Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)

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Hudes, G. et al.

Hudes, Haas, Yeslow, Gillon, Gunnarsson, Ellman, Nordle, Eriksson, Miller, Cisar, Kopreski, Viaro, Hartley-Asp,

Phase I clinical and pharmacologic trial of intravenous estramustine phosphate.

PURPOSE: To determine the dose-limiting toxicities, maximum-tolerated dose, and pharmacokinetics of intravenous estramustine phosphate (IV EMP). PATIENTS AND METHODS: A total of 31 patients with hormone-refractory prostate cancer received IV EMP as a 30- to 90-minute infusion weekly (n = 28) or for 3 consecutive days followed by a single weekly dose (n = 3). IV EMP dose was escalated from 500 to 3,000 mg/m(2). Pharmacokinetics of EMP and the metabolites estramustine (EaM), estromustine (EoM), estradiol, and estrone were assessed after weeks 1 and 4 of treatment. RESULTS: The initial IV EMP infusion caused perineal discomfort that was ameliorated by lengthening the infusion time. Other common toxicities were grade 1 to 2 hepatotoxicity, nausea or vomiting, and fatigue or malaise. Lower-extremity thrombosis occurred in one patient, and two others developed upper-extremity thrombosis associated with venous infusion catheters. Dose-limiting fatigue and hypotension occurred at 3,000 mg/m(2), and cumulative fatigue developed after multiple cycles at 2,500 mg/m(2). Mean EMP clearance, estimated steady-state volume of distribution, and elimination half-life were 3.7 L/h, 10.6 L, and 3.7 hours, respectively. Variability of EMP clearance was 21%, and variation in area under the curve per dose for the metabolites was 28% to 36%. Elimination half-lives of EoM and EaM were 110 hours and 64 hours, and peak plasma concentrations of these active metabolites exceeded 10 micromol/L after IV EMP doses greater-than-or-equal 2,000 mg/m(2). CONCLUSION: High-dose IV EMP can be administered safely as a weekly short infusion to patients with HRPC. High peak concentrations of active metabolites after IV EMP may provide an advantage over oral EMP in antimicrotubule drug combinations.[1]

References

Phase I clinical and pharmacologic trial of intravenous estramustine phosphate. Hudes, G., Haas, N., Yeslow, G., Gillon, T., Gunnarsson, P.O., Ellman, M., Nordle, O., Eriksson, B., Miller, L., Cisar, L., Kopreski, M., Viaro, D., Hartley-Asp, B. J. Clin. Oncol. (2002) [Pubmed]

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