Clinical Research Papers:

Phase I clinical trial of the base excision repair inhibitor methoxyamine in combination with fludarabine for patients with advanced hematologic malignancies

Paolo F. Caimi, Brenda W. Cooper, Basem M. William, Afshin Dowlati, Paul M. Barr, Pingfu Fu, John Pink, Yan Xu, Hillard M. Lazarus, Marcos de Lima and Stanton L. Gerson _

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Oncotarget. 2017; 8:79864-79875. https://doi.org/10.18632/oncotarget.20094

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Paolo F. Caimi1,2, Brenda W. Cooper1,2, Basem M. William3, Afshin Dowlati1,2, Paul M. Barr4, Pingfu Fu5, John Pink1, Yan Xu1, Hillard M. Lazarus1,2, Marcos de Lima1,2 and Stanton L. Gerson1,2

1Case Comprehensive Cancer Center, Cleveland, Ohio, USA

2Division of Hematology and Oncology, Department of Medicine, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA

3Division of Hematology. The Ohio State University Medical School, Columbus, Ohio, USA

4Division of Hematology and Oncology, Department of Medicine, University of Rochester, Rochester, New York, USA

5Department of Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA

Correspondence to:

Paolo F. Caimi, email: [email protected]

Keywords: phase I, methoxyamine, base excision repair, hematologic malignancies, pharmacokinetics

Received: April 14, 2017     Accepted: July 26, 2017     Published: August 09, 2017


Purpose: We determined the safety, pharmacokinetics, pharmacodynamics and recommended phase II dose of the base excision repair blocker methoxyamine combined with fludarabine.

Materials and Methods: This was a phase I study with intravenous fludarabine (25 mg/m2, days 1–5), and methoxyamine (15 mg/m2–120 mg/m2, once). A maximum of six cycles were given. Adult patients with relapsed/refractory hematologic malignancies, excluding acute myeloid leukemia, were eligible.

Results: Twenty patients were treated; diagnoses included CLL/SLL (n = 10), follicular lymphoma (n = 3), DLBCL (n = 3), mantle cell lymphoma (n = 1), anaplastic large cell lymphoma (n = 1) and plasma cell myeloma (n = 2). No DLTs were observed and dose escalation reached the maximum planned dose. Hematologic toxicity was frequent; most common grade 3–4 toxicities were lymphopenia (70%), neutropenia (60%), leukopenia (50%) and anemia (40%). Four patients achieved a partial remission and 8 achieved stable disease. The drug combination resulted in increased DNA damage measured with the Comet assay.

Conclusions: Methoxyamine combined with fludarabine was safe and well tolerated. Hematologic toxicity was comparable to single agent fludarabine. Activity appears to correlate with increased levels of DNA damage. Further studies will examine use of this combination of as part conditioning regimens of stem cell transplant and use of methoxyamine as fludarabine dose-sparing agent.

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