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Procarbazine-induced specific-locus mutations in male mice.

Procarbazine is used in drug-combination treatment of Hodgkin's disease. The specific locus method was used to test and confirm the ability of procarbazine to induce gene mutations in pre- and post-meiotic germ cells of male mice. The lowest dose of procarbazine that significantly increased the mutation frequency in As spermatogonia over the control frequency was 400 mg/kg (P = 0.003). The corresponding dose for the post-spermatogonial germ-cell stages was 600 mg/kg (P = 0.009). The dose--response was linear for the point estimates of the mutation frequencies after treatment of As spermatogonia with 0, 200, 400 and 600 mg/kg. The point estimate of the mutation frequency at the 800 mg/kg level was one-third of that expected from a linear extrapolation. Variation in mutation rates among the 7 loci between the lowest (a locus) and the highest (p locus) was 12-fold. Only 24% of procarbazine-induced specific locus mutations in As spermatogonia were lethal in the homozygous condition. From the mutation spectra and the viability tests, it is concluded that procarbazine-induced mutations may be mainly due to base-pair changes. Procarbazine-induced specific-locus mutations fulfilled the criteria for the estimation of the doubling dose, the dose necessary to induce as many mutations as occur spontaneously. The doubling dose of procarbazine in As spermatogonia of mice was 114 mg/kg. The therapeutic dose for procarbazine is about 215 mg/kg. If man and mouse were equally sensitive, this dose would induce 1.9 times as many mutations as arise spontaneously. From the incidence of patients with Hodgkin's disease (1 : 42 000) the calculated population dose of procarbazine is 5.12 micrograms/kg. Assuming equal sensitivity between the sexes we can calculate, for an estimated number of 30 000 genes, the induction of about 22 mutations per million children due to procarbazine treatment. The same number of induced mutations can be calculated if the risk of patients is used for the estimation of the genetic hazard.

Animals

Characteristics of procarbazine as an inhibitor in-vitro of rat semicarbazide-sensitive amine oxidase.

Procarbazine (N-isopropyl-alpha-(2-methyl hydrazino)-p-toluamide hydrochloride) inhibited more powerfully the deamination of benzylamine by semicarbazide-sensitive amine oxidase (SSAO) of rat brown adipose tissue than the deamination of 5-hydroxytryptamine and benzylamine by rat liver monoamine oxidase-A or -B activities, respectively. Inhibition of SSAO, but not monoamine oxidase, was time-dependent. Use of metabolic inhibitors, and an enzyme dilution technique, suggested that any conversion of procarbazine to an active species must be as a result of the action of SSAO itself and not of any other enzyme. The non-competitive kinetics and the time-dependence of inhibition were indicative of a suicide interaction between procarbazine and SSAO. The slow reversal of inhibition by dialysis was evidence in favour of the involvement of tight binding, rather than covalent bonding. High concentrations of benzylamine afforded the enzyme significant protection from the action of procarbazine, indicating that the interaction is at or near the active site. If the properties of procarbazine, evident in in-vitro studies, are retained in-vivo, these data suggest that procarbazine might be suitable for the examination of SSAO activities, both in-vivo and ex-vivo.

Adipose Tissue, Brown

The mutational spectrum of procarbazine in Drosophila melanogaster.

The antineoplastic agent Procarbazine was tested for the induction of genetic damage in Drosophila melanogaster. The compound was administered to adult males by oral application. The following types of genetic damage were measured: (1) sex-linked recessive lethals; (2) dominant lethals; (3) total and partial sex-chromosome loss; and (4) translocations. Procarbazine is highly mutagenic in causing recessive lethal mutations in all stages of spermatogenesis. In sperm a clear-cut concentration-effect relationship is not apparent, but in spermatids such a relationship is obtained for mutation induction at low levels of procarbazine exposure, while at high concentrations the induction of recessive lethals is not a function of concentration. A low induction of total sex-chromosome loss (X,Y) and dominant lethals was observed in metabolically active germ cells (spermatids), but procarbazine failed to produce well-defined breakage events, such as partial sex-chromosome loss (YL,YS) and II-III translocations. The results obtained in Drosophila melanogaster are discussed and compared with the mutational pattern reported in the mouse after procarbazine treatment.

Administration, Oral

Carcinogenic and other adverse effects of procarbazine in nonhuman primates.

The carcinogenic potential of procarbazine is under investigation in three species (Macaca mulatta, Macaca fascicularis, and Cercopithecus aethiops) of nonhuman primates. A total of 55 monkeys have received procarbazine s.c., p.o., or i.p. for periods of up to 12 years. Eleven of the 42 monkeys (26%) necropsied thus far have had malignant neoplasms, 6 of which were acute leukemia. Two monkeys developed osteogenic sarcomas, two monkeys developed hemangiosarcomas, and a single case of lymphocytic lymphoma was found. The average total dose of procarbazine received by the monkeys developing cancers was 36.0 g; the average duration of procarbazine treatment was 75 months. A number of the toxic effects of procarbazine seen in humans were also noted in this series of monkeys, including vomiting and myelosuppression. Another striking toxic effect was on the reproductive system of the males. The majority of the adult males necropsied to date have had testicular atrophy with complete aplasia of the germinal epithelium.

Animals

Radiosensitization of E. coli B/r by the cytotoxic agent procarbazine: a hypoxic cell sensitizer preferentially toxic to aerobic cells and easily oxidized.

Procarbazine has been shown to be a hypoxic cell sensitizer of moderate ability in E. coli B/r, with an achievable enhancement ratio of 1.4 at subtoxic concentrations. The drug appears to act in a manner similar to the expected with the electron-affinic radiosensitizers. However, procarbazine and the electron-affinic sensitizers differ in two important respects. Unlike the electron-affinic sensitizers, procarbazine is not easily reduced, but is easily oxidized. It is more toxic to aerobic than to hypoxic cells. At the drug dosages in present clinical use, procarbazine is likely to be only a weak radiosensitizer. The possible implications of the data for the further development of a new class of sensitizers and combination therapy are discussed.

Escherichia coli

In vitro and in vivo evidence for the formation of methyl radical from procarbazine: a spin-trapping study.

Electron spin resonance (ESR) analysis combined with the use of 4-pyridyl-1-oxide-t-butyl nitrone (4-POBN) and dibromonitroso benzenesulfonic acid (DBNBS) as spin-trapping agents was used to characterize free radical generation during the metabolism of the anticancer agent procarbazine [N-isopropyl-a-(2-methylhydrazino)-p-toluamide hydrochloride]. The formation of free radical species, identified as methyl radicals, was observed during oxidation of procarbazine in rat liver microsomes and isolated hepatocytes in vitro, as well as in several organs following administration of the drug in vivo. A cytochrome P450-mediated reaction, involving P450IA and IIB isoenzymes, was responsible for the activation process. The metabolic pathway leading to free radical formation was characterized using various procarbazine metabolites and revealed strict analogies with previously published data on methane production from procarbazine. These results supported the identification of the trapped species as methyl free radical and suggested that C-oxidation of azoprocarbazine is the main source of radical intermediates derived from this anticancer drug.

Animals

Combined effect of procarbazine and ionizing radiation on mouse jejunal crypts.

The interaction between procarbazine and gamma-radiation on animal survival and on cell proliferation in the jejunum of the mouse was investigated. Procarbazine (501 mg/kg) injected intraperitoneally enhanced the effect of the gastrointestinal radiation syndrome in whole-body lethality studies by reducing the 7-day LD50 by 269 rads. Similar lethality responses were noted whether the drug was administered immediately before or after irradiation. In a series of temporal response studies, 501 mg/kg procarbazine injected intraperitoneally affected intestinal crypt cell proliferative activity in a manner similar to the effect of 1,000 rads of gamma-radiation, by an increase to above-normal proliferative activity. The indices of proliferative activity employed were tritiated thymidine activity per milligram intestine, tritiated thymidine activity per crypt, labeled nuclei per crypt, and mitotic figures per crypt. When procarbazine was injected 15 min prior to irradiation, the crypt cell proliferative activity decreased but never recovered, thus indicating an enhanced response with combined treatment.

Animals

BCNU (NSC-409962) and procarbazine (NSC-77213) treatment for malignant brain tumors.

Sixty-five patients with malignant brain tumors were treated with a combination of BCNU (100 mg/m2 qd X 1) and procarbazine (100 mg/m2 qd X 14); the cycle was repeated in 1 month and then on a 6-week schedule with procarbazine being given for 21 days. Forty-five patients had malignant gliomas (glioblastoma multiforme, anaplastic astrocytoma, malignant glioma, or gemistocytic astrocytoma) and were evaluated as a group. All patients had either shown evidence of tumor regrowth after previous surgery and/or radiotherapy, or had deep unbiopsied tumors presumed to be malignant gliomas. Of these 45 patients, 13 of 45 (30%) were judged to be unequivocal responders and an additional eight of 45 (17%) were designated as probable responders. The median duration of clinical response was 34 weeks for responders and 20 weeks for probable responders. The combination of BCNU and procarbazine, therefore, was somewhat inferior to a previous combination of procarbazine, CCNU, and vincristine.

Astrocytoma

A clinical trial of procarbazine plus vincristine plus bis-chloroethyl-nitrosourea plus imidazole carboxamide dimethyl triazeno in metastatic malignant melanoma.

Only a limited percentage of patients with metastatic malignant melanoma respond to single-agent chemotherapy. Vincristine, procarbazine, imidazole carboxamide dimethyl triazeno (DTIC) and bis-chloroethyl-nitrosourea (BCNU) have been used as single agents by various investigators. A response rate of +/- 20% was seen with vincristine (1-3) and BCNU (3, 4), and a response rate of 20-30% has been observed with DTIC (3, 5-8) and procarbazine (3, 9, 10). Newer agents such as triazeno imidazole carboxamide mustard (TIC mustard) (11), chloroethyl cyclohexyl nitrosourea (CCNU) (12), and chloroethyl methylcyclohexyl nitrosourea (methyl-CCNU) (13) have not so far proved superior. During the last years various drug combinations have been tried in an effort to improve the results of treatment in patients with metastatic malignant melanoma. In 1959 Moon reported objective response in 9 out of 20 patients who received a minimum of two courses of a combination of BCNU and vincristine (14). In a randomized trial performed by Acute Leukemia Group B (15), only 24% responded to this combination as compared to 32% and 29% for two different DTIC schedules. There were 120 patients who entered onto this protocol. A combination of DTIC plus cyclophosphamide plus vincristine was reported to give a 25% response (16). Workers at the Mayo Clinic reported objective response in 4 out of 18 patients treated with a combination of DTIC plus vincristine as compared to 1 out of 19 using CCNU (12). Costanza and co-workers (Eastern Co-Operative Oncology Group study) reported that 12 out of 61 patients responded to treatment with DTIC plus BCNU as compared to 9 out of 51 on DTIC alone (17); while Cohen (18) and co-workers reported that 10 out of 16 patients treated with the triple combination of vincristine plus BCNU plus DTIC showed significant response and concluded that this combined approach in the treatment of disseminated malignant melanoma warranted further study. Preliminary analysis of an Eastern Co-Operative Oncology Group protocol showed no statistical advantage of DTIC plus methyl-CCNU over each drug on its own (19). The present study was undertaken to investigate the possible advantage of combining DTIC plus vincristine plus BCNU plus procarbazine in courses of treatment. All of these agents are of some value on their own and all four have possible different mechanisms of action.

Adult

Optic neuroretinitis in association with BCNU and procarbazine therapy.

A 53-year-old man with multiple myeloma and plasma cell luekemia developed severe, acute bilateral optic neuroretinitis 8 days after chemotherapy with BCNU, procarbazine, cyclophosphamide, and prednisolone. He showed some return of function over the following 6 weeks before his death. Both BCNU and procarbazine are known to cross the blood--brain barrier. Procarbazine is known to interfere with neurological function. BCNU has been reported to transiently interfere with vision and, although this patient had highly morbid disease, the onset of optic neuroretinitis 8 days after combination therapy with these 2 drugs raises the possibility that one or both in combination may have been the cause of the optic neuropathy.

Carmustine

Genetic toxicity of procarbazine in bacteria and yeast.

Procarbazine [N-isopropyl-alpha-(2-methylhydrazino)-p-toluamide hydrochloride] is used to treat Hodgkin's disease. This compound was tested in vitro without and with S10 fraction from mice liver (microsomal assay) using Saccharomyces cerevisiae strain D7, Salmonella typhimurium (strains TA98, TA100, TA1535) and in vivo in Swiss albino mice (host-mediated assay) using D7. Procarbazine, without S10 fraction, is highly toxic and induced mitotic crossover, gene conversion, and reverse mutation in D7. It had a toxic effect on all the Salmonella strains; but did not induce reverse mutations at the histidine loci. Procarbazine, with S10 fraction, was less toxic and did not induce genetic effects in yeast or Salmonella. In the host-mediated assay, no genetic effects were seen.

Drug Evaluation, Preclinical

Oxidation of procarbazine in the presence of Ti(IV).

The air oxidation of procarbazine in the presence of Ti(IV) was examined as a model system for the effects titanium has on oxidative processes and intermediates involving molecular oxygen. It was found that Ti(IV) inhibited oxidation when the substrate, procarbazine, was coordinated to titanium. This inhibition was most prominent (reduction of overall rate constant by a factor of 10(2)) in its interference with Cu(II) catalyzed oxidation of the substrate whole oxidation by the neutral species O2 was only slightly inhibited (factor of 2). However, when Mn(II) was used to catalyze the oxidation of procarbazine by air, titanium enhanced the catalytic effect of Mn(II) by a factor of 10(2). This enhancement was found to be due to Ti(IV) catalysis of the air oxidation of Mn(II), and the effect was found to be inhibited by catalase but not superoxide dismutase or peroxidase. These results are discussed in terms of a Ti(IV) ability to activate molecular oxygen and its ability to form oxygen free-radical complexes.

Air

Comparison of procarbazine, imidazole-carboxamide and cyclophosphamide in relapsing patients with advanced carcinoma of the prostate.

In this third cooperative chemotherapy trial of the National Prostatic Cancer Project 165 patients with histologically confirmed, relapsing clinical stage D prostatic cancer were randomized to receive either imidazole-carboxamide, procarbazine or cyclophosphamide. All patients had received and failed previous hormonal therapy. Patients whose disease progressed after 12 weeks on initial therapy were crossed over or randomized to receive an alternate drug. There were 129 patients available for comparison of treatments. The objective response rates (partial regression plus stable disease) were 26% for cyclophosphamide, 27% for imidazole-carboxamide and 14% for procarbazine. Subjective responses were noted in pain relief, improvement in performance status and weight gain. Procarbazine was associated with excessive toxicity, resulting in many patients (28%) discontinuing therapy within the first 3 weeks and closure of this particular arm of the study. The regimen of initial imidazole-carboxamide therapy with a later cross-over to cyclophosphamide when the disease continues to progress is associated with the longest increase in survival. Imidazole-carboxamide and cyclophosphamide appear to be active agents in advanced prostatic cancer and are worthy of continued use in this disease.

Aged

Effectiveness of prostaglandin E1 and procarbazine hydrochloride in prolonging the survival of vascularized cardiac hamster-to-rat xenograft.

The immunosuppressive effects of prostaglandin E1 and procarbazine hydrochloride were compared in a vascularized organ xenograft model. Hamster-to-rat cardiac grafts were used. Both procarbazine hydrochloride and prostaglandin E1 prolonged survival of the xenograft. Prostaglandin E1 had the additional feature of coincident suppression of hemagglutination titer to hamster red cells. Prostaglandin E1 was somewhat less effective than procarbazine hydrochloride.

Animals

Diffuse pulmonary disease after therapy with nitrogen mustard, vincristine, procarbazine, and prednisone.

Pulmonary reactions may follow therapy with nitrogen mustard, vincristine, procarbazine, and prednisone. Two patients with Hodgkin's disease are described who were treated with nitrogen mustard, vincristine, procarbazine, and prednisone and developed diffuse lung disease. Their disease processes were evaluated with serial pulmonary function studies, chest radiography, and open lung biopsy. Hypersensitivity reactions appeared to be responsible, and treatment with corticosteroids was successful. Procarbazine may have been the responsible agent.

Adult

Temporal specificity of procarbazine in the inhibition of mouse immune responses to allogeneic tumor.

The inhibition of the cellular response of C57Bl/6 mice against allogeneic P815 mastocytoma by procarbazine was shown to be uniquely dependent upon time of administration with respect to antigen. If the drug was given 4 or 6 days after antigen, the development of the T cell effectors was inhibited; if it was given earlier (2 hr or 1 or 2 days after antigen), the response was affected less. In contrast to the immunosuppressive effectiveness of delayed administration of procarbazine, the inhibition of the T cell response by daunorubicin was greatest when the agent was given 2 days after antigen, and that by cyclophosphamide, at the concentrations used, was relatively time independent. Under similar conditions the effects of the three agents on the humoral response were found to be less selective. The inhibition of both responses by procarbazine was shown to be dose dependent and relatively independent of the route of administration.

Animals

Phase II trials with procarbazine (NSC-77213), streptozotocin (NSC-85998), 6-THIOGUANINE (NSC-752), and CCNU (NSC-79037) in patients with metastatic cancer of the large bowel.

One hundred and ninety-seven patients with measurable metastatic cancer of the colon have been treated with one of four anticancer drugs which have had little prior trial in this disease. Objective tumor responses lasting a median of 9 weeks occurred with 0.5 g/m of streptozotocin given intravenously every week (10 percent), 130 mg/m of CCNU given orally every 6 weeks (10%), 1.0 mg/kg/day of 6-thioguanine given orally (8%), and 3 mg/kg/day of procarbazine given orally (3%). Performance status declined more rapidly with streptozotocin and 6-thioguanine and the median survival time was less (12 and 16 weeks respectively) than with procarbazine and CCNU (23 and 20 weeks respectively). This study suggests that procarbazine given in this way is ineffective but trials of streptozotocin or 6-thioguanine combined with other agents active against colon cancer should ensue as well as further exploration of the usefulness of other nitrosoureas.

Clinical Trials as Topic

Effect of six weekly transfusions on canine marrow grafts: tests for sensitization and abrogation of sensitization by procarbazine and antithymocyte serum.

We have previously shown that blood transfusions can immunize a dog and lead to rejection of a subsequent marrow graft despite lethal total body irradiation (TBI). Sensitization to histocompatibility antigens induced by two prior transfusions of whole blood could be overcome by a regimen of procarbazine and anti-thymocyte serum (ATS) preceding TBI. The current study investigated a) whether this regimen could abrogate sensitization induced by six weekly transfusions given from days --50 to --15 preceding a marrow graft, and b) whether platelet survival studies and two in vitro tests of immunity could predict marrow graft rejection. All donor-recipient pairs were histoincompatible, unrelated, and of different breed. Twenty-two recipients received platelet concentrate transfusions and eight received whole blood transfusions. Recipients were given 1200 R TBI and a graft of marrow and peripheral blood leukocytes from the transfusion donor on day 0. Three of 15 recipients (20%) given procarbazine, 12.5 mg/kg i.v. on days --8, --6, and --4, and ATS, 0.6 ml/kg subcutaneously on days --7, --5 and --3, Rejected their grafts, whereas 11 of 15 dogs (73%) not given procarbazine and ATS rejected their grafts (p less than 0.01). Serum lymphocytotoxic antibodies, peripheral leukocyte migration inhibition, and in vivo donor platelet recovery and survival were studied in those recipients receiving six weekly transfusions and in 18 other recipients receiving a single donor transfusion 3 months before marrow grafting. No significant correlation was found among these in vitro and in vivo tests of sensitization. Sensitization to marrow grafts was not reliably detected by the presence of cytotoxic antibodies or leukocyte migration inhibition. Platelet survival, however, was positively correlated with the results of marrow grafting in 12 of 15 (80%) evaluable recipients (p approximately 0.15).

Animals