Synthesis of 4-Hydroperoxy Derivatives of Ifosfamide and Trofosfamide by Direct Ozonation and Preliminary Antitumor Evaluation in V/Vo

Total Page:16

File Type:pdf, Size:1020Kb

Synthesis of 4-Hydroperoxy Derivatives of Ifosfamide and Trofosfamide by Direct Ozonation and Preliminary Antitumor Evaluation in V/Vo [CANCER RESEARCH, 36, 2278-2281, July 1976] Synthesis of 4-Hydroperoxy Derivatives of Ifosfamide and Trofosfamide by Direct Ozonation and Preliminary Antitumor Evaluation in V/vo Hans-J. Hohorst, Gernot Peter, and Robert F. Struck Gustav-Embden-Zentrum der Biologischen Chemie, Abteilung KIr Zellchemie der J. W. Goethe-Universit~t, 6000 Frankfurt am Main, West Germany [H-J. H., G. P.], and Kettering-Meyer Laboratory, Southern Research Institute, Birmingham, Alabama 35205 [R. F. S.] SUMMARY reported routes (15, 17 to 19, 20), as well as to improve the yields. Two of us (11) have recently described such a syn- A one-step synthesis of 4-hydroperoxyifosfamide and 4- thesis of 4-hydroperoxycyclophosphamide, and application hydroperoxytrofosfamide is described. The method in- of this method to ifosfamide and trofosfamide and evalua- volves direct ozonation of ifosfamide and trofosfamide and tion of the products against leukemia L1210 in vivo are the offers improved yields in comparison with Fenton oxidation subjects of this report. The method is advantageous be- and greater convenience in comparison with ozonation of cause of its simplicity, its use of available starting materials, the appropriate 3-butenyl phosphorodiamidate. Evaluation the ease of isolation of products, and respectable yields. of the 4-hydroperoxy derivatives of cyclophosphamide, ifos- famide, and trofosfamide against leukemia L1210 in vivo suggests a superior effect for the ifosfamide derivative. MATERIALS AND METHODS Starting Materials. Cyclophosphamide, ifosfamide, and INTRODUCTION trofosfamide were obtained from Dr. Robert R. Engle, Drug Development Branch, National Cancer Institute, Silver Cyclophosphamide and its congeners ifosfamide and tro- Spring, Md., and from Asta Werke, 4800 Bielefeld, West fosfamide (1, 3) (Chart 1) are effective antitumor agents in Germany. [~H]Cyclophosphamide was obtained from Dr. E. clinical and experimental use. Metabolic activation of cyclo- SchaumlOffel, Radiologie-Zentrum der Phillipps-Universi- phosphamide is known to proceed by C4-hydroxylation by tat, Marburg/Lahn, Germany. the mixed-function oxidase of liver microsomes (4, 7, 9, 13), Ozonation, A solution of cyclophosphamide or one of its the resulting 4-hydroxycyclophospham~de then sponta- congeners (1 g) in aqueous acetone and 30% hydrogen neously yielding the unstable aldophosphamide and subse- peroxide was treated with ozone (25 mmoles/hr) generated quently the possible "ultimate" alkylating metabolite, phos- by a Welsbach Ozonator T-816 (Welsbach Corp., Philadel- phoramide mustard (5, 6, 14). phia, Pa.) at a flow rate of 0.3 liter/rain and 50 watts of Synthesis of 4-hydroxycyclophosphamide (10, 17, 19, 20), power by bubbling into the ice bath cooled solution through as well as the "preactivated" derivatives, 4-hydroperoxycy- a capillary tube. clophosphamide (10, 17, 19, 20) and 4-peroxycyclophos- TLC. "~ TLC was performed on Analtech (Newark, Del.) phamide (15, 16, 20), has been accomplished. In addition, precoated Silica Gel G plates (250 /~m thick) in ace- 4-hydroxy- and 4-hydroperoxyifosfamide have been pre- tone:chloroform (1:3). The plates were activated at 120 ~ for pared, and the latter is currently undergoing clinical trials in 1 hr and stored in a desiccated chamber. Japan (A. Takamizawa, personal communication). Experi- Alkylating Activity. Thin-layer chromatograms were mental or clinical use of the peroxidized derivatives of cy- sprayed with a 1% solution of 4-(p-nitrobenzyl)pyridine clophosphamide and its congeners, rather than the 4-hy- (Aldrich Chemical Co., Milwaukee, Wis.)in acetone, heated droxy derivatives, is preferred because the former are much in an oven for 15 min at 140 ~ and sprayed with a 3% solution more stable and spontaneously yield the hydroxy deriva- of potassium hydroxide in methanol. Alkylating compo- tives under physiological conditions (20, 21). nents yielded blue spots. Because of the potential importance of the peroxidized Column Chromatography. Column chromatography was derivatives of cyclophosphamide and its congeners, a direct performed on Silica Gel 40 (70 to 230 mesh; EM Laborato- synthesis of these types of preactivated derivatives was ries, Elmsford, N. Y.) in acetone:chloroform (3:1) for ozon- sought for the sake of convenience over the previously ized product of cyclophosphamide and in ace- tone:chloroform (1:3) for the ifosfamide and trofosfamide products. ' This investigation was supported by Contract NO1-CM-43762, National Cancer Institute, NIH, USPHS, Department of Health, Education, and Wel- Instrumentation. Mass spectral analysis was performed fare, and by Program SN 6025 (Arbeitsgemeinschaft Cytostatika) des Bundesministeriums f(ir Forschung und Technologie, Bonn, Federal Republic of Germany. 2The abbreviations used are: TLC, thin-layer chromatography; PMR, pro- Received January 27, 1976; accepted March 18, 1976. ton magnetic resonance; M, molecular ion. 2278 CANCER RESEARCH VOL. 36 Downloaded from cancerres.aacrjournals.org on September 30, 2021. © 1976 American Association for Cancer Research. Direct Ozonation of Ifosfamide and Trofosfamide CICH2(~H2 CICH2I~H2 H 4/~--N tO 0 N(CH2CH2Cl)2 5~---S0 NHCH2CH2CI N(CHzCH2CI) 2 C yclophosphomide lfosfomide Trofosfomide (Isophosphomide) (Tri Iophosph o mi de) Chart 1. Cyclophosphamide and its congeners. with a Varian MAT Model 311A mass spectrometer and PMR ide). PMR analysis of the total product indicated a 20% yield measurements with a Varian XL-100-15 spectrometer (Var- of each product and a 35% recovery of starting material. ian, Inc., Palo Alto, Calif.). Infrared analysis was performed Column chromatography served to isolate 4-hydroperoxyi- with Perkin-Elmer Model 521 and 621 infrared spectropho- fosfamide in 11% yield; m.p. 123 to 125 ~ with explosive tometers (Perkin-Elmer Corp., Norwalk, Conn .). Radiochro- decomposition (Heizbank); mass spectrum, PMR, infrared, matograms were scanned with a Berthold-Radiochromato- and TLC data identical with the data for authentic 4-hydro- gram-scanner II, LB 2722 (Laboratory Professor Dr. Bert- peroxyifosfamide (18). hold, 7547 Wildbad/Schwarzwald, West Germany). 4-Hydroperoxytrofosfamide (NSC 260608). Ozonation of Evaluation against L1210 Leukemia. Compounds were trofosfamide under identical conditions yielded 25% of 4- administered i.p. on the 1st day of inoculation of 105 or 106 hydroperoxytrofosfamide, as indicated by PMR analysis. leukemia cells in C57BL • DBA/2 mice. Control and test Column chromatographic separation of the chloroform ex- animals were observed for days of survival. tract of the aqueous solution gave a fraction containing only the hydroperoxide. Concentration of the column eluate and RESULTS AND DISCUSSION refrigeration resulted in the isolation of 18% crystalline ma- terial (3 crops) that was homogeneous upon TLC analysis; Two synthetic routes to 4-hydroperoxycyclophosphamide m.p. 145 ~ with explosive decomposition (Heizbank); PMR,ti_ and 4-hydroperoxyifosfamide were heretofore available. m,,thyi ,u~f,,xid,,, tetramethylsilane reference: $1.70 to 2.33 (2H, Fenton oxidation was used successfully for synthesis of 4- multiplet, - CH2CH2CH -), 2.94 to 3.88 (12H, complex multi- hydroperoxycyclophosphamide (C. Benckhuysen, personal plet, CH2CH2CI), 3.88 to 4.60 (2H, multiplet, -C__H20-), 4.99 communication), as well as 4-peroxycyclophosphamide, al- (1H, doublet of triplets, -CH-OOH), 11.50 (1H, singlet, - though characterization of products generated by this route OOH)" infrared (cm-'): 3150, 3015, 2965, 2950, 2820, 1485, was not completed until after Takamizawa et al. (17, 19) 1445, 1370, 1345, 1310, 1260, 1235, 1215, 1140, 1105, 1085, reported their synthesis by ozonation of 3-butenyl N,N- 1060, 1030, 1010, 980, 955, 930, 905, 875, 805, 785, 740, bis(2-chloroethyl)phosphorodiamidate, a route used unsuc- 655, 540, 515: field desorption mass spectrum (re~e): 355 cessfully by Struck and Hill (12) for the synthesis of aldo- (3 CI, M + 1) +, 336 (3 CI, M - H20) § 320 (3 Ci, M - phosphamide. Van der Steen et al. (20) and Montgomery H202) § TLC" Rr 0.48 in acetone:chloroform (1:3) (RF of and Struck (10) were able to produce 4-hydroperoxycyclo- trofosfamide, 0.59). Elemental analysis: phosphamide in yields of 4 and 9%, respectively, by the Fenton method. Takamizawa et al. (17) synthesized this CqH,,CI3N.~O4P hydroperoxide in 44% overall yield by their procedure. Calculated" C 30.40, H 5.10, N 7.88 Preparation of 4-hydroperoxyifosfamide was also reported Found- C 30.37, H 4.94, N 7.81 by both methods (10, 18). For a larger scale preparation, ifosfamide (10 g) was Because of the availability of cyclophosphamide and its dissolved in a mixture of 70 ml acetone, 30 ml water, and10 congeners, synthesis of the corresponding hydroperoxides ml 30% hydrogen peroxide. Ozone (1 mmole/min) was bub- by use of the d rugs themselves appeared to be a potential, bled into the solution through a sintered glass disc at 0 ~ convenient route, and such a procedure was developed by over a 4.5-hr period. After evaporation of acetone under Peter and Hohorst (11) for 4-hydroperoxycyclophospham- reduced pressure, the reaction mixture, which showed an ide. The general applicability of the method is confirmed by oily bottom layer, was extracted with CH2CI2 (3 x 100 ml), this report on the synthesis of 4-hydroperoxyifosfamide and and the combined organic layers were dried over Na=SO4. -trofosfamide. After filtration, CH2CI2 was evaporated under reduced pres- 4-Hydroperoxyifosfamide (NSC 207117 and NSC sure at 15 ~ leaving a colorless oil. While
Recommended publications
  • Combination Effects of Radiotherapy / Drug Treatments for Cancer Recommendation by the German Commission on Radiological Protection with Scientific Background
    Strahlenschutzkommission Geschäftsstelle der Strahlenschutzkommission Postfach 12 06 29 D-53048 Bonn http://www.ssk.de + Combination Effects of Radiotherapy / Drug Treatments for Cancer Recommendation by the German Commission on Radiological Protection with scientific Background Adopted at the 264th session of the SSK on 21 October 2013 Combination Effects of Radiotherapy / Drug Treatments for Cancer 2 The German original of this English translation was published in 2013 by the Federal Ministry for the Environment, Nature Conservation, Building and Nuclear Safety under the title: Kombinationswirkungen Strahlentherapie/medikamentöse Tumortherapie Empfehlung der Strahlenschutzkommission mit wissenschaftlicher Begründung This translation is for informational purposes only, and is not a substitute for the official statement. The original version of the statement, published on www.ssk.de, is the only definitive and official version. Combination Effects of Radiotherapy / Drug Treatments for Cancer 3 Contents Preface ....................................................................................................................... 8 Recommendation ...................................................................................................... 9 Scientific background of the recommendation .................................................... 11 1 Introduction ..................................................................................................... 11 2 Drug licensing and pharmacovigilance .......................................................
    [Show full text]
  • Protocol of Clinical Study
    Protocol of clinical study Title Therapy-Optimization Trial and Phase II Study for the Treatment of Relapsed or Refractory of Primitive Neuroectodermal Brain Tumors and Ependymomas in Children and Adolescents Inclusion Criteria: Disease Characteristics • Histologically confirmed Medulloblastoma, cerebral PNET or Ependymoma • Refractory or relapsed disease • Measurable disease by MRI or detection of tumor cells in cerebrospinal fluid Patients characteristics • Performance status ECOG ≥ 3 or Karnofsky Status ≥ 40% • Life expectancy ≥ 8 weeks Hematological: • Absolute leukocyte count ≥ 2.0 x 10^9 /l • Hemoglobin ≥ 10g/dl • Platelet count ≥ 70 x 10^9/l Renal: • Creatinine no greater than 1.5 times UNL • No overt renal disease Hepatic: • Bilirubin less than 2.5 times UNL • AST and ALT less than 5 times UNL • No overt hepatic disease • Pulmonary: • No overt pulmonary disease • Cardiovascular: • No overt cardiovascular disease Other: • Not pregnant or nursing • Negative pregnancy test • Fertile patients must use effective contraception Orphanet Database. Clinical trial 2009. http://www.orpha.net/data/eth/DE/ID60629Eng.pdf • No uncontrolled infection Prior concurrent therapy • More than 2 weeks since prior systemic chemotherapy • More than 4 weeks since prior radiotherapy • No other concurrent anticancer or experimental drugs Examinations required • Examination of lumbar CSF • Cranial and spinal MRI within 14 days prior to start of treatment Intervention 1: P-HIT-REZ 2005: Active Comparator Carboplatine, Etoposide, Thiotepa, Trofosfamide intravenous chemotherapy 2: P-HIT-REZ 2005: Active Comparator Temozolomide, Etoposide, Thiotepa oral chemotherapy 3: E-HIT-REZ 2005: Experimental Temozolomide, Etoposide, Trofosfamide Phase II Intravent. Etoposide: Experimental Etoposide Phase II Number of expected inclusions 200 patients Study start February 2006 Estimated Study Completion January 2016 Study phase Phase II Phase III Study Design National, multicentre, treatment, randomized, crossover assignment, active control efficacy study Orphanet Database.
    [Show full text]
  • Intravenous Ascorbate and Oncologic Agents
    © PAUL S. ANDERSON 2013 INTRAVENOUS ASCORBATE AND ONCOLOGIC AGENTS Updated Data Review and Policies for concurrent use at Anderson Medical Specialty Associates, Southwest College of Naturopathic Medicine Research Institute and Medical Center and Bastyr University Clinical Research Center Paul S. Anderson 05/01/2013 © Paul S. Anderson – All rights reserved – Reproduction and redistribution only allowed with proper attribution. Abstract: Intravenous application of ascorbic acid (IVAA) has a long history in adjunctive oncology communities. Its use has stimulated much debate regarding efficacy, safety and appropriate inclusion in oncologic practice. The potential for both antagonistic and synergistic interactions between IVAA and chemotherapies or radiation has existed for some time as an unanswered or confusing question in the naturopathic and allopathic oncology community. The purpose of this publication is to summarize and update the state of understanding of this complicated topic for clinicians employing either standard or integrative oncology care. INTRAVENOUS ASCORBATE AND ONCOLOGIC AGENTS Introduction: Intravenous ascorbate has been used in oncology practice by naturopathic and alternative allopathic physicians for decades. Published data regarding this therapy shows that it continues to be one of the most commonly employed alternative IV therapies. This popularity has both stimulated awareness of this therapy and concern regarding not only the safety and efficacy of IVAA in the oncology patient but also for the potential of antagonistic
    [Show full text]
  • Nephroblastoma High-Dose Chemotherapy with Autologous Stem Cell Rescue in Children with Nephroblastoma
    Bone Marrow Transplantation (2002) 30, 893–898 2002 Nature Publishing Group All rights reserved 0268–3369/02 $25.00 www.nature.com/bmt Nephroblastoma High-dose chemotherapy with autologous stem cell rescue in children with nephroblastoma B Kremens1, B Gruhn2, T Klingebiel13, C Hasan3, H-J Laws4, E Koscielniak12, B Hero5, B Selle6, C Niemeyer7, FG Finckenstein8, A Schulz9, A Wawer10, F Zintl2 and N Graf11 1Department of Pediatric Hematology/Oncology, University of Essen, Germany; 2Department of Pediatric Hematology/Oncology, University of Jena, Germany; 3Department of Pediatric Hematology/Oncology, University of Bonn, Germany; 4Department of Pediatric Hematology/Oncology, University of Du¨sseldorf, Germany; 5Department of Pediatric Hematology/Oncology, University of Cologne, Germany; 6Department of Pediatric Hematology/Oncology, University of Heidelberg, Germany, 7Department of Pediatric Hematology/Oncology, University of Freiburg, Germany; 8Department of Pediatric Hematology/Oncology, University of Hamburg, Germany; 9Department of Pediatric Hematology/Oncology, University of Ulm, Germany; 10Department of Pediatric Hematology/Oncology, University of Halle, Germany; 11Department of Pediatric Hematology/Oncology, University of Homburg/Saar, Germany; 12Department of Pediatric Hematology, Oncology and Immunology, Olga-Hospital, Stuttgart, Germany; and 13Department of Pediatric Hematology/Oncology, University of Frankfurt, Germany Summary: Keywords: Wilms tumor; high-dose chemotherapy; auto- logous bone marrow transplantation Children with Wilms tumor who have a particular risk of failure at relapse or at primary diagnosis were treated with high-dose chemotherapy (HDC) and auto- logous peripheral blood stem cell rescue in order to A child with newly diagnosed Wilms tumor (WT) has a improve their probability of survival. From April 1992 probability of about 85% of being cured with multimodal to December 1998, 23 evaluable patients received HDC treatment nowadays.
    [Show full text]
  • Cisplatin, Gemcitabine, and Treosulfan in Relapsed Stage IV Cutaneous Malignant Melanoma Patients
    British Journal of Cancer (2007) 97, 1329 – 1332 & 2007 Cancer Research UK All rights reserved 0007 – 0920/07 $30.00 www.bjcancer.com Cisplatin, gemcitabine, and treosulfan in relapsed stage IV cutaneous malignant melanoma patients *,1,2,3 1 1 2 J Atzpodien , K Terfloth , M Fluck and M Reitz 1 2 Fachklinik Hornheide an der Westfa¨lischen Wilhelms-Universita¨t Mu¨nster, Dorbaumstr. 300, Mu¨nster 48157, Germany; Europa¨isches Institut fu¨r Tumor Immunologie und Pra¨vention (EUTIP), Bad Honnef, Germany To evaluate the efficacy of cisplatin, gemcitabine, and treosulfan (CGT) in 91 patients with pretreated relapsed AJCC stage IV À2 cutaneous malignant melanoma. Patients in relapse after first-, second-, or third-line therapy received 40 mg m intravenous (i.v.) À2 À2 Clinical Studies cisplatin, 1000 mg m i.v. gemcitabine, and 2500 mg m i.v. treosulfan on days 1 and 8. Cisplatin, gemcitabine, and treosulfan therapy was repeated every 5 weeks until progression of disease occurred. A maximum of 11 CGT cycles (mean, two cycles) was administered per patient. Four patients (4%) showed a partial response; 15 (17%) patients had stable disease; and 72 (79%) patients progressed upon first re-evaluation. Overall survival of all 91 patients was 6 months (2-year survival rate, 7%). Patients with partial remission or stable disease exhibited a median overall survival of 11 months (2-year survival rate, 36%), while patients with disease progression upon first re-evaluation had a median overall survival of 5 months (2-year survival rate, 0%). Treatment with CGT was efficient in one-fifth of the pretreated relapsed stage IV melanoma patients achieving disease stabilisation or partial remission with prolonged but limited survival.
    [Show full text]
  • Section B Changed Classes/Guidelines Final
    EPHMRA ANATOMICAL CLASSIFICATION GUIDELINES 2019 Section B Changed Classes/Guidelines Final Version Date of issue: 24th December 2018 1 A3 FUNCTIONAL GASTRO-INTESTINAL DISORDER DRUGS R2003 A3A PLAIN ANTISPASMODICS AND ANTICHOLINERGICS R1993 Includes all plain synthetic and natural antispasmodics and anticholinergics. A3B Out of use; can be reused. A3C ANTISPASMODIC/ATARACTIC COMBINATIONS This group includes combinations with tranquillisers, meprobamate and/or barbiturates except when they are indicated for disorders of the autonomic nervous system and neurasthenia, in which case they are classified in N5B4. A3D ANTISPASMODIC/ANALGESIC COMBINATIONS R1997 This group includes combinations with analgesics. Products also containing either tranquillisers or barbiturates and analgesics to be also classified in this group. Antispasmodics indicated exclusively for dysmenorrhoea are classified in G2X1. A3E ANTISPASMODICS COMBINED WITH OTHER PRODUCTS r2011 Includes all other combinations not specified in A3C, A3D and A3F. Combinations of antispasmodics and antacids are classified in A2A3; antispasmodics with antiulcerants are classified in A2B9. Combinations of antispasmodics with antiflatulents are classified here. A3F GASTROPROKINETICS r2013 This group includes products used for dyspepsia and gastro-oesophageal reflux. Compounds included are: alizapride, bromopride, cisapride, clebopride, cinitapride, domperidone, levosulpiride, metoclopramide, trimebutine. Prucalopride is classified in A6A9. Combinations of gastroprokinetics with other substances
    [Show full text]
  • Multistage Delivery of Active Agents
    111111111111111111111111111111111111111111111111111111111111111111111111111111 (12) United States Patent (io) Patent No.: US 10,143,658 B2 Ferrari et al. (45) Date of Patent: Dec. 4, 2018 (54) MULTISTAGE DELIVERY OF ACTIVE 6,355,270 B1 * 3/2002 Ferrari ................. A61K 9/0097 AGENTS 424/185.1 6,395,302 B1 * 5/2002 Hennink et al........ A61K 9/127 (71) Applicants:Board of Regents of the University of 264/4.1 2003/0059386 Al* 3/2003 Sumian ................ A61K 8/0241 Texas System, Austin, TX (US); The 424/70.1 Ohio State University Research 2003/0114366 Al* 6/2003 Martin ................. A61K 9/0097 Foundation, Columbus, OH (US) 424/489 2005/0178287 Al* 8/2005 Anderson ............ A61K 8/0241 (72) Inventors: Mauro Ferrari, Houston, TX (US); 106/31.03 Ennio Tasciotti, Houston, TX (US); 2008/0280140 Al 11/2008 Ferrari et al. Jason Sakamoto, Houston, TX (US) FOREIGN PATENT DOCUMENTS (73) Assignees: Board of Regents of the University of EP 855179 7/1998 Texas System, Austin, TX (US); The WO WO 2007/120248 10/2007 Ohio State University Research WO WO 2008/054874 5/2008 Foundation, Columbus, OH (US) WO WO 2008054874 A2 * 5/2008 ............... A61K 8/11 (*) Notice: Subject to any disclaimer, the term of this OTHER PUBLICATIONS patent is extended or adjusted under 35 U.S.C. 154(b) by 0 days. Akerman et al., "Nanocrystal targeting in vivo," Proc. Nad. Acad. Sci. USA, Oct. 1, 2002, 99(20):12617-12621. (21) Appl. No.: 14/725,570 Alley et al., "Feasibility of Drug Screening with Panels of Human tumor Cell Lines Using a Microculture Tetrazolium Assay," Cancer (22) Filed: May 29, 2015 Research, Feb.
    [Show full text]
  • Trofosfamide and Etoposide
    SMGr up Research Article SM Journal of Trofosfamide and Etoposide - A Well Sarcoma Research Tolerated Palliative Treatment for Adults with Advanced Soft Tissue Sarcoma: A Single Center Experience Marie Ahlstrom1*, Maja Sloth2 and Mikael Eriksson1 1Department of Oncology, Skane University Hospital, Sweden 2Department of Radiology, Skane University Hospital and Lund University, Sweden Article Information Abstract Received date: Sep 28, 2017 Background: Patients with a metastatic or locally advanced Soft Tissue Sarcoma (STS) are normally Accepted date: Oct 09, 2017 treated with chemotherapy. However, pretreated or vulnerable patients with comorbidities may have difficulties tolerating the intensive intravenous standard regimens. Trofosfomide, a peroral prodrug to ifosfamide, has been Published date: Oct 24, 2017 described to have promising effects in the treatment of STS. For childhood STS the combination of trofosfamide and etoposide has been used as maintenance therapy, but its utility in the treatment of adult STS has yet to be *Corresponding author described. Marie Ahlstrom, Department of Oncology, Methods: A retrospective single center experience comprising of 69 adult patients with advanced STS, Skane University Hospital, Lund, treated with Trofosfamide and Etoposide in combination (TE), is presented. The medical records, including pathology and radiology reports, of all patients who initiated TE between May 2002 and September 2015 were Sweden, Tel: 046-177435; reviewed. We present data on duration of treatment, best radiological response and reason for ending treatment Email: [email protected] and side-effects. The treatment schedule consisted of oral trofosfamide 100 mg (total dose) twice a day from day 1-10, and oral etoposide 50 mg (total dose) twice a day from day 1-10, with a cycle length of 21 days.
    [Show full text]
  • Infiltrative Lung Diseases: Complications of Novel Antineoplastic Agents in Patients with Hematological Malignancies
    10628_vahid.qxd 28/05/2008 11:39 AM Page 211 REVIEW Infiltrative lung diseases: Complications of novel antineoplastic agents in patients with hematological malignancies Bobbak Vahid MD1, Paul E Marik MD FCCP2 B Vahid, PE Marik. Infiltrative lung diseases: Complications of Les maladies pulmonaires infiltrantes : Les novel antineoplastic agents in patients with hematological complications de nouveaux antinéoplasiques malignancies. Can Respir J 2008;15(4):211-216. chez des patients atteints de tumeurs Infiltrative lung disease is a well-known complication of antineoplas- hématologiques malignes tic agents in patients with hematological malignancies. Novel agents are constantly being added to available treatments. The present La maladie pulmonaire infiltrante est une complication bien connue des review discusses different pulmonary syndromes, pathogenesis and antinéoplasiques chez les patients atteints de tumeurs hématologiques management of these novel agents. malignes. De nouveaux agents s’ajoutent constamment aux traitements disponibles. La présente analyse porte sur divers syndromes pulmonaires, Key Words: Chemotherapy; Pneumonitis; Pulmonary toxicity; différentes pathogenèses et diverses prises en charge de ces nouveaux Respiratory failure agents. ulmonary involvement is a common and challenging con- emphasize that these patterns of lung injury for many antineo- Pdition in patients with hematological malignancies. plastic agents have been described in limited case reports or Infiltrative lung diseases as a result of antineoplastic agent- small case series. On the other hand, patients with hematolog- associated pulmonary toxicity are being increasingly recog- ical malignancies often have multiple comorbidities and estab- nized as a cause of lung disease in patients with hematological lishing a cause and effect relationship between specific agents malignancies. New agents are constantly being added to the and lung disease is sometimes a difficult task.
    [Show full text]
  • Low-Dose Trofosfamide Plus Rituximab Is an Effective And
    Schelker et al. BMC Cancer (2018) 18:1000 https://doi.org/10.1186/s12885-018-4885-5 RESEARCH ARTICLE Open Access Low-dose trofosfamide plus rituximab is an effective and safe treatment for diffuse large B-cell lymphoma of the elderly: a single center experience Roland Christian Schelker* , Wolfgang Herr, Albrecht Reichle and Martin Vogelhuber Abstract Background: Rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is broadly accepted as standard for the treatment of diffuse large B-cell lymphoma (DLBCL). Nevertheless, there is sparsely data concerning the management of elderly patients. Methods: We performed a retrospective study of treatment with rituximab and low-dose trofosfamide in elderly patients (≥ 75 years) with DLBCL who were not suitable for R-CHOP or R-CHOP-like regimens or who did not consent to aggressive treatment. The choice regarding the qualification for R-CHOP or R-CHOP-like regimen was left to the estimation of the treating physicians. Results: Eleven patients with a median age of 83 years (range, 75–90 years) were included. The age-adjusted international prognostic index was low risk in one patient, low-intermediate in four patients, high-intermediate in three patients, and high risk in 3 patients. All patients were evaluable for response. Five patients (45%) achieved a complete response, three (27%) a partial response, one (9%) stable disease, and two (18%) progressive disease. The estimated 1-yr overall survival was 54.5%, and the estimated 1-yr progression-free survival 45.5%, however, three patients (27%) were alive without evidence of disease at 16–20 months from start of treatment.
    [Show full text]
  • Anatomical Classification Guidelines V2021 EPHMRA ANATOMICAL CLASSIFICATION GUIDELINES 2021
    EPHMRA ANATOMICAL CLASSIFICATION GUIDELINES 2021 Anatomical Classification Guidelines V2021 "The Anatomical Classification of Pharmaceutical Products has been developed and maintained by the European Pharmaceutical Marketing Research Association (EphMRA) and is therefore the intellectual property of this Association. EphMRA's Classification Committee prepares the guidelines for this classification system and takes care for new entries, changes and improvements in consultation with the product's manufacturer. The contents of the Anatomical Classification of Pharmaceutical Products remain the copyright to EphMRA. Permission for use need not be sought and no fee is required. We would appreciate, however, the acknowledgement of EphMRA Copyright in publications etc. Users of this classification system should keep in mind that Pharmaceutical markets can be segmented according to numerous criteria." © EphMRA 2021 Anatomical Classification Guidelines V2021 CONTENTS PAGE INTRODUCTION A ALIMENTARY TRACT AND METABOLISM 1 B BLOOD AND BLOOD FORMING ORGANS 28 C CARDIOVASCULAR SYSTEM 36 D DERMATOLOGICALS 51 G GENITO-URINARY SYSTEM AND SEX HORMONES 58 H SYSTEMIC HORMONAL PREPARATIONS (EXCLUDING SEX HORMONES) 68 J GENERAL ANTI-INFECTIVES SYSTEMIC 72 K HOSPITAL SOLUTIONS 88 L ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS 96 M MUSCULO-SKELETAL SYSTEM 106 N NERVOUS SYSTEM 111 P PARASITOLOGY 122 R RESPIRATORY SYSTEM 124 S SENSORY ORGANS 136 T DIAGNOSTIC AGENTS 143 V VARIOUS 145 Anatomical Classification Guidelines V2021 INTRODUCTION The Anatomical Classification was initiated in 1971 by EphMRA. It has been developed jointly by Intellus/PBIRG and EphMRA. It is a subjective method of grouping certain pharmaceutical products and does not represent any particular market, as would be the case with any other classification system.
    [Show full text]
  • Efficacy, Safety, and Tolerability of Approved Combination BRAF and MEK Inhibitor Regimens for BRAF-Mutant Melanoma
    Cancers 2019, 11, 1642; doi:10.3390/cancers11111642 S1 of S5 Supplementary Materials: Efficacy, Safety, and Tolerability of Approved Combination BRAF and MEK Inhibitor Regimens for BRAF-Mutant Melanoma Omid Hamid, C. Lance Cowey, Michelle Offner, Mark Faries and Richard D. Carvajal Table S1. Anticancer Treatment by Regimen Following Study Drug Discontinuation. Dabrafenib + Trametinib Vemurafenib + Encorafenib + [1,2] Cobimetinib [3] Binimetinib [4] COMBI-v † COMBI-d coBRIM COLUMBUS n = 352 n = 209 n = 183 n = 192 Any treatment 72 (20%) 101 (48%) 105 (57%) 80 (42%) Immunotherapy NR 117 (56%) 67 (37%) NR Any anti–PD-1/anti–PD-L1 NR NR 28 (15%) 39 (20%) Ipilimumab (anti-CTLA-4) 41 (12%) 86 (41%) 53 (29%) 33 (17%) Nivolumab (anti-PD-1) NR 15 (7%) NR NR Pembrolizumab (anti–PD-L1) 4 (1%) 27 (13%) NR NR anti-CTLA-4 + NR NR 4 (2%) 6 (3%) anti–PD-1/anti–PD-L1 ‡ Targeted therapies NR 21 (10%) § 32 (18%) NR BRAFi + MEKi NR NR 15 (8%) 10 (5%) ¶ BRAFi NR NR 19 (10%) 11 (6%) # MEKi NR NR 2 (1%) NR Chemotherapy NR 37 (18%) 30 (16%) 14 (7%) ** Other NR NR 2 (1%) †† 5 (3%) ‡‡ NR = not reported. Data are n (%). PD-1 = programmed death cell receptor 1. PD-L1 = programmed death cell ligand 1. † Multiple uses of a type of therapy for an individual patient were only counted once in the frequency for that treatment category; patients mght have received multiple lines of treatment. Received by ≥2% of patients. ‡ Ipilimumab + nivolumab or ipilimumab + pembrolizumab. § Small-molecule targeted therapy.
    [Show full text]