If one of the three patients experienced DLT by day 28 of cycle 1, then the cohort was expanded to six patients. If none of these three additional patients experienced DLT, then the dose was escalated to the next higher dose level in the subsequent cohort. The MTD was the dose level at which none of EX 527 mouse six or one of six patients experienced a DLT during the first 4-week cycle with the next higher

dose having at least two of six patients experiencing a DLT. At the MTD, a total of six additional patients were enrolled to better assess potential toxicities. A standard 3 + 3 design was used in this setting with toxicity end points rather than pharmacodynamic end points due to the potential differences in the panel of epigenetically silenced tumor suppressors between the various tumor types, as well as within tumor types. A pharmacodynamic end point was deemed to be more appropriate for evaluation in a controlled phase II trial. A total of 29 patients were enrolled, and 27 were treated. One

withdrew consent before initiating any therapy, and one never received therapy due to a rapid decline in performance status. Of those treated, there were 19 females and 8 males, with a median age of 57 years Tacrolimus in vivo (range = 29-75 years), and a median ECOG performance status of 0. These subjects had received a median of four prior regimens (range = 1-12). The data are summarized in Table 2. This combination was largely well tolerated. Twenty-seven patients received the combination through six consecutive cohorts with increasing doses of hydralazine. The potential toxicities associated with hydralazine are known to be associated with formulation and acetylator phenotype; whereas the formulation was controlled (immediate vs sustained release preparations), the limited number of subjects involved in this study precluded adequate stratification or assessment by acetylator phenotype (slow vs fast). Each subject was able to take the valproic acid at therapeutic levels. Lymphopenia and

fatigue were the most common adverse effects (Table Table 3A, Table 3B, Table 3C and Table 3D), CYTH4 and adverse effects required reducing the dose of valproic acid in three patients; subsequent serum levels were not recorded. Hydralazine caused edema in five subjects but resulted in treatment discontinuation in only one of the subjects who experienced testicular edema at the dose level of 50 mg per day (the other four experienced lower extremity edema). Two other subjects withdrew for treatment-related toxicities occurring after the DLT observation period, including rash in the one subject (dose level of 25 mg per day) and hyponatremia and an increase in serum lipase in the other subject (dose level of 300 mg per day).