The single Quinacrine manufacture facility in the US was shut down by the FDA

Establish the tolerability and safety of aimed dose of both quinacrine and capecitabine in combination to treat patients with advanced colorectal adenocarcinoma.

Because of the well published safety profiles of both quinacrine and capecitabine, the Phase I portion of our study will aim to determine the tolerability of both agents in combinations when used at established clinical doses. This portion of the study will more closely resemble a pilot study or feasibility study rather than a dose escalation Phase I trial. The objective is to determine toxicities and adverse reactions, not a maximally tolerated dose. The investigators hypothesize that there will be no toxic interactions at the pharmacokinetic or pharmacodynamic level, and want to know the feasibility of using quinacrine and capecitabine at their respective recommended single agent doses. Because capecitabine is already regarded as standard treatment for colorectal cancer, the investigators will begin the study with a full dose of capecitabine combined with a slightly lower dose of quinacrine. If the safety-interim analysis does not detect an excess of toxicity, then subsequent patients will be enrolled using the full dose of both drugs.

Inclusion Criteria:

• Patients much have histologically confirmed adenocarcinoma of the colon or rectum.
• Patients must have measurable recurrence or metastases in the liver and/or lungs.
• Patients must have prior chemotherapy for advanced colorectal cancer and have previously received both an oxaliplatin and an irinotecan based regimen.
• Age > 18 years.
• Life expectancy greater than 4 weeks.
• ECOG performance status <3.
• Patients must have normal organ and marrow function.
• Patients must be able to swallow capsules.
• Patients must be able to understand and willing to sign a written informed consent document.
• Patients are included regardless of KRAS/BRAF status.

Exclusion Criteria:

• Patients who have had chemotherapy or radiotherapy within 4 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier.
• Patients may not be receiving any other investigational agent.
• Patients with know brain metastases should be excluded from this clinical trial because they often develop progressive neurological dysfunction that would confound the evaluation of neurologic and other adverse events.
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to quinacrine, capecitabine or fluorouracil.
• The concomitant use of quinacrine and primaquine is contraindicated.
• Uncontrolled intercurrent illness including but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Pregnant women are excluded from this study.
• Patients with a baseline creatinine clearance of < 50 mL/min.
• Patients must be currently not treated with quinacrine or drugs related to quinacrine.
• Patients who require anti-arrhythmic treatment with amiodarone or any drug with a quinidine-like effect on the heart or who have history of a malignant ventricular arrhythmia unless they have a functioning automatic implantable cardio defibrillator implanted.
• Patients who have a history of noninfectious hepatitis or alcoholism.
• Patients with a lifetime history of porphyria or psoriasis because it can exacerbate these conditions.
• Patients with documented glucose-6-phosphate dehydrogenase deficiency.
• Patients with a lifetime history of seizure disorder.
• Patients with a lifetime history of dermatitis as an allergic/toxic reaction to any medication.
• Patients with know dihydropyrimidine dehydrogenase deficiency.

Started study at new Institution

Of the 19 patients enrolled in the study, two were not analyzed. One patient withdrew before receiving treatment, the other patient received no further treatment after a grade 3 toxicity at C1D1.

38 months

Uncertain optimal time of peak plasma concentrations due to sample measurements at only 4 time points. Inaccurate half-life of Cmax due to lack of samples. Technical errors for lower-than-expected concentrations in participants.