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Apoptosis of rat thymocytes triggered by prednisolone, camptothecin, or teniposide is selective to G0 cells and is prevented by inhibitors of proteases.

Rat thymocytes were treated in culture with prednisolone or the DNA topoisomerase I or II inhibitors, camptothecin (CAM) or teniposide (TN), and proportions of cells in different phases of the cell cycle were estimated by flow cytometry using a staining methodology which makes it possible to discriminate between G0 and G1 cells, as well as to recognize the cells which undergo apoptosis. The appearance of apoptotic cells in cultures treated with pharmacological concentrations of these drugs, observed as early as 3-6 hr after treatment, coincided with the selective loss of G0 cells in these cultures, while no significant changes in the proportion of S or G2+M cells were apparent. Agarose gel electrophoresis of DNA isolated from the treated cells indicated degradation of the internucleosomal spacer sections, typical of the endonucleolytic activity which accompanies apoptotic cell death. The data indicate that G0 thymocytes were particularly sensitive to agents that induce apoptosis while cells progressing through the cell cycle were resistant. This suggests that under in vivo conditions (immunological response), the selective death of G0 cells may promote the clonal expansion of stimulated thymocytes which enter the cell cycle. Together with our earlier studies on the effects of CAM and TN on MOLT-4 and HL-60 leukemic cell lines, these data indicate that both, phenotypic- and and cell cycle phase specific- factors modify the ability of cells to respond to toxic agents, including chemotherapeutics by apoptosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Allergic reactions to teniposide (VM-26) in children with neoplasms].

Allergic reactions of dramatic intensity were observed in 5 children treated with Teniposide (VM-26) for acute lymphoblastic leukaemia and histiocytosis X. In the further treatment this drug was replaced with epoxide, a cytostatic agent which is also a podophyllin derivative but in other chemical formulation. In none of these patients the allergic reaction returned.

Adolescent↗

Human cytochrome P450 metabolism of teniposide and etoposide.

Although teniposide (VM26) and etoposide (VP16) are eliminated mostly by nonrenal mechanisms, their cytochrome P450 metabolism in humans has not been reported. Our objective was to determine the affinity and capacity of P450 O-demethylation of VM26 and VP16 in a variety of human livers. Formation of catechols of VM26 and VP16 was detected in 24 and 26 of 26 liver microsomal preparations, respectively, with wide variability in maximum catechol formation rates from VM26 (41-fold) and VP16 (39-fold range), even among normal livers. Maximal activity measurements at 500 microM substrate were lower for VM26 catechol formation (mean = 1.5 nmol/mg/hr) than for VP16 catechol (mean = 3.2 nmol/mg/hr) in 26 livers (P less than .001). Maximal activities for VP16 and VM26 O-demethylation, and ethoxycoumarin O-deethylation were significantly higher in normal than in diseased livers. No differences were found in activities related to age, sex or race of the liver donor. In all five livers tested over a range of substrate concentrations, Km (19.7, 23.2, 43.5, 30.1 and 22.0 microM) and Vmax values (1.0, 1.2, 4.4, 8.2 and 4.0 nmol/mg/hr) for VM26 were lower compared to values for VP16 (Km = 60.2, 115.1, 87.3, 42.1 and 81.9 microM; Vmax = 1.4, 3.3, 10.3, 27.5 and 10.1 nmol/mg/hr). Despite higher VP16 catechol formation, VM26 underwent greater overall reduced nicotinamide adenine dinucleotide phosphate-dependent metabolism than VP16, consistent with greater nonrenal clearance of VM26 in vivo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Teniposide induces nuclear but not mitochondrial DNA degradation.

Teniposide [4'-demethylepipophyllotoxin-4-(4,6-O-thenylidene-beta-D- glucopyranoside) (VM-26)] is a cancer chemotherapeutic drug with a high target specificity for DNA topoisomerase II. This agent induces repairable protein-bridged double-strand DNA breaks, which have been correlated with cytotoxicity, but high concentrations of VM-26 also induce irreversible DNA degradation and apoptotic cell death. It is not known whether this degradation occurs uniformly throughout the genome or in a gene-specific manner. To answer this question, DNA was isolated from HL-60 promyelocytic leukemia cells exposed to 5 microM VM-26 for varying periods of up to 12 h. Nucleosomal "ladders" on 2.0% agarose gels stained with ethidium bromide were detectable after 3 h of exposure, indicative of apoptosis. Gene-specific DNA degradation was investigated by Southern blot analysis. The genes for 18S rRNA and glucose-6-phosphate dehydrogenase were representatives of constitutively expressed (i.e., "housekeeping") genes. The proto-oncogenes c-myc, c-Ha-ras, and bcl-2 were examined as examples of other transcriptionally active genes, while transcriptionally inactive genes in HL-60 cells were studied by probing for the immunoglobulin heavy chain joining region and lambda light chain constant region genes. The rates of DNA degradation, and its extent after 12 h, were similar for all nuclear genes studied. However, there was striking resistance of mitochondrial DNA to endonucleolytic degradation. These data demonstrate that VM-26 can elicit a widespread degradative process which affects nuclear but not mitochondrial DNA.

Blotting, Southern↗

Mechanisms of resistance to etoposide and teniposide in acquired resistant human colon and lung carcinoma cell lines.

Stable acquired resistance to etoposide (VP-16) or teniposide (VM-26) in HCT116 human colon carcinoma cells and A549 human lung adenocarcinoma cells, was previously obtained by weekly 1-h exposures to either drug (B. H. Long, Natl. Cancer Inst. Monogr., 4: 123-127, 1987). The purpose of this study was to identify possible mechanisms of resistance present in these cells by using human mdr1 and topoisomerase II DNA probes, antibodies to these gene products, and P4 phage unknotting assay for topoisomerase II activities. HCT116(VP)35 cells were 9-, 7-, and 6-fold resistant to VP-16, VM-26, and Adriamycin, respectively, and showed no cross-resistance to colchicine and actinomycin D. These cells had no differences in mdr1 gene, mdr1 mRNA, or P-glycoprotein levels but displayed decreased levels of topoisomerase II mRNA and enzyme activity without any alteration of drug sensitivity displayed by the enzyme. HCT116(VM)34 cells were 5-, 7-, and 21-fold resistant to VP-16, VM-26, and Adriamycin; were cross-resistant to colchicine (7-fold) and actinomycin D (18-fold); and possessed a 9-fold increase in mdr1 mRNA and increased P-glycoprotein without evidence of mdr1 gene amplification. No alterations in topoisomerase II gene or mRNA levels, enzyme activity, or drug sensitivity were observed. A549(VP)28 and A549(VM)28 cells were 8-fold resistant to VP-16 and VM-26 and 3-fold resistant to Adriamycin. Both lines were not cross-resistant to colchicine or actinomycin D but were hypersensitive to cis-platinum. No alterations in mdr1 gene, mdr1 mRNA, or P-glycoprotein levels, but lower topoisomerase II mRNA levels and decreased enzyme activities, were observed. Of the four acquired resistant cell lines, resistance is likely related to elevated mdr1 expression in one line and to decreased topoisomerase II expression in the other three lines.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Treatment of advanced refractory lymphomas with a combination of carmustine, bleomycin, teniposide, dexamethasone, and cisplatin (the BBVDD regimen). An ECOG pilot study.

Forty-four patients with relapsed, refractory malignant lymphomas (12 Hodgkin's disease, 32 non-Hodgkin's lymphoma) were treated with a combination of carmustine, bleomycin, teniposide, dexamethasone, and cisplatin (BBVDD regimen). Patients had failed at least one, and frequently two, chemotherapy regimens before admission to the study. Of the patients with Hodgkin's disease, 2 (17%) achieved complete response (CR), and 3 (25%) attained a partial response (PR) for an overall response rate (CR + PR) of 42%. Among the patients with non-Hodgkin's lymphoma there were 6 CR (19%) and 12 PR (37%), for an overall response rate of 56%. Median durations of response ranged from 2.5 months for nodular non-Hodgkin's lymphoma in PR to 28.5 + months for Hodgkin's disease in CR. In these heavily pretreated patients, the incidence of toxic effects was grade 3 (48%), grade 4 (23%), grade 5 (2%). The one death (grade 5 toxicity) was attributed to pulmonary impairment due to bleomycin. BBVDD is a moderately effective regimen for the palliation of patients with refractory lymphomas and merits further study.

Ambulatory Care↗

Teniposide (VM26) as second-line treatment for small cell lung cancer.

Twenty-six out of 53 patients with small cell lung cancer (SCLC) who relapsed or progressed following a first treatment (induction plus maintenance), were treated by a second-line chemotherapy consisting of: Teniposide (VM26), 60 mg/m2 i.v., days 1-5, every 3 weeks until further progression. The response rate obtained in 24 evaluable patients was: 7 (29%) partial response, 4 (17%) minor response, 8 stable disease, 5 progressive disease and 2 patients with early death. In the whole group, median survival time from the start of VM26 treatment, was 4 months (range 1-11). These data were compared to the median survival (1.5 months, range 1-7) of the remaining 27 patients, the control group, who at the time of progression did not receive further treatment. The difference between survivals was statistically significant (Log-rank test: p less than 0.05). According to these data VM26 seemed to be active, but larger studies better focused on all clinical variables are needed before firm conclusions can be drawn.

Aged↗

Reduction of drug accumulation and DNA topoisomerase II activity in acquired teniposide-resistant human cancer KB cell lines.

We have isolated stable teniposide (VM26)-resistant cell lines from human cancer KB cells by stepwise exposure to increasing doses of the drug. At each step, we have purified VM26-resistant cell lines. KB/VM-a, KB/VM-b, KB/VM-1, KB/VM-2, KB/VM-3, and KB/VM-4 showed 3-, 6-, 12-, 16-, 74-, and 95-fold higher resistance to VM26 than did KB. We have further characterized KB/VM-2 and KB/VM-4 which showed about 15- and 100-fold higher resistance to VM26 or etoposide (VP16) than did KB. Both VM26-resistant cell lines showed 4- to 11-fold higher relative resistance to daunomycin and Adriamycin than did KB. Steady-state levels of the cellular accumulation of radioactive VP16 in KB/VM-2 and KB/VM-4 cells were about 40% of that of KB cells, whereas similar levels of radioactive daunomycin accumulation were observed in KB/VM-2 and KB/VM-4 cells as KB cells. Topoisomerase II activity of nuclear extracts of both KB/VM-2 and KB/VM-4 assayed by decatenation of kinetoplast DNA was consistently two-thirds or less the activity of KB cells. A similar reduction was seen in both immunoblot assays with specific anti-topoisomerase II antibody and Northern blot analysis with specific human DNA topoisomerase II complementary DNA. DNA topoisomerase I activity, however, was similar between the mutants and their parent. Furthermore, cell growth of KB/VM-2 and KB/VM-4 was more thermolabile than that of KB, while KB/VM-b already showed temperature-sensitive growth. KB/VM-1 did show reduced accumulation of VP16 as in KB/VM-2 or KB/VM-4, but it had a normal level of topoisomerase II content as in KB cells. These data suggest that the reduced expression of DNA topoisomerase II, possibly combined with decreased permeability to the drugs, can account for the acquired VM26 resistance of KB/VM-2 and KB/VM-4 cells and also that the temperature-sensitive phenotype might not be obligatorily coupled with the reduced expression of topoisomerase II or the decreased permeability.

DNA Topoisomerases, Type I↗

DNA breakage in human lung carcinoma cells and nuclei that are naturally sensitive or resistant to etoposide and teniposide.

Evidence suggests that the anticancer agents etoposide (VP16-213) and teniposide (VM26) produce DNA breaks and cytotoxicity by interaction with type II topoisomerase. Therefore, levels of type II topoisomerase may influence sensitivity to VP16-213 and VM26. We have characterized four lung carcinoma-derived cell lines for natural sensitivity or resistance to VP16-213 and VM26. Included in this study were two small cell lung carcinoma lines (SW900 and SW1271), an adenocarcinoma line (A549), and a large cell carcinoma (H157). SW1271 was the most sensitive line with a median inhibitory concentration for cell proliferation of 0.5 microM for VM26 and 2.7 microM for VP16-213, and SW900 was the most resistant with median inhibitory concentration values of 2.0 and 16 microM, respectively. A549 and H157 cells were intermediate in sensitivity to these drugs. Alkaline elution techniques were used to study in vivo formation and repair of single and double strand DNA breaks. Single strand DNA breaks were observed in SW1271 cells exposed to as little as 10 nM VM26 or 100 nM VP16-213 for 1 h, whereas SW900 cells required exposure to 10-fold higher concentrations of VM26 or VP16-213 to produce similar results. Single strand DNA breaks predominated only in SW1271 and A549 cells and then, only at low drug concentrations, whereas the ratios between single and double strand DNA breaks decreased at higher drug concentrations. Plots of cytotoxicity versus single and double strand DNA breakage revealed that cytotoxicity produced by both drugs was more closely related to double strand DNA break formation in all four cell lines. DNA breaks appeared rapidly upon addition of drug, reaching plateaus in DNA breaks within 30 min, and repair of both single and double strand DNA breaks occurred rapidly with time to repair one-half of the DNA breaks of 20 to 60 min in all four cell lines upon removal of drug, arguing against repair as a mechanism for drug resistance. DNA breakage was also observed in nuclei isolated from SW900 and SW1271 cells in similar magnitude to that observed in the respective cells. Results indicate that DNA breakage plateaus may reflect a steady-state equilibrium established between the drug and its nuclear target, possibly type II topoisomerase, and suggest that natural resistance to VP16-213 and VM26 may be due to different enzyme levels in sensitive and naturally resistant cells.

Adenocarcinoma↗

In vitro antitumor activity of teniposide against carcinoma of the lung in human tumor clonogenic assay.

The antitumor activity of teniposide (VM26) on carcinoma of the lung was tested by comparing it with its congener, etoposide (VP16) in an in vitro soft agar clonogenic assay system (HTCA). Of 56 tumor biopsies placed in culture, 40 tumors were evaluable for drug sensitivity information (i.e., greater than or equal to 30 colonies in the control plate). The overall in vitro response rate (defined as less than or equal to 50% survival of TCFU) at the standard dose (10% peak plasma concentration) was 35%, which is higher than that of VP16 (28%). In cell lines derived from human carcinoma of the lung, VM26 showed 50% inhibition against colony formation of PC-7 cells at 0.45 microgram/ml which is less than that of VP16. A superior antitumor activity of VM26 on PC-9 cells was also observed. VM26 was observed to act faster than VP16 thus indicating its possible superior antitumor activity in vivo.

Adenocarcinoma↗

Protein-linked DNA strand breaks produced by etoposide and teniposide in mouse L1210 and human VA-13 and HT-29 cell lines: relationship to cytotoxicity.

The two demethylepipodophyllotoxin glycosides, teniposide (VM-26) and etoposide (VP-16), have previously been reported to interact with DNA topoisomerase II by stabilizing a topoisomerase II-DNA covalent intermediate. This study examined the protein-associated aspect of the topoisomerase II-DNA-epipodophyllotoxin lesion. We found that in mouse (L1210) and human (VA-13 and HT-29) log-phase cell cultures, all DNA strand breaks produced by VP-16 or VM-26 were protein-associated. We found also that these protein-associated breaks occurred with a frequency which correlated with cytotoxicity in all three cell lines. For all three cell lines and for both compounds the regression lines were similar. Therefore, for a given class of topoisomerase II inhibitors, it may be possible to generate a characteristic line from which DNA-protein crosslink frequency predicts cytotoxicity.

Animals↗

Peptichemio, teniposide and high-dose dexamethasone: a new active combination for relapsing and refractory multiple myeloma. A pilot study.

Twelve patients with refractory (8 pts) and relapsing (4 pts) myeloma were treated with Peptichemio. Teniposide and high-dose dexamethasone. Eight patients experienced an objective response (5 out 8 with refractory and 3 out 4 with relapsing disease) with a median duration of 10+ months. Overall toxicity was mild to moderate and chiefly haematological. Our preliminary results seem very promising and justify a larger phase II study with this regimen.

Adult↗

Teniposide and cytarabine combination chemotherapy in the treatment of relapsed adolescent and adult acute lymphoblastic leukemia.

Nineteen adolescents and adults with relapsed acute lymphoblastic leukemia (ALL) were treated with teniposide (VM-26) plus cytarabine (ara-C). Eight patients (42%) achieved complete remission. Infection and bleeding secondary to myelosuppression were the most serious complications seen. Responders received periodic reinductions with VM-26 and ara-C, but all relapsed within 16 weeks from remission. Our data demonstrate the effectiveness of combination chemotherapy with VM-26 plus ara-C in adolescent and adult ALL in relapse and suggest testing of this combination in first-line protocols. For remission maintenance, the association of other drug combinations is necessary.

Acute Disease↗

Phase II evaluation of teniposide and ifosfamide in refractory adult acute lymphocytic leukemia: a Southwest Oncology Group Study.

The Southwest Oncology Group undertook a phase II study of teniposide (VM-26) and ifosfamide in refractory adult acute lymphocytic leukemia. The 49 evaluable patients were heavily pretreated; 15 of these had received only one prior induction attempt. Two treatment regimens were used. Eighteen patients received VM-26 (30 mg/m2) on Days 1-5 and ifosfamide (1000 mg/m2) by continuous iv infusion on Days 1-5. When acceptable toxicity was observed, the dose of VM-26 was increased and 30 patients received VM-26 (50 mg/m2) on Days 1-5 in addition to ifosfamide. Complete remission (CR) was observed in two patients who received the lower-dose VM-26 regimen and in six patients who received the higher-dose regimen. Of the eight patients who achieved CR, six were found among the 15 patients who had received only one prior induction therapy. Hematologic toxicity was the major toxic effect observed, with 41 patients (84%) having wbc counts less than 1000/microliter during induction therapy. Nonhematologic toxicity was dose-limiting in seven patients for the following reasons: hematuria (four patients), neurological disturbance (one), and mucositis (two). The combination of VM-26 and ifosfamide is capable of producing CR in refractory acute lymphocytic leukemia in adults with manageable toxicity. Inclusion of the combination in a multidrug consolidation regimen for newly diagnosed patients is an appropriate avenue for further study.

Adolescent↗

Pharmacokinetics of high-dose teniposide.

This paper describes the pharmacokinetics of teniposide (VM-26) after being administered iv in high doses to eight cancer patients (maximum dose, 1.0 g/m2). VM-26 levels in plasma, urine, saliva, duodenal fluid, and cerebrospinal fluid were determined using high-performance liquid chromatography in combination with electrochemical detection. The plasma concentration-time curve of VM-26 showed a triphasic decay with a slow third phase in five patients, whereas in two patients the plasma concentration decay was biphasic. The plasma pharmacokinetics of VM-26 proved to be linear and could be fitted to a three-compartment model (five patients) and to a two-compartment model (two). The steady-state volume of distribution varied from 13.2 to 24.7 L/m2. The total-body clearance ranged from 5.84 to 10.18 ml/minute/m2. Low concentrations of VM-26 were found in saliva, duodenal fluid, cerebrospinal fluid, and urine. Excretion of unchanged VM-26 into the urine varied from 8.8% to 13.9% of the administered dose. No glucuronide of VM-26 could be detected in plasma or other biological fluid.

Adult↗

High-dose teniposide for refractory malignancies: a phase I study.

To evaluate the dose-limiting toxicity of teniposide (VM-26), a phase I study was conducted. VM-26, a semisynthetic podophyllotoxin derivative, was administered on 3 consecutive days. The initial total dose per course was 0.3 g/m2, with dose escalation to 0.6 and 1 g/m2. The most prominent side effects observed were severe skin rash in all three patients in the highest dose group and a dose-dependent degree of leukocytopenia and thrombocytopenia. In the highest dose group the leukocyte count in all courses was less than 1 X 10(9) cells/L and in three of five courses the platelet count was less than 25 X 10(9) cells/L. Of the 13 evaluable patients, five had partial remission, one had minor response, and four had stable disease. Further study should be centered on phase II studies in selected tumor groups at a VM-26 dose of 0.6 g/m2.

Adult↗

Single- and double-strand DNA breakage and repair in human lung adenocarcinoma cells exposed to etoposide and teniposide.

The anticancer agents 4'-demethylepipodophyllotoxin-4-(4,6-O-ethylidene-beta-D-glucopyra noside (etoposide) (VP16-213) and 4'-demethylepipodophyllotoxin-4-(4,6-O-thenylidene-beta-D-gl ucopyranoside (teniposide) (VM26) produce cytotoxicity by inhibiting type II topoisomerase, resulting in an accumulation of DNA breaks. By using alkaline elution techniques to assess in vivo DNA break frequencies, we have been able to follow formation and repair of both single- and double-strand DNA breaks induced by the exposure of A549 human lung adenocarcinoma cells to VP16-213 and VM26. Single-strand DNA breaks are detectable in cells within 2 min of drug exposure, increase in frequency to a maximum after as little as 15 min of exposure, and remain near maximum levels. Double-strand breaks accumulate more slowly, reaching a maximum after 1 to 2 h, and remaining constant thereafter upon continuous exposure to drug. Single-strand DNA breaks predominate at early incubation times and low drug concentrations, whereas the ratios between single- and double-strand DNA breaks decrease at higher drug concentrations. Changing to drug-free medium after 1-h drug exposure results in rapid exponential repair of both single- and double-strand DNA breaks with a time required for repair of one-half of the DNA breaks of 20 to 60 min. VM26 and VP16-213 have similar kinetics for DNA break formation and repair and similar relationships between DNA breakage and cytotoxicity, but VM26 is five to ten times more potent than VP16-213. Results indicate that DNA breakage plateaus may reflect a steady state equilibrium established between the drug and its nuclear target, possibly type II topoisomerase, and demonstrate unique properties of VP16-213- and VM26-induced DNA breakage.

Adenocarcinoma↗