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Phase II Study of Troxacitabine, a Novel Dioxolane Nucleoside Analog, in Patients With Refractory Leukemia

From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX; Johns Hopkins Oncology Center, Baltimore, MD; and Suire BioChem Inc, Laval, Quebec, Canada.

Address reprint requests to Francis J. Giles, MD, University of Texas, M.D. Anderson Cancer Center, Department of Leukemia, 1400 Holcombe Blvd, Box 428, Houston, TX 77030; email: fgiles@ mdanderson.org.

PURPOSE: To investigate the activity of a novel dioxolane L-nucleoside analog, troxacitabine (L-(-)-OddC, BCH-4556), in patients with refractory leukemia.

PATIENTS AND METHODS: Study participants were patients with refractory or relapsed acute myeloid (AML) or lymphocytic (ALL) leukemia, myelodysplastic syndromes (MDS), or chronic myelogenous leukemia in blastic phase (CML-BP). Troxacitabine was provided as an intravenous infusion for more than 30 minutes daily for 5 days at a dose of 8.0 mg/m²/d (40 mg/m² per course). Courses were given every 3 to 4 weeks according to antileukemic efficacy.

RESULTS: Forty-two patients (AML, 18 patients; MDS, one patient; ALL, six patients; CML-BP, 17 patients) were treated. Median age was 51 years (range, 23 to 80 years); 22 patients were male. Stomatitis was the most significant adverse event, with three patients (7%) and two patients (5%), respectively, experiencing grade 3 or 4 toxicity. Ten patients (24%) had grade 3 hand-foot syndrome, and two patients (5%) had grade 3 skin rash. One patient (2%) had grade 3 fatigue and anorexia. Marrow hypoplasia occurred between days 14 and 28 in 12 (75%) of 16 assessable patients with AML. Two complete remissions and one partial remission (18%) were observed in 16 assessable patients with AML. None of six patients with ALL responded. Six (37%) of 16 assessable patients with CML-BP experienced a return to chronic-phase disease.

CONCLUSION: Troxacitabine has significant antileukemic activity in patients with AML and CML-BP.

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