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Stein M, Lin H, Jeyamohan C, Dvorzhinski D, Gounder M, Bray K, Eddy S, Goodin S, White E, DiPaola RS. Targeting tumor metabolism with 2-deoxyglucose in patients with castrate-resistant prostate cancer and advanced malignancies. Prostate 2010; 70:1388-94. [PMID: 20687211 PMCID: PMC4142700 DOI: 10.1002/pros.21172] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A profound difference between cancer and normal tissues is the preferential utilization of glycolysis by cancer cells. To translate this paradigm in the clinic, we completed a phase I study of 2-deoxyglucose (2DG), and assessed 2DG uptake with fluorodeoxyglucose (FDG) positron emission tomography (PET) and the autophagy substrate p62 as a marker of 2DG resistance. METHODS Patients received 2DG orally on days 1-14 of a 21-day cycle in cohorts of three in a dose-escalating manner. Correlative assessments included PET scans at baseline and day 2 and p62 protein in peripheral blood mononuclear cells as a potential marker of 2DG resistance. RESULTS The dose of 45 mg/kg was defined as the recommended phase II dose, secondary to dose-limiting toxicity of grade 3 asymptomatic QTc prolongation at a dose of 60 mg/kg. PK evaluation of 2DG revealed linear pharmacokinetics with C(max) 45 microg/ml (277 microM), 73.7 microg/ml (449 microM), and 122 microg/ml (744 microM) in dose levels 30, 45, and 60 mg/kg, respectively. Five of eight patients assessed with FDG-PET scanning demonstrated decreased FDG uptake by day 2 of therapy, suggesting competition of 2DG with FDG. Five of six patients assessed for p62 had a decrease in p62 at 24 hr. CONCLUSIONS These data support the safety of 2DG, defined 2DG PK, demonstrated the effect of 2DG on FDG-PET imaging, and demonstrated the feasibility of assessment of p62 as an autophagic resistance marker. These data support future studies of 2DG alone or in combination with approaches to abrogate autophagy.
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Affiliation(s)
- Mark Stein
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
- Correspondence to: Mark Stein and Robert S. DiPaola, MD, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901. , Grant sponsor: Department of Defense, Threshold Pharmaceuticals; Grant number: W81XWH-05-1-0036
| | - Hongxia Lin
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
| | - Chandrika Jeyamohan
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
| | - Dmitri Dvorzhinski
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
| | - Murugesan Gounder
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
| | - Kevin Bray
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
- Rutgers University,Piscataway,New Jersey
| | - Simantini Eddy
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
| | - Susan Goodin
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
| | - Eileen White
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
- Rutgers University,Piscataway,New Jersey
| | - Robert S. DiPaola
- Cancer Institute of New Jersey,Robert Wood Johnson Medical School, Universityof Medicine and Dentistryof New Jersey,New Brunswick,New Jersey
- Correspondence to: Mark Stein and Robert S. DiPaola, MD, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901. , Grant sponsor: Department of Defense, Threshold Pharmaceuticals; Grant number: W81XWH-05-1-0036
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Carducci MA, Carroll PR. Multidisciplinary management of advanced prostate cancer: Changing perspectives on referring patients and enhancing collaboration between oncologists and urologists in clinical trials. Urology 2005; 65:18-22; discussion 22. [PMID: 15885275 DOI: 10.1016/j.urology.2005.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Revised: 02/25/2005] [Accepted: 03/07/2005] [Indexed: 10/25/2022]
Abstract
Prostate cancer traditionally was managed by monotherapy, and treatment was almost exclusively provided by the urologic surgeon. As ongoing clinical trials in advanced disease identify novel agents or combination therapies with good tolerability and potential survival benefits, multidisciplinary management may offer optimal care for men with high-risk prostate cancer, as it does for women with breast cancer. Patients with high-risk recurrent or metastatic disease should be informed of clinical trials for which they may be eligible.
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Affiliation(s)
- Michael A Carducci
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland 21231-1000, USA.
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