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Phase I Trial of Escalating Doses of Paclitaxel Plus Doxorubicin and Dexrazoxane in Patients With Advanced Breast Cancer

From the Eastern Cooperative Oncology Group Breast Cancer Committee, Albert Einstein Comprehensive Cancer Center, Montefiore Medical Center, Bronx, NY; the Kaplan Comprehensive Cancer Center, New York University School of Medicine, New York, NY; Northwestern University School of Medicine, Chicago, IL; and the University of Maryland Greenebaum Cancer Center, Baltimore, MD.

Address reprint requests to Joseph A. Sparano, MD, Department of Oncology, Albert Einstein Comprehensive Cancer Center, Montefiore Medical Center, 2 South, Room 52, 1825 Eastchester Rd, Bronx, NY 10461-2373; email sparano{at}jimmy.harvard.edu

PURPOSE: To determine the maximum-tolerable dose (MTD) of paclitaxel given as a 3-hour intravenous (IV) infusion that could be used in conjunction with doxorubicin and dexrazoxane, and to determine the effect of dexrazoxane on the pharmacokinetics of paclitaxel and doxorubicin.

PATIENTS AND METHODS: Twenty-five patients with advanced breast cancer received dexrazoxane (600 mg/m² by IV infusion over 15 minutes), followed 15 minutes later by doxorubicin (60 mg/m² IV), followed 15 minutes later by paclitaxel (150 or 175 mg/m² by IV infusion over 3 hours) in cohorts of three to six patients using a standard phase I design without (group A) and with (group B) granulocyte colony-stimulating factor (G-CSF). Treatment continued until there was a substantial decrease in the left ventricular ejection fraction (LVEF), congestive heart failure, progressive disease, or physician discretion to discontinue.

RESULTS: The MTD of paclitaxel was 150 mg/m², and adjunctive therapy with G-CSF was required to prevent febrile neutropenia. Dexrazoxane had no significant effect on the pharmacokinetics of paclitaxel or doxorubicin. After a median cumulative doxorubicin dose of 360 mg/m² (range, 60 to 870 mg/m²), no patient developed congestive heart failure or had a decrease in LVEF below normal. An objective response occurred in all five patients with locally advanced breast cancer and in eight of 20 patients (40%; 95% confidence interval, 19% to 61%) with metastatic breast cancer.

CONCLUSION: When combined with doxorubicin (60 mg/m²) and dexrazoxane (600 mg/m²), paclitaxel given as a 3-hour infusion had an MTD of 150 mg/m², and G-CSF was required to prevent febrile neutropenia. Dexrazoxane had no effect on the pharmacokinetics of paclitaxel or doxorubicin. No patient in this trial had a decrease in the LVEF below normal, compared with about 20% to 50% of patients treated with doxorubicin and paclitaxel without dexrazoxane in other trials.

Presented in part on December 5, 1997, at the 20th Annual San Antonio Breast Cancer Symposium, San Antonio, TX.

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