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A Phase I and Pharmacokinetic Study of the Mitochondrial-specific Rhodacyanine Dye Analog MKT 077¹

Cancer Therapy and Research Center, Institute for Drug Development, and The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 [C. D. B., E. K. R., S. D. B., G. R. W., L. S., M. R., D. D. V. H., S. G. E.]; South Texas Oncology and Hematology, San Antonio, Texas 78229 [L. S.]; Brooke Army Medical Center, Fort Sam Houston, Texas 78234 [J. S.]; and Novartis Pharma AG, Basle, Switzerland [J. C., W. C.]

This Phase I study was performed to evaluate the tolerability and pharmacokinetic behavior of MKT-077, a water soluble rhodacyanine dye analogue, which partitions into tumor cell mitochondria where it is thought to act as a metabolic poison, leading to G₁ arrest and apoptosis. Thirteen patients with advanced solid malignancies were treated with MKT-077 administered as a 30-min i.v. infusion weekly for 4 weeks every 6 weeks at doses ranging from 42 to 126 mg/m²/week. The principal toxicity was renal magnesium wasting, which was dose-limiting (grade 3) in one patient at each of the 84- and 126-mg/m² dose levels. The other three patients at the 126-mg/m² dose level developed grade 2 hypomagnesemia, which was cumulative in nature, improved with i.v. magnesium supplementation, and was controlled in two patients by the administration of prophylactic magnesium before and after treatment with MKT-077. Given the requirement for extensive monitoring of serum magnesium levels, dose escalation >126 mg/m² was not considered feasible. Thus, the recommended dose for disease-oriented studies with this schedule of MKT-077 is 126 mg/m²/week. Pharmacokinetic studies revealed a prolonged terminal half-life (37 ± 17 h) and a large volume of distribution (685 ± 430 liters/m²). Clearance averaged 39 ± 13 liters/h/m². Peak MKT-077 plasma concentrations (1.2 ± 0.31 to 6.3 ± 5.3 µg/ml) exceeded the IC₅₀ concentrations required for human CX-1 colon, MCF-breast, CRL-1420 pancreas, EJ bladder, and LOX melanoma tumor cell lines in vitro (0.15–0.5 µg/ml). These results indicate that at the recommended dose level of 126 mg/m²/week of MKT-077, the toxicity profile was consistent with the preferential accumulation of the agent within tumor cell mitochondria, and biologically relevant plasma concentrations were achieved.

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