1. A dose-finding, pharmacokinetic and pharmacodynamic study of a novel schedule of flavopiridol in patients with advanced solid tumors.
- Author
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Ramaswamy B, Phelps MA, Baiocchi R, Bekaii-Saab T, Ni W, Lai JP, Wolfson A, Lustberg ME, Wei L, Wilkins D, Campbell A, Arbogast D, Doyle A, Byrd JC, Grever MR, and Shah MH
- Subjects
- Adult, Aged, Antineoplastic Agents adverse effects, Antineoplastic Agents blood, Area Under Curve, Cytokines blood, Female, Flavonoids adverse effects, Flavonoids blood, Humans, Infusions, Intravenous, Male, Maximum Tolerated Dose, Middle Aged, Neoplasms blood, Neoplasms pathology, Ohio, Piperidines adverse effects, Piperidines blood, Protein Kinase Inhibitors adverse effects, Protein Kinase Inhibitors blood, Treatment Outcome, Antineoplastic Agents administration & dosage, Antineoplastic Agents pharmacokinetics, Flavonoids administration & dosage, Flavonoids pharmacokinetics, Neoplasms drug therapy, Piperidines administration & dosage, Piperidines pharmacokinetics, Protein Kinase Inhibitors administration & dosage, Protein Kinase Inhibitors pharmacokinetics
- Abstract
Purpose: Based on the promising activity and tolerability of flavopiridol administered with a pharmacokinetically-derived dosing schedule in chronic lymphocytic leukemia (CLL), we conducted a phase I study using this schedule in patients with advanced solid tumors., Experimental Design: Flavopiridol was given IV as a 30-min loading dose followed by a 4-hr infusion weekly for 4 weeks repeated every 6 weeks. Dose-escalation was in cohorts of three patients using the standard 3+3 phase I study design. Blood samples were obtained for pharmacokinetic and pharmacodynamic studies., Results: Thirty-four eligible patients with advanced solid tumors received a total of 208 doses (median 7, range 1-24). Total doses ranged from 40 to 105 mg/m(2). The primary dose limiting toxicity was cytokine release syndrome (CKRS). No antitumor responses were observed. The mean peak plasma concentration across all doses was 1.65 ± 0.86 μM. Area under the concentration-versus-time curve ([Formula: see text]) ranged from 4.31 to 32.2 μM[Symbol: see text]hr with an overall mean of 13.6 ± 7.0 μM[Symbol: see text]hr. Plasma flavopiridol concentrations and AUC increased proportionally with dose. There was no correlation between cytokine levels and clinical outcomes., Conclusions: The maximum-tolerated dose of flavopiridol is 20 mg/m(2) bolus followed by 20 mg/m(2) infusion over 4 h given weekly for 4 weeks on a 6-week cycle in patients with advanced solid tumors. Flavopiridol PK was notably different, and there was a higher frequency of CKRS, despite prophylactic steroids, seen in this patient group compared to previous studies with CLL using a similar dosing schedule.
- Published
- 2012
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