This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dimaggio, J. J. Articles by Young, C. W. Search for Related Content PubMed PubMed Citation Articles by Dimaggio, J. J. Articles by Young, C. W.

Phase I Clinical and Pharmacological Study of Merbarone¹

Developmental Chemotherapy Service [J. J. D., R. P. W., J. M., D. A. L., I. H., T. D. W., C. W. Y.] and Clinical Pharmacology Laboratory [J. M., Y-W. S., S. J. L., L. B., S. Y., C. W. Y.], Memorial Sloan-Kettering Cancer Center, New York, New York 10021

Merbarone, a nonsedating derivative of thiobarbituric acid, has demonstrated excellent activity against certain murine tumors, including L1210 and P388 leukemias, B16 melanoma, and M5076 sarcoma. Preclinical studies suggested that the antitumor effects of this drug were schedule dependent, since repeated dosing increased killing of tumor cells when compared to intermittent injections. We have completed a Phase I clinical and pharmacological study of merbarone in which the drug was administered both as a 2-h infusion and as a continuous i.v. infusion over 24 h. In view of the increased toxicity observed in animals following bolus injections and the possibility of schedule-dependent anticancer activity, a schedule of drug administration daily for 5 days was selected.

Fifty patients with advanced cancer were treated at dose levels that ranged from 100 to 1500 mg/m²/day. When the drug was administered by peripheral vein, phlebitis was observed at the infusion site at daily doses 150 mg/m². Therefore, all patients who received drug doses 200 mg/m² were treated by continuous i.v. infusion using central venous catheters. Renal insufficiency, initially observed at a dose of 1000 mg/m²/day, was the dose-limiting toxic reaction at 1500 mg/m²/day. Three of five patients treated at the highest dose level were unable to complete the infusion due to this effect. Marked hypouricemia was observed in all patients. Other toxic effects were mild and included nausea, fatigue, leukopenia, thrombocytopenia, and anorexia. Alopecia was noted in several patients who received doses 1000 mg/m²/day. No major antitumor effects were observed.

Dose-dependent, steady-state plasma concentrations of merbarone were reached within 24–48 h after beginning the continuous i.v. infusion. Elimination of drug from plasma followed a two-compartment model, with a t of 4.2 h and a t_ß of 15.3 h. Renal excretion of merbarone and its major metabolites accounted for less than 30% of the administered dose.

We conclude that merbarone is relatively well tolerated with few constitutional symptoms. The current formulation of the drug causes phlebitis when administered by peripheral vein, and renal insufficiency is commonly observed at daily doses which exceed 1250 mg/m². The recommended dose for extended Phase II evaluation is 1000 mg/m²/day daily for 5 days administered by central venous catheter.

¹ Supported in part by Grants CA-05826 and N01-CM-59272 from the National Cancer Institute. Published in part in abstract form (Proc. Am. Assoc. Cancer Res., 29: 189, 1988).

² To whom requests for reprints should be addressed, at Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021.

Received 4/18/89. Revised 11/ 6/89. Accepted 11/ 8/89.