PHASE-I AND PHARMACOLOGICAL STUDIES OF THE CAMPTOTHECIN ANALOG IRINOTECAN ADMINISTERED EVERY 3 WEEKS IN CANCER-PATIENTS

Purpose: A phase I study was undertaken to determine the maximum-tolerated dose (MTD), principal toxicities, and pharmacokinetics of the novel topoisomerase I inhibitor irinotecan (CPT-11). Patients and Methods: Sixty-four patients meeting I standard phase I eligibility criteria were included (24 women, 40 men; median age, 51 years; primary sites: colon, head and neck, lung, pleura; 60 of 64 had been previously treated). Pharmacokinetics was determined by high-performance liquid chromatography (HPLC). Results: One hundred ninety CPT-11 courses were administered as a 30-minute intravenous (IV) infusion every 3 weeks (100 to 750 mg/m(2)). Grade 3 to 4 nonhematologic toxicities included diarrhea (16%; three hospitalizations), nausea and vomiting (9%), asthenia (14%), alopecia (53%), elevation of hepatic transaminases (8%), and one case of skin toxicity. An acute cholinergic syndrome wets observed during CPT-11 administration. Diarrhea appeared dose-limiting at 350 mg/m(2), but this was circumvented by using a high-dose loperamide protocol that allowed dose escalation, Dose-dependent, reversible, noncumulative granulocytopenia was the dose-limiting toxicity (nadir, days 6 to 9; median recovery time, 5 days). Grade 3 to 4 anemia was observed in 9% of patients. One patient died during the study, 8 days after CPT-11 treatment. Two complete responses (cervix, 450 mg/m(2); head and neck, 750 mg/m(2)) and six partial responses in fluorouracil (5-FU)-refractory colon cancer were observed (260 to 600 mg/m(2)). pharmacokinetics of CPT-11 and active metabolite SN-38 were performed in 60 patients (94 courses). CPT-11 plasma disposition was bi- or triphasic, with a mean terminal half-life of 14.2 +/- 0.9 hours (mean +/- SEM]. The mean volume of distribution (Vdss) was 157 +/- 8 L/m(2), and total-body clearance was 15 a 1 L/m(2)/h. The CPT-11 area under the plasma concentration versus rime curves [AUG) and SN-38 AUC increased linearly with dose. SN-38 plasma decoy had an apparent half-life of 13.8 +/- 1.4 hours. Both CPT-11 and SN-38 AUCs correlated with nadir leukopenia and granulocytopenia, with grade 2 diarrhea, and with nausea and vomiting. Conclusion: The MTD of CPT-11 administered as a 30-minute IV infusion every 3 weeks is 600 mg/m(2), with granulocytopenia being dose-limiting At 350 mg/m(2), diarrhea appeared dose-limiting, but high-dose loperamide reduced this toxicity and allowed dose escalation. For safety reasons, the recommended dose is presently 350 mg/m(2) every 3 weeks; more experience must be gained to establish the feasibility of a higher dose in large multicentric phase II studies. However, when careful monitoring of gastrointestinal toxicities is possible, a higher dose of 500 mg/m(2) could be recommended in good-risk patients. The activity of this agent in 5-FU-refractory colorectal carcinoma makes it unique and mandates expedited phase II testing. (C) 1995 by American Society of Clinical Oncology.