Phase I Study of Topotecan, Ifosfamide, and Etoposide (TIME) with autologous stem cell transplant in refractory cancer: pharmacokinetic and pharmacodynamic correlates

Convection Enhanced Delivery of Topotecan for Gliomas: A Single-Center Experience

A key limitation to glioma treatment involves the blood brain barrier (BBB). Convection enhanced delivery (CED) is a technique that uses a catheter placed directly into the brain parenchyma to infuse treatments using a pressure gradient. In this manuscript, we describe the physical principles behind CED along with the common pitfalls and methods for optimizing convection. Finally, we highlight our institutional experience using topotecan CED for the treatment of malignant glioma.

Andrographolide potentiates the antitumor effect of topotecan in acute myeloid leukemia cells through an intrinsic apoptotic pathway

Background

Topotecan (TP) is an anticancer drug acting as topoisomerase I inhibitor that is used in the treatment of many types of cancers including leukemia, but it has significant side effects. Andrographolide, a compound extracted from Andrographis paniculata, was recently proven to inhibit the growth of cancer cells and can induce apoptosis. The aim of this study is to investigate the possible synergism between TP and andrographolide in acute myeloid cells in vitro.

Materials and methods

U937 acute myeloid leukemic cells were cultured using Roswell Park Memorial Institute (RPMI) medium and then treated for 24 h with TP and andrographolide prepared through the dilution of dimethyl sulfoxide (DMSO) stocks with RPMI on the day of treatment. Cell proliferation was assessed using cell proliferation assay upon treatment with both compounds separately and in combination. Cell-cycle study and apoptosis detection were performed by staining the cells with propidium iodide (PI) stain and Annexin V/PI stain, respectively, followed by flow cytometry analysis. Western blotting was used to assess the expression of various proteins involved in apoptotic pathways.

Results

Both TP and andrographolide showed an antiproliferative effect in a dose-dependent manner when applied on U937 cells separately; however, pretreating the cells with andrographolide before applying TP exhibited a synergistic effect with lower inhibitory concentrations (half-maximal inhibitory concentration). Treating the cells with TP alone led to specific cell-cycle arrest at S phase that was more prominent upon pretreatment combination with andrographolide. Using Annexin V/PI staining to assess the proapoptotic effect following the pretreatment combination showed an increase in the number of apoptotic cells, which was supported by the Western blot results that manifested an upregulation of several proapoptotic proteins expression.

Conclusion

The pretreatment of U937 with andrographolide followed by low doses of TP showed an enhancement in inducing apoptosis when compared to the application of each compound separately.

Topotecan combined with Ifosfamide, Etoposide, and L-asparaginase (TIEL) regimen improves outcomes in aggressive T-cell lymphoma

This study evaluated the efficacy and safety of a new regimen consisting of Topotecan, Ifosfamide, Etoposide, and L-asparaginase (TIEL) in treating aggressive T-cell lymphoma. Twenty-four patients were included in the research, eighteen males and six females. Half of the patients were in stages III and IV, and nearly half of them experienced failure of at least one regimen. Eleven were diagnosed as peripheral T-cell lymphoma (PTCL), five extranodal NK/T-cell lymphoma, non-specific, four angioimmunoblastic, and four anaplastic large-cell lymphoma (2 ALK positive). Patients were given 98 cycles of TIEL altogether. The responsive rate to TIEL was 76.9 % among 13 cases who received the regimen as the first-line treatment. Among 11 cases, TIEL was the second- or more-line treatment, the responsive rate was 63.6 %. The median PFS was 32.0 ± 21.0 (95 % CI 0-73.29) months. Median overall survival (OS) was not reached yet. Approximately 41.3 % of patients showed the third- to fourth-degree hematological side effects. Non-hematological toxicity included nausea, vomiting, diarrhea, and abnormal liver function. Among those patients received L-asparaginase, nine experienced mild abnormal coagulation function after 7 days of initiating chemotherapy, and no pancreatic injury was found. TIEL regimen is effective for aggressive T-cell lymphoma with controllable side effect and can be used for more patients.