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A Phase I Trial of a Potent P-Glycoprotein Inhibitor, Zosuquidar.3HCl Trihydrochloride (LY335979), Administered Orally in Combination with Doxorubicin in Patients with Advanced Malignancies

Departments of Medicine and Pharmacology, Robert-Wood Johnson Medical School [E. H. R., R. M., S. L. G., S. L. S., D. L. T., J. M., M. K.] and Division of Biometrics, The Cancer Institute of New Jersey [Y. L.], University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey 08903; Lilly Research Laboratories, Indianapolis, Indiana 46285 [L. G., P. M., A. C., C. J., C. A. S.]; and Lilly Research Centre, Erl Wood, Surrey, GU206PH United Kingdom [D. P. d. A., I. P., M. B.]

Purpose: The purpose of this study was to investigate the safety and tolerability of Zosuquidar.3HCl, a potent inhibitor of P-glycoprotein (Pgp), when administered p.o. alone and in combination with doxorubicin and to determine whether Zosuquidar.3HCl affects doxorubicin pharmacokinetics and inhibits Pgp function in peripheral blood natural killer lymphocytes.

Experimental Design: Patients with advanced nonhematological malignancies were eligible for this Phase I trial. Zosuquidar.3HCl and doxorubicin were administered separately during the first cycle of therapy and then administered concurrently. Zosuquidar.3HCl was administered over 4 days, with doses escalated until the occurrence of dose-limiting toxicity. Subsequently, doxorubicin doses were increased from 45 to 75 mg/m². Zosuquidar.3HCl, doxorubicin, and doxorubicinol pharmacokinetics were analyzed, and dual fluorescence cytometry was used to determine the effects of Zosuquidar.3HCl on Pgp function in natural killer cells.

Results: A total of 38 patients were treated at nine dose levels. Neurotoxicity was dose-limiting for oral Zosuquidar.3HCl, characterized by cerebellar dysfunction, hallucinations, and palinopsia. The maximum-tolerated dose for oral Zosuquidar.3HCl administered every 12 h for 4 days is 300 mg/m². Zosuquidar.3HCl did not affect doxorubicin myelosuppression or pharmacokinetics, and Zosuquidar.3HCl pharmacokinetics were similar in the absence and presence of doxorubicin. Higher plasma concentrations of Zosuquidar.3HCl were associated with greater Pgp inhibition in natural killer cells.

Conclusion: Zosuquidar.3HCl can be coadministered with doxorubicin using a 4-day oral dosing schedule, with little effect on doxorubicin toxicity or pharmacokinetics. Further refinement in Zosuquidar.3HCl dosing and scheduling should be explored to optimize Pgp inhibition while minimizing cerebellar toxicity.

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