bay-12-9566 and Lung-Neoplasms

Anticancer treatment has recently shifted to include a broad range of antineoplastic therapies. Old agents are continuously being re-evaluated, and new mechanisms of treatment are rapidly being explored and developed. At the same time, the patient's perceived quality of life, adverse effects of therapy, time demands, and healthcare costs have become paramount in the treatment process. Lung cancer is the most common cause of cancer death in the USA, and because many of the patients are older or debilitated, these issues become all the more important. The oral administration of anticancer therapy offers both quality-of-life and healthcare cost advantages. Oral forms of 3 new cytotoxic agents and 2 novel oral therapies are discussed. Vinorelbine, a vinca alkaloid, has well documented activity in non-small cell lung cancer. Myelosuppression is dose limiting; neurotoxicity is rare. Satraplatin (JM-216), an oral platinum derivative, shows activity in lung cancer with a favourable adverse effect profile, with no neurotoxicity or nephrotoxicity. The oral topoisomerase I inhibitor topotecan may be ideal for obtaining long term low plasma drug concentrations, which appears to maximise efficacy. LGD-1069 is a retinoid X receptor agonist that modulates cell proliferation, and BAY-129566, a matrix metalloproteinase inhibitor, appears to interrupt both the processes of angiogenesis and metastasis. LGD-1069 and BAY-129566 are nontraditional anticancer agents which may be used in conjunction with chemotherapy, other modalities, or in prevention. These 5 agents will be discussed with particular reference to recent developments in the treatment of lung cancer.

Topics: Administration, Oral; Animals; Antineoplastic Agents; Bexarotene; Biphenyl Compounds; Clinical Trials as Topic; Humans; Lung Neoplasms; Organic Chemicals; Organoplatinum Compounds; Phenylbutyrates; Tetrahydronaphthalenes; Topotecan; Vinblastine; Vinorelbine

This phase I study was performed to evaluate the safety, tolerability, and efficacy of the oral matrix metalloproteinase inhibitor BAY 12-9566 in combination with 5-fluorouracil/leucovorin in patients with advanced solid tumours, and to identify the maximum tolerated dose and the dose for use in future studies.. BAY 12-9566 and 5-fluorouracil/leucovorin were administered to 17 patients in 3 cohorts. Each patient served as his/her own control, with 5-fluorouracil being given alone on days 1-5 of cycle 1. In cohort 1, BAY 12-9566 at 800 mg p.o. b.i.d. was given with 350 mg/m2 5-fluorouracil/20 mg/m2 leucovorin x 5 days q28 days. In cohort 2, the BAY 12-9566 dose was reduced to 400 mg p.o. b.i.d., with the 5-fluorouracil/leucovorin doses remaining unchanged. Finally, in cohort 3, BAY 12-9566 400 mg bid was given with 5-fluorouracil 400 mg/m2/day. Patients were continued on therapy until unacceptable toxicity or tumour progression occurred. Pharmacokinetic analyses for both BAY 12-9566 and 5-fluorouracil were performed.. The maximum tolerated dose was 400 mg p.o. b.i.d. BAY 12-9566 plus 5-fluorouracil/leucovorin at 400 mg/m2/day and 20 mg/m2/day, respectively. Thrombocytopenia necessitated a decrease of the dose of BAY 12-9566 by 50% from cohort 1 to cohort 2. Two dose-limiting toxicities occurred in cohort 3 consisting of neutropenic fever, and ileitis, causing severe diarrhea. Of 17 patients treated on study, 7 of 14 patients evaluable for response achieved stable disease. Pharmacokinetic analysis suggested there was no interaction between BAY 12-9566 and 5-fluorouracil.. BAY 12-9566 400 mg bid and 5-fluorouracil 350 mg/m2 plus leucovorin 20 mg/m2 can be co-administered. Although there is some evidence of a clinical interaction, there is no apparent pharmacokinetic interaction. Future studies with these 2 types of agents administered in combination are warranted.

Topics: Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Biphenyl Compounds; Canada; Cohort Studies; Colorectal Neoplasms; Dose-Response Relationship, Drug; Female; Fluorouracil; Humans; Kidney Neoplasms; Leucovorin; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Matrix Metalloproteinase Inhibitors; Maximum Tolerated Dose; Organic Chemicals; Phenylbutyrates; Safety; Salvage Therapy

BAY 12-9566N (BAY), which is a substituted 4-biarylbutyric acid and has the properties of a matrix metalloproteinase (MMP) inhibitor, was tested in the accelerated cancer bioassay (ACB). In the ACB, three different genotoxic carcinogens were administered individually to groups of male and female Wistar rats, in initiation (IN) segments lasting 10 weeks, followed by BAY in promotion segments lasting 42 weeks, for a total of 52 weeks of treatment, followed by 12 weeks of recovery. The IN target organs in males were the liver using diethylnitrosamine (DEN), and the lungs, using N-nitrosodimethylamine (NDA), and in females, the mammary gland using 7,12-dimethylbenz(a)anthracene (DMBA). The study consisted of eight groups of 24 rats each as follows: controls (male and female), DEN alone (male), DEN/BAY (male), NDA (male), NDA/BAY (male), DMBA (female), and DMBA/BAY (female). The daily dose of BAY was 240 mg/kg in the diet, yielding a cumulative dose of 70,560 mg/kg. The cumulative doses of carcinogens were 220 mg/kg DEN, 150 mg/kg NDA, or 15 mg/kg DMBA. No significant difference in body-weight gain pattern was evident between any of the groups at 52 or 64 weeks. Rather, in males, DEN-induced hepatocellular adenomas were reduced with BAY treatment from 29% to 21% (p < 0.05) and carcinomas from 42% to 29% (p < 0.01). Also, in males, NDA-induced pulmonary adenomas were reduced with BAY treatment from 38% to 21% (p < 0.01) and carcinomas from 21% to 4% (p < 0.01). In females, DMBA-induced mammary gland adenomas were reduced from 13% to 4% (p < 0.01) and carcinomas from 54% to 42% (p < 0.05). Thus, BAY produced a consistent and significant reduction of neoplasm development in both genders in three target tissues of carcinogenicity in which neoplasms were induced by three different DNA-reactive initiators. This inhibition may be due to inhibition of MMP, leading to reduced neoplastic growth and development.

Topics: 9,10-Dimethyl-1,2-benzanthracene; Adenoma; Animals; Antineoplastic Agents; Biphenyl Compounds; Carcinogens; Diethylnitrosamine; Dimethylnitrosamine; Drug Screening Assays, Antitumor; Female; Liver Neoplasms; Lung Neoplasms; Male; Mammary Neoplasms, Experimental; Matrix Metalloproteinase Inhibitors; Neoplasms; Organic Chemicals; Phenylbutyrates; Rats; Rats, Wistar; Sex Factors

Excessive or poorly regulated matrix metalloproteinase (MMP) activity has been implicated as a pathogenic factor in a range of diseases where the extracellular matrix is degraded or remodelled. Synthetic, potent, low molecular weight MMP inhibitors (MMPIs) have been developed and, over the past five years, these agents have begun clinical testing in patients with cancer, rheumatoid arthritis, osteoarthritis and acute macular degeneration. The past year has seen a number of disappointments with the halting of clinical trials of Ro 32-3555 in patients with rheumatoid arthritis and of BAY 12-9566 in patients with cancer. There have, however, been some successes with perhaps the clearest indication of efficacy being seen in the results of a Phase III trial of marimastat in patients with advanced gastric cancer. Clinical trials are continuing with marimastat and other MMPIs, including prinomastat, solimastat, BMS 275291, metastat and neovastat. Results from these trials are expected in the next two years and it is likely that clinical trials with MMPIs will begin in patients with other diseases where MMPs are believed to be involved, such as restenosis, cerebral haemorrhage and multiple sclerosis. Future research is likely to focus on the identification of specific MMP targets in different diseases, both in order to improve efficacy and to reduce the musculoskeletal side effect profile that has characterised several of the first generation oral MMPIs.

Topics: Animals; Antineoplastic Agents; Biphenyl Compounds; Breast Neoplasms; Clinical Trials, Phase III as Topic; Colorectal Neoplasms; Enzyme Inhibitors; Humans; Hydroxamic Acids; Lung Neoplasms; Matrix Metalloproteinase Inhibitors; Organic Chemicals; Phenylbutyrates