A phase I and pharmacokinetic study of fixed-dose selenomethionine and irinotecan in solid tumors

Purpose: We conducted a phase I study to determine the maximum tolerated dose (MTD) of irinotecan with fixed, nontoxic high dose of selenomethionine. Experimental Design: Selenomethionine was given orally as a single daily dose containing 2,200 μg of elemental selenium (Se) starting 1 week before the first dose of irinotecan. Irinotecan was given i.v. once weekly × 4 every 6 weeks (one cycle). The starting dose of irinotecan was 125 mg/m ²/wk. Escalation occurred in cohorts of three patients until the MTD was defined. Pharmacokinetic studies were done for selenium and irinotecan and its metabolites. Results: Three of four evaluable patients at dose level 2 of irinotecan (160 mg/m²/wk) had a dose-limiting diarrhea. None of the six evaluable patients at dose level 1 (125 mg/m²/wk irinotecan) had a dose-limiting toxicity. One patient with history of irinotecan-refractory colon cancer achieved a partial response. The long half-life of selenium resulted in a prolonged accumulation towards steady-state concentrations. No significant changes in the pharmacokinetics of CPT-11, SN-38, or SN-38G were identified; however, the coadministration of selenomethionine significantly reduced the irinotecan biliary index, which has been associated with gastrointestinal toxicity. Conclusions: Selenomethionine at 2,200 μg/d did not allow the safe escalation of irinotecan beyond the previously defined MTD of 125 mg/m². None of the patients receiving 125 mg/m² of irinotecan had grade >2 diarrhea. Unexpected responses and disease stabilizations were noted in a highly refractory population. Further escalation of selenomethionine is recommended in future trials to achieve defined protective serum concentrations of selenium.