Journal of Clinical Oncology, Vol 13, 210-221, Copyright © 1995 by American Society of Clinical Oncology
Phase I and pharmacologic studies of the camptothecin analog irinotecan administered every 3 weeks in cancer patients
D Abigerges, GG Chabot, JP Armand, P Herait, A Gouyette and D Gandia
Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France.
PURPOSE: A phase I study was undertaken to determine the maximum- tolerated
dose (MTD), principal toxicities, and pharmacokinetics of the novel
topoisomerase I inhibitor irinotecan (CPT-11). PATIENTS AND METHODS:
Sixty-four patients meeting standard phase I eligibility criteria were
included (24 women, 40 men; median age, 51 years; primary sites: colon,
head and neck, lung, pleura; 60 of 64 had been previously treated).
Pharmacokinetics was determined by high-performance liquid chromatography
(HPLC). RESULTS: One hundred ninety CPT-11 courses were administered as a
30-minute intravenous (IV) infusion every 3 weeks (100 to 750 mg/m2). Grade
3 to 4 nonhematologic toxicities included diarrhea (16%; three
hospitalizations), nausea and vomiting (9%), asthenia (14%), alopecia
(53%), elevation of hepatic transaminases (8%), and one case of skin
toxicity. An acute cholinergic syndrome was observed during CPT-11
administration. Diarrhea appeared dose-limiting at 350 mg/m2, but this was
circumvented by using a high-dose loperamide protocol that allowed dose
escalation. Dose-dependent, reversible, noncumulative granulocytopenia was
the dose-limiting toxicity (nadir, days 6 to 9; median recovery time, 5
days). Grade 3 to 4 anemia was observed in 9% of patients. One patient died
during the study, 8 days after CPT-11 treatment. Two complete responses
(cervix, 450 mg/m2; head and neck, 750 mg/m2) and six partial responses in
fluorouracil (5-FU)- refractory colon cancer were observed (260 to 600
mg/m2). Pharmacokinetics of CPT-11 and active metabolite SN-38 were
performed in 60 patients (94 courses). CPT-11 plasma disposition was bi- or
triphasic, with a mean terminal half-life of 14.2 +/- 0.9 hours (mean +/-
SEM). The mean volume of distribution (Vdss) was 157 +/- 8 L/m2, and
total-body clearance was 15 +/- 1 L/m2/h. The CPT-11 area under the plasma
concentration versus time curves (AUC) and SN-38 AUC increased linearly
with dose. SN-38 plasma decay had an apparent half-life of 13.8 +/- 1.4
hours. Both CPT-11 and SN-38 AUCs correlated with nadir leukopenia and
granulocytopenia, with grade 2 diarrhea, and with nausea and vomiting.
CONCLUSION: The MTD of CPT-11 administered as a 30-minute IV infusion every
3 weeks is 600 mg/m2, with granulocytopenia being dose-limiting. At 350
mg/m2, diarrhea appeared dose-limiting, but high- dose loperamide reduced
this toxicity and allowed dose escalation. For safety reasons, the
recommended dose is presently 350 mg/m2 every 3 weeks; more experience must
be gained to establish the feasibility of a higher dose in large
multicentric phase II studies. However, when careful monitoring of
gastrointestinal toxicities is possible, a higher dose of 500 mg/m2 could
be recommended in good-risk patients. The activity of this agent in
5-FU-refractory colorectal carcinoma makes it unique and mandates expedited
phase II testing.
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