Originally published as JCO Early Release 10.1200/JCO.2003.01.238 on September 8 2003

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Phase I and Pharmacokinetic Study of Two Different Schedules of Oxaliplatin, Irinotecan, Fluorouracil, and Leucovorin in Patients With Solid Tumors

Matthew P. Goetz, Charles Erlichman, Anthony J. Windebank, Joel M. Reid, Jeffrey A. Sloan, Pamela Atherton, Alex A. Adjei, Joseph Rubin, Henry Pitot, Evanthia Galanis, Matthew M. Ames, Richard M. Goldberg

From the Division of Medical Oncology, Division of Oncology Research, Biostatistics, and Department of Neurology, Mayo Clinic, Rochester, MN.

Address reprint requests to Matthew P. Goetz, MD, Department of Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: goetz.matthew{at}mayo.edu.

Purpose: We sought to determine the maximum-tolerated dose (MTD) and evaluate the toxicities and clinical activity of two irinotecan (CPT-11), fluorouracil (FU), leucovorin (LV), and oxaliplatin schedules in patients with advanced solid tumors. Additionally, we investigated the effect of CPT-11 on oxaliplatin pharmacokinetics.

Patients and Methods: Thirteen patients (cohort 1) received intravenous CPT-11 (infusion) and FU/LV (bolus) on days 1, 8, 15, and 22 and oxaliplatin (infusion) on days 1 and 15 every 6 weeks for a total 37 courses (median, three courses) at three dose levels. Twenty-two cohort 2 patients received intravenous CPT-11/oxaliplatin (infusion, day 1) and FU/LV (90-minute bolus infusion, days 2 to 5) every 3 weeks for a total of 122 courses (median, four courses) at three dose levels. Pharmacokinetic and neurotoxicity assessments were performed at the cohort 2 MTD.

Results: Dose-limiting toxicity (DLT) seen in both cohorts at the starting dose required dose de-escalation. Cohort 1 DLT included diarrhea and neutropenia. In cohort 2, diarrhea, vomiting, dehydration, neutropenia, febrile neutropenia, and paresthesias were DLTs. Antitumor activity was seen in both cohorts. In cohort 2, the total platinum area under the curve of patients increased 17% in cycle 2 (P = .048), but objective neurotoxicity was not seen.

Conclusion: The toxicities resulting from the addition of oxaliplatin to CPT-11/FU/LV are significant but manageable. The MTDs for the weekly schedule are CPT-11 (75 mg/m²), oxaliplatin (50 mg/m²), FU (320 mg/m²), and LV (20 mg/m²); and, for the 3-weekly schedule, the MTDs are CPT-11 (175 mg/m²), oxaliplatin (85 mg/m²), FU (240 mg/m²), and LV (20 mg/m²). Second-cycle platinum accumulation raises the possibility for enhanced cumulative neurotoxicity with CPT-11/oxaliplatin combinations.

Supported in part by grant Nos. CA15083 and CA69912 and grant No. M01 RR00585 from the Mayo Clinic General Clinical Research Center, Rochester, MN.

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