Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
Nancy Chan , Daniella E. Portal , Rebecca Anne Moss , Ann W. Silk , Mark N. Stein , Joseph Aisner , Jyoti Malhotra , Weichung Shih , Hongxia Lin , Michael P. Kane , Janice M. Mehnert , Antoinette R. Tan
Background: Pazopanib (pazo) is an oral tyrosine kinase inhibitor of VEGFR, PDGFR and c-Kit. It is a weak inhibitor of CYP3A4 and CYP2C8 and may decrease paclitaxel (P) clearance. Daily pazo with P and carboplatin (C) every 21 days was not feasible on a previous study. We hypothesized that pazo dosed intermittently and on a different day from P and C may be tolerable. We sought to determine the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), and pharmacokinetics (PK) of pazo with weekly P and C. Methods: Using a 3+3 standard design, a schedule of P 60-80 mg/m2 and C AUC2 on days 1, 8, and 15 with pazo 400-800 mg on days 2-5, 9-12, and 16-26 on a 28-day cycle was evaluated. Pazo alone could be continued if P and C were omitted due to maximal benefit or toxicity. PK was collected during cycles 1 and 2. Results: 34 patients (pts) were treated over 6 dose levels (Table). Mean age 57 (37-79). Tumor types: breast (22), lung (3) and other (9); 27 had prior platinum. Delay in starting cycle 2 due to grade 3 neutropenia was a DLT at dose level 2 and 5. Pts on 5A missed dosing during C1 and C2 due to neutropenia and required subsequent growth factor, and this was deemed unlikely to be sustainable long-term. All grade toxicities included anemia (62%), neutropenia (59%), and thrombocytopenia (56%). Protocol-defined MTD was not determined. PK analysis showed a dose proportional increase in pazo concentration, consistent with previous reports. Pazo did not alter the PK of C. Cmax of P was higher C2D1 vs C1D1; mean Cmax ratio between C2D1:C1D1 was 1.63 (95% CI:1.29-1.96). There were 11 objective responses (3 CRs, 8 PRs). Five breast pts were on pazo alone for a median of 9 cycles (2-52) with CR (2), PR (2) and SD (1); a squamous cell of unknown primary in CR received 22 cycles. Clinical trial information: NCT01407562Conclusions: PK confirm that pazo is a weak inhibitor of CYP3A4 and CYP2C8. Myelosuppression was a major adverse event at all dose levels. MTD was not determined. Antitumor activity was achieved with this alternate combination schedule and sustained responses from sequential pazo monotherapy was observed.
Dose Level | Paclitaxel | Carboplatin | Pazopanib | No. of Pts | No. of Pts with DLT |
---|---|---|---|---|---|
1 | 60 mg/m2 | AUC 2 | 400 mg | 3 | |
2 | 60 mg/m2 | AUC 2 | 600 mg | 9 | 1 |
3 | 70 mg/m2 | AUC 2 | 600 mg | 7 | |
4 | 70 mg/m2 | AUC 2 | 800 mg | 4 | |
5 | 80 mg/m2 | AUC 2 | 800 mg | 8 | 1 |
5A | 80 mg/m2 | AUC 2 | 600 mg | 3 |
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