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Effects of double and multiple doses of hydroxyurea on mouse duodenum and mammary tumors.

Previous data on the effects of a single dose of hydroxyurea on C3H mouse duodenum and mammary tumors from a fast growing line (S102F) were used to predict times that may be optimal (i.e., minimize killing of the duodenal S-phase cells while enhancing the killing of tumor S-phase cells) for the administration of subsequent doses of hydroxyurea. These predicted protocols were tested by giving tumor-bearing mice injections of 2 doses at 24 hr intervals. A preliminary in vivo tumor treatment experiment was also done wherein multiple doses (up to 10) were given either at 12, 20, or 24 hr intervals with the mouse survival, body weights, and tumor volumes being recorded daily. The data show that partial cell synchronization was achieved in both tissues and the initial knetics of the surviving cells was essentially the same after a single dose, 2 doses, or 4 doses of hydoxyurea. Also, the different intervals between the 2 doses did not affect the timing of the initital peaks of DNA synthesis in partially synchronized cells; however, the height of the peaks was affected The results demonstrate that kinetic data can be useful for predicting optimal intervals for 2-dose regimes and probably multiple-dose regimes involving a single cell-cycle phase-speeific drug when applied to a mouse tumor model. However, the recovery phenomena in the respective tissues are extremely complicated and more animal tumor data need to be collected before one can make adquate use of cell-synchronizing agents and perturbed cellular kinetic data for routine clinical chemotherapy or combined modality therapy.

Animals↗

[Failure to partial synchronization with hydroxyurea to improve results of chemotherapy of solid neurosarcoma in the rat (author's transl)].

Partial synchronization of the slow-growing cell of solid neurosarcoma in the rat can be achieved by blocking DNA synthesis with hydroxyurea. Possible augmentation after synchronization of the therapeutic effects achieved with various cytostatics was tested. The substances were administered to tumour-bearing rats at various times after synchronization (at the transition from G1 to S phase; at maximal DNA synthesis; at the transition from the S to the G2 phases; at mitosis) and therapeutic effects on tumour gs. Cyclophosphamide and adriamycin reduced tumour size, the effect being dose-dependent. No differences were noted between synchronized and non-synchronized cells. Hydroxyurea and vincristine had significantly less effect on the tumour cells, this minimal effect not being enhanced by synchronization. The reported results were obtained in tests on 360 rats and are statistically significant (double variance analysis).

Animals↗

The effect of hydroxyurea on vasculopathy in a child with sickle cell disease.

We report serial CNS findings in a girl with sickle cell disease and stroke. Religious considerations precluded transfusion and bone marrow transplantation; therefore, she received single-agent hydroxyurea therapy for almost 6 years. MR angiography showed that vascular patency improved, although diffuse cerebral atrophy slowly worsened. Hydroxyurea can be effective in treating vasculopathy, but it might not prevent the progression of parenchymal damage in advanced disease.

Antisickling Agents↗

Are we underestimating the leukemogenic risk of hydroxyurea.

Hydroxyurea is an established drug that has been used for the treatment of myeloproliferative disorders and some solid tumors for some time. In recent years it has also been found to be effective in the treatment of sickle cell disease. Short term side effects are not serious, and are manageable. The major concern is the potential leukemogenesis with long term use. The risk of leukemogenesis is not defined with its use in benign hematological conditions. We report a case of acute myeloid leukemia with no preceding myelodysplastic syndrome, occurring after 2 years of hydroxyurea therapy in a patient with sickle cell disease.

Anemia, Sickle Cell↗

Multicenter randomized Phase II study of paclitaxel (1-hour infusion), fluorouracil, hydroxyurea, and concomitant twice daily radiation with or without erythropoietin for advanced head and neck cancer.

PURPOSE: To expand on our experience with the combination of paclitaxel, fluorouracil, hydroxyurea, and twice daily irradiation (T-FHX) and to assess the impact of weekly administration of erythropoietin (r-HuEpo) on transfusion requirements, we conducted a Phase II multi-institutional trial with a simplified 1-h paclitaxel infusion schedule and randomized patients to receive weekly doses of r-HuEpo. PATIENTS AND METHODS: A total of 90 patients with locally advanced head and neck cancers (stage IV, 96%; N(2)/N(3), 66%) were treated on a regimen of 1-h infusion of paclitaxel (100 mg/m(2)/day, day 1), 120-h infusion of 5-fluorouracil (600 mg/m(2)/day, days 0-5); hydroxyurea 500 mg p.o. every 12 h for 11 doses; and radiation 150cGy bid, days 1-5 of each 14-day cycle repeated for five cycles over 10 weeks (7200-7500 cGy). Before initiating therapy, patients were randomized to receive r-HuEpo 40,000 IU s.c. once weekly. RESULTS: At median follow-up of 40 months, 3-year progression-free survival is 62%, locoregional control is 84%, and systemic control is 79%. Overall survival is 59%. Anemia, leucopenia, dermatitis, and mucositis were the most frequent grade 3 or 4 toxicities. Patients randomized to erythropoietin experienced less grade 2/3 anemia (52 versus 77%; P = 0.02), but transfusion requirements were not significantly different. CONCLUSIONS: T-FHX is an active and tolerable regimen inducing local tumor control and promising survival with organ preservation in high-risk patients. One h infusion of paclitaxel simplified the regimen without compromising efficacy. Addition of erythropoietin does not reduce the need for transfusion with this nonplatinum-containing regimen. T-FHX should be advanced to a randomized trial and compared with a cisplatin-based concomitant regimen.

Adult↗

Nitroxide metabolites from alkylhydroxylamines and N-hydroxyurea derivatives resulting from reductive inhibition of soybean lipoxygenase.

One proposed mechanism of the inactivation of lipoxygenase by inhibitors is the reduction of the catalytically active ferric form of the enzyme to its ferrous form. Recent studies have shown that compounds containing the hydroxamate moiety are potent inhibitors of lipoxygenase. The hydroxamate portion of the inhibitor is thought to bind to iron at the catalytic site of the enzyme. We now report evidence that the NOH of the hydroxamate group of N-(4-chlorophenyl)-N-hydroxy-N'-(3-chlorophenyl)urea, N-[(E)-3-(3-phenoxyphenyl)prop-2-enyl]acetohydroxamic acid (BW A4C), and N-(1-benzo(b)thien-2-ylethyl)-N-hydroxyurea (Zileuton) is oxidized by lipoxygenase to form their corresponding nitroxides, which are directly detected by electron paramagnetic resonance spectroscopy. It is consistently found that the selected NOH-containing compounds, e.g. alkylhydroxylamines or N-hydroxyureas, are also oxidized by lipoxygenase to form their corresponding nitroxides.

Benzeneacetamides↗

Hydroxyurea induction of fetal hemoglobin synthesis in sickle-cell disease.

In the past 8 years, it has become apparent that some cytotoxic drugs that interfere with DNA replication can reprogram erythroid progenitors to switch from adult hemoglobin to fetal hemoglobin (HbF) production. Hydroxyurea has now been shown to substantially increase HbF in patients with sickle cell anemia. Since HbF interferes with sickle hemoglobin polymerization, hydroxyurea may become an important therapeutic agent for patients with sickle cell anemia.

Anemia, Sickle Cell↗

A case of spinal cord compression by extramedullary haemopoiesis in a thalassaemic patient: a putative role for hydroxyurea?

We report a case of homozygous beta thalassaemia who developed chronic paraparesis due to spinal cord compression by paravertebral extramedullary masses. Our patient was successfully treated with hypertransfusion and hydroxyurea. This drug in addition to its well-known cytostatic effects, may be a good alternative in conditions analogous to our case. This action of hydroxyurea can also be attributed to its favourable effect on foetal haemoglobin production.

Adult↗

Effect of cytosine arabinoside and hydroxyurea on micronucleus formation induced by model clastogens in Chinese hamster V79 cells.

Post-cultivation of treated cells in the presence of DNA repair inhibitors has been proposed as a new methodological approach of the micronucleus (MN) assay to increase the sensitivity of this technique. In order to assess the advantages and limitations of this promising methodological approach, several genotoxic/clastogenic agents with different mechanisms of activity were chosen to assess the effect of DNA repair inhibitors on the level of micronuclei (MNi) induced by particular agent using Chinese hamster V79 cells. Both UV light (UV) and benzo(a)pyrene (BaP) increased significantly the micronucleus level in V79 cells (p<0.01-0.001). In contrast, only at cytotoxic concentration (>0.8 mM) a slight but statistically significant rise of MNi was determined in cells exposed to N-methyl-N-nitroso urea (MNU). However, post-cultivation of MNU-treated cells in the presence of DNA repair inhibitors (cytosine arabinoside, AraC and hydroxyurea, HU) led to an additional rise of MNi. While AraC had a synergistic effect on MN formation (0.4 mM and 0.8 mM, DS=2.14 and 1.13, respectively), HU had less than additive effect (DS=0.86 and 0.66) and the combined treatment of cells with AraC and HU was least effective (Cf=0.36 and 0.28). On the other hand, post-cultivation of UV- and BaP-treated cells in the presence of AraC did not result in any synergistic effect on MN formation. No effect or even a decrease of MNi was measured particularly due to HU or combined treatment of HU and AraC. Incubation of control untreated cells with AraC gave rise to a significant increase of MN formation (2- to 2.5-fold) as well. Hydroxyurea or the combined treatment of HU with AraC had lower effect on the spontaneous level of MNi. Our study shows, that the combination of MNU treatment with DNA repair inhibitors increased the number of MNi on well proliferating V79 cells; in case UV light and BaP treatment, the involvement of DNA repair inhibitors did not contribute to an increase of sensitivity of MN assay. On the basis of our results we suppose that the AraC/CBMN assay might be a promising approach in genetic toxicology applied only to lymphocytes.

Animals↗

Quantitation of apoptosis induction by etoposide or hydroxyurea in mouse interleukin 3-dependent lymphoma cells.

BACKGROUND: The apoptosis induction by etoposide or hydroxyurea in mouse interleukin 3-dependent lymphoma cells (DA-1) was studied. Treatments with 1.25 mM hydroxyurea and 100 microM etoposide for 17 hours were considered appropriate concentrations for such studies. MATERIALS AND METHODS: The viability of the cells was studied by propidium iodide exclusion. The presence of apoptotic bodies was observed, and DNA fragmentation of apoptotic cells was asessed by the observation of ladder patterns in agarose electrophoresis gels and an increase in the proportion of cells with subdiploid DNA content in cytometric studies. RESULTS: Alterations of membrane properties, DNA degradation and chromatin condensation highlighted a possible apoptotic process induced by these two antitumor agents. CONCLUSION: These studies have established conditions for examining apoptotic processes in interleukin 3-dependent lymphoma cells. This is of great interest for deeper analysis of the mechanisms involved in the apoptosis of these cells after interleukin 3 depletion or treatment with cytotoxic antitumor compounds.

Animals↗

Involvement of Bax, Bcl-2 and caspase 3 in hydroxyurea- or etoposide-induced apoptosis of mouse interleukin-3-dependent lymphoma cells.

BACKGROUND: The apoptosis action induced by hydroxyurea or etoposide in interleukin 3-dependent lymphoma cells (DA-1) was studied. MATERIALS AND METHODS: The conditions to study apoptosis of these cells were 17 hours of cell treatment with concentrations of 1.25 mM hydroxyurea or 100 microM etoposide using flow cytometry, fluorometry and immunoblots techniques. RESULTS: Time-dependent reductions of cell viability after these treatments were observed. Caspase 3 activity was highly activated in both cases. Chemical treatments or interleukin 3 withdrawal rendered level changes in Bax and Bcl-2 expression. CONCLUSION: These results support the implication of these factors in DA-1 cell apoptosis induced by these chemical treatments or interleukin 3 depletion.

Animals↗

Use of hydroxyurea in heavily pretreated patients with HIV infection.

This study was designed to assess the potential benefit of hydroxyurea (HU) on virological and immunological markers in heavily pretreated human immunodeficiency virus (HIV)-infected patients. A total of 118 patients received hydroxyurea as treatment added to their current antiviral therapy ('add' group), or as treatment added together with a switched nucleoside reverse transcriptase inhibitor or protease inhibitor or with the introduction of an additional antiviral agent ('add and switch' group). Efficacy of HU was also compared among patients receiving didanosine- and non-didanosine-containing regimens. Results showed that HU was not associated with a significant decline in plasma HIV-1 RNA, and no significant difference in plasma HIV-1 RNA changes was noted between patients who did and did not receive didanosine. The absolute number of CD4 cells, but not the CD4 percentage, declined significantly from baseline. Significantly more grade 3-4 neutropenia occurred among patients receiving HU combined with zidovudine, although the discontinuation rate for haematological toxicity was similar in zidovudine- and non-zidovudine-treated patients.

Adult↗

Treatment of primary HIV infection: a pilot study of stavudine and didanosine plus nevirapine with or without hydroxyurea.

Treatment of primary human immunodeficiency virus (HIV) infection (PHI) may provide an opportunity to achieve a long lasting suppression of viral replication. Although there is growing evidence of the benefit of treating PHI, clinical data are still very limited. Special therapeutic considerations in this clinical setting include the prevalence of resistant viruses in the community, complexity of regimens and their long-term toxicity. In addition, adjunctive therapies aimed at exploring the role of immune modulation and intensification of antiretroviral therapy are becoming areas of great interest. In this regard, the role of hydroxyurea, a cytostatic agent that potentiates the antiviral effect of didanosine, and possibly of stavudine is being investigated. A pilot study to assess the antiviral effect of a combination of didanosine plus stavudine plus nevirapine with or without hydroxyurea in the treatment of PHI is currently under way. Preliminary results on 22 patients who completed at least 36 weeks of therapy suggest that the combination is safe, well tolerated and effective for the treatment of PHI.

Acute Disease↗

A phase II pilot trial of high-dose hydroxyurea in chronic myelogenous leukemia.

Suppression or eradication of the Philadelphia (Ph1) chromosome has been a major goal in the therapy of chronic myelogenous leukemia (CML). Variable levels of Ph1 chromosome negativity have been achieved using interferon-alfa, busulfan, combination chemotherapy, and allogeneic bone marrow transplantation. This study evaluated the effect of achieving a predetermined level of myelosuppression using hydroxyurea on bone marrow cytogenetics in CML. Fourteen patients with chronic phase CML received 25 cycles of therapy. Fourteen of the 25 cycles were associated with cytogenetic responses consisting of 25% or more Ph1 negative metaphases (range, 25% to 100%). Nine of the responses consisted of 50% or greater Ph1 negative metaphases. Toxicity was exclusively due to consequences of myelosuppression, including febrile neutropenia and thrombocytopenia. In chronic phase CML, hydroxyurea induces cytogenetic responses with tolerable toxicity and is an attractive agent for further study as a component of treatment strategies aimed at eradicating the Ph1 + population in CML.

Administration, Oral↗

Experience with hydroxyurea as a radiosensitizer in carcinoma of the cervix.

Since 1968, hydroxyurea has been used as a radiosensitizer in combination modality treatments for carcinoma of the cervix. The drug has shown an advantage over placebo in several randomized trials. Although hydroxyurea is given orally on an outpatient basis, it has not gained widespread acceptance. Previous reports are reviewed and possible future uses are discussed.

Animals↗

Long-term hydroxyurea treatment in children with sickle cell disease: tolerance and clinical outcomes.

Two hundred twenty-five SCD children have been enrolled in a study assessing the tolerability of hydroxyurea treatment. Mean age at inclusion was 9.2+/-4.4 years, median duration of treatment was 3.8 years. Ten and 75 patients have been treated respectively for more than 10 and 5 years. No severe side effect was related to hydroxyurea treatment, which was discontinued in 81 children mainly for treatment failure (30 cases) or non-compliance (17 cases). Treatment was also withdrawn in 5 of 6 children who had developed hypersplenism, in 3 because of a pathological transcranial Doppler, and in 2 after a stroke.

Adolescent↗

[Essential thrombocythemia associated with incomplete type intestinal Behçet disease during hydroxyurea treatment].

A 77-year-old man was diagnosed as having essential thrombocythemia in 1992. Treatment with hydroxyurea was started in 1997, which stabilized the platelet count. The patient then suffered from pharyngalgia and rhinitis with a high fever, immediately after which he developed tarry stools and anemia and was admitted to our hospital. The physical examination revealed splenomegaly, oral aphthous ulcers, genital ulcers and skin lesions on the lower limbs. His hematological and biochemical tests revealed anemia and increased level of C-reactive protein. He also had an HLA-B51 phenotype. The findings of gastro-intestinal and colon fiberoscopy showed a duodenal ulcer and multiple ulcers on ascending colon. He was thus diagnosed as having intestinal tract-type Behçet disease. After withdrawal of the hydroxyurea administration, the intestinal ulcers, oral aphthous ulcers and genital ulcers improved.

Aged↗

Hydroxyurea accelerates loss of extrachromosomally amplified genes from tumor cells.

Gene amplification is one mechanism mediating the resistance of tumor cells to antineoplastic agents and the overexpression of a variety of oncogenes in diverse tumor types. There is mounting evidence that acentric extrachromosomal elements such as double minute chromosomes are common intermediates in the amplification process. These acentric structures partition unequally at mitosis and can be lost in the absence of selection. In the present study, we used human and hamster cell lines documented to contain extrachromosomally amplified drug resistance genes to investigate the feasibility of enhancing the loss rate of the extrachromosomally amplified genes to make the cells more sensitive to drug treatment. The results show that treatment of each of these lines with hydroxyurea accelerates the loss of the extrachromosomally amplified drug resistance genes. Loss of these extrachromosomal genes was associated with a corresponding increase in the drug sensitivity in the cases examined. The mechanism of accelerated loss does not appear to involve a differential effect on the replication of extrachromosomal DNA sequences. The results suggest that hydroxyurea treatment may provide a valuable tool for the general accelerated elimination of extrachromosomally amplified genes.

Aspartate Carbamoyltransferase↗