Multicentre phase I/II study of PI-88, a heparanase inhibitor in combination with docetaxel in patients with metastatic castrate-resistant prostate cancer

Background: Docetaxel (Taxotere) improve survival and prostate-specific antigen (PSA) response rates in patients with metastatic castrate-resistant prostate cancer (CRPC). We studied the combination of PI-88, an inhibitor of angiogenesis and heparanase activity, and docetaxel in chemotherapy-naive CRPC.

Patients and methods: We conducted a multicentre open-label phase I/II trial of PI-88 in combination with docetaxel. The primary end point was PSA response. Secondary end points included toxicity, radiologic response and overall survival. Doses of PI-88 were escalated to the maximum tolerated dose; whereas docetaxel was given at a fixed 75 mg/m2 dose every three weeks

Results: Twenty-one patients were enrolled in the dose-escalation component. A further 35 patients were randomly allocated to the study to evaluate the two schedules in phase II trial. The trial was stopped early by the Safety Data Review Board due to a higher-than-expected febrile neutropenia of 27%. In the pooled population, the PSA response (50% reduction) was 70%, median survival was 61 weeks (6–99 weeks) and 1-year survival was 71%.

Conclusions: The regimen of docetaxel and PI-88 is active in CRPC but associated with significant haematologic toxicity. Further evaluation of different scheduling and dosing of PI-88 and docetaxel may be warranted to optimise efficacy with a more manageable safety profile.

The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial

OBJECTIVE: To determine how much physical activity, in the form of walking, can be safely and feasibly tolerated for people with severe knee osteoarthritis (OA). DESIGN: Phase I dose response trial with escalating walking doses of 10, 20, 35, 50, 70, and 95 min over 1 week, were prescribed non-randomly to people with severe knee OA. The primary stopping rule was a substantial increase in knee pain. The primary outcomes were an estimation of the maximum tolerated dose of walking; and the proportion of people who did not complete the dose for feasibility reasons. The secondary outcomes were pain, stiffness and activity limitation Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Twenty-four participants (13 women) aged 53-83 years, and average body mass index (BMI) of 34 kg/m(2) (SD 9) were recruited. Three participants were assigned to each dose between 10 and 70 min, and nine participants assigned to the 95-min dose. The trial was stopped at 95 min due to the maximum number of adverse events occurring at this dose. Therefore, the maximum tolerated dose was 70 min. No participant stopped due to reasons related to feasibility. There was a moderate association between dose and increased activity (linear R(2) = 0.31, cubic R(2) = 0.69) and reduced stiffness (linear R(2) = 0.20, cubic R(2) = 0.52), with increased benefits at moderate to higher doses. CONCLUSIONS: There is preliminary evidence that 70 min per week of moderate intensity supervised walking was safe and feasible for people with severe OA of the knee; for higher doses there was a risk of exacerbating knee pain levels.

Transport and phase dynamics of poly(vinyl pyrrolidone) doped plastically crystalline N-methyl-N-propylpyrrolidinium tetrafluoroborate

The plastic crystal phase forming <i>Ni>-methyl-<i>Ni>-propylpyrrolidinium tetrafluoroborate organic salt (P₁₃BF₄) was combined with 2, 5 and 10 wt.% poly(vinyl pyrrolidone) (PVP). The ternary 2 wt.% PVP/2 wt.% LiBF₄/P₁₃BF₄ was also investigated. Thermal analysis, conductivity, optical thermomicroscopy, and Nuclear Magnetic Resonance (¹¹B, ¹⁹F, ¹H, ⁷Li) were used to probe the fundamental transport processes. Both the onset of phase I and the final melting temperature were reduced with increasing additions of PVP. Conductivity in phase I was 2.6 &times; 10^{&minus; 4} S cm^{&minus; 1} 5.2 &times; 10^{&minus; 4} S cm^{&minus; 1} 1.1 &times; 10^{&minus; 4} S cm^{&minus; 1} and 3.9 &times; 10&minus; 5 S cm&minus; 1 for 0, 2, 5 and 10 wt.%PVP/P₁₃BF₄, respectively. Doping with 2 wt.% LiBF₄ increased the conductivity by up to an order of magnitude in phase II. Further additions of 2 wt.% PVP slightly reduced the conductivity, although it remained higher than for pure P₁₃BF₄.

Unusual phase behaviour of the organic ionic plastic crystal N,N-dimethylpyrrolidinium tetrafluoroborate

Analysis of <i>N,Ni>-dimethylpyrrolidinium tetrafluoroborate by ¹H and ¹¹B NMR, Raman spectroscopy and powder XRD shows that this organic ionic plastic crystal material exhibits unusual phase behaviour. ¹H NMR analysis indicates that the mobility of the pyrrolidinium cation decreases when the material is heated into phase I, while the X-ray diffraction pattern changes from a simple, one peak structure in phase II to a more complex pattern in phase I. The possible origins of these unusual transitions are discussed.

Design of new oxazaphosphorine anticancer drugs

The oxazaphosphorines including cyclophosphamide (CPA, Cytoxan, or Neosar), ifosfamide (IFO, Ifex) and trofosfamide (Ixoten) represent an important group of therapeutic agents due to their substantial antitumor and immunomodulating activity. However, several intrinsic limitations have been uncounted during the clinical use of these oxazaphosphorines, including substantial pharmacokinetic variability, resistance and severe host toxicity. To circumvent these problems, new oxazaphosphorines derivatives have been designed and evaluated with an attempt to improve the selectivity and response with reduced host toxicity. These include mafosfamide (NSC 345842), glufosfamide (D19575, β-Dglucosylisophosphoramide mustard), S-(-)-bromofosfamide (CBM-11), NSC 612567 (aldophosphamide perhydrothiazine) and NSC 613060 (aldophosphamide thiazolidine). Mafosfamide is an oxazaphosphorine analog that is a chemically stable 4-thioethane sulfonic acid salt of 4-hydroxy-CPA. Glufosfamide is IFO derivative in which the isophosphoramide mustard, the alkylating metabolite of IFO, is glycosidically linked to a β-D-glucose molecule. Phase II studies of glufosfamide in the treatment of pancreatic cancer, non-small cell lung cancer (NCSLC), and recurrent glioblastoma multiform (GBM) have recently completed and Phase III trials are ongoing, while Phase I studies of intrathecal mafosfamide have recently completed for the treatment of meningeal malignancy secondary to leukemia, lymphoma, or solid tumors. S-(-)- bromofosfamide is a bromine-substituted IFO analog being evaluated in a few Phase I clinical trials. The synthesis and development of novel oxazaphosphorine analogs with favourable pharmacokinetic and pharmacodynamic properties still constitutes a great challenge for medicinal chemists and cancer pharmacologists.

Drug bioactivation, covalent binding to target proteins and toxicity relevance

A number of therapeutic drugs with different structures and mechanisms of action have been reported to undergo metabolic activation by Phase I or Phase II drug-metabolizing enzymes. The bioactivation gives rise to reactive metabolites/intermediates, which readily confer covalent binding to various target proteins by nucleophilic substitution and/or Schiff's base mechanism. These drugs include analgesics (e.g., acetaminophen), antibacterial agents (e.g., sulfonamides and macrolide antibiotics), anticancer drugs (e.g., irinotecan), antiepileptic drugs (e.g., carbamazepine), anti-HIV agents (e.g., ritonavir), antipsychotics (e.g., clozapine), cardiovascular drugs (e.g., procainamide and hydralazine), immunosupressants (e.g., cyclosporine A), inhalational anesthetics (e.g., halothane), nonsteroidal anti-inflammatory drugs (NSAIDSs) (e.g., diclofenac), and steroids and their receptor modulators (e.g., estrogens and tamoxifen). Some herbal and dietary constituents are also bioactivated to reactive metabolites capable of binding covalently and inactivating cytochrome P450s (CYPs). A number of important target proteins of drugs have been identified by mass spectrometric techniques and proteomic approaches. The covalent binding and formation of drug-protein adducts are generally considered to be related to drug toxicity, and selective protein covalent binding by drug metabolites may lead to selective organ toxicity. However, the mechanisms involved in the protein adduct-induced toxicity are largely undefined, although it has been suggested that drug-protein adducts may cause toxicity either through impairing physiological functions of the modified proteins or through immune-mediated mechanisms. In addition, mechanism-based inhibition of CYPs may result in toxic drug-drug interactions. The clinical consequences of drug bioactivation and covalent binding to proteins are unpredictable, depending on many factors that are associated with the administered drugs and patients. Further studies using proteomic and genomic approaches with high throughput capacity are needed to identify the protein targetsof reactive drug metabolites, and to elucidate the structure-activity relationships of drug's covalent binding to proteins and their clinical outcomes.

Clincial pharmacogenetics and potential application in personalized medicine

The current `fixed-dosage strategy' approach to medicine, means there is much inter-individual variation in drug response. Pharmacogenetics is the study of how inter-individual variations in the DNA sequence of specific genes affect drug responses. This article will highlight current  pharmacogenetic knowledge on important drug metabolizing enzymes, drug transporters and drug targets to understand interindividual variability in drug clearance and responses in clinical practice and potential use in  personalized medicine. Polymorphisms in the cytochrome P450 (CYP) family may have had the most impact on the fate of pharmaceutical drugs. CYP2D6, CYP2C19 and CYP2C9 gene polymorphisms and gene duplications account for the most frequent variations in phase I metabolism of drugs since nearly 80% of drugs in use today are metabolised by these enzymes. Approximately 5% of Europeans and 1% of Asians lack CYP2D6 activity, and these  individuals are known as poor metabolizers. CYP2C9 is another clinically significant drug metabolising enzyme that demonstrates genetic variants. Studies into CYP2C9 polymorphism have highlighted the importance of the CYP2C9*2 and CYP2C9*3 alleles. Extensive polymorphism also occurs in a majority of Phase II drug metabolizing enzymes. One of the most important polymorphisms is thiopurine S-methyl transferases (TPMT) that catalyzes the S-methylation of thiopurine drugs. With respect to drug transport  polymorphism, the most extensively studied drug transporter is  P-glycoprotein (P-gp/MDR1), but the current data on the clinical impact is limited. Polymorphisms in drug transporters may change drug's distribution, excretion and response. Recent advances in molecular research have revealed many of the genes that encode drug targets demonstrate genetic polymorphism. These variations, in many cases, have altered the targets sensitivity to the specific drug molecule and thus have a profound effect on drug efficacy and toxicity. For example, the β2-adrenoreceptor, which is encoded by the ADRB2 gene, illustrates a clinically significant genetic variation in drug targets. The variable number tandem repeat polymorphisms in serotonin transporter (SERT/SLC6A4) gene are associated with response to antidepressants. The distribution of the common variant alleles of genes that encode drug metabolizing enzymes, drug transporters and drug targets has been found to vary among different populations. The promise of pharmacogenetics lies in its potential to identify the right drug at the right dose for the right individual. Drugs with a narrow therapeutic index are thought to benefit more from pharmacogenetic studies. For example, warfarin serves as a good practical example of how pharmacogenetics can be utilized prior to commencement of therapy in order to achieve maximum efficacy and minimum toxicity. As such, pharmacogenetics has the potential to achieve optimal quality use of medicines, and to improve the efficacy and safety of both prospective and licensed drugs.

Improving English language teaching in Thailand

The teaching of English in Thailand is a matter of national concern. The national government believes that the ability of Thai people to use English for effective communication is very important for the continuing economic development of Thailand. However many students who have had primary, secondary and university exposure to English find it difficult to conduct a conversation with a native speaker of English. The reasons for this include lack of student motivation and contextual support, large classes, the dominating effects of assessment on what is taught, and the English language competency of the teachers. The research in this thesis focuses on the teaching of English as a foreign language in secondary schools in Khon Kaen. The research reported here consists of one major and three minor studies. In the major study some of the principles of action research were used to explore strategies that would improve the teaching of English in a number of secondary schools in Khon Kaen in Thailand. In the first phase of the major study I worked with two teachers to design and implement a series of classroom activities that encouraged lower secondary students to use English. In the second phase I worked with a group of teachers to design and deliver a professional development program for twenty school teachers interested in improving their English language teaching. In the third phase I used data from the first two phases to design five new activities that were used in classrooms by two teachers. Findings from the three phases indicated that working collaboratively with school teachers can be a mutually beneficial professional experience and can improve student interest and learning. In the first minor study I used interview-conversations to investigate the perceptions that subject co-ordinators and teachers have towards English language teaching. The conversations covered the merits of detailed curricula and curricula frameworks, professional development, assessment, resources, and integration of English language with other subjects. It was clear that the teachers were aware of the national government s policies for the improving English language teaching and accepted the need for change. It was equally clear that the preparation of teachers and the resources available were major limiting factors in schools to teacher effectiveness. In the second minor study I examined the teaching of Mandarin in an Australian school that suffered from some of the same resource problems as Thai schools. Although there was only one teacher available for all of the Mandarin classes in the school she was extremely effective. Her teaching was an example of best practice. It included thorough preparation, the ability to manage lessons at the pace of the learners, active classes and individual attention, detailed assessment records, and the integration of language and culture. Some or all of these could be used in Thai schools. The third minor study was an investigation of the professional development experiences of English language teachers in Thai schools. In most schools there are consultative and administrative mechanisms, acceptable to principals and teachers, in place to support professional development. Access to native speakers was seen as very important. However, the schools in Khon Kaen province have little or no access to native speakers of English. Even if they were available, the schools do not have the funds to employ them. Findings from the four studies indicate that it is quite possible to use interactive, participatory or student-centred pedagogies to teach English as a foreign language in Thai classrooms. However, one cannot expect teachers to adopt such pedagogies unless they are convinced of their value. This can be achieved most effectively through a systematic and sustained program of professional development.

Rotational and translational mobility of a highly plastic salt : Dimethylpyrrolidinium thiocyanate

Thermal analysis, impedance spectroscopy, NMR and Raman spectroscopy have been used to investigate the plastic crystal dimethylpyrrolidinium thiocyanate in order to gain further insight into the properties of organic ionic plastic crystals. This compound has a solid–solid phase transition at 82 °C, and melts at 122 °C. A step increase in conductivity of about one order of magnitude is observed at the phase transition, followed by a decrease in activation energy for conduction. A large entropy gain occurs at the II → I transition, and ¹H NMR linewidth measurements together with second moment calculations showed that the dimethylpyrrolidinium cation goes from a static state, to full isotropic tumbling. Raman measurements confirm that the cation as well as the anion exhibit increased rotational mobility when entering phase I.

Plastic crystal behaviour in tetraethylammonium dicyanamide

The plastic crystal tetraethylammonium dicyanamide ([N_2,2,2,2][dca]) has been investigated with an emphasis on structure and dynamics in the plastic phase. It was found that almost all of the volume expansion occurs at the II → I transition, with no volume expansion at the melt transition (as normally observed for crystals). The conductivity of this material shows a rapid increase at temperatures below the II → I transition, reaching values ~ 10^{&minus; 3} S/cm in Phase I, and 0.1 S/cm in the melt. The NMR measurements show that there is a sudden onset of rotational motions of the cations at the plastic transition; below this temperature the cations appear static. The rotational motion of the cation in Phase I has been discussed in terms of isotropic tumbling.

Structure and transport properties in an N,N-substituted pyrrolidinium tetrafluoroborate plastic crystal system

The structure and transport of N-propyl-N-methylpyrrolidinium tetrafluoroborate (P₁₃BF₄) has been investigated over a wide temperature range in consequence to exhibiting properties suitable for potential solid-state superionic electrolyte applications. Prior to melting, the organic salt, P₁₃BF₄, transforms into a plastic crystal phase. Intrinsic conductivity in this solid, phase I (45–65 °C), is comparable to that in the melt (_~10^&minus;3 S cm^&minus;1). Ionic motion and transport properties were investigated by ¹H and ¹¹B nuclear magnetic resonance (NMR) spectroscopy. Pressure-induced plastic flow in this system may accommodate volume changes in device application and to this extent, X-ray diffraction (XRD) has been used. Scanning electron microscopy (SEM) revealed complex surface morphology and lattice imperfections associated with the strong orientational disorder of the plastic state.

Thermal and physical properties of an archetypal organic ionic plastic crystal electrolyte

The thermal and mechanical properties of the ionic plastic crystal <i>Ni>-methyl-<i>Ni>-propylpyrrolidinium hexafluorophosphate have been investigated and the effect of adding a miscible polymer on the mechanical properties is reported. The physical properties of the pure plastic crystal are discussed in detail and for the first time the change in volume with temperature for an organic ionic plastic crystal is reported. An increase in volume in conjunction with increased conductivity supports the hypothesis that ion conduction within the plastic crystal proceeds via defects. For phase I and melting, the magnitude of the volume increase does not appear to be in accord with the subtle change in conductivity. This is suggested to be due to the presence of layer defects, which allow for correlated ionic motion, which does not increase the conductivity. Addition of polymer to the plastic crystal significantly increases the mechanical strength, decreases the conductivity, but has little effect on the phase behaviour, further supporting the hypothesis of vacancy-mediated conduction.

Proton transport in choline dihydrogen phosphate/H3PO4 mixtures

Mixtures of the plastic crystal material choline dihydrogen phosphate [Choline][DHP] and phosphoric acid, from 4.5 mol% to 18 mol% H₃PO₄, were investigated and shown to have significantly higher proton conductivity compared to the pure [Choline][DHP]. This was particularly evident from the electrochemical hydrogen reduction reaction and the proton NMR diffusion measurements, in addition to ionic conductivity measured from the impedance spectroscopy. The ionic conductivity was observed to increase by more than an order of magnitude in phase I (<i>i.e.i> the highest temperature solid phase in [Choline][DHP]) reaching up to 10^&minus;2 S cm^&minus;1. The multinuclear NMR spectroscopy data suggest that, at least on the timescale of the NMR measurement, the H⁺ cations and [DHP] anions are equivalent in both phases. The pulsed field gradient NMR diffusion measurements of the 18 mol% acid sample indicate that all three ions are mobile, however the H⁺ diffusion coefficient is an order of magnitude higher than for the [Choline] cation or the [DHP] anion, and therefore conduction in these materials is dominated by proton conductivity. The thermal stability, as measured by TGA, is unaffected with increasing acid additions and remains high; <i>i.e.i> no significant mass loss below 200 °C.