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Phase I Trial of an Oral Immunomodulator and Interferon Inducer in Cancer Patients¹

Cancer Center, Departments of Microbiology and Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226 [P. L. W., P. S. R., T. L. M., L. W., S. E. G., E. C. B.], and Marshfield Clinic, Marshfield, Wisconsin 54449 [D. R.]

Imiquimod [1-(2-methylpropyl)-1H-imidazo[4,5c]quinolin-4-amine] is a compound of low molecular weight that, when administered p.o., induces interferon- in several animal species and inhibits tumor growth in mice. To determine maximum tolerated dose, toxicity, and biological response in humans, a phase I clinical trial was conducted with 14 eligible cancer patients who received 100–500 mg imiquimod p.o. either once or twice weekly. Imiquimod induced interferon- in serum in 10 of 19 doses of 200–300 mg. Interferon serum levels peaked 8–24 h after treatment and reached a maximum of 23,000 IU/ml in one patient. Significant mean increases (P < 0.01) in serum ß₂-microglobulin (1.5-fold), serum neopterin (3.5-fold), and 2-5A synthetase activity in peripheral blood mononuclear cells (7.9-fold) indicated that 200–300 mg imiquimod had biological and immunological activity in all evaluable patients. Increases in serum interferon, ß₂-microglobulin, and neopterin correlated significantly with dose (P < 0.001). No patient developed measurable antibody to interferon-. Dose-limiting side effects included fatigue, malaise, fever, headache, and lymphocytopenia; no hepatic or renal toxicity or other hematological changes exceeded the normal range. Patients tolerated weekly doses of up to 500 mg, with the longest treatment lasting 4 weeks at 200 mg weekly. Twice-weekly doses up to to 300 mg were tolerated, with the longest twice-weekly treatments being 200 mg for 9 weeks and 100 mg for 25 weeks. No clinical responses were observed. Imiquimod, as an oral inducer of interferon, may have therapeutic usefulness in human cancers, viral infections, and other diseases. However, before initiation of phase II trials, additional work will be required to establish a tolerated dose and schedule for continued administration.

¹ Supported by 3M Pharmaceuticals, St. Paul, MN, and by NIH Grant 5M01RR00058 to the Clinical Research Center at Froedtert Hospital, Milwaukee, WI.

² To whom requests for reprints should be addressed, at Cancer Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-4801.

Received 5/ 5/93. Accepted 8/24/93.

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