Journal Article

Phase I trial of vinflunine and pemetrexed in refractory solid tumors

Dees, E. Claire, Sanoff, Hanna K., Ivanova, Anastasia, Keller, Kimberly, Walko, Christine, Buie, Larry, Davies, Janine, Chiu, Wing-Keung, Stinchcombe, Thomas E., O’Neil, Bert

2011

Overview

Summary Background Vinflunine is a novel vinca alkaloid with promising single agent clinical activity. Pemetrexed has at least additive activity with other vincas. A phase I trial was undertaken to assess the safety of vinflunine and pemetrexed in patients with refractory solid tumors. Methods A standard 3-patient cohort dose escalation scheme was used to determine the dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of the vinflunine/pemetrexed combination. Pemetrexed 500 mg/m 2 was given with vinflunine 280 mg/m 2 (cohort 1), 300 mg/m 2 (cohort 2) or 320 mg/m 2 (cohort 3) on day 1 of a 21-day cycle. Results 19 patients were enrolled, median age 58 years (range 32 to 77) and had a median of 3 (range 1–6) prior therapies. DLT occured 1 of 6 pts in cohort 1 (thrombocytopenia, hyponatremia), 2 of 10 pts in cohort 2 (febrile neutropenia, hyponatremia, hyperbilirubinema; febrile neutropenia), and 2 of 3 pts in cohort 3 (febrile neutropenia, hypokalemia; febrile neutropenia). 1 pt in cohort 2 died prior to completion of cycle 1 likely from disease progression. Most common grade 3/4 adverse events were neutropenia (7), leukopenia (5). Febrile neutropenia occurred in 4 patients (21%). No objective responses were seen. Two patients (breast and lung) had prolonged stable disease for 25 and 20 cycles respectively. Conclusions Based on this experience we recommend vinflunine 300 mg/m 2 and pemetrexed 500 mg/m 2 in combination every 3 weeks for future study. At these doses, the combination of vinflunine and pemetrexed was tolerable in this heavily pretreated population. Hematologic toxicity, including febrile neutropenia, was prominent.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adult / Aged / Antineoplastic Agents - administration & dosage / Antineoplastic Agents - adverse effects / Antineoplastic Agents - therapeutic use / Antineoplastic Combined Chemotherapy Protocols - administration & dosage / Antineoplastic Combined Chemotherapy Protocols - adverse effects / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Bladder / Cancer therapies / Chemotherapy / Constipation / Creatinine / Cytochrome P-450 CYP3A - metabolism / Dose-Response Relationship, Drug / Drug dosages / Drug Resistance, Neoplasm / Enrollments / Female / Glutamates - administration & dosage / Glutamates - adverse effects / Glutamates - therapeutic use / Guanine - administration & dosage / Guanine - adverse effects / Guanine - analogs & derivatives / Guanine - therapeutic use / Humans / Hyponatremia / Lung cancer / Male / Medicine / Medicine & Public Health / Mesothelioma / Midazolam - pharmacokinetics / Middle Aged / Neoplasms - drug therapy / Neoplasms - enzymology / Neutropenia / Oncology / Patients / Pemetrexed / Pharmaceuticals / Pharmacology/Toxicology / Phase I Studies / Phenotype / R&D / Research & development / Statistics, Nonparametric / Studies / Toxicity / Treatment Outcome / Tumors / Vinblastine - administration & dosage / Vinblastine - adverse effects / Vinblastine - analogs & derivatives / Vinblastine - therapeutic use / Vitamin B