Phase I and pharmacokinetic study of LU79553, a DNA intercalating bisnaphthalimide, in patients with solid malignancies

Purpose: To determine the maximum-tolerated dose and characterize the pharm acokinetic behavior of LU79553, a novel bisnaphthalimide antineoplastic age nt, when administered as a daily intravenous infusion for 5 days every 3 we eks. Patients and Methods: Patients with advanced solid malignancies received es calating doses of LU79553. plasma sampling and urine collections were perfo rmed on both days 1 and 5 of the first course. Results: Thirty patients received 105 courses of LU79553 at doses ranging f rom 2 to 24 mg/m(2)/d. Proximal myopathy, erectile dysfunction, and myelosu ppression precluded the administration of multiple courses at doses above 1 8 mg/m(2)/d. These toxicities were intolerable in two of six patients after receiving three courses at the 24-mg/m(2)/d dose level. At the 18-mg/m(2)/ d dose, one of six patients developed febrile neutropenia and grade 2 proxi mal myopathy after three courses of LU79553. The results of electrophysiolo gic, histopathologic, and ultrastructural studies supported a drug-induced primary myopathic process. A patient with a platinum- and taxane resistant papillary serous carcinoma of the peritoneum experienced a partial response lasting 22 months. Pharmacokinetics were dose-independent, optimally descr ibed by a three-compartment model, and there was modest drug accumulation o ver the 5 days of treatment. Conclusion: Although no dose-limiting events were noted in the first two co urses of LU79553, cumulative muscular toxicity precluded repetitive treatme nt with LU79553 at doses above 18 mg/m(2)/d, which is the recommended dose for subsequent disease-directed evaluations. the preliminary antitumor acti vity noted is encouraging, but the qualitative and cumulative nature of the principal toxicities, as well as the relatively small number of patients t reated repetitively, mandate that rigorous and long-term toxicologic monito ring be performed in subsequent evaluations of this unique agent. (C) 2001 by American Society of Clinical Oncology.