RESUMO
BACKGROUND: Dexanabinol is a synthetic analogue of tetrahydrocannabinol identified as a potential anti-cancer therapeutic by e-Therapeutics PLC. Dexanabinol was selected for further investigation based on its preclinical tumoricidal activity. This phase I dose-escalation trial examined the safety, drug penetration into the central nervous system (CNS), preliminary antitumor activity, and recommended phase II dose. METHODS: Dexanabinol formulated in cremophor/ethanol was administered once weekly via 3-hour intravenous infusion to patients with brain cancer. RESULTS: A total of 26 patients were dosed once weekly at 2, 4, 8, 16, 24, 28, and 36 mg/kg. Two patients at 36 mg/kg were nonevaluable for dose level confirmation, having withdrawn early for reasons unrelated to study treatment. A recommended phase II dose of dexanabinol was established at 28 mg/kg due to related, reversible adverse events at higher dose levels that required medications for symptomatic relief. The most common drug-related toxicities were the depressed level of consciousness and lightheadedness, diarrhea, itching, fatigue, chest discomfort, and tingling in the mouth. Systemic exposure to dexanabinol (AUC0-t and C max) increased from 2 to 36 mg/kg, with dose nonproportionality apparent at the highest dose; dexanabinol was present in appreciable levels in the cerebrospinal fluid (CSF), which implies the possibility of exposure of intracranial tumors to drug. Five of 24 efficacy-evaluable patients (21%) experienced stable disease with a median duration of 2 cycles (28-day cycle) as the best response. CONCLUSIONS: Dexanabinol administered weekly by intravenous infusion was safe and well-tolerated up to 28 mg/kg in brain cancer patients, but has limited antitumor activity in patients with brain cancer.
RESUMO
BACKGROUND: Long-term corticosteroid therapy has been associated with increased risk of thrombotic disease in dogs. OBJECTIVE: The purpose of this prospective study was to use thrombelastography (TEG) and thrombin generation (TG) to detect development of a hypercoagulable state in healthy Beagle dogs receiving oral prednisone. We hypothesized that administration of corticosteroids would result in a hypercoagulable profile on TEG tracings and an increase in TG. METHODS: Six healthy adult Beagles from the University of Montreal's research colony were used to conduct a prospective longitudinal study in which all dogs received 1 mg/kg of prednisone orally once daily for 2 weeks, followed by a 6-week washout period, and then 4 mg/kg of prednisone orally once daily for 2 weeks. TEG tracings on citrated whole blood and TG measurements on frozen-thawed platelet-poor plasma were obtained before prednisone administration (baseline), at the end of the washout period, and at the end of both corticosteroid trials. RESULTS: Significant differences compared with baseline values were obtained for K, α, and MA, with tracings compatible with a hypercoagulable profile following both corticosteroid trials. There was a significant increase in endogenous thrombin potential only after low-dose (1 mg/kg) prednisone. CONCLUSION: Administration of prednisone to healthy Beagles resulted in hypercoagulability as indicated by TEG tracings, whereas the effect on TG was more variable. Further studies are needed to determine the underlying mechanisms of hypercoagulability and its clinical impact.
