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Clinical Cancer Research Vol. 8, 718-728, March 2002
© 2002 American Association for Cancer Research


Clinical Trials

Phase I Trial of the Histone Deacetylase Inhibitor, Depsipeptide (FR901228, NSC 630176), in Patients with Refractory Neoplasms

Victor Sandor, Susan Bakke, Robert W. Robey, Min H. Kang, Mikhail V. Blagosklonny, Jonathon Bender, Rebecca Brooks, Richard L. Piekarz, Eben Tucker, William D. Figg, Kenneth K. Chan, Barry Goldspiel, Antonio Tito Fojo, Stanley P. Balcerzak and Susan E. Bates1

McGill University, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada H3T 1E2 [V. S.]; Cancer Therapeutics Branch, Center for Cancer Research, National Cancer Institute [S. B., R. W. R., M. H. K., M. V. B., R. L. P., W. D. F., A. T. F., S. E. B.], Clinical Center, Cardiology [E. T.], and Clinical Center, Pharmacy [B. G.], NIH, Bethesda, Maryland 20892; and The Ohio State University, Columbus, Ohio 43210 [J. B., R. B., K. K. C., S. P. B.]

Purpose: The primary objectives of this trial were to define the maximum tolerated dose (MTD) and to characterize the toxicities and pharmacokinetics of depsipeptide (FR901228) given on a day-1 and day-5 schedule every 21 days. A secondary objective of the trial was to seek evidence of antineoplastic activity.

Patients and Methods: Patients with advanced or refractory neoplasms received depsipeptide by a 4-h i.v. infusion on days 1 and 5 of a 21-day cycle. On the basis of preclinical data suggesting that depsipeptide may have significant cardiac toxicity, patients were treated while receiving continuous cardiac monitoring and were followed with serial cardiac enzyme determinations, electrocardiograms (ECGs), and nuclear ventriculograms (MUGA scans). The starting dose of the trial was 1 mg/m2, and dose escalations proceeded through a total of eight dose levels to a maximum of 24.9 mg/m2. Toxicities were graded using the National Cancer Institute common toxicity criteria, and pharmacokinetics were determined using a liquid chromatography/tandem mass spectrometry method.

Results: Patients (37) received a total of 88 cycles of treatment on study (range: one to eight cycles). Dose-limiting toxicity (DLT) was observed, and the MTD exceeded at a dose of 24.9 mg/m2. The DLTs included grade-3 fatigue (3 patients), grade-3 nausea and vomiting (1 patient), grade-4 thrombocytopenia (2 patients), and grade-4 cardiac arrhythmia (1 patient, atrial fibrillation). The MTD was defined at the seventh dose level (17.8 mg/m2). Reversible ST/T changes and mild reversible dysrhythmias were observed on the post-treatment ECG. There were no clinically significant changes in left ventricular ejection fraction. One patient achieved a partial response. The plasma disposition of depsipeptide was well described by a first-order, two-compartment model. The mean volume of distribution, clearance, t1/2{alpha} and t1/2ß at a dose of 17.8 mg/m2 was: 8.6 liters/m2, 11.6 liters/h/m2, 0.42 h, and 8.1 h, respectively. The mean maximum plasma concentration at the MTD was 472.6 ng/ml (range: 249–577.8 ng/ml). Biological assays showed that the serum levels achieved could cause the characteristic cell cycle effects of this agent when serum was added to PC3 cells in culture, as well as increased histone acetylation in patient-derived peripheral blood mononuclear cells.

Conclusion: The MTD of depsipeptide given on a day-1 and -5 schedule every 21 days is 17.8 mg/m2. The DLTs are fatigue, nausea, vomiting, and transient thrombocytopenia and neutropenia. Whereas cardiac toxicity was anticipated based on preclinical data, there was no evidence of myocardial damage. However, reversible ECG changes with ST/T wave flattening were regularly observed. Biologically active serum concentrations were achieved, and 1 patient obtained a partial response. The recommended Phase II dose is 17.8 mg/m2 administered on day 1 and 5 of a 21-day cycle.


Commentary

Histone Deacetylase Inhibitors: A New Class of Potential Therapeutic Agents for Cancer Treatment : Commentary re: V. Sandor et al., Phase I Trial of the Histone Deacetylase Inhibitor, Depsipeptide (FR901228, NSC 630176), in Patients with Refractory Neoplasms. Clin. Cancer Res., 8: 718–728, 2002.
Victoria M. Richon and James P. O’Brien
Clin. Cancer Res. 2002 8: 662-664. [Full Text] [PDF]



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Synergistic Effect of Histone Deacetylase Inhibitors FK228 and m-Carboxycinnamic Acid Bis-Hydroxamide with Proteasome Inhibitors PSI and PS-341 against Gastrointestinal Adenocarcinoma Cells
Clin. Cancer Res., June 1, 2004; 10(11): 3853 - 3862.
[Abstract] [Full Text] [PDF]


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J. Virol.Home page
N. Mori, T. Matsuda, M. Tadano, T. Kinjo, Y. Yamada, K. Tsukasaki, S. Ikeda, Y. Yamasaki, Y. Tanaka, T. Ohta, et al.
Apoptosis Induced by the Histone Deacetylase Inhibitor FR901228 in Human T-Cell Leukemia Virus Type 1-Infected T-Cell Lines and Primary Adult T-Cell Leukemia Cells
J. Virol., May 1, 2004; 78(9): 4582 - 4590.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
C. E. Denlinger, M. D. Keller, M. W. Mayo, R. M. Broad, and D. R. Jones
Combined proteasome and histone deacetylase inhibition in non-small cell lung cancer
J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1078 - 1086.
[Abstract] [Full Text] [PDF]


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