Phase i dose escalation study with irinotecan, capecitabine, epirubicin, and granulocyte colony-stimulating factor support for patients with solid malignancies

Carlos R. Becerra, Udit N. Verma, Hia T. Tran, Denise Tavana, Noelle S. Williams, Eugene P. Frenkel

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVES:: Preclinical studies using sequences of topoisomerase I and II inhibitors suggested synergism; preliminary clinical studies, resulting in enhanced antitumor responses, confirm this in selected malignancies. This study determined the maximum-tolerated dose (MTD), toxicity, and pharmacokinetics of irinotecan (CPT-11), capecitabine, and epirubicin in patients with metastatic adenocarcinoma of lung, breast, or gastrointestinal tract. Correlation of topoisomerase IIβ was also done. METHODS:: Eligibility criteria included the following: documented adenocarcinoma of the lung, breast, or gastrointestinal tract, <3 prior chemotherapy regimens, Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2, age >18 years, adequate organ function, and signed informed consent. Irinotecan was administered at 250 mg/m intravenously day 1 every 21-day cycle, but was reduced to 180 mg/m in cohort 2 due to toxicity. Capecitabine was administered at 750 mg/m twice daily days 2 to 14 in cohort 1 but only on days 2 to 7 from cohort 2 due to early neutropenia and to allow for prophylactic granulocyte colony-stimulating factor (GCSF) support. Epirubicin was administered at 40 mg/m in cohort 1, but reduced to 30 mg/m in cohort 2, then reescalated until the MTD was reached. RESULTS:: Toxicity was assessed in 21 patients; response was assessed in 17 patients. The most common grade 3 to 4 toxicities included neutropenia (57.1%) and anemia (28.6%). The MTD of epirubicin was 50 mg/m. In evaluable patients, there were 2 partial responses (11.8%) and 13 stable disease (76.5%); these correlated well with topoisomerase IIβ. CONCLUSIONS:: The recommended doses for phase II studies: irinotecan 180 mg/m day 1, epirubicin 50 mg/m day 2, and capecitabine 750 mg/m twice daily days 2 to 7 of each 21-day cycle. This combination is reasonably active and warrants evaluation in the phase II setting.

Original languageEnglish (US)
Pages (from-to)219-225
Number of pages7
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume31
Issue number3
DOIs
StatePublished - Jun 2008

Fingerprint

irinotecan
Epirubicin
Granulocyte Colony-Stimulating Factor
Maximum Tolerated Dose
Type II DNA Topoisomerase
Neutropenia
Gastrointestinal Tract
Neoplasms
Breast
Topoisomerase I Inhibitors
Topoisomerase II Inhibitors
Informed Consent
Anemia
Pharmacokinetics
Capecitabine

Keywords

  • Sequencing agents
  • Topoisomerase inhibitors
  • Topoisomerase mRNA levels in blood

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Medicine(all)

Cite this

@article{1180aa268afb4a2dbf3d777828bd0967,
title = "Phase i dose escalation study with irinotecan, capecitabine, epirubicin, and granulocyte colony-stimulating factor support for patients with solid malignancies",
abstract = "OBJECTIVES:: Preclinical studies using sequences of topoisomerase I and II inhibitors suggested synergism; preliminary clinical studies, resulting in enhanced antitumor responses, confirm this in selected malignancies. This study determined the maximum-tolerated dose (MTD), toxicity, and pharmacokinetics of irinotecan (CPT-11), capecitabine, and epirubicin in patients with metastatic adenocarcinoma of lung, breast, or gastrointestinal tract. Correlation of topoisomerase IIβ was also done. METHODS:: Eligibility criteria included the following: documented adenocarcinoma of the lung, breast, or gastrointestinal tract, <3 prior chemotherapy regimens, Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2, age >18 years, adequate organ function, and signed informed consent. Irinotecan was administered at 250 mg/m intravenously day 1 every 21-day cycle, but was reduced to 180 mg/m in cohort 2 due to toxicity. Capecitabine was administered at 750 mg/m twice daily days 2 to 14 in cohort 1 but only on days 2 to 7 from cohort 2 due to early neutropenia and to allow for prophylactic granulocyte colony-stimulating factor (GCSF) support. Epirubicin was administered at 40 mg/m in cohort 1, but reduced to 30 mg/m in cohort 2, then reescalated until the MTD was reached. RESULTS:: Toxicity was assessed in 21 patients; response was assessed in 17 patients. The most common grade 3 to 4 toxicities included neutropenia (57.1{\%}) and anemia (28.6{\%}). The MTD of epirubicin was 50 mg/m. In evaluable patients, there were 2 partial responses (11.8{\%}) and 13 stable disease (76.5{\%}); these correlated well with topoisomerase IIβ. CONCLUSIONS:: The recommended doses for phase II studies: irinotecan 180 mg/m day 1, epirubicin 50 mg/m day 2, and capecitabine 750 mg/m twice daily days 2 to 7 of each 21-day cycle. This combination is reasonably active and warrants evaluation in the phase II setting.",
keywords = "Sequencing agents, Topoisomerase inhibitors, Topoisomerase mRNA levels in blood",
author = "Becerra, {Carlos R.} and Verma, {Udit N.} and Tran, {Hia T.} and Denise Tavana and Williams, {Noelle S.} and Frenkel, {Eugene P.}",
year = "2008",
month = "6",
doi = "10.1097/COC.0b013e31815a438f",
language = "English (US)",
volume = "31",
pages = "219--225",
journal = "American Journal of Clinical Oncology",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",
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}

TY - JOUR

T1 - Phase i dose escalation study with irinotecan, capecitabine, epirubicin, and granulocyte colony-stimulating factor support for patients with solid malignancies

AU - Becerra, Carlos R.

AU - Verma, Udit N.

AU - Tran, Hia T.

AU - Tavana, Denise

AU - Williams, Noelle S.

AU - Frenkel, Eugene P.

PY - 2008/6

Y1 - 2008/6

N2 - OBJECTIVES:: Preclinical studies using sequences of topoisomerase I and II inhibitors suggested synergism; preliminary clinical studies, resulting in enhanced antitumor responses, confirm this in selected malignancies. This study determined the maximum-tolerated dose (MTD), toxicity, and pharmacokinetics of irinotecan (CPT-11), capecitabine, and epirubicin in patients with metastatic adenocarcinoma of lung, breast, or gastrointestinal tract. Correlation of topoisomerase IIβ was also done. METHODS:: Eligibility criteria included the following: documented adenocarcinoma of the lung, breast, or gastrointestinal tract, <3 prior chemotherapy regimens, Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2, age >18 years, adequate organ function, and signed informed consent. Irinotecan was administered at 250 mg/m intravenously day 1 every 21-day cycle, but was reduced to 180 mg/m in cohort 2 due to toxicity. Capecitabine was administered at 750 mg/m twice daily days 2 to 14 in cohort 1 but only on days 2 to 7 from cohort 2 due to early neutropenia and to allow for prophylactic granulocyte colony-stimulating factor (GCSF) support. Epirubicin was administered at 40 mg/m in cohort 1, but reduced to 30 mg/m in cohort 2, then reescalated until the MTD was reached. RESULTS:: Toxicity was assessed in 21 patients; response was assessed in 17 patients. The most common grade 3 to 4 toxicities included neutropenia (57.1%) and anemia (28.6%). The MTD of epirubicin was 50 mg/m. In evaluable patients, there were 2 partial responses (11.8%) and 13 stable disease (76.5%); these correlated well with topoisomerase IIβ. CONCLUSIONS:: The recommended doses for phase II studies: irinotecan 180 mg/m day 1, epirubicin 50 mg/m day 2, and capecitabine 750 mg/m twice daily days 2 to 7 of each 21-day cycle. This combination is reasonably active and warrants evaluation in the phase II setting.

AB - OBJECTIVES:: Preclinical studies using sequences of topoisomerase I and II inhibitors suggested synergism; preliminary clinical studies, resulting in enhanced antitumor responses, confirm this in selected malignancies. This study determined the maximum-tolerated dose (MTD), toxicity, and pharmacokinetics of irinotecan (CPT-11), capecitabine, and epirubicin in patients with metastatic adenocarcinoma of lung, breast, or gastrointestinal tract. Correlation of topoisomerase IIβ was also done. METHODS:: Eligibility criteria included the following: documented adenocarcinoma of the lung, breast, or gastrointestinal tract, <3 prior chemotherapy regimens, Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2, age >18 years, adequate organ function, and signed informed consent. Irinotecan was administered at 250 mg/m intravenously day 1 every 21-day cycle, but was reduced to 180 mg/m in cohort 2 due to toxicity. Capecitabine was administered at 750 mg/m twice daily days 2 to 14 in cohort 1 but only on days 2 to 7 from cohort 2 due to early neutropenia and to allow for prophylactic granulocyte colony-stimulating factor (GCSF) support. Epirubicin was administered at 40 mg/m in cohort 1, but reduced to 30 mg/m in cohort 2, then reescalated until the MTD was reached. RESULTS:: Toxicity was assessed in 21 patients; response was assessed in 17 patients. The most common grade 3 to 4 toxicities included neutropenia (57.1%) and anemia (28.6%). The MTD of epirubicin was 50 mg/m. In evaluable patients, there were 2 partial responses (11.8%) and 13 stable disease (76.5%); these correlated well with topoisomerase IIβ. CONCLUSIONS:: The recommended doses for phase II studies: irinotecan 180 mg/m day 1, epirubicin 50 mg/m day 2, and capecitabine 750 mg/m twice daily days 2 to 7 of each 21-day cycle. This combination is reasonably active and warrants evaluation in the phase II setting.

KW - Sequencing agents

KW - Topoisomerase inhibitors

KW - Topoisomerase mRNA levels in blood

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