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Sequences of topotecan and cisplatin: phase I, pharmacologic, and in vitro studies to examine sequence dependence.
J Clin Oncol. 1996 Dec; 14(12):3074-84.JC

Abstract

PURPOSE

A phase I and pharmacologic study was performed to evaluate the feasibility of administering the topoisomerase I (topo I) inhibitor topotecan (TPT) in combination with cisplatin (CDDP) in minimally pretreated adults with solid tumors. The study was designed to evaluate the magnitude of the toxicologic and pharmacologic differences between the two sequences of drug administration.

MATERIALS AND METHODS

TPT was administered as a 30-minute infusion daily for 5 days and CDDP was given either before TPT on day 1 or after TPT on day 5. Each patient was treated with both schedules on an alternating basis every 3 weeks. Sequential dose escalation of TPT or CDDP resulted in three dosage permutation of TPT/CDDP (mg/m2): 0.75/50, 1/50, and 0.75/75. After the maximum-tolerated dose (MTD) level was achieved, the feasibility of using granulocyte colony-stimulating factor (G-CSF) to permit further dose escalation was studied. To examine the interaction of TPT and CDDP in vitro, human A549 lung cancer cells were exposed to these agents concurrently and sequentially.

RESULTS

Dose-limiting neutropenia and thrombocytopenia resulted after the doses of TPT or CDDP were increased to greater than 0.75 and 50 mg/m2, respectively, without and with G-CSF. The sequence of CDDP before TPT induced significantly worse neutropenia and thrombocytopenia than the alternate sequence. In vitro studies failed to provide any evidence for the differences in the cytotoxicity of these two sequences. Instead, pharmacokinetic studies suggested that the differences in toxicity were due, in part, to lower TPT clearance and exposure when CDDP preceeds TPT, possibly due to subclinical renal tubular toxicity induced by CDDP.

CONCLUSION

The sequence of CDDP before TPT at doses of 50 and 0.75 mg/m2, respectively, is recommended for subsequent clinical trials in tumor types in which both agents have significant single-agent activity. The potential for sequence-dependent cytotoxic, toxicologic, and pharmacologic effects should be evaluated in concurrent clinical and laboratory studies in the course of developing combination chemotherapy regimens that consist of topo I-targeting agents and other antineoplastic agents, particularly DNA-damaging agents.

Authors+Show Affiliations

Division of Pharmacology and Experimental Therapeutics, Johns Hopkins Oncology Center, Baltimore, MD, USA. erowinsk@ctrc.fs.sacl.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Clinical Trial, Phase I
Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

8955652

Citation

Rowinsky, E K., et al. "Sequences of Topotecan and Cisplatin: Phase I, Pharmacologic, and in Vitro Studies to Examine Sequence Dependence." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 14, no. 12, 1996, pp. 3074-84.
Rowinsky EK, Kaufmann SH, Baker SD, et al. Sequences of topotecan and cisplatin: phase I, pharmacologic, and in vitro studies to examine sequence dependence. J Clin Oncol. 1996;14(12):3074-84.
Rowinsky, E. K., Kaufmann, S. H., Baker, S. D., Grochow, L. B., Chen, T. L., Peereboom, D., Bowling, M. K., Sartorius, S. E., Ettinger, D. S., Forastiere, A. A., & Donehower, R. C. (1996). Sequences of topotecan and cisplatin: phase I, pharmacologic, and in vitro studies to examine sequence dependence. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 14(12), 3074-84.
Rowinsky EK, et al. Sequences of Topotecan and Cisplatin: Phase I, Pharmacologic, and in Vitro Studies to Examine Sequence Dependence. J Clin Oncol. 1996;14(12):3074-84. PubMed PMID: 8955652.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sequences of topotecan and cisplatin: phase I, pharmacologic, and in vitro studies to examine sequence dependence. AU - Rowinsky,E K, AU - Kaufmann,S H, AU - Baker,S D, AU - Grochow,L B, AU - Chen,T L, AU - Peereboom,D, AU - Bowling,M K, AU - Sartorius,S E, AU - Ettinger,D S, AU - Forastiere,A A, AU - Donehower,R C, PY - 1996/12/1/pubmed PY - 1996/12/1/medline PY - 1996/12/1/entrez SP - 3074 EP - 84 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 14 IS - 12 N2 - PURPOSE: A phase I and pharmacologic study was performed to evaluate the feasibility of administering the topoisomerase I (topo I) inhibitor topotecan (TPT) in combination with cisplatin (CDDP) in minimally pretreated adults with solid tumors. The study was designed to evaluate the magnitude of the toxicologic and pharmacologic differences between the two sequences of drug administration. MATERIALS AND METHODS: TPT was administered as a 30-minute infusion daily for 5 days and CDDP was given either before TPT on day 1 or after TPT on day 5. Each patient was treated with both schedules on an alternating basis every 3 weeks. Sequential dose escalation of TPT or CDDP resulted in three dosage permutation of TPT/CDDP (mg/m2): 0.75/50, 1/50, and 0.75/75. After the maximum-tolerated dose (MTD) level was achieved, the feasibility of using granulocyte colony-stimulating factor (G-CSF) to permit further dose escalation was studied. To examine the interaction of TPT and CDDP in vitro, human A549 lung cancer cells were exposed to these agents concurrently and sequentially. RESULTS: Dose-limiting neutropenia and thrombocytopenia resulted after the doses of TPT or CDDP were increased to greater than 0.75 and 50 mg/m2, respectively, without and with G-CSF. The sequence of CDDP before TPT induced significantly worse neutropenia and thrombocytopenia than the alternate sequence. In vitro studies failed to provide any evidence for the differences in the cytotoxicity of these two sequences. Instead, pharmacokinetic studies suggested that the differences in toxicity were due, in part, to lower TPT clearance and exposure when CDDP preceeds TPT, possibly due to subclinical renal tubular toxicity induced by CDDP. CONCLUSION: The sequence of CDDP before TPT at doses of 50 and 0.75 mg/m2, respectively, is recommended for subsequent clinical trials in tumor types in which both agents have significant single-agent activity. The potential for sequence-dependent cytotoxic, toxicologic, and pharmacologic effects should be evaluated in concurrent clinical and laboratory studies in the course of developing combination chemotherapy regimens that consist of topo I-targeting agents and other antineoplastic agents, particularly DNA-damaging agents. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/8955652/Sequences_of_topotecan_and_cisplatin:_phase_I_pharmacologic_and_in_vitro_studies_to_examine_sequence_dependence_ L2 - https://ascopubs.org/doi/10.1200/JCO.1996.14.12.3074?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -