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Suramin in Adrenal Cancer: Modulation of Steroid Hormone Production, Cytotoxicity in Vitro, and Clinical Antitumor Effect^*

R. V. LA ROCCA, C. A. STEIN, R. DANESI, C. A. JAMIS-DOW, G. H. WEISS and C. E. MYERS

Medicine (R.V.L., C.A.S., R.D., C.A.J.-D., C.E.M.) and Surgery (G.H.W.) Branches, Clinical Oncology Program, National Cancer Institute, National Institutes of Health Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Renato V. La Rocca, M.D., Medicine Branch, National Cancer Institute, National Institutes of Health, Building 10, Room 12N-226, Bethesda, Maryland 20892.

Suramin, a drug known to have antiparasitic effects, has been previously shown to have adrenocorticolytic activity in primates. We now confirm preferential accumulation of this compound in the normal adrenal gland, evaluate its in vitro effect against two human adrenocortical carcinoma cell lines (SW-13 and NCI-H295), and report the clinical activity of suramin in 17 patients with metastatic adrenocortical carcinoma. Inhibition of colony formation occurred in both adrenal cell lines in vitro at concentrations that are clinically achievable in humans. In addition, suramin concentrations as low as 100 µg/mL were able to inhibit glucocorticoid, mineralocorticoid, and androgen production by the NCI-H295 cell line. Of 16 patients with adrenocortical carcinoma now evaluable for tumor response, 2 achieved a partial response, 2 had a minor response, and 5 remained with stable disease for periods ranging from 3–10 months; the remainder progressed. One of 7 patients with excessive steroid hormone production achieved a partial normalization of her steroid levels for the duration of suramin therapy in the setting of radiographic disease stabilization. An additional patient treated off-study for lack of radiographically measurable disease, achieved complete normalization of plasma aldosterone levels. We conclude that suramin preferentially accumulates in adrenal cells, induces cytotoxicity and significant down-regulation of steroid hormone production in vitro, and has some therapeutic efficacy as a single agent in patients with metastatic adrenocortical carcinoma.

^* This is a U.S. government work. There are no restrictions on its use.

Visiting fellow from the Instituto di Farmacologia, Facolta’ di Medicina e Chirungia, Universita di Pisa, Pisa, Italy.

Received January 24, 1990.

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