Phase I clinical investigation of fludarabine phosphate by a loading-dose and continuous-infusion schedule.

Fludarabine phosphate was studied in a phase I trial of a loading-dose/continuous-infusion schedule. The schedule was chosen to rapidly achieve and maintain concentrations that have been shown in vitro to achieve maximal inhibition of cell growth. The initial level was a loading dose of 20 mg/m2 followed by a 48-hour continuous iv (CIV) infusion of 30 mg/m2 every 24 hours. For the single-dose escalation, the loading dose was held constant while the CIV dose was increased to 45 mg/m2/24 hours for 48 hours. The dose-limiting toxicity was myelosuppression, especially leukopenia. No other significant toxicity was encountered. The maximum tolerated dose was 20 mg/m2 by iv push followed by a 48-hour CIV infusion of 30 mg/m2/24 hours for 48 hours. The recommended starting dose for phase II trials is 20 mg/m2 by iv push followed by a 48-hour CIV infusion of 30 mg/m2/24 hours. This dose level achieved the target plasma levels in the 2 patients studied.

Limited sampling models for amonafide (NSC 308847) pharmacokinetics.

The limited sampling model (LSM) offers a means of estimating the area under the concentration-time curve (AUC) from only two timed plasma concentrations. In this study, pharmacokinetic profiles were simulated for 23 patients treated with amonafide, using each patient's individual pharmacokinetic parameters. Data were simulated for a dose of 250 mg/m2 administered over 1 h. The initial 15 patients formed the training data set. Based on the training data set, five different LSMs were generated, with the multiple r ranging from 0.92 to 0.98. A single model was selected as optimal: AUC (micrograms min/ml) = 292.9 (min) C45 (micrograms/ml) + 3262 (min) C1440 (micrograms/ml) + 21.8 (micrograms min/ml) dose (mg/m2)/250 mg/m2 where C45 = 45-min plasma concentration and C1440 = 24-h plasma concentration. This model was revalidated on a second test data set of seven patients actually treated with a 1-h infusion. The relative root mean square predictive error was 15.8%, acceptable for most clinical uses. We conclude that the LSM is a powerful tool for estimation of the AUC in a large patient population. The LSM may facilitate population pharmacodynamic studies in conjunction with Phase II trials.

Boron neutron capture therapy of intracerebral melanoma using boronophenylalanine as a capture agent.

A rat brain tumor model has been developed utilizing nude rats and the human melanoma cell line MRA 27. For pharmacokinetic and tissue distribution studies, 2 10(5) MRA 27 cells were implanted intracerebrally (i.c.), and 30 days later, 120 mg of 10B-enriched L-boronophenylalanine were injected i.p. into nude rats. 10B concentrations in the tumor, blood, and normal brain were 23.7, 9.4, and 8.4 micrograms/g, respectively, 6 h following administration. For therapy experiments, tumor bearing rats were irradiated at the Brookhaven Medical Research Reactor 30 days following implantation. The median survival time was 44 days for untreated rats, 76 days for those receiving a physical dose of 2.7 Gy, and 93 days for those receiving 3.6 Gy. Animals receiving both 10B-L-boronophenylalanine and physical doses of 1.8, 2.7, or 3.6 Gy (total tumor physical doses of 5.0, 7.5, or 10.1 Gy) had median survival times of 170, 182, and 262 days, respectively. Forty % of rats that received the highest tumor dose (10.1 Gy) survived > 300 days. In a replicate experiment 21% of animals that had received L-boronophenylalanine and irradiation (total tumor physical dose of 10.1 Gy) were alive 220 days after therapy. In a parallel study, animals that were irradiated with gamma photons from a 137Cs source with 12 Gy or 2.0 Gy 9 delivered to the head had median survival times of 86 and 79 days, respectively, compared to 47 days for untreated animals. Our results indicate that boron neutron capture therapy is effective against i.c. melanoma in a rodent model and suggest that large animal studies are warranted to further assess its efficacy.

Pharmacokinetics of 2-F-ara-A (9-beta-D-arabinofuranosyl-2-fluoroadenine) in cancer patients during the phase I clinical investigation of fludarabine phosphate.

Fludara I.V. (fludarabine phosphate) (2-F-ara-adenosine monophosphate [2-F-ara-AMP], NSC 312887) is the 5'-phosphate of 2-F-ara-A-(9-beta-D-arabinofuranosyl-2-fluoroadenine), a derivative of ara-A that is resistant to deamination and selectively inhibits DNA synthesis. Concurrent with the phase I evaluation of 2-F-ara-AMP administered as a single intravenous (IV) bolus every 21 days to patients with advanced malignancy, plasma pharmacokinetic profiles of 2-F-ara-A were determined in 30 patients following the rapid infusion (2 to 5 minutes) of doses of 2-F-ara-AMP ranging from 80 to 260 mg/m2. The parent drug was almost quantitatively converted to 2-F-ara-A by apparent first-pass metabolism, with maximum levels of 2-F-ara-A and very low levels (less than 1 fmol/L) of 2-F-ara-AMP observed only in the plasma samples obtained shortly after dosing (2 to 4 minutes). The plasma concentration-time profiles exhibited three exponential phases. Plasma concentrations were computer fitted to a three-compartment open model using a zero-order input function for the injection period. The 2-F-ara-A harmonic mean half-lives were t1/2 alpha = 4.97 minutes, t1/2 beta = 1.38 hours, t1/2 gamma = 10.41 hours, and the mean residence time was 10.51 hours. The rate-limiting process for elimination of the drug from the body appeared to be release from tissue binding sites. The mean total-body plasma clearance was 67.98 +/- 19.58 mL/min/m2 (mean +/- SD). The mean central compartment volume of distribution (V1) was 7.49 L/m2 or 0.20 L/kg. The mean steady-state volume of distribution (Vdss) was 44.17 L/m2 or 1.19 L/kg, indicating that 2-F-ara-A is distributed and bound to the tissues of the body. Total-body clearance and the volume parameters Vdss and Vd gamma decreased with an increase in serum creatinine, indicating that these pharmacokinetic parameters depend upon renal function. Dose reduction in patients with renal dysfunction is recommended.

A nude rat model for neutron capture therapy of human intracerebral melanoma.

PURPOSE: The present study was carried out to determine the efficacy of Boron Neutron Capture Therapy (BNCT) for intracerebral melanoma using nude rats, the human melanoma cell line MRA 27, and boronophenylalanine as the capture agent. METHODS AND MATERIALS: Pharmacokinetic and tissue distribution studies: MRA 27 cells (2 x 10(5)) were implanted intracerebrally, and 30 days later, 120 mg of 10B-L-BPA were injected intraperitoneally into nude rats. Therapy experiments: Thirty days following implantation, tumor bearing rats were irradiated at the Brookhaven Medical Research Reactor. RESULTS: Pharmacokinetic experiments: Six hours following administration of BPA, tumor, blood, and normal brain boron-10 levels were 23.7, 9.4, and 8.4 micrograms/g respectively. Therapy experiments: Median survival time of untreated rats was 44 days compared to 76 days and 93 days for those receiving physical doses of 2.73 Gy and 3.64 Gy, respectively. Rats that had received both 10B-BPA and physical doses of 1.82, 2.73, or 3.64 Gy had median survival times of 170, 182, and 262 days, respectively. Forty percent of rats that had received the highest tumor dose (10.1 Gy) survived for > 300 days and in a replicate experiment 21% of the rats were longterm survivors (> 220 days). Animals that received 12 Gy in a single dose or 18 Gy fractionated (2 Gy x 9) of gamma photons from a 137Cs source had median survival times of 86 and 79 days, respectively, compared to 47 days for untreated animals. Histopathologic examination of the brains of longterm surviving rats, euthanized at 8 or 16 months following BNCT, showed no residual tumor, but dense accumulations of melanin laden macrophages and minimal gliosis were observed. CONCLUSION: Significant prolongations in median survival time were noted in nude rats with intracerebral human melanoma that had received BNCT thereby suggesting therapeutic efficacy. Large animal studies should be carried out to further assess BNCT of intracerebral melanoma before any human trials are contemplated.

An enzymatic kinetic method for the determination of 2'-deoxycoformycin in biological fluids.

An analytical method for determination of 2'-deoxycoformycin (2'-DCF) concentrations in plasma and urine was developed based upon a modification of adenosine deaminase (ADA) inhibition assays described in the literature. The method involves the spectrophotometric monitoring of the rate of deamination of adenosine by the enzyme in the presence of various concentrations of the inhibitor 2'-DCF, and relating the deamination rate to the 2'-DCF concentration. In the course of developing the method, it was found that adenosine deaminase appears to lose activity after dilution with phosphate buffer (pH 7.2). Enzyme inactivation was found to occur mono-exponentially with time and, in order to accommodate for this inactivation, a method was developed for quantitating 2'-DCF which takes into consideration the relative activity of the enzyme in the incubation mixtures. The results obtained from the analysis of samples containing known concentrations of 2'-DCF were fitted to a three-dimensional standard surface by means of a nonlinear least-squares regression computer program. Quantitation of 2'-DCF in patient samples is accomplished by an ADA inhibition titration technique in which the spectrophotometrically determined absorbance change is related to the two independent variables, the concentration of 2'-DCF in the standards and the relative time of the analysis. As little as 1 ng/ml of 2'-DCF in plasma can be quantitated with the assay.

Pharmacokinetics: an analysis of the method.

The field of radiology in general, and gastrointestinal radiology in particular, can and has benefited by the application of pharmacokinetic principles in contrast agent research and development. The application of basic pharmacokinetic principles can aid in the design of new synthetic analogues. In many cases, the presence or the absence of certain functional groups in particular locations on the aromatic ring system can predictively influence the binding, clearance and half-life values of these compounds. Detailed pharmacokinetic understanding of gastrointestinal contrast agents, particularly cholecystopaques, hold the key for unlocking the "black box" aspects of hepatic/biliary functions. Specific agents are currently quantitating and characterizing hepatic uptake, enzyme transformations, and biliary excretion functions of the liver. Pharmacokinetic principles can also be applied within the clinical radiology setting. Studies are currently underway to correlate blood iodine levels following iopanoic acid (Telepaque) administration with the causes of gallbladder nonvisualization. In summary, the use of pharmacokinetics has and will continue to assist the gastrointestinal radiologist interested in developmental, basic, and/or clinical research.

Saturation kinetics of iopanoate in the dog.

Experiments were carried out in dogs with a modified Thomas cannula in the duodenum through which the common bile duct could be catheterized. Constant intravenous infusion of sodium iopanoate at different infusion rates greater than the apparent excretion maximum revealed linearity of the blood concentration with time above a threshold concentration. When the slopes of the blood curves were plotted against the known infusion rates, a straight line relationship was obtained. The X axis intercept of this straight line represents an apparent transport maximum. This value obtained from the X axis intercept matched closely with the observed excretion maximum determined from bile and urine collection. The slope of this same line equals the inverse of the volume of distribution of the drug. Although previous workers have failed to appreciate an apparent transport maximum for iopanoate, the current studies clearly demonstrate that iopanoate is excreted by a saturable mechanism. Using this technique the apparent transport maximum for iopanoate was evaluated at high and low rates of taurocholate replacement to evaluate the quantitative effect of bile salt on the apparent transport maximum. A five-fold increase in taurocholate replacement led to an average 40% increase in the apparent transport maximum of iopanoate without effecting its volume of distribution significantly.

Saturation kinetics of iopanoate in dogs with an intact enterohepatic circulation. Before and after phenobarbital induction.

Capacity-limited elimination of sodium iopanoate and a reproducible apparent transport maximum (Tm) were demonstrated in nonoperated dogs having an intact enterohepatic circulation and normal endogenous bile salt pool. Using a multiple infusion technique, estimation of apparent Tm of iopanoate in the liver was possible without sampling either bile or urine. Values obtained for apparent Tm of iopanoate in dogs with normal bile salt pool were similar to those obtained in studies of dogs with chronic bile fistulas. Use of this technique in 4 dogs demonstrated that pretreatment with phenobarbital significantly increases apparent Tm of iopanoate.

Saturation kinetics of iocetamic acid: Evaluation of indirect pharmacokinetic techniques and comparison with iopanoic acid.

The biliary excretion of two oral cholecystographic contrast agents, iocetamic acid and iopanoic acid, were compared during low and high taurocholate infusion rates. The pharmacokinetics of these compounds after intravenous infusion were studied in bile-fistula dogs using both indirect and direct pharmacokinetic techniques. The indirect multiple infusion technique, corrected for urinary excretion, provides a reliable estimate of the maximum biliary excretion rates of either contrast agent without necessitating the sampling of biliary output. The results indicate that taurocholate facilitates the biliary excretion of both agents. At both taurocholate infusion rates studied, the maximum biliary excretion rate of iocetamic acid is greater than that of iopanoic acid.

Neutron capture therapy of a rat glioma using boronophenylalanine as a capture agent.

The purpose of the present study was to determine the efficacy of boron neutron capture therapy (BNCT) in treating the therapeutically refractory F98 glioma, using boronophenylalanine (BPA) as the capture agent. F98 glioma cells (10(5)) were implanted stereotactically into the brains of Fischer rats and 15 days later the animals were injected intraperitoneally with 897 mg/kg of D,L-BPA. Between 3 and 9 h after administration blood and tumor boron concentrations exhibited monoexponential decay with half-lives (t1/2) of 4.3 and 5.3 h, respectively. When 803 mg/kg of 10B-L-BPA was administered, the tumor 10B concentration was 29.4 micrograms/g and tumor-to-blood and tumor-to-brain ratios were 3.5 and 3.9, respectively. Seven days after intracerebral implantation of 10(5) F98 cells, BNCT was initiated at the Brookhaven Medical Research Reactor. The median survival time for irradiated controls (no BPA), which had received tumor physical doses of 1.7, 2.6 or 3.5 Gy, were 27, 33 and 38 days, respectively, compared to 24 days for untreated rats (P < or = 0.025-0.0001). The median survival time for BNCT-treated groups that had received 803 mg/kg of 10B-L-BPA 6 h prior to irradiation with total estimated tumor physical doses of 5.7, 8.6 and 11.5 Gy were 32, 37 and 59 days, respectively. Although the enhanced median survival times of two of the BNCT-treated group (8.6 and 11.5 Gy) were significant compared to their matched irradiated controls (P < or = 0.0175-0.0277), all BNCT-treated animals died in less than 160 days. It remains to be determined whether better survival can be achieved using higher doses of BPA and neutrons to treat a tumor, which at this time cannot be cured by any therapeutic modality.

Parenteral nutrition: short term effects on hepatic clearance of sodium taurocholate and indocyanine green.

Total parenteral nutrition (TPN) is thought to induce cholestasis. However, serum hepatic enzyme abnormalities were found in 70 percent of patients before TPN was started. Rate constants (alpha, beta, K(E] and total clearance (CIT) of sodium taurocholate (STC) and indocyanine green (ICG) were studied in 20 carefully selected patients not on TPN and who had no hepatic or renal disease. Clearance measurements were made prior to initiation and 7 days into dextrose-based TPN. Four modes of TPN administration were used; low calorie (35 cal/kg) versus high calorie (50 cal/kg), with or without protection of TPN solutions from ultraviolet light. Protein doses for all groups were isonitrogenous. TPN was uninterrupted and no patient had surgery, other major procedures, or food by mouth. While serum gamma-glutamyl transpeptidase (GGT) increased, no STC or ICG clearance parameter (total or subgroup) changed in response to TPN. These data do not support the hypothesis that TPN directly causes cholestasis, but suggest that cholestasis caused by concurrent liver disease may appear aggravated by TPN.

Peritoneal carcinomatosis and radioimmunoguided surgery.

The Radioimmunoguided Surgery (RIGS) system was developed, in part, to detect occult tumor in patients with recurrent colorectal cancer. Unfortunately, however, patients are sometimes found to have unresectable peritoneal metastasis. For these patients, intraperitoneal hyperthermic perfusion (IPHP) with mitomycin C (MMC) was used as a novel treatment method. Thirty-six intraperitoneal hyperthermic perfusions with MMC were given over the course of several studies. A preliminary study delineated two groups as possible candidates for this treatment: patients with pseudomyxoma peritonei and patients with peritoneal metastasis < 0.5 cm. Intraperitoneal hyperthermic perfusion (IPHP) was conducted for 1 hour after achieving an abdominal temperature of 41 degrees C. A dose of 30 mg MMC in 31 Plasmalyte was injected followed by a second 30 mg dose given at 30 minutes. Plasma pharmacokinetics of IPHP with MMC indicate an advantage in the range of 100-fold enhancement of exposure compared with delivery in plasma. The method was found to be safe when flow was observed and dosage decisions were made during perfusion according to flow. A clinical study group consisting of 15 patients underwent cytoreductive surgery followed by IPHP. The majority of them had either gastrointestinal or urologic anastomoses. There were no complications. In every patient the CEA level decreased after surgery and IPHP, with a median response of 6 months. RIGS technology aided in the selection of IPHP as a treatment choice by demonstrating the presence of an occult tumor burden in those patients whose traditional explorations were deceiving. This chapter includes technical details and suggestions for improving and modifying the use of IPHP.

Boron neutron capture therapy of a rat glioma.

The purpose of the present study was to utilize a well-established rat glioma to evaluate boron neutron capture therapy for the treatment of malignant brain tumors. Boron-10 (10B) is a stable isotope which, when irradiated with thermal neutrons, produces a capture reaction yielding high linear energy transfer particles (10B + 1nth----[11B]----4He(alpha) + 7Li + 2.79 MeV). The F98 tumor is an anaplastic glioma of CD Fischer rat origin with an aggressive biological behavior similar to that of human glioblastoma multiforme. F98 cells were implanted intracerebrally into the caudate nuclei of Fischer rats. Seven to 12 days later the boron-10-enriched polyhedral borane, Na2B12H11SH, was administered intravenously at a dose of 50 mg/kg body weight at varying time intervals ranging from 3 to 23.5 hours before neutron irradiation. Pharmacokinetic studies revealed blood 10B values ranging from 0.33 to 10.5 micrograms/ml depending upon the time after administration, a T1/2 of 6.2 hours, normal brain 10B concentrations of 0.5 microgram/g, and tumor values ranging from 1.1 to 12.8 micrograms/g. No therapeutic gain was seen if the capture agent was given at 3 or 6 hours before irradiation with 4 x 10(12) n/cm2 (10 MW-min; 429 cGy). A 13.5-hour preirradiation interval resulted in a mean survival of 37.8 days (P less than 0.01), compared to 30.5 days (P less than 0.03) for irradiated controls and 22.1 days for untreated animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Boron neutron capture therapy of brain tumors: biodistribution, pharmacokinetics, and radiation dosimetry sodium borocaptate in patients with gliomas.

OBJECTIVE: The purpose of this study was to obtain tumor and normal brain tissue biodistribution data and pharmacokinetic profiles for sodium borocaptate (Na2B12H11SH) (BSH), a drug that has been used clinically in Europe and Japan for boron neutron capture therapy of brain tumors. The study was performed with a group of 25 patients who had preoperative diagnoses of either glioblastoma multiforme (GBM) or anaplastic astrocytoma (AA) and were candidates for debulking surgery. Nineteen of these patients were subsequently shown to have histopathologically confirmed diagnoses of GBM or AA, and they constituted the study population. METHODS: BSH (non-10B-enriched) was infused intravenously, in a 1-hour period, at doses of 15, 25, and 50 mg boron/kg body weight (corresponding to 26.5, 44.1, and 88.2 mg BSH/kg body weight, respectively) to groups of 3, 3, and 13 patients, respectively. Multiple samples of tumor tissue, brain tissue around the tumors, and normal brain tissue were obtained at either 3 to 7 or 13 to 15 hours after infusion. Blood samples for pharmacokinetic studies were obtained at times up to 120 hours after termination of the infusion. Sixteen of the patients underwent surgery at the Beijing Neurosurgical Institute and three at The Ohio State University, where all tissue samples were subsequently analyzed for boron content by direct current plasma-atomic emission spectroscopy. RESULTS: Blood boron values peaked at the end of the infusion and then decreased triexponentially during the 120-hour sampling period. At 6 hours after termination of the infusion, these values had decreased to 20.8, 29.1, and 62.6 microg/ml for boron doses of 15, 25, and 50 mg/kg body weight, respectively. For a boron dose of 50 mg/kg body weight, the maximum (mean +/- standard deviation) solid tumor boron values at 3 to 7 hours after infusion were 17.1+/-5.8 and 17.3+/-10.1 microg/g for GBMs and AAs, respectively, and the mean tumor value averaged across all samples was 11.9 microg/g for both GBMs and AAs. In contrast, the mean normal brain tissue values, averaged across all samples, were 4.6+/-5.1 and 5.5+/-3.9 microg/g and the tumor/normal brain tissue ratios were3.8 and 3.2 for patients with GBMs and AAs, respectively. The large standard deviations indicated significant heterogeneity in uptake in both tumor and normal brain tissue. Regions histopathologically classified either as a mixture of tumor and normal brain tissue or as infiltrating tumor exhibited slightly lower boron concentrations than those designated as solid tumor. After a dose of 50 mg/kg body weight, boron concentrations in blood decreased from 104 microg/ml at 2 hours to 63 microg/ml at 6 hours and concentrations in skin and muscle were 43.1 and 39.2 microg/g, respectively, during the 3- to 7-hour sampling period. CONCLUSION: When tumor, blood, and normal tissue boron concentrations were taken into account, the most favorable tumor uptake data were obtained with a boron dose of 25 mg/kg body weight, 3 to 7 hours after termination of the infusion. Although blood boron levels were high, normal brain tissue boron levels were almost always lower than tumor levels. However, tumor boron concentrations were less than those necessary for boron neutron capture therapy, and there was significant intratumoral and interpatient variability in the uptake of BSH, which would make estimation of the radiation dose delivered to the tumor very difficult. It is unlikely that intravenous administration of a single dose of BSH would result in therapeutically useful levels of boron. However, combining BSH with boronophenylalanine, the other compound that has been used clinically, and optimizing their delivery could increase tumor boron uptake and potentially improve the efficacy of boron neutron capture therapy.

Optimal perfusion rate determined for in situ intestinal absorption studies in rats.

Iopanoic acid was used as a model compound to study the effect of the intestinal perfusion rate on the mean absorption clearance. Absorption of iopanoic acid followed first-order kinetics, with a first-order absorption rate constant (ka) linearly dependent on the dry intestinal weight. An absorption clearance--time plot revealed three phases. Phase I represented an equilibration phase, Phase II was a uniform phase, and Phase III was a physiological deterioration of the animal under prolonged anesthesia. The variability in the observations during Phase II of the absorptive clearance--time profiles was assessed statistically, and the minimum occurred at 9.9 microliters/sec (0.594 ml/min). The relation between the coefficient of variance (CV) and the perfusion rate is given by CV = (-5.52 X 10(-5)Q3 + (2.78 X 10(-3)Q2 - (3.87 X 10(-2)Q + 0.243, where Q is the perfusion rate through the intestinal lumen. These studies demonstrate that an optimal flow rate exists for minimizing the variability in in situ absorption studies. The dependency of the absorption clearance on the intestinal perfusion rate appears to conform to the convective diffusion model.

Urinary iodine excretion rates following intrathecal injections of iodinated organic carbonates.

Oily iodinated organic carbonates were investigated for use as myelographic media. The urinary excretion of total iodine was used to monitor the apparent elimination rate of these compounds from the subarachnoid space. Within the chain length series of C2-C6, the decrease of elimination rates and disposition rate constants with increasing chain length was demonstrated. This observation is consistent with a dissolution rate-limited elimination model. Such a model was derived and successfully NONLIN computer fitted to the observed elimination data. The model-derived parameter of clearance from the cerebrospinal fluid through the lipid "blood-brain barrier" correlated well with the compound's water solubilities and projected octanol-water partition coefficients. Additional compounds need to be tested to evaluate the postulated model system.

Plasma naltrexone kinetics after intravenous bolus administration in dogs and monkeys.

This investigation generated data characterize a specific electron-capture GLC assay reported previously for naltrexone and applied the method to a determination of naltrexone pharmacokinetics. Extraction efficiencies are reported for the assay, and mass spectral evidence indicates that naltrexone forms a triester when derivatized for electron-capture GLC with pentafluoropropionic anhydride and a base catalyst. Plasma level-time data for intravenous naltrexone at two dose levels in monkeys yielded no evidence of dose-dependent kinetics. A two-compartment open pharmacokinetic model was fitted to plasma level-time data for naltrexone in two dogs and yielded a total body clearance of 51-55 ml/min/kg. Urine collected for 0-24 hr contained 36% of the dose as naltrexone conjugates with less than 1% as unchanged naltrexone. Plasma level-time data for intravenous naltrexone in six monkeys yielded an average terminal half-life of 7.8 hr and a total body clearance of 64 ml/min/kg. The total body clearance for naltrexone was greater than the hepatic plasma or blood flow in both dogs and monkeys. This finding, together with the extremely low renal excretion of naltrexone, suggests the existence of elimination mechanisms besides liver metabolism and renal excretion.

Determination of the efficacy of topical oral pilocarpine for postirradiation xerostomia in patients with head and neck carcinoma.

Pilocarpine hydrochloride suspended in a candy-like pastille was evaluated as a topical treatment for radiation-induced xerostomia in head and neck cancer patients. This local delivery system, which differs from systemically administered pilocarpine preparations, was developed to hopefully maximize the local response and minimize the systemic side effects. A prospective, randomized, double-blind, placebo-controlled trial was undertaken to determine objective and subjective efficacy in reversing the decrease in salivation. Forty previously irradiated patients received increasingly higher pilocarpine dosages in pastilles for 5 successive weeks. At each successive dose of pilocarpine, no significant increased salivation was noted. However, 25 (74%) of 34 patients reported that pilocarpine alleviated their subjective xerostomia. Topical pilocarpine administration has shown similar results to previous systemic delivery methods for radiation-induced xerostomia, but with improved patient tolerance.

DISIDA kinetics measure liver function in dogs.

We have investigated the ability of 99Tcm-disofenin (DISIDA) kinetics to measure liver function. Two approaches have been used: first, quantitative analysis of serial liver images, and second, clearance estimation from whole blood concentration-time data. Graded liver dysfunction was produced in 11 dogs over three months by common bile duct ligation and surgical relief of biliary obstruction one month later. The kinetic analysis of serial liver images showed clear abnormalities during biliary obstruction, with calculated rates of liver uptake falling in stages from 11.09 to 5.15 cts s-1 (p less than 0.001), and rates of elimination from the liver from 8.8 to 1.6 x 10(-4) cts s-1 (p less than 0.0001). These parameters paralleled the deterioration and recovery of liver function through the experimental period, and had not fully recovered 7 weeks after relief of biliary obstruction (10.5 and 6.2 x 10(-4) cts s-1 respectively). Serial blood sampling after injection of DISIDA permitted calculation of whole blood disposition rates (for hepatic clearance). Mean values fell from 256 to 67 ml min-1 with chronic biliary obstruction (p less than 0.001), and returned to almost normal (206 ml min-1) 10 days after surgical relief of biliary obstruction. It is clear that the gradual nature of recovering liver function was more sensitively identified by image analysis than serial blood data. Serial liver biopsies showed marked changes following biliary obstruction. These improved over a period of 7 weeks following its relief, when there was still considerable residual abnormality. This work supports the view that hepatic abnormalities caused by biliary obstruction do not recover quickly following its relief. DISIDA kinetics can quantitate both major and minor degrees of hepatic dysfunction, and may prove to be a valuable method to quantitative liver function.