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Nontoxic Suramin as a Chemosensitizer in Patients: Dosing Nomogram Development

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Purpose

We reported that suramin produced chemosensitization at nontoxic doses. This benefit was lost at the ∼10-fold higher, maximally tolerated doses (MTD). The aim of the current study was to identify in patients the chemosensitizing suramin dose that delivers 10–50 μM plasma concentrations over 48 h.

Methods

Nonsmall cell lung cancer patients were given suramin, paclitaxel, and carboplatin, every 3 weeks. The starting chemosensitizing suramin dose was estimated based on previous results on MTD suramin in patients, and adjusted by using real-time pharmacokinetic monitoring. A dosing nomogram was developed by using population-based pharmacokinetic analysis of phase I results (15 patients, 85 treatment cycles), and evaluated in phase II patients (19 females, 28 males, 196 treatment cycles).

Results

The chemosensitizing suramin dose showed a terminal half-life of 202 h and a total body clearance of 0.029 L h−1 m−2 (higher than the 0.013 L h−1 m−2 value for MTD of suramin). The dosing nomogram, incorporating body surface area as the major covariate of intersubject variability and the time elapsed since the previous dose (to account for the residual concentrations due to the slow elimination), delivered the target concentrations in >95% of treatments.

Conclusions

The present study identified and validated a dosing nomogram and schedule to deliver low and nontoxic suramin concentrations that produce chemosensitization in preclinical models.

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Acknowledgments

This study was supported in part by R37CA49816, R01CA78577, R21CA91547 and U01CA76576 from the National Cancer Institute, NIH, DHHS. Patients were treated at a General Clinical Research Center (GCRC), which is supported by M01-RR00034 from the National Institutes of Health, DHHS. Analysis of carboplatin concentrations was performed by the Pharmacoanalytical Core Laboratory of The Ohio State University Comprehensive Cancer Center. Tong Shen's invaluable help in the renal clearance studies and management of clinical trial data is gratefully acknowledged.

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Authors and Affiliations

  1. College of Pharmacy, The Ohio State University, 496 West 12th Avenue, Columbus, Ohio, 43210, USA

    Danny Chen, Sae Heum Song, M. Guillaume Wientjes, Teng Kuang Yeh, Liang Zhao, Rhonda Jensen & Jessie L-S. Au

  2. James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA

    M. Guillaume Wientjes, Miguel Villalona-Calero, Gregory A. Otterson, Rhonda Jensen, Michael Grever & Jessie L-S. Au

  3. Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA

    Miguel Villalona-Calero, Gregory A. Otterson & Michael Grever

  4. National Cancer Institute, Bethesda, Maryland, USA

    Anthony J. Murgo

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  1. Danny Chen
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Correspondence to M. Guillaume Wientjes.

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Chen, D., Song, S.H., Wientjes, M.G. et al. Nontoxic Suramin as a Chemosensitizer in Patients: Dosing Nomogram Development. Pharm Res 23, 1265–1274 (2006). https://doi.org/10.1007/s11095-006-0165-1

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