Abstract | INTRODUCTION:
Hypoxia is an adverse prognostic factor in locoregionally advanced cervical cancer treated with radiation. The aim of this phase I study was to develop a well-tolerated regimen that added tirapazamine to the standard regimen of radiation and weekly low-dose cisplatin. METHODS: Eligible patients had previously untreated carcinoma of the cervix, stages IB2 to IVA. The starting schedule was radiotherapy (45-50.4 Gy external beam radiation followed by brachytherapy), with concomitant weekly intravenous cisplatin, 40 mg/m on weeks 1 to 6 and weekly intravenous tirapazamine, 290 mg/m in weeks 1 to 5. RESULTS: Eleven patients were enrolled. The median age was 52 years (range, 31-65 years). Ten patients had squamous cell carcinoma and 1 patient had adenocarcinoma; 5 patients had stage 1B2 disease, 1 had stage IIA, 3 had stage IIB-3, 1 had stage IIIB, and 1 had stage IVA. The first 2 patients on dose level 1 experienced a dose-limiting toxicity (DLT): 1 experienced grade 3 alanine amino transferase elevation and grade 4 pulmonary embolism, and 1 experienced grade 3 ototoxicity. Doses were decreased to dose level -1 with a 30-mg/m dose of cisplatin and a 260-mg/m dose of tirapazamine. Three patients were treated without any DLTs. Six patients were then treated on dose level -1a: a 35-mg/m dose of cisplatin and a 260-mg/m doses of tirapazamine with 2 DLTs--grade 3 neutropenia with dose omission and grade 4 pulmonary embolism with major hemodynamic compromise. Three of 10 evaluable patients have experienced locoregional failure. CONCLUSIONS: The combination of weekly tirapazamine and cisplatin with radiation for locally advanced cervical cancer was associated with more toxicity than anticipated with the recommended dose level being tirapazamine 260 mg/m and cisplatin 30 mg/m. Further study of this weekly schedule is not warranted.
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Authors | Danny Rischin, Kailash Narayan, Amit M Oza, Linda Mileshkin, David Bernshaw, Jimin Choi, Rodney Hicks, Bev McClure, Anthony Fyles |
Journal | International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
(Int J Gynecol Cancer)
Vol. 20
Issue 5
Pg. 827-33
(Jul 2010)
ISSN: 1525-1438 [Electronic] England |
PMID | 20606530
(Publication Type: Clinical Trial, Phase I, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Triazines
- Tirapazamine
- Cisplatin
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Topics |
- Adenocarcinoma
(therapy)
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols
(administration & dosage)
- Cisplatin
(administration & dosage)
- Combined Modality Therapy
- Female
- Humans
- Middle Aged
- Neoplasms, Squamous Cell
(therapy)
- Tirapazamine
- Triazines
(administration & dosage)
- Uterine Cervical Neoplasms
(therapy)
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