Newell D R, Burtles S S, Fox B W, Jodrell D I, Connors T A
Medical School, University of Newcastle, UK.
Br J Cancer. 1999 Nov;81(5):760-8. doi: 10.1038/sj.bjc.6690761.
Preclinical toxicology studies are performed prior to phase I trials with novel cancer therapeutics to identify a safe clinical starting dose and potential human toxicities. The primary aim of this study was to evaluate the ability of rodent-only toxicology studies to identify a safe phase I trial starting dose. In addition, the ability of murine studies to predict the quantitative and qualitative human toxicology of cancer therapeutics was studied. Data for 25 cancer drugs were collated for which the preclinical and clinical routes and schedules of administration were either the same (22/25), or closely matched. The maximum tolerated dose/dose lethal to 10% of mice (MTD/LD10) was identified for 24 drugs, and in patients the maximum administered dose (MAD) was associated with dose-limiting toxicity (DLT) in initial clinical trials with 20 compounds. In addition, for 13 agents, the toxicity of the drug at one-tenth the mouse MTD/LD10 was also investigated in rats, following repeated administration (20 doses). A phase I trial starting dose of one-tenth the mouse MTD/LD10 (mg m(-2)) was, or would have been, safe for all 25 compounds. With the exception of nausea and vomiting, which cannot be assessed in rodents, other common DLTs were accurately predicted by the murine studies (i.e. 7/7 haematological and 3/3 neurological DLTs). For two of the 13 drugs studied in rats, repeated administration of one-tenth the mouse MTD/LD10 was toxic, leading to a reduction in the phase I trial starting dose; however, one-tenth the mouse MTD/LD10 was subsequently tolerated in patients. For the 20 drugs where clinical DLT was reached, the median ratio of the human MAD to the mouse MTD/LD10 was 2.6 (range 0.2-16) and the median ratio of the clinical starting dose to the MAD was 35 (range 2.3-160). In contrast, in 13 subsequent phase I trials with 11 of the initial 25 drugs, the median ratio of the clinical starting dose to the MAD was 2.8 (range 1.6-56), emphasizing the value of early clinical data in rapidly defining the dose range for therapeutic studies. For all 25 drugs studied, rodent-only toxicology provided a safe and rapid means of identifying the phase I trial starting dose and predicting commonly encountered DLTs. This study has shown that the routine use of a non-rodent species in preclinical toxicology studies prior to initial clinical trials with cancer therapeutics is not necessary.
在新型癌症治疗药物进行I期试验之前,需开展临床前毒理学研究,以确定安全的临床起始剂量和潜在的人体毒性。本研究的主要目的是评估仅使用啮齿动物的毒理学研究确定安全的I期试验起始剂量的能力。此外,还研究了小鼠研究预测癌症治疗药物定量和定性人体毒理学的能力。整理了25种癌症药物的数据,这些药物的临床前和临床给药途径及方案相同(22/25)或紧密匹配。确定了24种药物的最大耐受剂量/对10%小鼠致死的剂量(MTD/LD10),在患者中,20种化合物在初始临床试验中的最大给药剂量(MAD)与剂量限制性毒性(DLT)相关。此外,对于13种药物,在重复给药(20次)后,还在大鼠中研究了药物在小鼠MTD/LD10的十分之一剂量下的毒性。小鼠MTD/LD10的十分之一(mg m(-2))作为I期试验起始剂量,对所有25种化合物都是或本应是安全的。除了无法在啮齿动物中评估的恶心和呕吐外,小鼠研究准确预测了其他常见的DLT(即7/7种血液学和3/3种神经学DLT)。在大鼠中研究的13种药物中有2种,重复给予小鼠MTD/LD10的十分之一是有毒的,导致I期试验起始剂量降低;然而,随后患者耐受了小鼠MTD/LD10的十分之一。对于达到临床DLT的20种药物,人体MAD与小鼠MTD/LD10的中位数比值为2.6(范围0.2 - 16),临床起始剂量与MAD的中位数比值为35(范围2.3 - 160)。相比之下,在随后对最初25种药物中的11种进行的13次I期试验中,临床起始剂量与MAD的中位数比值为2.8(范围为1.6 - 56),强调了早期临床数据在快速确定治疗研究剂量范围方面的价值。对于所研究的所有25种药物,仅使用啮齿动物的毒理学提供了一种安全、快速的方法来确定I期试验起始剂量并预测常见的DLT。本研究表明,在癌症治疗药物进行初始临床试验之前的临床前毒理学研究中,常规使用非啮齿动物物种是不必要的。