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Vorinostat combined with bexarotene for treatment of cutaneous T-cell lymphoma: in vitro and phase I clinical evidence supporting augmentation of retinoic acid receptor/retinoid X receptor activation by histone deacetylase inhibition.

Abstract
The retinoid X receptor (RXR)-agonist bexarotene and the histone deacetylase inhibitor (HDACI) vorinostat are each established monotherapies for cutaneous T-cell lymphomas (CTCLs). We investigated the combination of HDACI and retinoic acid receptor (RAR)/RXR agonists in vitro and in a phase I, multicenter, open-label, two-part dose-escalation study. The combination of bexarotene with a HDACI in vitro leads to cooperative activation of gene transcription and reduction of cell viability in human tumor cell lines. The primary clinical objective was to determine the maximum tolerated dose (MTD) of bexarotene plus vorinostat in 23 patients with CTCLs. The MTD for part I was established at vorinostat 200 mg/day plus bexarotene 300 mg/m(2)/day. The MTD for part II was not reached. Four patients had an objective response and seven patients experienced pruritus relief. We conclude that concomitant administration of vorinostat and bexarotene is feasible only if lower doses of each drug are administered relative to the product label monotherapy doses.
AuthorsReinhard Dummer, Marc Beyer, Kenneth Hymes, Mirjam T Epping, Rene Bernards, Matthias Steinhoff, Wolfram Sterry, Helmut Kerl, Karl Heath, Janet D Ahern, James S Hardwick, Jose Garcia-Vargas, Katrin Baumann, Syed Rizvi, Stanley R Frankel, Sean J Whittaker, Chalid Assaf
JournalLeukemia & lymphoma (Leuk Lymphoma) Vol. 53 Issue 8 Pg. 1501-8 (Aug 2012) ISSN: 1029-2403 [Electronic] United States
PMID22239668 (Publication Type: Clinical Trial, Phase I, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
Chemical References
  • Histone Deacetylase Inhibitors
  • Hydroxamic Acids
  • Receptors, Retinoic Acid
  • Retinoid X Receptors
  • Tetrahydronaphthalenes
  • Vorinostat
  • Bexarotene
Topics
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Bexarotene
  • Cell Line, Tumor
  • Cell Survival
  • Female
  • Histone Deacetylase Inhibitors (pharmacology)
  • Humans
  • Hydroxamic Acids (administration & dosage)
  • In Vitro Techniques
  • Lymphoma, T-Cell, Cutaneous (drug therapy)
  • Male
  • Middle Aged
  • Receptors, Retinoic Acid (metabolism)
  • Retinoid X Receptors (metabolism)
  • Tetrahydronaphthalenes (administration & dosage)
  • Transcription, Genetic
  • Vorinostat

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