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Phase II Study of Troxacitabine (BCH-4556) in Patients With Advanced and/or Metastatic Renal Cell Carcinoma: A Trial of the National Cancer Institute of Canada-Clinical Trials Group

From the Princess Margaret Hospital, University Health Network, Toronto; BCCA-Vancouver Cancer Centre; Tom Baker Cancer Centre, Calgary; CHUM-Pavillon Notre-Dame, Montreal; Toronto-Sunnybrook Regional Cancer Centre, Toronto; Ottawa Regional Cancer Centre; Shire Pharmaceuticals Development Inc; National Cancer Institute of Canada-Clinical Trials Group.

Address reprint requests to Malcolm J. Moore, MD, Department of Medical Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, M5G 2M9 Canada; email: malcolm.moore{at}uhn.on.ca.

Purpose: A multi-institution phase II study was undertaken by National Cancer Institute of Canada–Clinical Trials Group to evaluate the efficacy and toxicity of intravenous troxacitabine (Troxatyl; Shire Pharmaceuticals Plc, Laval, Quebec, Canada), in patients with renal cell carcinoma.

Patients and Methods: Between June 1999 and March 2000, 35 patients (24 male) with a mean age of 60 years who had advanced and/or metastatic disease were treated with troxacitabine given as an intravenous infusion over 30 minutes at a dose of 10 mg/m² intravenously, once every 3 weeks.

Results: Of the 33 of 35 patients evaluable for response, there were two confirmed partial responses, 21 patients had stable disease (median duration, 4.4 months), and 10 patients had progressive disease. Eight patients remained stable for more than 6 months, of whom six remain free of progression. The most common drug-related nonhematologic toxicities observed were skin rash (77.1%), hand-foot syndrome (68.6%), alopecia (51.4%), fatigue (51.4%), and nausea (57.1%). Out of a total of 145 cycles of treatment, 98 were given without steroid premedication, whereas 47 cycles were given with steroid premedication. Without premedication, skin rash occurred in 37% of cycles compared with 26% when steroids were given prophylactically.

Conclusion: Troxacitabine given at a dose of 10 mg/m² once every 3 weeks was well tolerated in patients with metastatic renal cell cancer, with common toxicities being a moderate to severe granulocytopenia and skin rash. Steroid premedication may reduce the frequency and severity of the skin rash. Our current study suggests that the nucleoside analog troxacitabine may have modest activity against renal cell carcinoma; however, larger studies are required to confirm this.

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