Phase I trial of irinotecan and amrubicin with granulocyte colony-stimulating factor support in extensive-stage small-cell lung cancer.

Abstract

PURPOSE:

We conducted a phase I trial of irinotecan (CPT-11), a topoisomerase I inhibitor, combined with amrubicin, a topoisomerase II inhibitor, with recombinant human granulocyte colony-stimulating factor (rhG-CSF) support to overcome the neutropenia associated with this particular combination. The aim was to determine the maximum tolerated dose (MTD) of amrubicin combined with a fixed dose of CPT-11 and the dose-limiting toxicities (DLTs) of this combination in extensive-stage small-cell lung cancer (ED-SCLC) patients.

METHODS:

Fifteen patients with ED-SCLC were treated at 3-week intervals with amrubicin on days 1-3 plus 60 mg/m(2) CPT-11 on days 1 and 8. In addition, prophylactic rhG-CSF (50 μg/m(2)) was given from day 4 to day 21, except on the day of CPT-11 administration. Amrubicin was started at 30 mg/m(2) and then escalated in 5 mg/m(2) increments until MTD was reached.

RESULTS:

The MTD of amrubicin was 35 mg/m(2), since 2 of 4 patients experienced DLTs during the first cycle of treatment at the 40 mg/m(2) dose level. Neutropenia, neutropenic fever, ileus, and diarrhea were the DLTs. There were 13 partial responses among the 13 assessable patients, yielding an overall response rate of 100 %. Median progression-free survival and overall survival were 7.4 months and 13.4 months, respectively.

CONCLUSION:

The combination of amrubicin and CPT-11 showed high activity against ED-SCLC with acceptable toxicity. Use of rhG-CSF allowed the dose of amrubicin to be raised 40 % above that in the original regimen (60 mg/m(2) CPT-11 and 25 mg/m(2) amrubicin).

• Authors: Maiko Asakuma, Michiko Yamamoto, Mayuko Wada, Shinichiro Ryuge, Ken Katono, Masanori Yokoba, Tomoya Fukui, Akira Takakura, Sakiko Otani, Sachiyo Maki, Satoshi Igawa, Tomoko Yanaihara, Hisashi Mitsufuji, Masaru Kubota, Masato Katagiri, Jiichiro Sasaki, Noriyuki Masuda
• Journal: Cancer chemotherapy and pharmacology (Cancer Chemother Pharmacol) Vol. 69 Issue 6 Pg. 1529-36 (Jun 2012) ISSN: 1432-0843 [Electronic] Germany
• PMID: 22415148 (Publication Type: Clinical Trial, Phase I, Journal Article)

Chemical References

• Anthracyclines
• Recombinant Proteins
• Granulocyte Colony-Stimulating Factor
• Irinotecan
• amrubicin
• Camptothecin

Topics

• Aged
• Anthracyclines (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Camptothecin (administration & dosage, adverse effects, analogs & derivatives)
• Carcinoma, Small Cell (drug therapy, mortality, pathology)
• Female
• Granulocyte Colony-Stimulating Factor (administration & dosage, adverse effects)
• Humans
• Irinotecan
• Lung Neoplasms (drug therapy, mortality, pathology)
• Male
• Middle Aged
• Neoplasm Staging
• Recombinant Proteins (administration & dosage)