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Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial

Sunitinib is the most commonly prescribed drug for advanced renal cell carcinoma in the first-line setting and has been associated with multiple adverse events related to its on–and off–target effects, including hand and foot syndrome and fatigue. It was hypothesized that sunitinib-induced fatigue m...

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Autores principales: Buonerba, Carlo, De Placido, Pietro, Bruzzese, Dario, Pagliuca, Martina, Ungaro, Paola, Bosso, Davide, Ribera, Dario, Iaccarino, Simona, Scafuri, Luca, Liotti, Antonietta, Romeo, Valeria, Izzo, Michela, Perri, Francesco, Casale, Beniamino, Grimaldi, Giuseppe, Vitrone, Francesca, Brunetti, Arturo, Terracciano, Daniela, Marinelli, Alfredo, De Placido, Sabino, Di Lorenzo, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864863/
https://www.ncbi.nlm.nih.gov/pubmed/29615901
http://dx.doi.org/10.3389/fphar.2018.00189
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author Buonerba, Carlo
De Placido, Pietro
Bruzzese, Dario
Pagliuca, Martina
Ungaro, Paola
Bosso, Davide
Ribera, Dario
Iaccarino, Simona
Scafuri, Luca
Liotti, Antonietta
Romeo, Valeria
Izzo, Michela
Perri, Francesco
Casale, Beniamino
Grimaldi, Giuseppe
Vitrone, Francesca
Brunetti, Arturo
Terracciano, Daniela
Marinelli, Alfredo
De Placido, Sabino
Di Lorenzo, Giuseppe
author_facet Buonerba, Carlo
De Placido, Pietro
Bruzzese, Dario
Pagliuca, Martina
Ungaro, Paola
Bosso, Davide
Ribera, Dario
Iaccarino, Simona
Scafuri, Luca
Liotti, Antonietta
Romeo, Valeria
Izzo, Michela
Perri, Francesco
Casale, Beniamino
Grimaldi, Giuseppe
Vitrone, Francesca
Brunetti, Arturo
Terracciano, Daniela
Marinelli, Alfredo
De Placido, Sabino
Di Lorenzo, Giuseppe
author_sort Buonerba, Carlo
collection PubMed
description Sunitinib is the most commonly prescribed drug for advanced renal cell carcinoma in the first-line setting and has been associated with multiple adverse events related to its on–and off–target effects, including hand and foot syndrome and fatigue. It was hypothesized that sunitinib-induced fatigue may be related to off target inhibition of the AMPK enzyme, which results in impairment of energy-producing processes at a systemic level. Quercetin is a naturally occurring flavonol with established AMPK-stimulating activity. While clinical use of quercetin is limited by its poor bio-availability, quercetin-3-O-β-d-glucopyranoside, that is isoquercetin, has an improved pharmacokinetic profile. On the grounds of the in vitro stimulatory activity with respect to AMPk, we hypothesized that oral isoquercetin could improve fatigue in kidney cancer patients receiving sunitinib. Given the lack of data on the safety of isoquercetin given concomitantly with sunitinib, we conducted a phase I trial to assess the safety of GMP manufactured isoquercetin given at two dose levels (450 and 900 mg a day). In the 12-patient study cohort included in this study, isoquercetin was administered concomitantly with 50 mg sunitinib for a median 81 days (IQR, 75.5, 86.5). None of the 12 patients required isoquercetin suspension or isoquercetin dose reduction because of adverse events. No abnormalities in ECG, heart or lower limbs doppler ultrasound were detected. A statistically significant improvement was reported for the FACIT fatigue score (6.8 points; 95% CI: 2.8–10.8; p = 0.002) and for the FACIT Adverse Events score (18.9 points; 95% CI: 9.1–28.8; p < 0.001) after isoquercetin consumption vs. baseline. In this phase I trial, isoquercetin was remarkably safe, with a preliminary signal of activity in terms of improvement of sunitinib adverse events.
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spelling pubmed-58648632018-04-03 Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial Buonerba, Carlo De Placido, Pietro Bruzzese, Dario Pagliuca, Martina Ungaro, Paola Bosso, Davide Ribera, Dario Iaccarino, Simona Scafuri, Luca Liotti, Antonietta Romeo, Valeria Izzo, Michela Perri, Francesco Casale, Beniamino Grimaldi, Giuseppe Vitrone, Francesca Brunetti, Arturo Terracciano, Daniela Marinelli, Alfredo De Placido, Sabino Di Lorenzo, Giuseppe Front Pharmacol Pharmacology Sunitinib is the most commonly prescribed drug for advanced renal cell carcinoma in the first-line setting and has been associated with multiple adverse events related to its on–and off–target effects, including hand and foot syndrome and fatigue. It was hypothesized that sunitinib-induced fatigue may be related to off target inhibition of the AMPK enzyme, which results in impairment of energy-producing processes at a systemic level. Quercetin is a naturally occurring flavonol with established AMPK-stimulating activity. While clinical use of quercetin is limited by its poor bio-availability, quercetin-3-O-β-d-glucopyranoside, that is isoquercetin, has an improved pharmacokinetic profile. On the grounds of the in vitro stimulatory activity with respect to AMPk, we hypothesized that oral isoquercetin could improve fatigue in kidney cancer patients receiving sunitinib. Given the lack of data on the safety of isoquercetin given concomitantly with sunitinib, we conducted a phase I trial to assess the safety of GMP manufactured isoquercetin given at two dose levels (450 and 900 mg a day). In the 12-patient study cohort included in this study, isoquercetin was administered concomitantly with 50 mg sunitinib for a median 81 days (IQR, 75.5, 86.5). None of the 12 patients required isoquercetin suspension or isoquercetin dose reduction because of adverse events. No abnormalities in ECG, heart or lower limbs doppler ultrasound were detected. A statistically significant improvement was reported for the FACIT fatigue score (6.8 points; 95% CI: 2.8–10.8; p = 0.002) and for the FACIT Adverse Events score (18.9 points; 95% CI: 9.1–28.8; p < 0.001) after isoquercetin consumption vs. baseline. In this phase I trial, isoquercetin was remarkably safe, with a preliminary signal of activity in terms of improvement of sunitinib adverse events. Frontiers Media S.A. 2018-03-16 /pmc/articles/PMC5864863/ /pubmed/29615901 http://dx.doi.org/10.3389/fphar.2018.00189 Text en Copyright © 2018 Buonerba, De Placido, Bruzzese, Pagliuca, Ungaro, Bosso, Ribera, Iaccarino, Scafuri, Liotti, Romeo, Izzo, Perri, Casale, Grimaldi, Vitrone, Brunetti, Terracciano, Marinelli, De Placido and Di Lorenzo. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Buonerba, Carlo
De Placido, Pietro
Bruzzese, Dario
Pagliuca, Martina
Ungaro, Paola
Bosso, Davide
Ribera, Dario
Iaccarino, Simona
Scafuri, Luca
Liotti, Antonietta
Romeo, Valeria
Izzo, Michela
Perri, Francesco
Casale, Beniamino
Grimaldi, Giuseppe
Vitrone, Francesca
Brunetti, Arturo
Terracciano, Daniela
Marinelli, Alfredo
De Placido, Sabino
Di Lorenzo, Giuseppe
Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial
title Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial
title_full Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial
title_fullStr Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial
title_full_unstemmed Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial
title_short Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial
title_sort isoquercetin as an adjunct therapy in patients with kidney cancer receiving first-line sunitinib (quasar): results of a phase i trial
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864863/
https://www.ncbi.nlm.nih.gov/pubmed/29615901
http://dx.doi.org/10.3389/fphar.2018.00189
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