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Phase I study of NKT-01
Abstract:
A phase I study of NKT-01 (deoxyspergualin), which is a derivative of an antitumor antibiotic, spergualin, was performed by a cooperative study group. NKT-01 was given intravenously by 3-h infusion. The effect of single administration was studied prior to evaluation of daily administration for 5 consecutive days. In all, 5 and 33 patients with various malignancies, including leukemia, were entered into the trials of single and daily administration, respectively. In the single-administration study, all patients were evaluable and no clear adverse effect was observed at doses ranging from 20 to 320 mg/m2. In the daily-administration study, 28 evaluable patients (16 men and 12 women; median age, 55.5 years) were treated with a daily dose of 20-500 mg/m2. Toxicities such as myelosuppression, mild nausea/vomiting, anorexia, alopecia, tongue and perioral numbness, and hypotension were observed dose-dependently during or after the treatment. Grade 2 leukopenia, thrombocytopenia, and anemia were experienced at a dose of 500 mg/m2. These usually recovered to normal values by approximately 3 weeks after treatment. A pharmacokinetic analysis of single administration revealed rapid plasma clearance, with mean half-lives for the alpha and beta phases being 28 min and 6.9 h, respectively. Approximately 12% of the infused dose was excreted into the urine in unmetabolized form. The pharmacokinetic parameters obtained after 5-day administration were similar to those recorded after single administration. Concerning treatment response, a transient but significant reduction in the number of leukemic cells was observed in one patient with adult T-cell leukemia. In this study, perioral numbness, hypotension, and hematological toxicity were concluded to be dose-limiting, with the maximal acceptable dose being 500 mg/m2. The recommended dose for a phase II study of NKT-01 against solid tumors was judged to be 400 mg/m2 given daily by 3-h infusion for 5 days, every 3 weeks. In hematological malignancies, however, higher myelosuppressive schedules of administration should be investigated.
Insights
NKT-01 (deoxyspergualin), an antitumor antibiotic derivative, showed dose-dependent toxicities in a phase I trial. The recommended dose for solid tumors is 400 mg/m2 daily for 5 days.
Area of Science:
- Oncology
- Pharmacology
- Clinical Trials
Background:
- NKT-01 (deoxyspergualin) is a derivative of the antitumor antibiotic spergualin.
- Phase I clinical trials are essential for evaluating novel anti-cancer agents.
Purpose of the Study:
- To assess the safety, tolerability, pharmacokinetics, and preliminary efficacy of NKT-01 in patients with various malignancies.
- To determine the maximum tolerated dose (MTD) and recommended dose for phase II studies.
Main Methods:
- A cooperative group conducted a phase I study involving single and daily intravenous infusions of NKT-01.
- Patients received doses ranging from 20 to 500 mg/m2.
- Pharmacokinetic analysis and toxicity assessments were performed.
Main Results:
- No significant adverse effects were observed in single-dose studies up to 320 mg/m2.
- Dose-dependent toxicities including myelosuppression, nausea, anorexia, alopecia, numbness, and hypotension were noted in daily administration.
- The maximal acceptable dose was determined to be 500 mg/m2, with dose-limiting toxicities of perioral numbness, hypotension, and hematological toxicity.
- A transient reduction in leukemic cells was observed in one patient with adult T-cell leukemia.
Conclusions:
- NKT-01 is generally well-tolerated at lower doses, but exhibits dose-limiting toxicities at higher doses.
- The recommended dose for phase II studies in solid tumors is 400 mg/m2 daily for 5 days.
- Further investigation into higher myelosuppressive schedules is warranted for hematological malignancies.