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Suramin for breast and prostate cancer: a pilot study of intermittent short infusions without adaptive control
P J Woll1, M Ranson, J Margison
1CRC Department of Medical Oncology, Christie Hospital, Manchester, UK.
Background:
Suramin has shown promising activity against prostate and breast cancer but is severely neurotoxic. Complex adaptive pharmacokinetics have previously been used to adjust doses. We have undertaken a pilot study to assess the feasibility of administering suramin to outpatients with advanced cancer, using simple peak and trough monitoring.
Patients And Methods:
Nine patients with cancer refractory to conventional therapy were studied, eight with breast cancer and one with prostate cancer. Two received continuous infusions of suramin 350 mg/m2/day through an indwelling central venous catheter. Both sustained axillary vein thromboses. Subsequent patients received suramin 500 mg/m2 as a one hour intravenous infusion thrice weekly until a trough serum level of 200 micrograms/ml was achieved. Treatment was repeated at 8 week intervals. Serum suramin levels were checked before and after each dose.
Results:
Suramin treatment was well tolerated. Despite peak serum levels of up to 506 micrograms/ml, no serious toxicity was seen. No tumour responses were seen.
Conclusions:
We conclude that suramin can be safely and conveniently administered to outpatients by intermittent infusion without using complex adaptive dosing strategies. Suramin merits further study in less heavily pretreated breast cancer patients.
Insights
This pilot study shows that suramin can be safely administered to cancer outpatients using simple intermittent infusions. This approach avoids complex dosing, making suramin a viable option for further investigation in breast cancer treatment.
Area of Science:
- Oncology
- Pharmacokinetics
- Clinical Pharmacology
Background:
- Suramin demonstrates potential against prostate and breast cancers.
- Severe neurotoxicity has limited suramin's clinical use.
- Complex adaptive pharmacokinetics were previously used for dose adjustments.
Purpose of the Study:
- To assess the feasibility of outpatient suramin administration for advanced cancer.
- To evaluate simple peak and trough monitoring for dose adjustment.
- To determine the safety and convenience of intermittent suramin infusion.
Main Methods:
- Nine patients with refractory cancer (8 breast, 1 prostate) were enrolled.
- Initial continuous infusions led to thromboses; subsequent patients received intermittent IV infusions.
- Suramin dosage was adjusted to achieve a trough serum level of 200 µg/ml, with levels monitored pre- and post-dose.
Main Results:
- Suramin administration was well-tolerated in outpatients.
- No serious toxicity was observed despite peak serum levels up to 506 µg/ml.
- No tumor responses were observed in this patient cohort.
Conclusions:
- Intermittent suramin infusion is a safe and convenient outpatient administration method.
- Complex adaptive dosing strategies are not necessary for outpatient suramin therapy.
- Suramin warrants further investigation in less heavily pretreated breast cancer patients.