Phase I and pharmacokinetic (PK) study of pazopanib (P) in combination with two schedules of ifosfamide (I) in patients (pts) with advanced solid tumors (STs).

Authors

null

Paul Hamberg

Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, Netherlands

Paul Hamberg , Marye Boers-Sonderen , Walter J. Loos , Maja J. De Jonge , Winette T.A. Van Der Graaf , Ben B Suttle , Ferry Eskens , Jaap Verweij , Carla Van Herpen , Stefan Sleijfer

Organizations

Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, Netherlands, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands, GlaxoSmithKline, Research Triangle Park, NC, Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands

Research Funding

Pharmaceutical/Biotech Company
Background: P is a tyrosine kinase inhibitor of PDGFR, VEGFR and KIT. This study aimed to determine the recommended phase II dose (RP2D) of P combined with I. To assess the impact of scheduling on tolerability, two I schedules were explored. Methods: Pts with progressive ST, no standard therapy available, PS 0-1 and good organ function were eligible. Pts received daily P with 3-weekly I, 9 g/m2/cycle, either continuously (Iciv) or as 3 hrs boluses (Ibolus) for 3 days. P was escalated in serial cohorts of 3-9 pts per I-schedule. If in 3-6 pts dose-limiting toxicity (DLT) of 33.3% within 1st cycle was seen 3 more pts at that dose level (DL) were enrolled. RP2D was exceeded if in > 1/3 pts, > 2/6 pts or ≥ 3/9 pts DLT occurred. P was maximized at 1000 mg/day. At RP2D, an expansion cohort of 6-9 pts was studied to confirm safety. PK samples of P and I were collected in all pts. Sampling allowed intra-individual comparison of I-PK with or without P and vice versa. Results: 47 pts were studied. For Iciv (25 pts), RP2D was the maximum dose of P (1000 mg), higher than the single agent RP2D. At RP2D 2 DLTs in 15 pts occurred: 1 febrile neutropenia (FN); 1 encephalopathy. With Ibolus (22 pts), P 400 mg with or without GCSF was not tolerated (5 DLTs in 10 pts: 3*FN, 1 encephalopathy; 1 proteinuria). At RP2D (P 200 mg + Ibolus + GCSF) 3 DLTs in 12 pts (FN; encephalopathy, renal insufficiency) were observed. Toxicity occurring in >30% of pts in Iciv (all grades/grade 3-4,%) were neutropenia (92/92) anemia (92/8); thrombocytopenia (35/12), elevated ASAT, ALAT, alkaline phosphatase (73/4; 73/0; 62/2), nausea (58/0), vomiting (73/0), diarrhea (54/0) and hypertension (31/12). 4/25 pts in Iciv evaluable for response had PR (2 sarcoma, 2 ovary) and 10 prolonged (≥3 mths) SD. In Ibolus, 6/20 pts had PR (2 urothelial, 1 sarcoma, 1 ovary, 1 CUP, 1 mesothelioma) and 3/20 prolonged SD. Preliminary PK analysis showed no effect of P on I-exposure, neither of Ibolus or Iciv on P. Conclusions: P is tolerated at a higher dose combined with Iciv compared to Ibolus (1000 vs 200 mg). PK cannot explain this difference. This study underlines the impact of scheduling on the tolerability of VEGFR-TKI and cytotoxic drug combinations.

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Abstract Details

Meeting

2012 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Developmental Therapeutics - Clinical Pharmacology and Immunotherapy

Track

Developmental Therapeutics

Sub Track

Pharmacology

Clinical Trial Registration Number

NTR2063

Citation

J Clin Oncol 30, 2012 (suppl; abstr 2593)

DOI

10.1200/jco.2012.30.15_suppl.2593

Abstract #

2593

Poster Bd #

8B

Abstract Disclosures