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Ghiuzeli CM, Stýblo M, Saunders J, Calabro A, Budman D, Allen S, Devoe C, Dhingra R. The pharmacokinetics of therapeutic arsenic trioxide in acute promyelocytic leukemia patients. Leuk Lymphoma 2021; 63:653-663. [PMID: 34689693 DOI: 10.1080/10428194.2021.1978084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Arsenic trioxide (ATO) treats Acute Promyelocytic Leukemia (APL). ATO is converted from inorganic arsenic (iAs) to methylated (MAs) and dimethylated (DMAs) metabolites, which are excreted in the urine. Methylation of iAs is important in detoxification, as iAs exposure is deleterious to health. We examined ATO metabolism in 25 APL patients, measuring iAs, MAs, and DMAs. Plasma total iAs increased after ATO administration, followed by a rapid decline, reaching trough levels by 4-6 h. We identified two patterns of iAs metabolism between 6 and 24 h after infusion: in Group 1, iAs increased and were slowly converted to MAs and DMAs, whereas in Group 2, iAs was rapidly metabolized. These patterns were associated with smoking and different treatments: ATO with all-trans retinoic acid (ATRA) alone vs. ATO preceded by ATRA and chemotherapy. Our data suggest that smoking and prior chemotherapy exposure may be associated with ATO metabolism stimulation, thus lowering the effective blood ATO dose.
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Affiliation(s)
- Cristina M Ghiuzeli
- Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Miroslav Stýblo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Institute for Environmental Health Solutions, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jesse Saunders
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony Calabro
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Daniel Budman
- Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Steven Allen
- Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Craig Devoe
- Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Radhika Dhingra
- Institute for Environmental Health Solutions, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Smith AH, Marshall G, Yuan Y, Steinmaus C, Liaw J, Smith MT, Wood L, Heirich M, Fritzemeier RM, Pegram MD, Ferreccio C. Rapid reduction in breast cancer mortality with inorganic arsenic in drinking water. EBioMedicine 2014; 1:58-63. [PMID: 25580451 PMCID: PMC4286879 DOI: 10.1016/j.ebiom.2014.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Arsenic trioxide is effective in treating promyelocytic leukemia, and laboratory studies demonstrate that arsenic trioxide causes apoptosis of human breast cancer cells. Region II in northern Chile experienced very high concentrations of inorganic arsenic in drinking water, especially in the main city Antofagasta from 1958 until an arsenic removal plant was installed in 1970. METHODS We investigated breast cancer mortality from 1950 to 2010 among women in Region II compared to Region V, which had low arsenic water concentrations. We conducted studies on human breast cancer cell lines and compared arsenic exposure in Antofagasta with concentrations inducing apoptosis in laboratory studies. FINDINGS Before 1958, breast cancer mortality rates were similar, but in 1958-1970 the rates in Region II were half those in Region V (rate ratio RR = 0·51, 95% CI 0·40-0·66; p<0·0001). Women under the age of 60 experienced a 70% reduction in breast cancer mortality during 1965-1970 (RR=0·30, 0·17-0·54; p<0·0001). Breast cancer cell culture studies showed apoptosis at arsenic concentrations close to those estimated to have occurred in people in Region II. INTERPRETATION We found biologically plausible major reductions in breast cancer mortality during high exposure to inorganic arsenic in drinking water which could not be attributed to bias or confounding. We recommend clinical trial assessment of inorganic arsenic in the treatment of advanced breast cancer.
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Affiliation(s)
- Allan H Smith
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Guillermo Marshall
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Yan Yuan
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Craig Steinmaus
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Jane Liaw
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Martyn T Smith
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Lily Wood
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Marissa Heirich
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Rebecca M Fritzemeier
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Mark D Pegram
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
| | - Catterina Ferreccio
- Arsenic Research Group, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof AH Smith MD, Y Yuan MPH, Assoc Prof C Steinmaus MD, J Liaw MPH); Departamento de Estadística, Facultad de Matemáticas, Pontificia Universidad Catòlica de Chile, Santiago, Chile (Prof G Marshall PhD); Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA (Prof MT Smith PhD); Breast Cancer Oncology Program, Stanford Cancer Institute, Stanford, CA (L Wood, M Heirich, RM Fritzemeier MS, Prof MD Pegram MD); Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Catòlica de Chile, and Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile (Prof C Ferreccio MD)
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