ING-1, a monoclonal antibody targeting Ep-CAM in patients with advanced adenocarcinomas.

PURPOSE: To determine the feasibility of administration, safety, toxicity, immunogenicity, pharmacokinetics, maximum tolerated dose, and biodistribution of ING-1, a high-affinity, Human-Engineered monoclonal antibody (heMAb) to the Mr 40,000 epithelial cell adhesion molecule Ep-CAM, in patients with advanced adenocarcinomas. EXPERIMENTAL DESIGN: ING-1 was initially administered to patients as a 1-hour intravenous infusion every 3 weeks. Toxicity and pharmacokinetic data led to the evaluation of a weekly schedule. The distribution of iodine-131 (131I)-labeled ING-1 was studied. RESULTS: Twenty-five patients received 82 courses of ING-1. Minimal toxicity was initially observed at the 0.03-, 0.10-, and 0.30-mg/kg dose levels. A patient dosed at 1.0 mg/kg developed acute pancreatitis with severe abdominal pain, nausea, and vomiting. A patient dosed at 0.3 mg/kg had an asymptomatic amylase and lipase elevation to 502 units/L and 1,627 units/L, respectively. Both patients made uncomplicated recoveries. No other dose-limiting toxicities were observed. Regardless of dose, the volume of distribution (mean +/- SEM) was 46.6 +/- 1.6 mL/kg. ING-1 clearance decreased with increasing dose. To minimize toxicity and increase dose intensity, we then administered ING-1 weekly. No significant toxicity was observed in 7 patients dosed at 0.1 mg/kg. Studies of 131I-labeled ING-1 biodistribution showed radiolocalization to colorectal and prostate cancers. A patient with colorectal cancer had an 80% decrement in the levels of carcinoembryonic antigen. CONCLUSION: The recommended dose for ING-1 is 0.10 mg/kg by intravenous infusion weekly. The absence of severe toxicity at this dose, low immunogenicity, and preliminary evidence of ING-1 tumor localization and antitumor efficacy support the further clinical development of this antibody to treat Ep-CAM-positive malignant diseases.     

Phase I study of weekly liposome-encapsulated doxorubicin in patients with advanced, androgen-independent prostate cancer

We performed a phase I study to evaluate the tolerability and activity of liposome-encapsulated doxorubicin (LED) given intravenously on a weekly basis in patients with advanced, androgen-independent prostate cancer. Nine patients were accrued to three dose levels: 10, 15, and 20 mg/m2. Treatment was administered weekly for 4 weeks out of a 6-week cycle. Two instances of grade II neutropenia were observed at the two higher dose levels. No dose adjustments were required. There were no severe hematologic or nonhematologic toxicities. Based on data from contemporaneous single-agent trials with this drug, we did not dose-escalate beyond 20 mg/m2. Six patients were removed from the study due to progressive disease by 6 weeks; the remaining 3 patients progressed by 12 weeks. These results suggest that LED is well tolerated at doses up to 20 mg/m2 when given weekly for 4 weeks out of a 6 week cycle. No clinical responses were seen; however, a phase II study of 20 mg/m2 is warranted to further delineate the activity of this regimen in patients with advanced prostate cancer.     

First in human phase I trial of 852A, a novel systemic toll-like receptor 7 agonist, to activate innate immune responses in patients with advanced cancer.

PURPOSE: Recent advances in the understanding of innate immunity suggest that an orchestrated sequence of events is required to elicit a productive immune response against cancer. We studied the systemic administration of the Toll-like receptor 7 agonist 852A, a small-molecule imidazoquinoline, in patients with advanced cancer. Preclinical studies showed that 852A stimulates plasmacytoid dendritic cells to produce multiple cytokines, such as IFN-alpha, interleukin-1 receptor antagonist, and IFN-inducible protein-10. Our goal was to define the tolerated dose, pharmacokinetics, pharmacodynamics, and immunologic effects of 852A in humans. EXPERIMENTAL DESIGN: Eligible adult patients with refractory solid organ tumors received i.v. 852A thrice weekly for 2 weeks. Patients who had responses or stable disease were eligible for additional cycles. RESULTS: Twenty-five patients (median age, 55.0 years; 72% male) were enrolled in six cohorts at dose levels of 0.15 to 2.0 mg/m(2). Serum drug levels showed dose proportionality and no evidence of drug accumulation. The maximum tolerated dose was 1.2 mg/m(2); higher doses were limited by fatigue and constitutional symptoms. Increases in IFN-alpha, interleukin-1 receptor antagonist, and IFN-inducible protein-10, immunologic activity, and clinical symptoms were observed in all patients receiving dose levels > or =0.6 mg/m(2). Significant correlations were found between pharmacodynamic biomarkers and pharmacokinetic variables, and an objective clinical response was seen. CONCLUSIONS: 852A was safely administered i.v. at doses up to 1.2 mg/m(2) thrice weekly for 2 weeks with transient or reversible adverse effects. This novel Toll-like receptor 7 agonist is biologically active and holds promise for stimulating innate immune responses. Future trials are warranted to assess its therapeutic role in patients with cancer.     

ING-1(heMAb), a monoclonal antibody to epithelial cell adhesion molecule, inhibits tumor metastases in a murine cancer model

ING-1(heMAb), a human-engineered monoclonal antibody (MAb) that specifically targets the epithelial cell adhesion molecule (Ep-CAM), kills adenocarcinoma cells in vitro and inhibits tumor growth in vivo. In the current study, we evaluated the efficacy of ING-1(heMAb) in a murine model of cancer metastases. Mice received intravenous dosing of 1 mg/kg ING-1(heMAb), twice a week, starting on day 2 or day 5. A negative control group received 1 mg/kg human immunoglobulin G with the same dose frequency starting on day 2. A positive control group received weekly 100 mg/kg 5-flurouracil/leucovorin starting on day 2. ING-1(heMAb)/day 2 treatment significantly reduced both the number of visible tumor nodules in body cavities (P <.01) and the number of metastases on lung surfaces (P <.005). The treatment also resulted in a 91% reduction of micrometastases in lung tissues (P <.0001). Delaying ING-1(heMAb) treatment until day 5 caused 54% reduction in micrometastases (P <.005). Our results indicate that a number of parameters, including treatment starting day, dose level, and dose frequency, are critical in achieving the optimal efficacy of ING-1(heMAb). We conclude that ING-1(heMAb) effectively reduced tumor metastases in a murine cancer model. Immunotherapy with ING-1(heMAb) may be beneficial in treating human metastatic diseases.     

In vitro and in vivo pharmacology and pharmacokinetics of a human engineered monoclonal antibody to epithelial cell adhesion molecule

ING-1(heMAb), a Human Engineered monoclonal antibody to epithelial cell adhesion molecule (Ep-CAM), was evaluated for its in vitro and in vivo activity. The dissociation constant of ING-1(heMAb) for binding to Ep-CAM on HT-29 human colon tumor cells was 2 to 5 nM, similar to chimeric ING-1. In antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity assays, ING-1(heMAb) caused a concentration-dependent lysis of BT-20 breast, MCF-7 breast, HT-29 colon, and CACO-2 colon tumor cells, with maximum cytolysis at approximately 1 microg/ml. After an intravenous injection in rats, plasma ING-1(heMAb) levels declined with an alpha half-life of 8 to 11 hours, and a beta half-life of 20 days, typical of an IgG in a species without the target for ING-1. In nude mice with human HT-29 colon tumors, plasma ING-1(heMAb) levels declined more rapidly than in non-tumor-bearing mice, suggesting an enhanced clearance via the tumor-associated human Ep-CAM. In nude mice, intravenous treatments with ING-1(heMAb) twice a week for 3 weeks significantly suppressed the growth of human HT-29 colon and PC-3 prostate tumors in a dose-dependent manner, with 1.0 mg/kg providing the greatest benefit. These results indicate that Human Engineered ING-1(heMAb) is a high-affinity antibody with potent in vitro activity that targets and suppresses the growth of human tumors in vivo.     

The multifractionated, twice-weekly dose schedule for a three-drug chemotherapy regimen: a phase I-II study of paclitaxel, cisplatin, and vinorelbine

BACKGROUND: Paclitaxel, cisplatin, and vinorelbine are three important antineoplastic drugs with different mechanisms of cell kill. A combination of these three drugs potentially could have additive therapeutic effects. METHODS. The three-drug combination (designated TPN) was administered on a twice-weekly (Monday/Thursday; Tuesday/Friday) schedule for 3 weeks, with cycles repeated every 28 days. The Phase I design utilized a dose de-escalation schema in which the maximum tolerated dose was defined by a patient's ability to complete 6 doses (a full cycle) without interruption for hematologic Grade 3 or 4 toxicity. RESULTS: Twenty-seven patients received a total of 42 evaluable courses of the 3-drug regimen. The cisplatin dose was fixed at 15 mg/M2/fraction. The paclitaxel dose was first fixed at 50 mg/M2/fraction, and venorelbine was delivered at 3 dose levels per fraction: 10, 7.5, and 5 mg/M2. Paclitaxel then was de-escalated to 40 mg/M2/fraction, and the same 3 dose levels of vinorelbine were evaluated. The dose-limiting toxicity was neutropenia. Using fixed doses of paclitaxel at 40 mg/ M2/fraction and cisplatin at 15 mg/M2, the optimal dose fraction for vinorelbine was 7.5 mg/M2, defined as the dose that allowed > 67% of patients to complete 3 weeks (6 consecutive doses) of therapy. Using paclitaxel at 50 mg/M2/fraction (cisplatin at 15 mg/M2/fraction), the optimal dose of vinorelbine was 5 mg/M2/fraction. Tumor responses were observed in 13 patients: 2 with unknown primary, 1 with esophageal carcinoma, 6 with nonsmall cell lung carcinoma, and 3 with breast carcinoma. Grade 2 neurologic (sensory) toxicity was observed in 5 patients. CONCLUSIONS: TPN administered according to a twice-weekly dosing scheme can be delivered with acceptable toxicity. The dose intensity for paclitaxel (60-75 mg/M2/week), cisplatin (22 mg/M2/week), and vinorelbine (15 mg/M2/week) is > 50% of the single agent dose intensity for the component agent. Recommended Phase II or Phase III trials could utilize dose fractions of paclitaxel, cisplatin, and vinorelbine at either 50, 15, and 5 mg/M2/fraction or 40, 15, and 7.5 mg/M2/fraction in this twice-weekly, multifractionated dose schedule.     

A phase I/IIA study of AGS-PSCA for castration-resistant prostate cancer

Background This first-in-human phase I/IIA study was designed to evaluate the safety and pharmacokinetics (PKs) of AGS-PSCA a fully human monoclonal antibody directed to prostate stem cell antigen (PSCA) in progressive castration-resistant prostate cancer. Patients and methods Twenty-nine patients were administered infusions of AGS-PSCA (1-40 mg/kg) every 3 weeks for 12 weeks; 18 final patients received a 40-mg/kg loading dose followed by 20-mg/kg repeat doses. Primary end points were safety and PK. Immunogenicity, antitumor activity and circulating tumor cells were also evaluated. Results No drug-related serious adverse events were noted. Dose escalation stopped before reaching the maximum tolerated dose as target concentrations were achieved. Drug levels accumulated linearly with dose and the mean terminal half-life was 2-3 weeks across dose levels. The 40-mg/kg loading dose followed by repeated 20-mg/kg doses yielded serum drug concentrations above the projected minimum therapeutic threshold after two to three doses without excessive drug accumulation or toxicity. Significant antitumor effects were not seen. Conclusions A 40-mg/kg loading dose followed by 20-mg/kg infusions every 3 weeks is the recommended phase II dose of AGS-PSCA. PSCA is a promising drug target and studies in prostate and other relevant solid tumors are planned.     

NTP report on the toxicology studies of dicyclohexylcarbodiimide (CAS No. 538-75-0) in F344/N rats, B6C3F 1 mice, and genetically modified (FVB Tg.AC hemizygous) mice and carcinogenicity study of dicyclohexylcarbodiimide in genetically modified [B6.129-Trp53 tm1Brd (N5) haploinsufficient] mice (dermal studies)

Dicyclohexylcarbodiimide is used in industry as a stabilizing agent, coupling agent, and condensing agent. Its widespread use during protein synthesis in the recombinant DNA industry and in the synthesis of polypeptides in the chemical and pharmaceutical industries provides an increasing potential for low-level human exposure. Dicyclohexylcarbodiimide was nominated for study by The National Cancer Institute as a key representative of the carbodiimide chemical class because of its acute toxicity and the absence of data on potential health effects. Male and female F344/N rats and B6C3F 1 mice were administered dicyclohexylcarbodiimide (greater than 98% pure) dermally for 3 or 13 weeks. Female Tg.AC hemizygous and p53 haploinsufficient mice were administered dicyclohexylcarbodiimide dermally for 20 or 27 weeks, respectively. Genetic toxicology studies were conducted in Salmonella typhimurium, male F344/N rat bone marrow cells, and B6C3F 1 mouse peripheral blood erythrocytes. 3-WEEK STUDY IN F344/N RATS Groups of five male and five female rats were dermally administered 0.3 mL ethanol containing 0, 0.6, 1.8, 5.1, 15, or 45 mg dicyclohexylcarbodiimide, 5 days per week for 3 weeks. All males and females in the 15 and 45 mg groups, four 5.1 mg males, and all 5.1 mg females died before the end of the study. Of the surviving groups, final mean body weights were similar to those of the vehicle controls, although the one surviving 5.1 mg male rat lost weight during the study. Histopathologic examination of rats dosed with 5.1 mg dicyclohexylcarbodiimide or less revealed treatment-related lesions of the skin at the site of application including epidermal hyperplasia, epidermal necrosis, or chronic active inflammation in the dermis. 3-WEEK STUDY IN B6C3F 1 MICE Groups of five male and five female mice were dermally administered 0.1 mL of ethanol containing 0, 0.2, 0.6, 1.7, 5, or 15 mg dicyclohexylcarbodiimide, 5 days per week for 3 weeks. One 0.6 mg female mouse and all mice in the 1.7, 5, and 15 mg groups died before the end of the study. Final mean body weights of the 0.6 mg groups were significantly less than those of the vehicle controls, and animals in these groups generally lost weight during the study. Histopathologic examination of mice dosed with 1.7 mg dicyclohexylcarbodiimide or less revealed treatment-related lesions of the skin at the site of application including epidermal hyperplasia, epidermal necrosis, and acute or chronic active dermal inflammation. 13-WEEK STUDY IN F344/N RATS Groups of 10 male and 10 female core study rats were dermally administered 0, 0.75, 1.5, 3, 6, or 12 mg dicyclohexylcarbodiimide/kg body weight in ethanol, 5 days per week for 13 weeks; groups of 10 male and 10 female clinical pathology study rats were administered the same doses for 22 days. All 12 mg/kg male and female core study rats died or were found moribund and sacrificed prior to day 45. Final mean body weight and body weight gain of 6 mg/kg males were significantly less than those of the vehicle controls. The predominant clinical pathology changes suggest a secondary, treatment-related inflammatory leukogram and minimal decreased erythron of chronic inflammation that would be consistent with necrosis and chronic active inflammation of the skin. Significantly increased incidences of skin lesions at the site of application included epidermal hyperplasia in 3 mg/kg or greater males and 1.5 mg/kg or greater females, chronic active inflammation in 6 and 12 mg/kg males and 1.5 mg/kg or greater females, and epidermal necrosis in 12 mg/kg males. The incidences and severities of epidermal hyperplasia increased in a dose-related manner in both sexes of rats 13-WEEK STUDY IN B6C3F 1 MICE Groups of 10 male and 10 female mice were dermally administered 0, 1.5, 3, 6, 12, or 24 mg dicyclohexylcarbodiimide/kg body weight in ethanol, 5 days per week for 13 weeks. All 24 mg/kg male and female mice died or were found moribund and sacrificed prior to day 16. Final mean body weights of 6 and 12 mg/kg males and mean body weight gains of 6 and 12 mg/kg males and females were significantly less than those of the vehicle controls. The predominant clinical pathology changes suggest a secondary, treatment-related inflammatory leukogram and minimal decreased erythron of chronic inflammation that would be consistent with necrosis and chronic active inflammation of the skin. Dermal administration of dicyclohexylcarbodiimide significantly decreased the weight of the epididymis in 6 and 12 mg/kg males and significantly decreased epididymal spermatozoal motility in 6 mg/kg males. Significantly increased incidences of skin lesions at the site of application included epidermal hyperplasia in all dosed groups except those administered 24 mg/kg, chronic active inflammation in all dosed groups except 1.5 mg/kg females, and epidermal necrosis in 24 mg/kg males and females. 20-WEEK STUDY IN FEMALE TG.AC HEMIZYGOUS MICE Groups of 10 female Tg.AC hemizygous mice were dermally administered 0, 0.75, 1.5, 3, 6, or 12 mg dicyclohexylcarbodiimide/kg body weight in ethanol, 5 days per week for up to 20 weeks. Due to the severity of skin lesions observed in 12 mg/kg animals, the application of dicyclohexylcarbodiimide was discontinued after eight dermal applications in this group. There were no deaths considered related to dicyclohexylcarbodiimide administration, although 13 animals died or were sacrificed moribund prior to the end of the study: three each from the vehicle control and 0.75 mg/kg groups, four from the 3 mg/kg group, two from the 6 mg/kg group, and one from the 12 mg/kg group. Overall, the survival was within the range known for the Tg.AC hemizygous mouse. Mean body weights of dosed groups of mice were similar to those of the vehicle controls. At the site of application, the incidences of squamous cell papilloma were increased in a dose-related manner. The incidences of chronic active inflammation of the dermis and epidermal hyperplasia were significantly increased in mice administered 3 or 6 mg/kg. 27-WEEK STUDY IN FEMALE p53 HAPLOINSUFFICIENT MICE Groups of 15 female mice were dermally administered 0, 0.75, 1.5, 3, 6, or 12 mg dicyclohexylcarbodiimide/kg body weight in ethanol, 5 days per week for up to 27 weeks. Dosing of the 6 and 12 mg/kg groups was discontinued after 11 and 8 days, respectively, because of the severity of skin lesions at the site of application. Twelve animals died or were sacrificed moribund prior to the end of the study: three from the 3 mg/kg group, one from the 6 mg/kg group, and eight from the 12 mg/kg group. Mean body weights of dosed groups of mice were similar to those of the vehicle controls. No neoplasms were attributed to administration of dicyclohexylcarbodiimide. At the site of application, the incidences of focal epidermal hyperplasia were significantly increased in 1.5, 3, and 12 mg/kg mice, the incidences of focal chronic active inflammation of the dermis were increased in groups administered 3 or 12 mg/kg, and the incidences of focal ulcer and focal chronic active inflammation of the subcutaneous tissue were increased in the 12 mg/kg group. GENETIC TOXICOLOGY Dicyclohexylcarbodiimide was not mutagenic in Salmonella typhimurium strains TA97, TA98, TA100, or TA1535, with or without rat or hamster liver S9 activation enzymes. In vivo, there was a small but significant increase in the frequency of micronucleated normochromatic erythrocytes in male and female B6C3F 1 mice after 13 weeks of dermal exposure to dicyclohexylcarbodiimide. Negative results were obtained, however, in an acute three-injection micronucleus study in bone marrow of male F344/N rats. CONCLUSIONS Under the conditions of this 27-week dermal study, there was no evidence of carcinogenic activity* of dicyclohexylcarbodiimide in female p53 haploinsufficient mice administered 0.75, 1.5, 3, 6, or 12 mg/kg in ethanol. Female Tg.AC hemizygous mice dermally dosed with dicyclohexylcarbodiimide for 20 weeks had significantly increased incidences of squamous cell papilloma of the skin at the site of application. Nonneoplastic lesions noted at the site of application included chronic active inflammation and epidermal hyperplasia in female p53 haploinsufficient mice and female Tg.AC hemizygous mice.     

Phase I and pharmacologic study of the combination of paclitaxel, cisplatin, and topotecan administered intravenously every 21 days as first-line therapy in patients with advanced ovarian cancer.

PURPOSE: To evaluate the feasibility of administering topotecan in combination with paclitaxel and cisplatin without and with granulocyte colony-stimulating factor (G-CSF) support as first-line chemotherapy in women with incompletely resected stage III and stage IV ovarian carcinoma. PATIENTS AND METHODS: Starting doses were paclitaxel 110 mg/m2 administered over 24 hours (day 1), followed by cisplatin 50 mg/m2 over 3 hours (day 2) and topotecan 0.3 mg/m2/d over 30 minutes for 5 consecutive days (days 2 to 6). Treatment was repeated every 3 weeks. After encountering dose-limiting toxicities (DLTs) without G-CSF support, the maximum-tolerated dose was defined as 5 microg/kg of G-CSF subcutaneously starting on day 6. RESULTS: Twenty-one patients received a total of 116 courses at four different dose levels. The DLT was neutropenia. At the first dose level, all six patients experienced grade 4 myelosuppression. G-CSF support permitted further dose escalation of cisplatin and topotecan. Nonhematologic toxicities, primarily fatigue, nausea/vomiting, and neurosensory neuropathy, were observed but were generally mild. Of 15 patients assessable for response, nine had a complete response, four achieved a partial response, and two had stable disease. CONCLUSION: Neutropenia was the DLT of this combination of paclitaxel, cisplatin, and topotecan. The recommended phase II dose is paclitaxel 110 mg/m2 (day 1), followed by cisplatin 75 mg/m2 (day 2) and topotecan 0.3 mg/m2/d (days 2 to 6) with G-CSF support repeated every 3 weeks.     

Clinical pharmacolinetics of 9, 10-anthracenedicarboxaldehyde-bis [(4,5-dihydro-1H-imidazol-2-yl)hydrazone]dihydrochloride

Summary We studied the clinical pharmacokinetics of the anthracene derivative bisantrene using high-performance liquid chromatographic analysis. We administered the drug to ten patients at 120–250 mg/m² IV; one of these patients also received a second dose of 120 mg/m² 6 weeks later, and another received 150 mg/m² weekly for three doses. Bisantrene disappeared from the plasma biphasically, with an initial t_1/2 of 0.6±0.3 h and a terminal t_1/2 of 24.7±6.9 h after single doses. The apparent volume of distribution according to the area under the curve was 42.1±5.9 l/kg, and the total clearance was 1045.5±51.0 ml/kg/h. The 96-h cumulative urinary excretion was 3.4%±1.1% of the dose; thus, renal excretion was a minor route of elimination for this agent. Bisantrene pharmacokinetics in the patient who received a second dose after 6 weeks showed insignificant changes. However, in the patient who was given this drug weekly for 3 weeks, the plasma t_1/2 of the drug during the terminal phase became increasingly longer, while the total clearance was significantly reduced. These results suggest that bisantrene may accumulate in the body and that caution is essential in the event of frequent administration.     

Toxicology studies of allyl bromide (CAS No. 106-95-6) in genetically modified (FVB Tg.AC hemizygous) mice and carcinogenicity studies of allyl bromide in genetically modified [B6.129-Trp53tm1Brd (N5) Haploinsufficient] mice (dermal and gavage studies)

Allyl bromide is primarily used as a starting material/chemical intermediate in organic synthesis and as an intermediate in the manufacture of polymers/resins, synthetic perfumes, pharmaceuticals, agricultural chemicals, and other allyl compounds. It has been described as an insecticidal fumigant used in crop protection. Male and female FVB/N and C57BL/6 mice received allyl bromide (greater than 99% pure) by gavage and dermal application, respectively, for 2 weeks, and FVB/N, C57BL/6, Tg.AC hemizygous, and p53 haploinsufficient mice received allyl bromide by gavage for 40 weeks. Genetic toxicology studies were conducted in Salmonella typhimurium and mouse peripheral blood erythrocytes. 2-WEEK STUDIES IN FVB/N MICE: Groups of five male and five female FVB/N mice were dermally administered 0, 7.5, 15, 30, 60, or 120 mg allyl bromide/kg body weight in acetone, 5 days a week for 2 weeks. The survival and mean body weights of all dosed groups of males and females were similar to those of the vehicle controls. There were no increases in the incidences of lesions in dosed mice. 2-WEEK STUDIES IN C57BL/6 MICE: Groups of five male and five female FVB/N mice were administered 0, 7.5, 15, 30, 60, or 120 mg allyl bromide/kg body weight in corn oil by gavage, 5 days a week for 2 weeks. Three 120 mg/kg male mice died prior to the end of the study. Mean body weights of all dosed groups of males and females were similar to those of the vehicle controls. Liver weights of 30 and 60 mg/kg males were significantly greater than those of the vehicle controls. Nonneoplastic lesions of the forestomach, including hyperplasia, inflammation, degeneration, and hyperkeratosis of the forestomach epithelium, were observed in dosed mice. 40-WEEK STUDIES IN FVB/N MICE: Groups of 15 male and 15 female FVB/N mice were administered 0 or 8 mg allyl bromide/kg body weight in corn oil by gavage, 5 days a week for 40 weeks. Survival of dosed mice was similar to that of the vehicle controls. Mean body weights of dosed mice were within 10% of those of the vehicle controls throughout most of the study. There were no chemical-related gross or microscopic findings in dosed mice. 40-WEEK STUDIES IN Tg.AC HEMIZYGOUS MICE: Groups of 15 male and 15 female Tg.AC hemizygous mice were administered 0, 0.5, 1, 2, 4, or 8 mg allyl bromide/kg body weight in corn oil by gavage, 5 days a week for 40 weeks. Survival of dosed mice was similar to that of the vehicle controls. Mean body weights were generally similar between dosed and vehicle control mice throughout the study. In female mice, there were increased numbers of cutaneous and mucocutaneous masses (gross observations) on the body, particularly the vaginal and vulvar area, and these papillomas were observed earlier in the dosed groups. There were positive trends in the incidences of squamous cell papilloma of the vulva and of all skin sites in females. 40-WEEK STUDIES IN C57BL/6 MICE: Groups of 15 male and 15 female C57BL/6 mice were administered 0 or 8 mg allyl bromide/kg body weight in corn oil by gavage, 5 days a week for 40 weeks. Survival of dosed mice was similar to that of the vehicle controls. Mean body weights and organ weights were similar between dosed and vehicle control mice throughout the study. There were no chemical-related gross or microscopic findings in dosed mice. 40-WEEK STUDIES IN p53 HAPLOINSUFFICIENT MICE: Groups of 15 male and 15 female p53 haploinsufficient mice were administered 0, 0.5, 1, 2, 4, or 8 mg allyl bromide/kg body weight in corn oil by gavage, 5 days a week for 40 weeks. Survival of dosed mice was similar to that of the vehicle controls. Mean body weights of dosed mice were within 10% of those of the vehicle controls throughout most of the study. Mean body weights of 8 mg/kg females were 11% to 15% greater than those of the vehicle controls from week 26 to week 33, and those of 4 mg/kg females were generally less after week 21. There were no chemical-related gross or microscopic findings. GENETIC TOXICOLOGY: Allyl bromide was mutagenic in S. typhimurium strain TA100, with and without exogenous metabolic activation (S9). No mutagenicity was detected in S. typhimurium strain TA98, with or without S9, over the same concentration range tested with TA100. The frequency of micronucleated erythrocytes was assessed in male and female mice for each of the four mouse strains administered allyl bromide by corn oil gavage for 40 weeks. Results in all four studies were concluded to be negative; in addition, no significant changes in the percentages of polychromatic erythrocytes (reticulocytes) among total erythrocytes were observed in any of the four strains of mice. CONCLUSIONS: Under the conditions of this study, there was no evidence of carcinogenic activity in male or female p53 haploinsufficient mice administered allyl bromide at 0, 0.5, 1, 2, 4, or 8 mg/kg per day by corn oil gavage, 5 days a week for 40 weeks. There was a marginal increase in the incidence of squamous cell papillomas, primarily of the vulva, in female Tg.AC mice administered allyl bromide by corn oil gavage for 40 weeks. No treatment-related neoplasms were seen in male Tg.AC hemizygous mice administered allyl bromide by gavage at 0.5, 1, 2, 4, or 8 mg/kg, 5 days per week for 40 weeks.     

Toxicology studies of trimethylolpropane triacrylate (technical grade) (CAS No. 15625-89-5) in F344/N rats, B6C3F1 mice, and genetically modified (FVB Tg.AC hemizygous) mice (dermal studies)

Trimethylolpropane triacrylate is a multifunctional monomer with a wide range of industrial applications. It is used in the production of ultraviolet-curable inks, electron beam irradiation-curable coatings, and polymers and resins; as a component of photopolymer and flexographic printing plates and photoresists; and as an ingredient in acrylic glues and anaerobic sealants. The chemical is also used in paper and wood impregnates, wire and cable extrusion, polymer-impregnated concrete, and polymer concrete structural composites. Trimethylolpropane triacrylate was nominated by the National Cancer Institute for testing due to its high production volume and use, its potential for consumer exposure, and a lack of adequate testing of the chemical. Male and female F344/N rats and B6C3F(1) mice were administered technical grade trimethylolpropane triacrylate (it is reactive and therefore not available as pure trimethylolpropane triacrylate) in acetone dermally for 2 weeks or 3 months. Male and female Tg.AC hemizygous mice were administered technical grade trimethylolpropane triacrylate in acetone for 6 months. Genetic toxicology studies were conducted in B6C3F(1) and Tg.AC hemizygous mouse peripheral blood erythrocytes. 2-WEEK STUDY IN RATS: Groups of five male and five female F344/N rats were administered 0, 12.5, 25, 50, 100, or 200 mg trimethylolpropane triacrylate/kg body weight in acetone 5 days per week for 16 days. All rats survived to the end of the study, and mean body weights of dosed groups were similar to those of the vehicle controls. Dosed rats had irritation at the site of application; this clinical finding was most commonly seen in rats administered 50 mg/kg or greater. Male and female rats had epidermal hyperplasia, hyperkeratosis, sebaceous gland hyperplasia, inflammation of the epidermis and dermis, ulceration, epidermal degeneration, and parakeratosis at the site of application. 2-WEEK STUDY IN B6C3F(1) MICE: Groups of five male and five female B6C3F(1) mice were administered 0, 12.5, 25, 50, 100, or 200 mg trimethylolpropane triacrylate/kg body weight in acetone 5 days per week for 16 days. All mice survived to the end of the study. The final mean body weight gain of 200 mg/kg males was less than that of the vehicle controls; 100 and 200 mg/kg females had significantly increased final mean body weights. Irritation at the site of application occurred in all dosed males, all 100 and 200 mg/kg females, and one 50 mg/kg female. Thymus weights of males administered 50 mg/kg or greater were significantly decreased. Dosed male and female mice had epidermal hyperplasia, hyperkeratosis, chronic active inflammation of the dermis, sebaceous gland hyperplasia, ulcer, epidermal degeneration, parakeratosis, and/or suppurative inflammation of the epidermis at the site of application. Atrophy of the thymus occurred in 100 and 200 mg/kg male mice. 3-MONTH STUDY IN RATS: Groups of 10 male and 10 female F344/N rats were administered 0, 0.75, 1.5, 3, 6, or 12 mg trimethylolpropane triacrylate/kg body weight in acetone 5 days per week for 14 weeks. All rats survived to the end of the study, and mean body weights of dosed groups were similar to those of the vehicle controls. Irritation at the site of application was noted in five males and all females administered 12 mg/kg. Hematology results indicated that trimethylolpropane triacrylate at the doses selected induced a neutrophil count increase at 12 mg/kg that would be consistent with an inflammatory response related to the dermatitis observed histopathologically. Thymus weights of 12 mg/kg males and 0.75 and 12 mg/kg females were decreased. Incidences of epidermal hyperplasia, degeneration, and necrosis (females only); chronic active inflammation of the dermis, hyperkeratosis, and sebaceous gland hyperplasia were generally increased at the site of application in 1.5 mg/kg or greater males and in 3 mg/kg or greater females. 3-MONTH STUDY IN B6C3F(1) MICE: Groups of 10 male and 10 female B6C3F(1) mice were administered 0, 0.75, 1.5, 3, 6, or 12 mg trimethylolpropane triacrylate/kg body weight in acetone 5 days per week for 14 weeks. All animals survived to the end of the study; mean body weights of dosed groups were similar to those of the vehicle controls. Irritation at the site of application occurred in male and female mice administered 12 mg/kg. Hematology results indicated that trimethylolpropane triacrylate induced a neutrophil count increase at 12 mg/kg that would be consistent with an inflammatory response related to the dermatitis observed histopathologically. Increased incidences of several nonneoplastic lesions occurred at the site of application in 3 mg/kg and greater males and females, including hyperplasia of the epidermis, hyperkeratosis, epidermal degeneration (except 3 mg/kg females) and necrosis, chronic active inflammation of the dermis, and sebaceous gland hyperplasia. Epidermal suppurative inflammation and necrosis and dermal fibrosis occurred in 12 mg/kg males and females. 6-MONTH STUDY IN Tg.AC HEMIZYGOUS MICE: Groups of 15 male and 15 female Tg.AC hemizygous mice were administered 0, 0.75, 1.5, 3, 6, or 12 mg trimethylolpropane triacrylate/kg body weight in acetone 5 days per week for 28 weeks. Additional groups of 15 male and 15 female mice maintained as positive controls received dermal applications of 1.25 microg 12-O-tetradecanoylphorbol-13-acetate per 100 mL acetone 3 days per week for 28 weeks; the dosing volume was held constant at 100 microL. Survival and mean body weights of dosed groups were similar to those of the vehicle controls throughout the study. Treatment-related clinical findings included papillomas at the site of application in 3 mg/kg and greater males and 6 and 12 mg/kg females. The heart weights of males and females administered 12 mg/kg and the kidney and lung weights of 12 mg/kg females were significantly increased. The lung weights of 6 and 12 mg/kg males and females were decreased. Squamous cell neoplasms at the site of application were associated with dermal application of trimethylolpropane triacrylate. At 6 months, the incidences of squamous cell papilloma were significantly increased in 6 and 12 mg/kg males and females. One female in each of the 1.5, 6, and 12 mg/kg groups also had squamous cell carcinoma. The incidence of squamous cell papilloma of the forestomach in 12 mg/kg females was significantly greater than that in the vehicle control group. Nonneoplastic skin lesions at the site of application in dosed mice included epidermal hyperplasia, hyperkeratosis, and chronic active inflammation. A hematopoietic disorder (myelodysplasia) also occurred in some 12 mg/kg males and females. GENETIC TOXICOLOGY: No increase in the frequency of micronucleated erythrocytes was observed in peripheral blood samples from male or female B6C3F(1) mice treated with trimethlylolpropane triacrylate by skin painting for 3 months. Similarly, no increase in micronucleus frequency was seen in male or female Tg.AC hemizygous mice administered trimethylolpropane triacrylate by skin painting for 6 months. CONTACT HYPERSENSITIVITY STUDIES: Studies were conducted with female BALB/c mice to evaluate the potential for trimethylolpropane triacrylate to induce contact hypersensitization. In an irritancy study in which the chemical, in acetone, was applied to the ear, the maximal nonirritating and minimal irritating doses were 0.1% and 0.25% trimethylolpropane triacrylate. No significant differences in the percentage of ear swelling occurred between trimethylolpropane triacrylate-sensitized and -challenged mice and background controls at 24 or 48 hours after dosing. The local lymph node assay indicated no significant increase in lymph node cell proliferation in mice administered trimethylolpropane triacrylate compared to that in the vehicle controls. Testing for sensitizing potential using the mouse ear swelling test and local lymph node assay failed to indicate trimethylolpropane triacrylate as a potential contact sensitizer. CONCLUSIONS: Male and female Tg.AC hemizygous mice dosed with trimethylolpropane triacrylate for 6 months had significantly increased incidences and multiplicity of papillomas of the skin at the site of dermal application. Treatment-related squamous cell carcinomas occurred at the site of application in dosed female mice. Increased incidences of forestomach squamous cell papilloma in female mice may have been related to chemical administration. Increased incidences of minimal to moderate (mostly mild) hyperplasia of the epidermis, hyperkeratosis, and chronic active inflammation also occurred at the site of application. A hematopoietic disorder (myelodysplasia) also occurred in exposed male and female mice.     

An open-label,randomized phase II study of adecatumumab,a fully human anti-EpCAM antibody,as monotherapy in patients with metastatic breast cancer

BackgroundHigh-level expression of epithelial cell adhesion molecule (EpCAM) is associated with unfavorable prognosis in breast cancer. This study was designed to investigate two doses of the fully human IgG1 anti-EpCAM antibody adecatumumab (MT201) in patients with metastatic breast cancer (MBC).MethodsA total of 109 patients were stratified into high- and low-level EpCAM expression by immunohistochemical staining of primary tumors and subsequently randomly assigned to receive monotherapy with either high- (6 mg/kg every two weeks (q2w)) or low-dose adecatumumab (2 mg/kg/ q2w) until disease progression.ResultsNo complete or partial tumor responses could be confirmed by central RECIST assessment. The probability for tumor progression was significantly lower in patients receiving high-dose adecatumumab and expressing high levels of EpCAM (hazard ratio 0.43; P = 0.0057 versus low dose and low EpCAM). Three of 18 patients with highest EpCAM expression treated with adecatumumab developed new metastases up to week 6, compared with 14 of 29 patients with low EpCAM. Most frequent treatment-related adverse events (high dose/low dose) were chills (59%/20%), nausea (55%/18%), fatigue (39%/23%) and diarrhea (43%/7%).ConclusionsSingle-agent adecatumumab shows dose- and target-dependent clinical activity in EpCAM-positive MBC, albeit no objective tumor regression. Further investigation of adecatumumab in patients with EpCAM-overexpressing tumors and lower tumor burden is warranted.     

Phase I and imaging trial of a monoclonal antibody directed against gastrin-releasing peptide in patients with lung cancer.

Small cell lung cancer (SCLC) cells express and secrete bombesin-like peptides (BLP) that can activate specific receptors that stimulate the growth of these cells. A murine monoclonal antibody, 2A11, which binds to the BLP, gastrin-releasing peptide with high affinity, has been reported to decrease the growth of SCLC cells in vitro and in athymic nude mice. A Phase I trial in lung cancer patients was performed using multiple doses of 2A11. Thirteen patients with lung cancer received 12 doses of 2A11 antibody three times a week for 4 weeks at one of four dose levels. Serum samples were obtained prior to initiation and before each dose of 2A11 antibody therapy for measurement of 2A11 antibody levels and determination of serum human anti-mouse antibody levels. A pilot imaging evaluation using 111In conjugated 2A11 monoclonal antibody was also performed in the same patients to aid in the study of pharmacokinetics and biodistribution. No toxic reactions were observed, and none of the patients developed detectable human antimouse antibody; however, no objective antitumor responses were observed. The mean trough serum 2A11 levels in patients increased with increasing dose level: 0.26+/-0.2 microg/ml, 6.7+/-6 microg/ml, 71.5+/-60 microg/ml, 248+/-184 microg/ml for dose levels 1 mg/m2, 10 mg/m2, 100 mg/m2, and 250 mg/m2, respectively. At each dose level, sustained detectable serum levels of the monoclonal antibody were achieved. Tumor uptake was noted in 11 of 12 patients who were injected with 111In conjugated 2A11. Because no dose-limiting clinical toxicity was observed, a mathematical model was used to define the recommended Phase II dose of 250 mg/m2. This trial established that repeated doses of monoclonal antibody 2A11 could be given safely to patients, and sustained levels could be achieved for a 4-week schedule. Further evaluation of the antitumor effects of 2A11 is warranted.     

A phase I study of cantuzumab mertansine administered as a single intravenous infusion once weekly in patients with advanced solid tumors.

PURPOSE: The purpose is to determine the maximum-tolerated dose, assess the toxicities, characterize the pharmacokinetic behavior, and seek preliminary evidence of biological activity of cantuzumab mertansine when administered as a weekly i.v. infusion without interruption. EXPERIMENTAL DESIGN: Patients with incurable solid tumors that expressed the target antigen for cantuzumab mertansine, CanAg, were treated with doses of cantuzumab mertansine ranging from 40 to 138 mg/m(2). The maximum-tolerated dose was defined as the highest dose at which no more than 1 of 6 patients experienced dose-limiting toxicity. Plasma concentrations of cantuzumab mertansine and total humanized antibody were determined, and area under the plasma concentration-time curve (to the last measured concentration) was calculated. RESULTS: Thirty-nine patients received a total of 280 weekly doses of cantuzumab mertansine. Acute, transient elevation of the hepatic transaminases and reversible fatigue were identified as the dose-limiting toxicities at the highest dose level. The maximum-tolerated dose was determined to be 115 mg/m(2)/week. Evidence of clinical activity was noted in 3 patients. Pharmacokinetic analyses revealed that the pharmacokinetic variability was moderate, without evidence of dose dependency. Furthermore, the drug had a long terminal half-life ( approximately 40 h). CONCLUSIONS: This study identified a safe and tolerable dose of the novel immunoconjugate prodrug cantuzumab mertansine. The evidence of antitumor activity suggests that additional clinical development is warranted, with a focus on tumors that express high levels of CanAg and which are known to be sensitive to antimicrotubule agents.     

A Phase I pharmacokinetic and biological correlative study of oblimersen sodium (genasense, g3139), an antisense oligonucleotide to the bcl-2 mRNA, and of docetaxel in patients with hormone-refractory prostate cancer.

PURPOSE: To assess the feasibility of administering oblimersen sodium, a phosphorothioate antisense oligonucleotide directed to the Bcl-2 mRNA, with docetaxel to patients with hormone-refractory prostate cancer; to characterize the pertinent pharmacokinetic parameters, Bcl-2 protein inhibition in peripheral blood mononuclear cell(s) (PBMC) and tumor; and to seek preliminary evidence of antitumor activity. EXPERIMENTAL DESIGN: Patients were treated with increasing doses of oblimersen sodium administered by continuous i.v. infusion on days 1 to 6 and docetaxel administered i.v. over 1 h on day 6 every 3 weeks. Plasma was sampled to characterize the pharmacokinetic parameters of both oblimersen and docetaxel, and Bcl-2 protein expression was measured from paired collections of PBMCs pretreatment and post-treatment. RESULTS: Twenty patients received 124 courses of the oblimersen and docetaxel combination at doses ranging from 5 to 7 mg/kg/day oblimersen and 60 to 100 mg/m(2) docetaxel. The rate of severe fatigue accompanied by severe neutropenia was unacceptably high at doses exceeding 7 mg/kg/day oblimersen and 75 mg/m(2) docetaxel. Nausea, vomiting, and fever were common, but rarely severe. Oblimersen mean steady-state concentrations were 3.44 +/- 1.31 and 5.32 +/- 2.34 at the 5- and 7-mg/kg dose levels, respectively. Prostate-specific antigen responses were observed in 7 of 12 taxane-na?ve patients, but in taxane-refractory patients no responses were observed. Preliminary evaluation of Bcl-2 expression in diagnostic tumor specimens was not predictive of response to this therapy. CONCLUSIONS: The recommended Phase II doses for oblimersen and docetaxel on this schedule are 7 mg/kg/day continuous i.v. infusion days 1 to 6, and 75 mg/m(2) i.v. day 6, respectively, once every 3 weeks. The absence of severe toxicities at this recommended dose, evidence of Bcl-2 protein inhibition in PBMC and tumor tissue, and encouraging antitumor activity in HPRC patients warrant further clinical evaluation of this combination.     

Toxicity and Cerebrospinal Fluid Levels of Carboplatin Chronically Infused into the Brainstem of a Primate

PURPOSE: Carboplatin was infused into the brainstem of cynomolgus monkeys to investigate neurotoxicity and systemic exposures following chronic local delivery. METHODS: Infusions at 0.42 microl/h were intended to deliver 0.025 (n = 2), 0.075 (n = 3), 0.25 (n = 5), and 0.75 (n = 3) mg/kg by day 30. Laboratory tests, radiographic measurements, and clinical observations were used to monitor toxicity. Blood and cerebrospinal fluid (CSF) were sampled for platinum. RESULTS: Lethargy and ataxia were observed after week 4 in the monkeys given 0.075 mg/kg, and week 2 in the monkeys given 0.25 mg/kg when the infused doses were approximately 250 and 400 microg, respectively. Rapidly progressive neurotoxicity with the 0.75 mg/kg dose required termination of the infusions at days 4-10. Hematology and chemistry values were unremarkable in all groups. Blood levels of platinum remained undetectable in 0.025 and 0.075 mg/kg dose groups. Levels in the 0.25 mg/kg group were 3.1 +/- 0.6 microg/l at 2 weeks and 5.2 +/- 0.8 microg/l at 1 month. The CSF platinum levels varied. Animals in the 0.25 mg/kg group had higher CSF levels at 2 weeks (avg. 65 microg/l, range 36-89) compared to their 1 month value (avg. 60 microg/l, range 7-170), despite the constant infusion. CONCLUSION: Carboplatin can be chronically infused into monkey brainstems. Neurotoxicity is the predominant side effect and is dose-dependent. Pharmacokinetics of local and systemic delivery are different for carboplatin. Further studies are needed to monitor toxicity at higher flow rates and to investigate drug binding to abnormal central nervous system (CNS) tissues.     

The effects of cyclophosphamide, ketoconazole, aclacinomycin-A, methotrexate, and scheduled methotrexate-5-fluorouracil combination chemotherapy on the transplantable R-3327 prostatic adenocarcinoma in the F1 hybrid male rat

Male F1 hybrid rats bearing the R-3327 transplantable prostatic adenocarcinoma demonstrating similar growth patterns within the original sample of animals were carefully separated into control and treatment groups. This assured treatment of tumors with similar cell kinetics within each group. In the first study, two separate drug protocols were investigated by intraperitoneal injection, namely cyclophosphamide (100 mg/kg) once every 4 weeks for 8 weeks and scheduled methotrexate (7.5 mg/kg) followed in 90 minutes by 5-fluorouracil (50 mg/kg) once each week for 8 weeks. Excellent suppression of tumor growth was obtained with each treatment protocol. Both were significant at the 0.01 level. In the second study, methotrexate (100 mg/kg) intraperitoneally once each week for 6 weeks, aclacinomycin-A intraperitoneally once each week for 4 weeks, and ketoconazole (60 mg/kg) via gavage 5 times a week for 6 weeks were administered to the animals in each respective group. Aclacinomycin-A and ketoconazole showed significant suppression of tumor growth at the 0.01 and 0.05 levels, respectively. Methotrexate suppressed tumor growth, but did not reach levels of significance over the duration of the study (0.2 less than P less than 0.3).     

Reduced toxicity and enhanced antitumor effects in mice of the ionophoric drug valinomycin when incorporated in liposomes

Valinomycin (NSC 122023) is a cyclic depsipeptide antibiotic with potassium selective ionophoric activity. This drug has been reported to display antitumor effects but its utilization has been limited by its extreme toxicity. Here we report that the incorporation of valinomycin into multilamellar liposomes composed of dimyristoyl phosphatidyl choline:cholesterol:phosphatidyl serine (10:4:1 M ratio) results in a profound reduction in toxicity with maintainence of antitumor efficacy. Thus the median lethal dose (LD50) for i.p. administered valinomycin (VM) in C57BL/6 X DBA/2 mice is 1.7 mg/kg whereas the LD50 for liposome incorporated valinomycin (MVL-VM) is in excess of 50 mg/kg. In like manner, the LD50 for i.v. administered VM is 0.18 mg/kg where the LD50 for MLV-VM preparations passed through a 0.6-micron filter is greater than 10 mg/kg. The antitumor efficacies of i.p. administered VM or MLV-VM against i.p. P388 mouse leukemia were similar in multiple dose formats using doses below the maximal tolerated dose for VM. However, since MLV-VM was substantially less toxic than VM, the liposomal drug also produced significant (170% median survival time of treated mice/median survival time of untreated control) antitumor effects when administered as a single dose at levels above the maximal tolerated dose for free VM; single doses of free VM at the maximal tolerated dose were ineffective in this context. In experiments with i.v. inoculated P388 leukemia, MLV-VM but not free VM, displayed antitumor activity (144% median survival time of treated mice/median survival time of untreated control) when administered i.v. at equitoxic doses. Thus the use of a lipid vesicle drug carrier system permits a reduction in the toxicity of valinomycin with maintainence or enhancement of antitumor activity against i.p. or i.v. P388 leukemia.     

Phase I and pharmacokinetic study of the novel redox-active agent, motexafin gadolinium, with concurrent radiation therapy in patients with locally advanced pancreatic or biliary cancers

Purpose: To determine the maximum tolerated dose and dose-limiting toxicity (DLT) of the novel anticancer agent, motexafin gadolinium (MGd), administered concurrently with radiation therapy (RT) in patients with locally advanced pancreatic or biliary tumors. The pharmacokinetics of MGd were also evaluated. Methods: Cohorts of three to six patients were treated with escalating doses of MGd, administered three times per week for a total of 16 doses concurrent with RT. The dose of RT was fixed at 5,040 cGy, and given in 28 fractions, from Monday to Friday of every week. Plasma MGd concentrations were measured by high performance liquid chromatography. Results: Eight patients were treated at dose level 1 (2.9 mg/kg), with one DLT (grade 3 fever). Three patients were treated at dose level 2 (3.6 mg/kg), and two DLTs were noted. One DLT was grade 3 nausea and vomiting (N/V), and the other was grade 3 skin toxicity. The most common toxicity was N/V. There were no objective responses. The median survival was 6 months. The MGd plasma concentration versus time profile in each patient was best fit by a two-compartment, open, linear model. There was minimal accumulation of MGd in plasma with the three-times/week dosing schedule. Simulation of the time course of MGd in the peripheral compartment indicated that maximal MGd concentrations of 1–2 μmol/kg occurred between 4 and 6 h after MGd infusion. Conclusion: Dose level 1 (2.9 mg/kg of MGd) is the recommended dose for combination with (RT) in phase II studies for locally advanced pancreatic and biliary cancers. Patient tolerance might be improved by modification of the RT schedule and antiemetic prophylaxis.