An evaluation of combination 5-fluorouracil and spirogermanium in the treatment of advanced colorectal carcinoma

Summary Seventeen patients with advanced colorectal carcinoma were treated with a combination of 5-fluorouracil and spirogermanium, a recently developed azaspiran-germanium compound remarkable for its lack of hematologic, gastrointestinal, renal or hepatic toxicity. Response to treatment and the incidence and severity of toxicity were evaluated. No patient achieved a complete response; there were three partial responses. Toxicity was unexpectedly frequent and severe; one patient was removed from study early due to intractable diarrhea, and there were two toxic deaths, both attributable to neutropenia and sepsis. Significant toxicity occurred in all seventeen patients, including three instances of Grade 3 or 4 hematologic toxicity. Given the low response rate and high incidence of life-threatening toxicity, we do not recommend further evaluation of this schedule of 5-fluorouracil and spirogermanium in the treatment of colorectal carcinoma.     

Phase I evaluation of spirogermanium and 5-fluorouracil in colorectal carcinoma

We have conducted a phase I study to evaluate the toxicity and tolerance of a 5 day continuous infusion of spirogermanium and 5-fluorouracil, (5-FU). The 5-FU was administered via a peripheral vein at 1000 mg/M²/day for 5 days by continuous infusion. Simultaneously, spirogermanium was administered via an indwelling central venous catheter by continuous infusion for 5 days starting at 50 mg/M²/day and escalating to 250 mg/M²/day. Sixteen patients received a total of 54.5 courses of therapy. The most common and severe toxicity was neurotoxicity. Mild to moderate gastrointestinal toxicity also occurred. No significant hematologic toxicity occurred. Two partial responses occurred lasting 11 and 20.5 months, both at the 100 mg/M²/day level of spirogermanium. The recommended phase II dosages are 5-FU 1000 mg/M²/day and spirogermanium 200 mg/M²/day by 5 day continuous infusion with escalation of the spirogermanium in selected individuals. Patients on long term therapy should have close neurologic evaluation and follow up. Consideration should also be given to evaluating a group of patients at the 100 mg/M²/day level of spirogermanium due to the responses seen at this level.Presented in part at the 79th annual meeting of the American Association for Cancer Research, May 1988, New Orleans, LA, USA.     

Chemotherapy of the squamous cell lung cancer LC-12 with 5-fluorouracil,cisplatin, carboplatin or iproplatin combinations

Summary The combination of Cis-dichlorodiammineplatinum (II) (CisDDPt) + 5-Fluorouracil (5-FU) was compared with two CisDDPt analogues + 5-FU [Iproplatin (CHIP) + 5-FU and Carboplatin (CBDCA) + 5-FU] for relative efficacy against advanced stage squamous cell lung tumors (LC-12) in Balb/c mice. At equitoxic dosages, the numbers of regressions and cures were similar for the three combinations (5-FU/CISDDPt 2/10 PR's, 2/10 CR's, 2/10 cures; 5-FU/CBDCA 1/10 PR's, 5/10 CR's, 3/10 cures; 5-FU/CHIP 1/10 PR's, 3/10 CR's, 3/10 cures). The tumor growth delay among the mice not cured was slightly superior in the 5-FU/ CisDDPt regimen. All the agents were active singly against this tumor model. Based on these results, the substitution of CBDCA or CHIP for CisDDPt in a FU regimen did not offer a cytotoxic advantage. Because of different dose limiting toxicities for the platinum compounds the possibility exists that these analogues could be used in drug combinations in substitution for CisDDPt.     

A phase II study of chemotherapy of metastatic colorectal carcinoma with 5-fluorouracil plus cisplatin

The combination of 5-fluorouracil and cisplatin has shown encouraging results in single institution pilot studies in colorectal carcinoma. This phase II SWOG study was undertaken to further evaluate this treatment. Cisplatin was administered at a dose of 60 mg/M² IV day 1, repeated every 21 days. 5-FU was given at a dose of 15 mg/Kg IV days 1, 8, and 15, with cycles repeated every 21 days. Among 47 eligible patients there were no complete responses and only three partial responses for an overall response rate of 6% with a 95% confidence interval of 1% to 18%. Seventeen patients (36%) had stable disease/no response and 22 (47%) progressed. Five patients (10%) had no evaluation and were assumed to have had no response, or were early deaths. Median survival was 9.1 months. Significant hematologic toxicity was seen with grade 3 leukopenia occurring in 11 patients. There were felt to be two deaths definitely related to treatment and two additional deaths possibly treatment related. The combination of 5-FU and cisplatin used in this dose and schedule is an ineffective and toxic regimen for treatment of colorectal carcinoma. Address for offprints: Southwest Oncology Group (SWOG-8424), Operations Office, 5430 Fredericksburg Road, Suite #618, San Antonio, TX 78229-6197, USA     

顺铂、5-氟尿嘧啶、长春新碱配伍对人肝癌细胞株(7721)的相互作用

目的:观察顺铂、5-氛尿嘧啶、长春新碱配伍在体外对人肝癌细胞株(7721)的相互作用.方法:采用MTT法利用中效原理判定两药合用的效果.结果:3种药物单独应用时随着药物剂量增加,其效应也增加;两药大剂量(大于中效剂量)合用时可产生拮抗作用(CI>1);小剂量(小于中效剂量)合用时可产生协同作用(CI>1);两药合用时的浓度比例及给药时间次序不同均会影响效应大小.结论:上述3种药物任何两种合用小剂量产生协同作用,大剂量产生拮抗作用,且效应大小与两药浓度比例及给药时间次序有关.     

Enhanced liver targeting of 5-fluorouracil using galactosylated human serum albumin as a carrier molecule

The objective of this study was to develop a liver-specific antihepatocarcinoma agent. The galactosylated human serum albumin 5-fluorouracil conjugate (GHSA-5-FU) was prepared and tested for its chemical characteristic, biodistribution and primary cytotoxicity. The matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was applied to determined the molar ratio (moles of 5-FU/mole of G-HSA and moles of galactose/mole of HSA) of the conjugate. The liver targeting ability of GHSA-5-FU labeled by ¹³¹I was evaluated by measuring the total radioactivity in organs after i.v. administration in mice and rabbits, and the cytotoxicity of the conjugate was assayed by MTT method. The results showed that the molar ratio of galactose to HSA was 50, and the 5-FU to GHSA was 15. Liver uptake in rabbits and mice peaked within 5–20 min after injection. The radioactivity (counts/g tissue) of the conjugate in the liver was several times higher than those in the other organs. The conjugate showed strong cytotoxicity, but no significant cytotoxicity difference was found between GHSA-5-FU and free 5-FU.     

反相HPLC法测定人血浆中5-氟尿嘧啶的浓度

目的：建立RP-HPLC法测定人血浆中5-氟尿嘧啶的浓度。方法采用Agilent Eclipse XDB-C18色谱柱,流动相为0.02mol· L -1的磷酸二氢钾缓冲溶液（pH＝3.0）,流速为1.0mL· min -1,检测波长为264nm,柱温为25℃。结果5-氟尿嘧啶在2.0～30.0μg· mL -1度范围内呈良好的线性关系,检测限为4.0ng。5-氟尿嘧啶浓度为2.0、10.0、20.0μg· mL -1的日内RSD分别为3.6％、2.2％、1.1％,日间 RSD分别为5.2％、3.4％、1.8％,平均回收率分别为105.3％、97.2％、98.6％。结论该方法简便、快速、准确、重现性好,适用于5-氟尿嘧啶的药代动力学研究及临床血药浓度检测。     

Relationship between 5-fluorouracil exposure and outcome in patients receiving continuous venous infusion with or without concomitant radiotherapy

AIMS: Toxicity and response are correlated with plasma 5-fluorouracil (5-FU) concentration in patients treated with 5-FU at a dose of 1000 mg m(-2) day(-1). Head and neck cancer patients are treated with various therapeutic regimens, including chemotherapy with 5-FU at a dose of 600 mg m(-2) day(-1) with radiotherapy. We investigated the plasma concentration-effect relationship for this regimen, with the aim of developing recommendations for dose adjustment. METHODS: Patients received 5-FU at doses of 600 or 1000 mg m(-2) day(-1), as a continuous infusion over 4 or 5 days, with or without radiotherapy for the 600 mg m(-2) day(-1) regimen. The area under the curve (AUC) for 5-FU concentration was estimated, based on a single morning blood sample taken each day during treatment. AUC values were compared between patients with and without toxicity. This simplified method for AUC estimation was compared with the standard two-samples-per-day method in an independent group of 50 patients. RESULTS: Forty-six patients, corresponding to 115 courses, were included in this prospective study. Considerable interindividual variability in estimated AUC was observed for both doses. Grade 3-4 toxicity occurred in 10 and 21% of patients given doses of 600 and 1000 mg m(-2) day(-1), respectively. Ths study confirmed the relationship between plasma 5-FU concentration and toxicity previously reported for 1000 mg m(-2) day(-1), but found no such relationship for the 600 mg m(-2) day(-1) regimen with concomitant radiotherapy. CONCLUSIONS: Our results do not support the use of therapeutic drug monitoring to improve tolerance for the 600 mg m(-2) day(-1) regimen with concomitant radiotherapy. A simplified method is proposed for 5-FU monitoring for the 1000 mg m(-2) day(-1) regimen.     

The use of human tumour cell lines in the discovery of new cancer chemotherapeutic drugs

Background: Human tumour cell lines have played a major role in anticancer drug discovery, but cell lines may model only some aspects of tumour behaviour in cancer patients. Growing evidence supports a theory that stem cells with self-renewing properties sustain tumours. Objective: This review considers the extent to which a deeper understanding of the origin and properties of tumour cell lines might lead to new strategies for anticancer drug discovery. Methods: Recent literature on normal and tumour stem cells is reviewed and placed in the context of a discussion on the derivation and properties of tumour cell lines. Results/conclusion: Early-passage cell lines may model the more rapidly proliferating cells in human tumours and, thus, retain some of the properties of tumour stem cells. The effects of anticancer drugs on cell lines should be considered not only with regards to the induction of apoptosis, but also to the induction of senescence or other pathways that lead to host immune and inflammatory responses.     

瘦素对5-氟尿嘧啶损伤结肠癌细胞的影响

目的探讨不同浓度的瘦素对5-氟尿嘧啶(5-FU)损伤结肠癌细胞的影响。方法同时用5-FU及不同浓度的瘦素进行体外干预结肠癌HT-29细胞株。MTT法检测5-FU50%细胞生长抑制率(IC50)的变化。流式细胞仪、原位末端转移酶标记法(TUNEL)进行周期及凋亡分析。以RT-PCR方法检测caspase-9,caspase-3mRNA的表达。结果瘦素抑制5-FU对HT-29的杀伤作用。抑制5-FU诱导的细胞周期阻滞及细胞凋亡。RT-PCR表明加入瘦素后caspase-9,caspase-3mRNA的表达均下降,且呈剂量依赖性。结论瘦素通过下调caspase-9,caspase-3的表达促进结肠癌细胞产生凋亡抵抗,抑制5-FU的损伤作用。     

Synergistic effect of combining paeonol and cisplatin on apoptotic induction of human hepatoma cell lines

Aim： To investigate whether paeonol （Pae） has synergistic effects with cisplatin （CDDP） on the growth-inhibition and apoptosis-induction of human hepatoma cell lines HepG2 and SMMC-7721. Methods： The cytotoxic effect of drugs was measured by 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyl-tetrazolium bromide assay. The coefficient of drug interaction was used to analyze the nature of drug interactions. Morphological changes were observed by acridine orange fluorescence staining. Cell cycle and the apoptosis rate were detected by flow cytometry. Bcl-2 and Bax expression were assayed by immunohistochemical staining. Results： Pae or CDDP had antiproliferative effect on the 2 cell lines in a dose-dependent manner, with different sensitivities to drugs. More interestingly, a synergistic inhibitory effect on the viability of the 2 cell lines was observed after treatment with a combination of Pae （15.63, 31.25, and 62.5 mg/L） with various concentrations of CDDP. Further study showed typical morphological changes of apoptosis if the cells were exposed to the two agents for 24 h. The apoptotic rate of the cells with combination treatment was significantly higher than that of cells treated with Pae or CDDP alone. The expression of Bcl-2 decreased and that of Bax increased in the treated groups, especially in the combination group, with the ratio of Bcl-2/Bax decreasing correspondingly. Additionally, a combination of Pae with CDDP resulted in a stronger S phase arrest, compared with Pae or CDDP alone. Conclusion： Pae, in combination with CDDP, had a significantly synergistic growth-inhibitory and apoptosis-inducing effect on the 2 human hepatoma cell lines, which may be useful in hepatoma treatment.     

姜黄素与5-氟尿嘧啶联用对人结肠癌HT-29细胞增殖的影响

目的　体外观察 5 氟尿嘧啶与姜黄素联用对人结肠癌HT 2 9细胞增殖的相互作用。方法　采用MTT法观察不同浓度姜黄素、5 氟尿嘧啶单独或联合应用对HT 2 9细胞生长的抑制作用 ,并利用中效原理判定两药合用的效果。结果　两种药物单独应用时 ,对HT 2 9细胞的抑制作用呈明显的剂量效应关系 ;对于HT 2 9细胞 ,姜黄素的中位抑制浓度为(32± 11) μmol·L- 1,5 氟尿嘧啶的中位抑制浓度为(10 4 0± 4 5 6 ) μmol·L- 1。应用中效原理分析显示 ,两药在联合应用时为协同效应 ,并且在不同的药物浓度配比下呈相同的趋势。增大姜黄素的用量可在更宽的效应范围内获得两种药物的协同效应。结论姜黄素与 5 氟尿嘧啶在联合应用时的相互作用为协同效应 ,本结果对于结肠癌的治疗具有一定的临床意义。     

Pretreatment with insulin enhances anticancer functions of 5-fluorouracil in human esophageal and colonic cancer cells

AIM: To investigate the effects of insulin on enhancing 5-fluorouracil (5-FU) anticancer functions and its mechanisms in the human esophageal cancer cell line (Eca 109) and human colonic cancer cell line (Ls-174-t). METHODS: The effect of insulin/5-FU combination treatment on the growth of Eca 109 and Ls-174-t cells was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay. After insulin treatment or insulin/5-FU treatment, cell cycle distribution of both cell lines was analyzed by flow cytometry. Western blot assay was used to assess the expression of caspase-3 and thymidylate synthase (TS). Apoptosis was detected by flow cytometry, DNA fragmentation assay, and terminal transferase dUTP nick end labeling assay (TUNEL). Moreover, the changes of 5-FU uptake after insulin pretreatment were detected by HPLC assay and Western blot analysis. RESULTS: We found that insulin enhanced the inhibitory effect of 5- FU on cell proliferation when Eca 109 cells and Ls-174-t cells were pretreated with insulin for the appropriate time. Insulin increased the cell number of the S phase and the uptake of 5-FU. Insulin/5-FU treatment enhanced apoptosis of tumor cells and upregulated the expression of cleaved caspase-3 compared with 5-FU treatment. Moreover, insulin/5-FU treatment induced the changes of free TS and the TS ternary complex level compared with 5-FU treatment in Eca 109 and Ls-174-t cells. CONCLUSION: These data suggest that insulin enhances anticancer functions of 5- FU when it is treated before 5-FU for the appropriate time in human esophageal and colonic cancer cell lines.     

Drug sensitivity of ten human tumor cell lines compared to mouse leukemia (L1210) cells

L1210 leukemia cells, because of their rapid growth rate in suspension culture and high growth fraction, are ideally suited to screen in vitro for cytotoxic compounds. Although L1210 cells may mimic rapidly growing tumors, they have not been effective in selecting agents active against slow growing solid tumors. We expected that cell lines originating from human solid tumors, because of their slower growth rate and lower S phase fraction, would be more drug resistant than L1210. Therefore, we compared ten human tumor cell lines (5 melanomas, 4 colon carcinomas and 1 small cell lung carcinoma) to L1210 growth inhibition by 9 anti-tumor drugs. Not one human tumor cell line was consistently more resistant to all nine drugs than L1210 when the cells were exposed to drugs for about 2 doubling times. The drug sensitivity of 2 cell lines (L1210 and SK MEL 28) was again determined after a short term (2 hr) exposure and using growth inhibition and cell survival as end points. For both end points these two cell lines exhibited a random pattern of sensitivity to the drugs tested. Cell kill showed an order of sensitivity different than growth inhibition. The implication of these findings for drug-screening is discussed.     

内镜下5-FU化疗粒子植入治疗晚期结直肠恶性肿瘤近期临床疗效及免疫功能变化的观察

目的 观察晚期结直肠肿瘤经内镜5-FU化疗缓释粒子植入术后近期疗效及对免疫功能的影响.方法 21例晚期结直肠癌患者在内镜下进行5-FU化疗粒子植入肿瘤体内治疗,观察治疗后1个月内,瘤体变化情况,临床症状缓解情况、T细胞亚群、免疫球蛋白的变化.结果 治疗后1个月,肿瘤体积缩小,有效率为90.5%;临床症状明显缓解;CD3＋、CD4＋、CD4＋/CD8＋较治疗前明显增多,差异有统计学意义（P〈0.01）;CD8＋较治疗前明显减少,差异有统计学意义（P〈0.01）.结论 经内镜化疗粒子植入治疗后,由于瘤体缩小,临床症状明显缓解,免疫功能有所改善,近期疗效肯定,远期疗效有待进一步观察.     

5-氟尿嘧啶对人SKOV3卵巢癌细胞株细胞增殖和Skp2的影响

目的：探讨体外不同浓度5-氟尿嘧啶对人SKOV3卵巢癌细胞株细胞增殖和Skp2表达的影响。方法不同浓度5-氟尿嘧啶0、10、20、40和80μg／ml作用于人SKOV3卵巢癌细胞株后72h,通过细胞计数试剂盒-8（CCK-8）法检测各组卵巢癌细胞增殖情况,采用免疫细胞化学染色法和Realtime PCR技术检测各组Skp2蛋白和mR-NA水平的变化。结果不同浓度的5-氟尿嘧啶作用于人SKOV3卵巢癌细胞株72h后,随着浓度的增加,细胞增殖受限明显,Skp2蛋白和mRNA表达水平明显降低,并与5-氟尿嘧啶的浓度呈负相关（ r＝－0．816,P＜0．05;免疫组化Skp2：r＝－0．926,P＜0．05;RealtimePCRmRNA：r＝－0．899,P＜0．05）。结论5-氟尿嘧啶能够抑制SKOV3卵巢癌细胞株的增殖,并能抑制Skp2蛋白和mRNA的表达。     

人肝癌Bel7402/5-FU耐药株多药耐药与凋亡关系的研究

目的　从凋亡的角度探讨人肝癌细胞Bel74 0 2 / 5 FU多药耐药的分子机制。方法　采用SRB法检测Bel74 0 2 / 5 FU耐药株的多药耐药性 ,用AnnexinV FITC/PI双标流式细胞术检测Bel74 0 2细胞及其耐药株的凋亡程度 ,PI单染检测细胞周期变化 ,RT PCR方法检测凋亡相关因子bcl 2、bcl xl、bcl xs、bax、fas、p5 3和cpp32的表达情况。 结果　Bel74 0 2 / 5 FU耐药株具有多药耐药性 ;相同剂量 30 μmol·L-1及 15 0 μmol·L-15 FU处理 ,Bel74 0 2细胞凋亡明显增加 ,G0 /G1期增加 ,S期、G2 /GM减少 ,耐药株不出现凋亡增加及细胞周期改变 ;耐药株凋亡相关因子bcl xl、bcl xs和bax表达上调 ,p5 3和cpp32表达下调。 结论　人肝癌Bel74 0 2 / 5 FU耐药株的多药耐药性可能和凋亡减少有关 ,抗凋亡因子bcl xl表达上调 ,促凋亡因子 p5 3和cpp32表达下调可能参与Bel74 0 2 / 5 FU耐药株的多药耐药。     

Comparative cytotoxicity of oxaliplatin and cisplatin in non-seminomatous germ cell cancer cell lines

Approximately 70-80% of patients with metastatic testicular cancer will become disease free with cisplatin-based chemotherapy and most of these patients will be longterm survivors. Despite these impressive results, the two limitations of cisplatin are its severe and potentially long-term side-effects, and the emergence of drug resistance which prevents a small proportion of these patients from achieving long-term remission. Oxaliplatin has an improved toxicity profile compared to cisplatin and contains the diaminocyclohexane (DACH) substituent known to be correlated with a lack of cross resistance with cisplatin. A phase II study has shown interesting activity when used in combination with cisplatin in cisplatin-refractory testicular cancer patients. Here we report the results of the first in vitro study investigating whether oxaliplatin as a single agent exhibits cross-resistance to cisplatin in a panel of non-seminomatous germ cell tumor (NSGCT) cell lines using short and long-term drug exposures in a five-day sulfhodamine B in vitro cytotoxicity assay. Oxaliplatin cytotoxicity was significantly superior to cisplatin in cell lines with both acquired (H12DDP) and intrinsic (1777NR Cl-A) intermediate level resistance to cisplatin. Following 24h or 96h drug exposure the fold resistance in H12DDP and 1777NR Cl-A was 1.7-2.2 with oxaliplatin compared to 3.9-6.1 with cisplatin. The cytotoxic activity of oxaliplatin was not significantly different from that of cisplatin in cisplatin-senstive cell lines or in cell lines with a high level (10-20 fold) of cisplatin resistance. The results of this study suggest that further pre-clinical studies in NSGCT are of interest, particularly in combination with cisplatin, ifosfamide and etoposide. Furthermore, the in vitro results support the use of an oxaliplatin administration schedules giving prolonged drug exposure, such as the flat or circadian rhythm-modulated schedule already under investigation for oxaliplatin.     

N-(2-羟丙基)甲基丙烯酰胺聚合物-5-氟尿嘧啶接合物的体外释药规律、体内分布及抗肿瘤活性研究

考察本实验室合成的N-(2-羟丙基)甲基丙烯酰胺[N-(2-hydroxypropyl)methacrylamide,HPMA]聚合物-5-氟尿嘧啶(5-flurouracil,5-FU)接合物(P-FU)的体外释药、体内分布及抗肿瘤活性。以小鼠血浆为介质,考察P-FU中5-FU的释放规律;以小鼠H22肝癌实体瘤模型(皮下型)为肿瘤模型,考察接合物在荷瘤小鼠体内的分布情况、药代动力学规律及抑瘤活性。结果表明,37℃时P-FU在小鼠血浆中具有一定的稳定性,半衰期(t1/2)为32.4 h。与5-FU相比,P-FU在荷瘤小鼠体内的循环时间明显延长(血浆中t1/2为原药的166倍),在肿瘤中的沉积量(AUC为5-FU的3.3倍)及滞留时间(t1/2为5-FU的2.3倍)均有明显增加。体内药效学研究表明,P-FU组对荷瘤小鼠的肿瘤生长抑制率(69.09%)显著高于5-FU组(56.49%,P<0.05),瘤块组织病理学观察结果也显示P-FU组小鼠肿瘤组织中细胞凋亡程度大于5-FU组。HPMA聚合物可被用于为5-FU构建一种新型实体瘤高分子给药系统。     

Modulating effect of mitomycin or cisplatin on lymphokine-activated killer cell proliferation and antitumor activity to bladder cancer cell lines in vitro

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