Phase I/II study of amrubicin in combination with S-1 as second-line chemotherapy for non-small-cell lung cancer without EGFR mutation

Introduction

Both amrubicin (Am) and S-1 are effective against non-small-cell lung cancer (NSCLC), and preclinical studies have demonstrated that the effect of tegafur/uracil, the original compound of S-1, in combination with Am significantly inhibits tumor growth.

Methods

We conducted a phase I/II study of Am and S-1 against pretreated NSCLC without EGFR mutation. We fixed the dose of S-1 at 40 mg/m² on days 1–14 and escalated the Am dose in increments of 5 mg/m² from a starting dose of 30 mg/m²/day on days 1–3 and repeated the cycle every 4 weeks.

Results

Twenty-six patients were registered. In phase I, at an Am dose of 35 mg/m²/day, three patients experienced grade 2 leukopenia during S-1 administration, and S-1 was withdrawn. Another patient developed grade 2 serum bilirubin in the first cycle. DLTs were observed in four of six patients at this dose level, and therefore, 30 mg/m²/day was set as the recommended dose for Am. Twenty patients received this recommended Am dose. Febrile neutropenia was observed in two patients, and one patient developed a grade 4 increase in serum creatinine. Grade 3 vomiting, infection, hypotension, and urinary retention were observed in one patient each, respectively. Other toxicities were mild, and there were no treatment-related deaths. Two patients showed a CR, three showed a PR, and the overall response rate was 25.0 %. The median progression-free and the median survival times were 3.8 and 15.6 months, respectively, and the 1-year survival rate was 60 %.

Conclusion

Am and S-1 every 4 weeks is an effective combination for pretreated NSCLC without EGFR mutation.