To: Machaon who wrote (21458 ) 5/29/1998 9:22:00 AM From: Henry Niman Respond to of 32384
bob, Speaking of breast cancer and Panretin, the ASCO abstracts are now available to the public, including the study combining Panretin (9-cis retinoic acid - 9cRA, LGD1057) with Tamoxifen to treat advanced (Stage IV) breast cancer patients. The study was very small (8 patients) but 25% (2 patients) have responded to the treatment and remain on the protocol at 11 and 14 months. This study was conducted by the National Cancer Institute: A PHASE I TRIAL AND PHARMACOKINETIC (PK) STUDY OF 9 CIS-RETINOIC ACID (9cRA, LGD 1057) AND TAMOXIFEN (Tam) IN METASTATIC BREAST CANCER PATIENTS. J.A. Lawrence, R.F. Murphy, R. Caruso, M. Shovlin, M. Noone, M. Kaiser, K.H. Cowan, P.C. Adamson, J. Zujewski, Division of Clinical Sciences, National Cancer Institute, Bethesda, MD. The antiproliferative, differentiation, and apoptotic effects of retinoids have led to their development for breast cancer. The inhibitory effect of Tam is potentiated by the addition of retinoids in preclinical models. A phase I trial and PK study of 9cRA and Tam in metastatic breast cancer patients was performed. 9cRA was administered p.o. daily at 5 planned dose levels of 50 to 140 mg/m2/d. Following 4 wks of 9cRA administration, patients received Tam 20 mg q.d. Dose limiting toxicity (DLT) was defined as >/= to grade 3 non-hematologic toxicity, grade 4 neutropenia >3 days, or grade 4 thrombocytopenia. Maximum tolerated dose (MTD) was defined as the highest dose level that not more than 1/6 patients experienced a DLT. Eight stage IV breast cancer patients (6 ER/PR positive, age 49 to 64 y.o.) were entered. Prior therapy included hormonal (n = 5) and chemotherapy (n = 6). At 90 mg/m2/d, 3/5 patients experienced DLT prior to Tam administration: grade 3 headache (n = 1), grade 3 hypercalcemia (n = 1), and grade 3 pulmonary toxicity (n = 1). Hyperlipidemia was seen (n = 7) but not considered a DLT. One of 5 patients had an asymptomatic delay in the rod-cone break by Goldman Weekers dark adaptometry at 8 weeks. Two patients (dose 70 and 90 mg/m2) demonstrated improvement in their pulmonary metastasis and remain on therapy at 11 and 14 months. The peak plasma concentration of 9cRA following a 70 mg/m2 dose was 1.6 ñ 0.9 M. Plasma AUC decreased from 237 ñ 135 M on day 1 to 135 ñ 125 M by day 28. In the pt with a rod-cone break delay, retinol decreased to 25% of baseline levels. Additional patients are being evaluated at the 70 mg/m2/d dose level. A well tolerated combination of such agents may be useful in the management of metastatic breast cancer and in the development of chemoprevention strategies.