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[Cancer Research 59, 2402-2410, May 1, 1999]
© 1999 American Association for Cancer Research
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[Cancer Research 59, 2402-2410, May 15, 1999]
© 1999 American Association for Cancer Research

Experimental Therapeutics

O6-Benzylguanine

A Clinical Trial Establishing the Biochemical Modulatory Dose in Tumor Tissue for Alkyltransferase-directed DNA Repair1

Timothy P. Spiro2, Stanton L. Gerson, Lili Liu, Susan Majka, John Haaga, Charles L. Hoppel, Stephen T. Ingalls, James M. Pluda and James K. V. Willson

Division of Hematology/Oncology, Department of Medicine [T. P. S., S. L. G., L. L., J. K. V. W.], Departments of Pharmacology and Medicine [C. L. H., S. T. I.] and Radiology [J. H.], Case Western Reserve University, Cleveland, Ohio 44106; Ireland Cancer Center [T. P. S., S. L. G., S. M., J. H., C. L. H., S. T. I., J. K. V. W.], University Hospitals of Cleveland [J. H.], Cleveland, Ohio 44106; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland 20852 [J. M. P.]; and Louis Stokes Cleveland Department of Veterans’ Affairs Medical Center [T. P. S., C. L. H., S. T. I.], Cleveland, Ohio 44106

Early phase evaluation of anticancer drugs has traditionally used toxicity (usually hematological) rather than efficacy end points to establish appropriate dosing schedules. To establish a biochemical efficacy end point for overcoming alkylguanine DNA alkyltransferase (AGT)-mediated tumor cell resistance to 1,3-bis(2-chloroethyl)-1-nitrosourea, we performed a novel dose escalation clinical trial for the AGT-depleting agent O6-benzylguanine (BG). The dose of BG required to deplete AGT to undetectable levels (BMDT) in sequential computed tomography-guided tumor tissue biopsies before BG and 18 h after BG was determined. Thirty patients received doses of BG ranging from 10 to 120 mg/m2. In tumor tissue, AGT depletion >86% of baseline was demonstrated at all doses tested. Residual tumor AGT activity, present 18 h after BG doses of 10–80 mg/m2, was eliminated at the 120 mg/m2 dose and is thus the BMDT of BG. BG pharmacokinetics are characterized by the rapid, dose-independent clearance of BG from plasma. Metabolism of BG to its biologically active metabolite, 8-oxo-benzylguanine (8-oxo-BG), was found. The t1/2 of 8-oxo-BG is longer than BG. Plasma concentrations of 8-oxo-BG well above 200 ng/ml 18 h after the end of the BG infusion were observed at the highest dose levels tested and appeared to correlate with depletion of AGT activity to undetectable levels in tumor tissue. AGT activity in peripheral blood mononuclear cells at baseline did not correlate with tumor tissue AGT activity. Depletion of AGT activity to undetectable levels in peripheral blood mononuclear cells occurred at lower doses and was not a reliable predictor for tumor tissue depletion. No serious side effects were observed with administration of BG alone or in combination with 13 mg/m2 1,3-bis(2-chloroethyl)-1-nitrosourea. This is the first clinical study in which biochemical analyses from pre- and posttreatment tumor biopsies have been used as an efficacy end point for the clinical development of an anticancer agent. From our tumor tissue biopsy data, we have established that a BG dose of 120 mg/m2 infused over 1 h should be used in Phase II clinical trials.




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