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Phase I Trial of the Antivascular Agent Combretastatin A4 Phosphate on a 5-Day Schedule to Patients With Cancer: Magnetic Resonance Imaging Evidence for Altered Tumor Blood Flow

James P. Stevenson, Mark Rosen, Weijing Sun, Maryann Gallagher, Daniel G. Haller, David Vaughn, Bruce Giantonio, Ross Zimmer, William P. Petros, Michael Stratford, David Chaplin, Scott L. Young, Mitchell Schnall, Peter J. O’Dwyer

From the University of Pennsylvania Cancer Center, Philadelphia, PA; Mary Babb Randolph Cancer Center, Morgantown, WV; Oxigene Inc, Boston, MA; and Gray Cancer Center, Norwood, United Kingdom.

Address reprint requests to James P. Stevenson, MD, University of Pennsylvania, 16 Penn Tower, 3400 Spruce St, Philadelphia, PA 19104; e-mail: james.stevenson{at}uphs.upenn.edu.

Purpose: Combretastatin A4 (CA4) phosphate (CA4P) inhibits microtubule polymerization and is toxic to proliferating endothelial cells in vitro. It causes reversible vascular shutdown in established tumors in vivo, consistent with an antivascular mechanism of action. The present study investigated escalating doses of CA4P administered intravenously to patients with advanced cancer.

Patients and Methods: Patients with solid malignancies and good performance status received CA4P as a 10-minute infusion daily for 5 days repeated every 3 weeks. Pharmacokinetic sampling was performed during cycle 1. Patients receiving 52 mg/m²/d had serial dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies to measure changes in tumor perfusion with CA4P treatment.

Results: Thirty-seven patients received 133 treatment cycles. CA4P dose levels ranged from 6 mg/m² to 75 mg/m² daily. Severe pain at sites of known tumor was dose limiting at 75 mg/m². Dose-limiting cardiopulmonary toxicity (syncope and dyspnea or hypoxia) was noted as well in two patients treated at 75 mg/m². Other toxicities included hypotension, ataxia, dyspnea, nausea or vomiting, headache, and transient sensory neuropathy. Plasma CA4P and CA4 area under the concentration-time curve and maximal concentration values increased linearly with dose. Tumor perfusion, as measured by the first-order rate constant of gadolinium plasma to tissue transfer during DCE-MRI studies, was found to decrease in eight of 10 patients. Relationships were also demonstrated between perfusion changes and pharmacokinetic indices. A partial response was observed in a patient with metastatic soft tissue sarcoma, and 14 patients exhibited disease stability for a minimum of two cycles.

Conclusion: Doses of CA4P on a daily times five schedule of 52 to 65 mg/m² were reasonably well-tolerated. The 52 mg/m² dose is recommended for further study based on cumulative phase I experience with CA4P. Antitumor efficacy was observed, and the use of DCE-MRI provided a valuable noninvasive measure of the vascular effects of CA4P treatment.

Supported by a grant from Oxigene Inc, Boston, MA.

Presented at the American Association of Cancer Research Annual Meeting, San Francisco, CA, April 1–5, 2000.

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