Phase I study of docetaxel and topotecan in patients with solid tumors |
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| Authors: | Katherine H Tkaczuk William C Zamboni Nancy S Tait Barry R Meisenberg L Austin Doyle Martin J Edelman Petr F Hausner Merrill J Egorin David A Van Echo |
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| Institution: | (1) University of Maryland Greenebaum Cancer Center, 22 South Greene St., Baltimore, MD 21201, USA e-mail: ktkaczuk@umm.edu Tel.: +1-410-3287855; Fax: +1-410-3286896, US;(2) Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA, US;(3) Veterans Administration Maryland Health Care System, Baltimore Medical Center, Baltimore, MD 21201, USA, US;(4) Department of Medicine, School of Medicine, University of Pittsburgh, PA 15213, USA, US;(5) Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, PA 15213, USA, US;(6) Program of Molecular Therapeutics and Drug Discovery, University of Pittsburgh Cancer Institute, PA 15213, USA, US;(7) Department of Pharmacology, School of Medicine, University of Pittsburgh, PA 15213, USA, US |
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| Abstract: | Purpose: Both docetaxel (DOC), a promoter and stabilizer of microtubule assembly, and topotecan (TOPO), a topoisomerase I inhibitor,
have shown antitumor activity in a variety of solid tumor malignancies. This phase I trial was conducted to determine the
overall and dose-limiting toxicities (DLT), the maximum tolerated dose (MTD) and the pharmacokinetics of the combination of
DOC and TOPO in patients with advanced solid tumor malignancies. Methods: DOC was administered first at 60 mg/m2 without G-CSF and at 60, 70, and 80 mg/m2 with G-CSF by 1-h infusion on day 1 of the odd-numbered cycles (1, 3, 5, etc.) and on day 4 of the even-numbered cycles (2,
4, 6, etc.). TOPO 0.75 mg/m2 was administered as a 30-min infusion on days 1, 2, 3 and 4 of each cycle. G-CSF 300 μg was administered subcutaneously (s.c.)
on days 5–14. Cycles were repeated every 21 days. All patients were premedicated with dexamethasone 8 mg orally every 12 h
for a total of six doses starting on the day before DOC infusion. Results: A total of 22 patients were treated. Six patients were treated in cohort I with DOC and TOPO doses of 60 and 0.75 mg/m2, respectively, without G-CSF, and two patients developed DLT (febrile neutropenia). Four patients were treated in cohort
II with DOC and TOPO doses of 60 and 0.75 mg/m2, respectively, with G-CSF, and no DLT was observed. Four patients were treated in cohort III with DOC and TOPO doses of 80
and 0.75 mg/m2, respectively, with G-CSF, and three developed DLT (febrile neutropenia). DOC was then de-escalated to 70 mg/m2 and delivered with TOPO 0.75 mg/m2 and G-CSF (cohort IV). Eight patients were treated at this dose level, and one DLT (febrile neutropenia) was observed. Two
patients developed a severe hypersensitivity reaction shortly after the DOC infusion was started, one in cycle 1 and one in
cycle 2. Both patients were removed from the study. Two patients developed severe dyspnea in the presence of progressive pulmonary
metastases. Other nonhematological toxicities were mild. One patient with extensively pretreated ovarian carcinoma had a partial
response, and eight patients with various solid tumor malignancies had stable disease with a median time to progression of
12 weeks (range 9–18 weeks). Administration of TOPO on days 1–4 and DOC on day 4 resulted in increased neutropenia. Conclusions: DOC 80 mg/m2 given first as a 1-h infusion on day 1 with TOPO 0.75 mg/m2 given as a 0.5-h infusion on days 1, 2, 3 and 4 with G-CSF was considered the MTD. The recommended phase II dose for DOC
given on day 1 is 70 mg/m2 with TOPO 0.75 mg/m2 given on days 1, 2, 3 and 4 every 21 days with G-CSF 300 μg s.c. on days 5–14. The alternative schedule with DOC given on
day 4 and TOPO on days 1–4 is not recommended.
Received: 18 February 2000 / Accepted: 19 July 2000 |
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| Keywords: | Docetaxel Topotecan Solid tumors Phase I |
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