A Phase I Trial of NG-Nitro-L-Arginine (L-NNA), a Nitric Oxide Synthase Inhibitor, Given as a Single Intravenous Infusion Over 10 Minutes in Patients With Advanced Solid Tumors
OBJECTIVES:
Primary
- To determine if there is a differential effect of NG-nitro-L-arginine (L-NNA) on tumor
and normal tissue vasculature (blood flow/volume) in patients with advanced solid
tumors in order to propose a safe recommended dose range for further evaluation.
Secondary
- To determine the correlation between plasma concentration of L-NNA and toxicity and
vascular effects.
- To further determine the effects of nitric oxide synthase (NOS) inhibition on tumor
tissue vasculature.
- To determine the pharmacokinetics of L-NNA.
- To determine the safety profile of L-NNA.
Tertiary
- To evaluate the potential pharmacodynamic effect of NOS inhibition on angiogenesis.
- To evaluate the effect of L-NNA on circulating NOS levels.
- To evaluate the correlation between expression levels of iNOS and eNOS and
vasoconstrictive effects of L-NNA in tumor tissue (where available).
OUTLINE: This is a dose-escalation study.
Patients receive a single dose of NG-nitro-L-arginine (L-NNA) IV over 10 minutes on day 1.
All patients undergo up to 6 dynamic contrast-enhanced computed tomography (DCE-CT).
Patients enrolled in the expanded cohort study undergo 4 additional scans of dynamic
contrast-enhanced magnetic resonance imaging (DCE-MRI) as well as DCE-CT scans.
Blood samples are collected periodically for pharmacokinetic and biomarker studies. Samples
are analyzed for L-NNA levels via a reverse-phase high performance liquid chromatography,
NOS inhibition via cGMP analysis, and VEGF-A and osteopontin levels. Previously collected
biopsy samples are analyzed for iNOS and eNOS expression.
After completion of study treatment and one week assessments, patients are followed up once
a week for 28 days and then monthly thereafter (if required).
Peer Reviewed and Funded or Endorsed by Cancer Research UK.
Interventional
Primary Purpose: Treatment
Dose-limiting toxicities (DLT) and/or subsequent maximum dose
Yes
Peter J. Hoskin, MD
Principal Investigator
Mount Vernon Cancer Centre at Mount Vernon Hospital
United Kingdom: Medicines and Healthcare Products Regulatory Agency
CDR0000697500
NCT01324115
April 2011
September 2012
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