Modulation of GemOx chemotherapy according to CIRS in elderly patients with advanced pancreatic cancer

The present study evaluated activity and toxicity of modulated doses of gemcitabine associated to oxaliplatin in patients with secondary CIRS and with locally advanced pancreatic adenocarcinoma (LAPC) and metastatic pancreatic adenocarcinoma (MPC). Since January 2006, untreated LAPC and MPC patients have been assessed with ADL, IADL, CIRS to modulate chemotherapy dosages according to co-morbidity stage. Patiens aged<75 years, co-morbidity stage primary/intermediate, or ≥75 years and co-morbidity stage primary, received gemcitabine 1,000 mg/m² as a 10 mg/m²/min infusion on day 1 and oxaliplatin 70 mg/m² as a 2-h infusion on day 2 every 2 weeks. Patiens aged<75 years, co-morbidity stage secondary or ≥75 years and co-morbidity stage intermediate/secondary patients received gemcitabine 800 mg/m². Primary endpoint was the overall response rate (ORR). Secondary endpoints were disease control rate (DCR), PFS, OS and toxicity. Thirty-one patients were recruited: 26% (8/31) LAPC and 74% (23/31) MPC; median age 69 years. Co-morbidity stage primary/intermediate, 19; secondary, 12. Twenty-seven valuable patients: ORR 30% (CI±0.14); disease control rate 85% (CI±0.18). Median follow-up 13 months: median PFS and OS were 6 and 15 months, respectively. Valuable cycles 140. Grade 3/4 toxicity per patient: leukopenia, 18.5%; neutropenia, 55,5%; thrombocytopenia, 7.4%; SGOT/SGPT, 7.4%; gamma-GT, 7.4%; fever without neutropenia, 3.7%. Median received dose intensity: gemcitabine 400 mg/m2/w; oxaliplatin 35 mg/m2/w. Modulation of GemOx chemotherapy according, to CIRS stage in advanced pancreatic cancer confirms reported efficacy and tolerability.

Effectiveness of FIr-B/FOx and liver metastasectomies in liver-only metastatic colorectal cancer (MCRC)

582

Background: Effectiveness of liver metastasectomies was evaluated in liver-MCRC patients treated with FIr-B/FOx association in a previous phase II study (Bruera et al, submitted 2010).

Methods: Treatment schedule: 12h-timed-flat-infusion/5-Fluorouracil 900 mg/m2 days 1-2, 8-9, 15-16, 22-23; Irinotecan 160 mg/m2, Bevacizumab 5 mg/kg days 1, 15; Oxaliplatin 80 mg/m2 days 8, 22; every 4 weeks. Resection rate, activity, efficacy were analysed and compared in liver-only versus multiple metastatic sites and single versus multiple liver metastases.

Results: Liver-MCRC were 33: liver-only 22 patients (67%); multiple metastatic sites 11 patients (33%). Liver metastasectomies were performed in 13 patients (11 R0, 84.6%): 26% of 50 MCRC patients enrolled in the FIr-B/FOx phase II study; 39% of liver-MCRC patients; 54% of liver-only, 6 of 9 (67%) single and 6 of 13 (46%) multiple liver metastases; one liver and lung metastasectomy. Pathologic complete responses (CRs) were 2 (15%); downsizing with modification of surgical resectability, 9 patients (41%); conversion rate of unresectable liver metastases, 83%. Overall activity, including 3 clinical CR, in liver-only patients, 68%. ORR, PFS, OS, respectively: in liver-MCRC patients, 84%, 11 and 23 months; in liver-only metastases, 86%, 17 and 44 months; in liver metastasectomies, 100%, 21 months (PFS from liver surgery 10 months) and 47 months. Significantly increased efficacy: PFS and OS in liver-only versus multiple metastatic sites (p 0.006 and 0.011, respectively) and single versus multiple liver metastasis (p 0.026 and 0.022, respectively).

Conclusions: FIr-B/FOx chemotherapy increases resection rate of liver metastases, thus significantly improving efficacy of liver-only MCRC patients.

No significant financial relationships to disclose.

The DOC combination in advanced gastric cancer: Preliminary data of a phase II study

104

Background: We describe activity of first line chemotherapy in advanced gastric carcinoma with docetaxel (DTX), oxaliplatin (OHP) and capecitabine (CAP).

Methods: Patients (pts) were enrolled in the phase II study, if they had the main subsequent criteria: histologically confirmed diagnosis of advanced gastric cancer (AGC) (local advanced or metastatic disease); normal renal and hepatic function; no myocardial infarction or angina pectoris; no uncontrolled severe diseases or active infections. Treatment schedule: DTX at fixed dose of 65 mg/m2 on day 1, OHP at fixed dose of 110 mg/m2 on day 1, CAP at fixed dose of 1,600 mg/ m2 with crhonomodulation in trhee daily administration from day 1 to day 14, every 3 weeks. Dose-limiting toxicity (DLT): G3 non-haematological or G4 haematological. Study design: Simon two-stage phase II optimal design with power (1- b) 80%, error a 5%, error b 20%, P0 40%, P1 60%. Planned sample size: I stage 7/16, II stage 23/46. Primary endpoint was response rate (RR). Secondary endpoints were time to progression (TTP), overall survival (OS), toxicity and quality of life.

Results: 38 pts were enrolled: 24 men and 14 women, median age of 58 years (range 50-67). Median number of cycles per pts was 4,5 (range 3-6). Total cycles administered: 41. Cumulative G3-4 toxicities were: neutropenia 21%, anemia 14%, asthenia 9%. G1-2 toxicities were: diarrhea 22%, neurotoxicity 18%. Median received-DI of DTX: 20 mg/mq/week (93% of recommended-DI), OHP 35 mg/mq/week (95%), CAP 7,000 mg/mq/week (94%) per patient, respectively. Overall pts were assessable (according to intent-to-treat analysis) with 58% (a0.05, CI + 29) of objective responses (OR): 7 partial responses, 4 stable disease and 1 progression. The disease control rate (DCR) was 91%. TTP and OS not done because median follow-up was of 8 months (2-15) only.

Conclusions: The combination DOC is tolerable without G3-4 toxicity and preliminary data show very high activity.

No significant financial relationships to disclose.

"Poker" association of weekly alternating 5-fluorouracil, irinotecan, bevacizumab and oxaliplatin (FIr-B/FOx) in first line treatment of metastatic colorectal cancer: a phase II study

BACKGROUND

This phase II study investigated efficacy and safety of weekly alternating Bevacizumab (BEV)/Irinotecan (CPT-11) or Oxaliplatin (OHP) associated to weekly 5-Fluorouracil (5-FU) in first line treatment of metastatic colorectal carcinoma (MCRC).

METHODS

Simon two-step design: delta 20% (p0 50%, p1 70%), power 80%, α 5%, β 20%. Projected objective responses (ORR): I step, 8/15 patients (pts); II step 26/43 pts. Schedule: weekly 12 h-timed-flat-infusion/5-FU 900 mg/m2, days 1-2, 8-9, 15-16, 22-23; CPT-11 160 mg/m2 plus BEV 5 mg/kg, days 1,15; OHP at three dose-levels, 60-70-80 mg/m2, days 8, 22; every 4 weeks.

RESULTS

Fifty consecutive, unselected pts < 75 years were enrolled: median age 63; young-elderly (yE) 24 (48%); liver metastases (LM) 33 pts, 66% Achieved OHP recommended dose, 80 mg/m2. ORR 82% intent-to-treat and 84% as-treated analysis. Median progression-free survival 12 months. Equivalent efficacy was obtained in yE pts. Liver metastasectomies were performed in 26% of all pts and in 39% of pts with LM. After a median follow-up of 21 months, median overall survival was 28 months. Cumulative G3-4 toxicities per patient: diarrhea 28%, mucositis 6%, neutropenia 10%, hypertension 2%. They were equivalent in yE pts. Limiting toxicity syndromes (LTS), consisting of the dose-limiting toxicity, associated or not to G2 or limiting toxicities: 44% overall, 46% in yE. Multiple versus single site LTS, respectively: overall, 24% versus 20%; yE pts, 37.5% versus 8%.

CONCLUSION

Poker combination shows high activity and efficacy in first line treatment of MCRC. It increases liver metastasectomies rate and can be safely administered.

TRIAL REGISTRATION

Osservatorio Nazionale sulla Sperimentazione Clinica dei Medicinali (OsSC) Agenzia Italiana del Farmaco (AIFA) Numero EudraCT 2007-004946-34.

Triplet schedule of weekly 5-fluorouracil and alternating irinotecan or oxaliplatin in advanced colorectal cancer: a dose-finding and phase II study

A weekly administration of alternating irinotecan or oxaliplatin associated to 5-Fluorouracil in advanced colorectal cancer was planned in order to evaluate a new schedule maintaining dose intensities of each drug as in double combinations and tolerability of the triplet association. The following weekly schedule was administered: irinotecan, days 1 and 15; oxaliplatin, days 8 and 22; 5-fluorouracil (5-FU) over 12-h (from 10:00 p.m. to 10:00 a.m.) timed flat infusion, days 1-2, 8-9, 15-16 and 22-23, every 4 weeks. Dose- finding and phase II study were planned. Thirteen patients were enrolled in the dose-finding study and 23 in the phase II study. The recommended doses of our study are: irinotecan 160 mg/m(2); oxaliplatin 80 mg/m(2); 5-FU 900 mg/m(2). The dose-limiting toxicity was diarrhea (35% of patients) but no cases of febrile neutropenia were observed. In 30 patients assessable for response two complete (6.7%) and 18 partial (60%) responses were observed, for an overall response rate of 66.7% (alpha 0.05, CI+/-17). The triplet association using this weekly alternating schedule is an active and well-tolerated outpatient regimen. Surgical removal of residual disease was considered in 5 patients and a radical resection was performed in 5 patients (147 %).

“Poker” schedule of weekly alternating 5-fluorouracil, irinotecan, bevacizumab, and oxaliplatin (FIR-B/FOX) in advanced colorectal cancer: A phase II study

4125

Background: Triplet combinations associating antimetabolites with irinotecan (CPT-11) and/or oxaliplatin (OHP) and/or bevacizumab (BEV) show increased activity in same phase III studies vs doublets, with objective responses (OR) between 40% and 60%. Thus we evaluated in a phase II study the addition of BEV to the triplet combination CPT-11/OHP/5-fluorouracil (5-FU) as first line chemotherapy in metastatic colorectal carcinoma (MCC). Methods: Main inclusion criteria: histologically diagnosis of colorectal cancer (CRC) with measurable disease; age 18–75 yrs; adequate bone marrow reserve and renal and hepatic function; no cardiac diseases; no uncontrolled hypertension; no thromboembolic diseases or coagulopathy, no preexisting bleeding diatheses. Treatment schedule: weekly 5-FU 12-h timed-flat-infusion (from 10:00 pm to 10:00 am) 900 mg/m2/d 1–2, 8–9, 15–16 and 22- 23; CPT-11 160 mg/m2 plus BEV 5 mg/kg days 1 and 15; OHP 80 mg/m2 days 8 and 22, every 4 weeks. A Simon two-stage optimal design was planned: power 80%, error probability α 5%, error probability β 20%, P0 50%, P1 70%, sample size 43 pts (I stage 8/15 OR; II stage 26/43 OR). Primary endpoint: OR. Secondary endpoints: time to progression (TTP), overall survival (OS), toxicity and quality of life. Results: Forty-eight pts were enrolled. Median number of cycles per patient was 5 (range 1–9). In the expected 43 pts assessable intent-to-treat (ITT), OR were 84% (α0.05, CI +12): 2 complete and 34 partial responses. In the overall 48 pts, 46 were assessable ITT: OR 80% (α0.05, CI +12), 2 complete and 35 partial responses, 4 stable disease and 5 progression. Median TTP was 12 months (2+-33+), median OS was 25 months (2+-34+), with a median follow-up of 12 months (2–34). Cumulative G3–4 toxicities by pts were: diarrhea 27%, mucositis 6%, hypertension 2%, hypertransaminasemy 2%, neutropenia 10%. No toxic deaths have occurred. Received-DI: CPT-11 84% of projected-DI, OHP 82%, 5-FU 85%, BEV 84%, per pt respectively. 17 pts (35%) had only liver metastasis and R0 resection was performed in 3 pts (18%). Conclusions: “Poker” combination with FIR-B/FOX schedule shows higher activity than triplet combinations. Thus it may be considered as the most active first line treatment of MCC.

No significant financial relationships to disclose.

The safety of dose-dense liposomal-encapsulated doxorubicin in association with docetaxel (MyTax) in breast cancer

Abstract #2157

Background: Liposomal-Encapsulated Doxorubicin (LED) shows equivalent efficacy, better cardiac tolerability at higher cumulative dose than conventional anthracyclines in breast cancer treatment.&#x2028; Methods: Sixteen pts were enrolled in a dose-finding study of LED (TLC-D99 Myocet ®) associated to Docetaxel (TXT). Twelve pts were treated with a fixed TXT dose (50 mg/m2) and TLC-D99 at three dose levels, 40-45-50 mg/m2, days 1 and 15 every 2 weeks using an intra- and inter-patient approach; four pts wrere treated at the TLC-D99 recommended dose (50 mg/m2). Cardiac monitoring of LVEF was performed every two cycles; Precursor Brain Natriuretic Peptide (proBNP) and cardiac Troponin (c-TnI) before and after 24 h chemotherapy was evaluated.&#x2028; Results: Breast cancer (BC) disease extension: metastatic (MBC), 8; locally advanced BC, 5; T2-T3 BC, 3. Previous chemotherapy: untreated, 11 pts; adjuvant, 5 pts. Enrolled pts for each dose-level: I, 7; II, 9; III, 14. Newly treated pts: I dose-level, 7; II dose-level, 3; III dose-level, 6. Valuable cycles for each dose-level in a total 77 cycles: I, 14; II, 21; III, 42. DLTs were observed in 3 pts, 21%, and 3 cycles, 4%: 2 cardiac, characterized by a 19% LVEF decrease and a symptomatic arrhythmia; one G4 hematologic resistant to G-CSF. DLTs for each dose-level by pts and cycles, respectively: I, 14% (1/7 pts) and 7% (1/14 cycles); II, no DLT in 9 pts and 21 cycles; III, 14% (2/14 pts) and 5% (2/42 cycles). Cumulative G3-4 toxicities by pts and cycles, respectively: cardiac arrhythmia 6% and 1,3%, cardiac general (symptomatic LVEF decrease), 6% and 1,3%; alopecia 81% and 65%; neutropenia resistant to G-CSF, 6% and 1,3%. Cardiac DLTs were observed in 2 elderly pts (&gt;65 y). The 2 cardiac DLTs were observed in 2 out of 3 pts with pre-existing diastolic dysfunction. No pathologic increase of c-TnI levels was detected. Seven pts showed increased pro-BNP after chemotherapy; 1 of these with increased pro-BNP after chemotherapy, persistent the day 1 of each subsequent chemotherapy showed a DLT;&#x2028; G2 toxicities by patients and cycles, respectively: asthenia 37% and 18%, stomatitis/mucositis 12% and 5%, nausea 31% and 12%. Median rDI of TLC-D99 was 25 mg/m2/w and TXT 25 mg/m2/w for pts, respectively. Preliminary efficacy in 16 assessable pts: LA-BC and MBC, 1 CR (pCR) 7 PR (OR 62%), 4 SD and 1 PD; T2-T3 BC, 2 PR and 1 SD.&#x2028; Conclusion: dose-dense TLC-D99/Docetaxel association can be safely recommended at the dose of 50 mg/m2 for each drug. Docetaxel intensification is ongoing.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2157.