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M9471091.TXT
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1994-08-09
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Document 1091
DOCN M9471091
TI A Phase I study of an angiogenesis inhibitor, TNP-470 (AGM-1470),
administered to patients (pts) with HIV-associated Kaposi's sarcoma (KS)
(Meeting abstract).
DT 9409
AU Pluda JM; Wyvill K; Figg WD; Whitcup SM; Lietzau J; Saville MW; Cohen R;
Feigal E; Parks D; Foli A; et al; NCI, Bethesda, MD
SO Proc Annu Meet Am Soc Clin Oncol; 13:A8 1994. Unique Identifier :
AIDSLINE ICDB/94600005
AB The fumagillin analogue TNP-470 is a potent inhibitor of angiogenesis in
vitro (Ingber, et al Nature 348, 555, 1990). Anti-tumor inhibitory
activity in animal models has been shown to be dose- but not
schedule-dependent. We have found that TNP-470 inhibits in vitro
KS-derived spindle cell proliferation (Saville, et al J Cell Biochem
Suppl 17E:22, 1993 abstr) at a concentration that is well tolerated in
animals and is not toxic to human lymphocytes. We therefore began a
Phase I trial of TNP-470 administered iv over 1 hr every other day to
pts with HIV-associated KS. 15 pts have been enrolled to date on 5 dose
levels (4.6, 9.3, 15.4, 23.2, and 32.4 mg/m2). Preclinical toxicology
studies revealed that at very high doses TNP-470 could cause seizures
associated with cerebral and pulmonary bleeding. No dose-limiting
toxicities have been noted in this study, although 2 pts developed
asymptomatic, transient, small white-centered retinal hemorrhages after
7 and 10 weeks of TNP-470 at 4.6 mg/m2 and 15.4 mg/m2 respectively that
were felt to be probably related to HIV. No objective, measurable
anti-KS responses have been seen although 4 pts have had stable disease
lasting 4-14 wk. Interestingly, the pt receiving 32.4 mg/m2 had the
disappearance of KS-associated, morphine-requiring foot pain after 6 wk
of TNP-470, along with a significant reduction in tumor-associated leg
edema and flattening and decrease in size in some KS lesions. A second
pt receiving 15.4 mg/m2 also had reduced tumor edema. Preliminary
pharmacokinetics suggest that TNP-470 has a rapid clearance (max 1164
+/- 718 L/hr) and an extremely short plasma half life (range 5.5-10
min). There have been no effects on CD4 cells or HIV p24 antigen. In
summary, although TNP-470 has been well tolerated, no objective,
measurable anti-KS responses have been noted to date. However, there has
been a suggestion of biological activity noted in 2 pts. We will
continue to accrue pts on successively higher dose levels, as tolerated.
DE Antibiotics, Antineoplastic/*ADMINISTRATION & DOSAGE/ADVERSE EFFECTS
Dose-Response Relationship, Drug Drug Administration Schedule HIV
Infections/*DRUG THERAPY Human Infusions, Intravenous Sarcoma,
Kaposi's/*DRUG THERAPY Sesquiterpenes/*ADMINISTRATION & DOSAGE/ADVERSE
EFFECTS Skin Neoplasms/*DRUG THERAPY MEETING ABSTRACT CLINICAL TRIAL
CLINICAL TRIAL, PHASE I
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).