Phase I study of vinorelbine and paclitaxel in small-cell lung cancer |
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Authors: | Rosario Vincenzo Iaffaioli Gaetano Facchini Anna Tortoriello Francesco Caponigro Alfonso Illiano Maria Gentile Adriano Gravina Paolo Muto Rosario Vincenzo Iaffaioli |
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Affiliation: | (1) Istituto Medicina Interna, Università di Cagliari, Cagliari, Italy, IT;(2) Divisione di Oncologia Medica A, Istituto Nazionale Tumori di Napoli, Naples, Italy, IT;(3) I Clinica Pneumologica, Università di Napoli, Naples, Italy, IT;(4) Chirurgia Toracica, Università di Napoli, Naples, Italy, IT;(5) Istituto Scienze Radiologiche, Università di Napoli, Naples, Italy, IT;(6) Università degli Studi Federico II, I Clinica Medica, Via S. Pansini 5, I-80131 Naples, Italy Tel.: +39 81 414000; Fax: +3981 416154, IT |
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Abstract: | Background: Vinorelbine and paclitaxel interfere with mitotic spindle function through different mechanisms of action. Both of the drugs show antitumor activity in small-cell lung cancer when used as single agents; furthermore, in vitro and in vivo studies have shown a synergistic activity between the two drugs. Patients and methods: Patients with small-cell lung cancer no longer amenable to conventional treatment were entered into a phase I study in which vinorelbine was given at a fixed dose of 30 mg/m2 by 15-min intravenous infusion, whereas paclitaxel was given by 3-h infusion starting 1 h after vinorelbine at an initial dose of 90 mg/m2, which was subsequently escalated by 30-mg/m2 steps. Cycles were repeated every 21 days. Results: Grade 3 neutropenia was observed only in three patients treated at the fifty dose level. Thrombocytopenia never reached grade 3. Neurotoxicity was considered dose-limiting, since grade 3 peripheral neuropathy occurred in three of five patients treated at the fifth dose level (paclitaxel 210 mg/m2). Other side effects were generally mild. The overall response rate in 22 evaluable patients was 32% (95% CI 13–51%); in particular, 1 complete response (4.5%) and 6 partial responses (27.3%) were observed. The maximally tolerated doses recommended for phase II studies are 180 mg/m2 for paclitaxel and 30 mg/m2 for vinorelbine. The observed myelosuppression was less severe than anticipated on the basis of the effects of each drug alone. Conclusions: The promising activity of this drug combination warrants a phase II study in untreated patients with extensive-stage small-cell lung cancer. Received: 9 February 1997 / Accepted: 9 June 1997 |
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Keywords: | Paclitaxel Small-cell lung cancer Vinorelbine |
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