m2) therapeutic plicamycin doses. Preliminary pharmacokinetic data in humans indicate that the plasma drug disappearance curve was biphasic with a mean elimination half-life of 10.6 ± 1.7 h, total clearance rate of 11.1 ± 0.4 ml/min/m2, and area under the plasma drug concentration-time curve of 1,289–1,546 ng-h/ml. This assay method is clinically useful for pharmacokinetic studies of plicamycin and may be helpful in the design of rational therapeutic drug trials.

Clinical pharmacology of bruceantin by radioimmunoassay.

SummaryDuring the phase I clinical trial of a new antitumor agent, bruceantin, the pharmacology was studied in 18 cancer patients. The drug was infused intravenously (IV) for 3 h at doses ranging from 1 to 3.6 mg/m2 per day for 5 days. The plasma drug disappearance curves were biphasic, with a fast initial half-life of less than 15 min. The second half-life (t1/2β) varied from 0.7 to 38 h among different patients and was not dose-related. The difference between the t1/2β on day 1 and that on day 5 was not significant. In patients with normal liver function, the mean plasma concentration at the end of infusion was 22 ng/ml, and the value of the area under the concentration x time curve (AUC) was 111 (ng/ml)h. In contrast, in patients with abnormal liver function the corresponding values were 115 ng/ml and 830 (ng/ml)h, respectively. In addition, these patients had a slower elimination half-life of 10.9 h and a decreased total clearance of 157. ml/min/m2, as compared with 2.6 h and 671 ml/min/m2, respectively, for the normal group. All these differences were statistically significant.Patients with abnormal liver function developed more severe toxicity, including fever, severe nausea, vomiting, and hypotension. Two patients with severe hepatic dysfunction received a reduced dose and developed no toxicity. These results demonstrated the importance of the effects of liver dysfunction on drug disposition and showed that the dosage should be reduced in patients with hepatic dysfunction.

Determination of peplomycin in mouse tissues and biofluids by radioimmunoassay

Peplomycin, an antitumour antibiotic analogue of bleomycin, was measured in mouse tissues using a rapid radioimmunoassay. Antiserum, obtained by immunizing rabbits with peplomycin-bovine serum albumin conjugate, showed no significant cross-reactivity with the closely related peplomycin analogues bleomycin and liblomycin, nor with a number of other structurally unrelated antitumour drugs. The assay is sensitive and can detect peplomycin levels as low as 2 ng ml-1. The relative intra- and inter-assay standard deviation is < or = 5%, indicating good assay reproducibility. Peplomycin levels in mouse tissues were easily determined without extraction. Fifteen minutes after administration of a single intraperitoneal dose of peplomycin at 8.5 mg kg-1 (1/10 of LD50), high drug levels were found in plasma (46 micrograms ml-1), kidneys (38 micrograms g-1), urine and bladder (32 micrograms ml-1), followed by gastrointestinal tract (13 micrograms g-1), lung (8 micrograms g-1), spleen (3.7 micrograms g-1), heart (3.6 micrograms g-1), gall bladder (2.7 micrograms g-1), liver (2 micrograms g-1), and brain (0.6 microgram g-1). The total amount of drug in all these organs accounted for more than 80% of the dose administered. We conclude that the radioimmunoassay is sensitive and reproducible and is an ideal tool for measuring peplomycin in tissues and biofluids for pharmacological studies.

Depletion of Patients' Plasma Tryptophan Using Tryptophan Side-Chain Oxidase Columns

The use of the enzyme tryptophan side-chain oxidase, isolated from Pseudomonas XA, was explored in 3 patients with refractory acute lymphocytic leukemia. Patients were given either a low-tryptophan diet or tryptophan-free hyperalimentation, prior to and during therapy. Their plasma, separated by pheresis, was continuously passed through a tryptophan depletion column containing the immobilized tryptophan side-chain oxidase. Up to 4 plasma volumes were passed through the column daily, 5 days per week for 2-3 weeks, and plasma tryptophan levels, both free and total, were measured by high-performance liquid chromatography. Pre- and postcolumn plasma samples were collected throughout the pheresis procedure. All postcolumn plasma samples had unmeasurable tryptophan levels throughout the treatment period, whereas precolumn samples were always measurable. Generally, tryptophan levels of plasma isolated from peripheral blood decreased after therapy, but rebounded by the next day. The enzyme depletion column reduces circulating plasma tryptophan levels, and its use is well tolerated by patients. However, further development of this method will require study of the effects of diet and of the duration, interval, and frequency of use of this column on therapeutic efficacy. Problems include difficulties with extended diet compliance and apparently intensive mobilization of tryptophan from body stores, which may preclude the clinical application of this enzyme depletion column.