毒理性
/症状和体征/ 在第一阶段临床试验中,难治性癌症病人在第1、3和5天接受VP-16治疗。在给予VP-16之前60分钟,给予止吐药,包括昂丹司琼和地塞米松。VP-16前30分钟口服新生霉素,并根据标准剂量递增设计,在连续的患者组中递增剂量。治疗周期每4周重复一次。在第一个治疗周期中,通过高效液相色谱法测定新生霉素的血浆浓度。33名患者共治疗了69个周期。11名患者以VP-16的起始剂量120 mg/m2开始治疗,其中3名患者出现中性粒细胞减少性发热。VP-16的剂量降至100 mg/平方米,并额外招募了22名患者。新生霉素的剂量范围为3至9克。当新生霉素剂量至少为5.5克时,血浆浓度至少为150 uM可维持24小时。剂量限制性毒性包括中性粒细胞减少性发热和可逆性高胆红素血症。在其他新生霉素试验中,恶心是一个限制性毒性,但通过使用血清素能抗吐药得到了很好的控制。腹泻在大多数患者中常见但轻微。在之前接受过治疗的患者中,推荐的新生霉素剂量为每天7克/平方米。新生霉素似乎不会增加VP-16对骨髓或胃肠道粘膜的毒性。在总体而非游离药物水平上,容易实现与体外调节VP-16所需水平相当的新生霉素血浆浓度。
/SIGNS AND SYMPTOMS/ Patients with refractory cancer were treated with VP-16 on days 1, 3, and 5 /in a Phase 1 Clinical Trial/. Antiemetics, consisting of ondansetron and dexamethasone, were given 60 minutes before the VP-16 was administered. Novobiocin was given orally 30 minutes before the VP-16, and the dose was escalated in successive groups of patients according to a standard dose escalation design. Treatment cycles were repeated every 4 weeks. Plasma concentrations of novobiocin were determined during the first treatment cycle by high-performance liquid chromatography. Thirty-three patients were treated for a total of 69 cycles. Eleven patients were treated with a starting dose of VP-16 of 120 mg/m2, and three of these patients experienced neutropenic fever. The dose of VP-16 was reduced to 100 mg/sq m, and an additional 22 patients were enrolled. The dose of novobiocin ranged from 3 to 9 g. At a novobiocin dose of at least 5.5 g, plasma concentrations of at least 150 uM were sustained for 24 hours. Dose-limiting toxicities consisted of neutropenic fever and reversible hyperbilirubinemia. Nausea, which was a limiting toxicity in other trials of novobiocin, was well controlled with the use of serotonergic antiemetics. Diarrhea was common but mild in most patients. In previously treated patients, the recommended dose of novobiocin in this schedule is 7 g/sq m/day. Novobiocin does not appear to augment the toxicity of VP-16 to the bone marrow or the gastrointestinal mucosa. Plasma concentrations of novobiocin equivalent to the levels required to modulate VP-16 in vitro are readily achievable for total but not unbound free drug.
来源:Hazardous Substances Data Bank (HSDB)