A phase I trial of 1,3-bis(2-chloroethyl)-1-nitrosourea plus temozolomide: a North American Brain Tumor Consortium study.

The North American Brain Tumor Consortium conducted a phase I trial of the combination 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and temozolomide. Eligibility included a patient with a cancer type that was considered refractory to standard therapy. Prior nitrosourea treatments were not permitted. There were parallel dose escalations in two treatment schedules. Forty-five patients were enrolled during an 18-month period. The maximum tolerated doses (MTDs) when temozolomide followed BCNU (Arm A) were temozolomide at 550 mg/m2/p.o. and BCNU at 150 mg/m2/i.v.), whereas the MTD when temozolomide preceded BCNU (Arm B) was temozolomide at 400 mg/m2/p.o. and BCNU at 100 mg/m2/i.v. Toxicity was predominantly hematologic, although there were three instances of pulmonary toxicity, which in one case could have represented potentiation of nitrosourea-induced pulmonary fibrosis. The half-life of temozolomide was 1.86 (+/-0.31) h. There was a moderate relationship between dose and peak concentration and a strong relationship between dose and plasma concentration time curve. Pharmacokinetic parameters of temozolomide were unaffected by the treatment schedule, so the difference in MTD between the schedules is likely due to a biologic rather than a pharmacokinetic sequence interaction. There were 9 partial responses among 43 patients evaluable for response, including 5 of 25 with a histologic diagnosis of glioblastoma. The recommended dose and schedule for phase II trials of this regimen are BCNU 150 mg/m2/i.v. followed in 2 h by temozolomide 550 mg/m2/p.o. repeated every 6 weeks. We are also recommending screening and periodic pulmonary function testing during treatment to assess the possible potentiation of nitrosourea-induced pulmonary fibrosis.

Infrequency of p53 gene mutations in ependymomas.

Ependymomas, which comprise 5% of central nervous system tumors, have not been extensively characterized genetically. The p53 tumor suppressor gene is frequently mutated in human cancer, and is important in the pathogenesis of other central nervous system (CNS) tumors. Chromosomal DNA corresponding to the p53 tumor suppressor gene was amplified by the polymerase chain reaction (PCR) from 31 archival ependymoma specimens. DNA was screened for the presence of p53 mutations by single strand conformational polymorphism (SSCP) analysis; samples with altered mobility were further tested for the presence of mutation by direct DNA sequence analysis. Of the 31 ependymomas tested, one contained a detectable DNA sequence change in the p53 gene. Sequencing revealed a silent mutation in exon 6, at codon 213, which represents a known p53 sequence polymorphism. These finding suggest that in contrast to many other human cancers, p53 mutation is not important in the pathogenesis or progression of ependymomas.

Rapid regulation of c-myc protooncogene expression by progesterone in the avian oviduct.

The mRNA levels of genes known to be regulated by sex steroids are not altered until 1 hr or longer after steroid treatment, although the steroid receptor complexes are bound to nuclear acceptor sites within 5 min. In a search for early regulation of gene transcription, total chick oviduct RNA was isolated at various times after injection (i.p.) of progesterone and analyzed for c-myc expression. Levels of c-myc mRNA began to decrease in response to progesterone by 10 min after injection. The mRNA levels continued to decrease, reached a 70% reduction at 30 min, and returned to control values by 8 hr after steroid injection. Changes in alpha-tubulin mRNA levels were markedly less in these same RNA preparations. The effect was dependent on the dose of the steroid and was target-tissue specific. These changes occurred much more rapidly than changes in egg-white protein mRNA levels. Vehicle alone did not alter c-myc mRNA levels. Early regulated genes such as c-myc may represent the initial site of action of steroid receptors in the genome.

Modulation of canine myocardial sarcolemmal membrane fluidity by amphiphilic compounds.

Amphiphilic moieties such as lysophosphoglycerides and long-chain acyl carnitines accumulate in ischemic myocardium and potentially contribute to the sequelae of myocardial ischemia. To characterize alterations in membrane molecular dynamics produced by amphiphilic compounds, highly purified preparations of canine myocardial sarcolemma were spin-labeled with paramagnetic probes (5-, 12-, or 16-doxyl stearate), and alterations produced by amphiphilic compounds were quantified by electron spin resonance spectroscopy. Incorporation of 1.5, 3, or 6 mol % palmitoyl lysophosphatidylcholine resulted in a decrease of the order parameter of 16-doxyl stearate from 0.164 to 0.161, 0.155, and 0.145, respectively. Similar increases in membrane fluidity in the interior of the bilayer were present when palmitoyl lysophosphatidylethanolamine, L-palmitoyl carnitine, and platelet-activating factor were incorporated into sarcolemma. In contrast, incubation of sarcolemma with lysophosphatidylcholine did not result in significant change of the order parameter of 5-doxyl stearate, even at 6 mol %, demonstrating that lysophosphatidylcholine increases the transmembrane fluidity gradient. Sarcolemma treated with phospholipase A2 exhibited a time-dependent decrease in the rotational correlation time and order parameter when lysophospholipids constituted a small amount (6%) of sarcolemmal phospholipids. Furthermore, the effects of lysophosphatidylcholine were not dependent upon its physical state, since bilayers composed of gramicidin and lysophosphatidylcholine resulted in similar increases in membrane fluidity as micellar lysophosphatidylcholine. The results suggest that alterations in sarcolemmal molecular dynamics are one mechanism through which amphiphilic moieties mediate their multiple effects. Such alterations could contribute to the electrophysiological and biochemical sequelae of myocardial ischemia.