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Phase I and Pharmacologic Study of a 3-Hour Infusion of Paclitaxel followed by Cisplatinum and 5-Fluorouracil in Patients with Advanced Solid Tumors

Division of Clinical and Translational Research, University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida 33136 [K. N. B., A. M. I.]; Department of Pharmacology [G. N. K., U. K. W., T. W.], Division of Hematology/Oncology [T. J., R. K. S.], and Department of Surgery [C. R.], Medical University of South Carolina, Charleston, South Carolina 29425; and National Cancer Institute, NIH, Rockville, Maryland 20852 [S. G. A.]

A Phase I and pharmacological study of paclitaxel administered as an outpatient, 3-h i.v. infusion just before a 5-day regimen of daily cisplatinum (CP) and a continuous infusion of 5-fluorouracil (5-FU) was performed in patients with advanced solid tumors. A secondary objective was to determine the objective response rate to this regimen. Forty-two patients were enrolled and were evaluable for toxicities. Eighteen patients were previously untreated, whereas the rest had received prior treatment with radiation (J. H. Schiller et al., J. Clin. Oncol., 12: 241–248, 1994), chemotherapy (M. J. Kennedy et al., Clin. Cancer Res., 4: 349–356, 1998), or both modalities (J. H. Schiller et al., J. Clin. Oncol., 12: 241–248, 1994). The paclitaxel dose was escalated from 100–135-170–200-225 to 250 mg/m², whereas i.v. 5-FU and CP doses were fixed at 1.0 g/m²/day continuous infusion and 20 mg/m²/day, respectively, daily for 5 days. Granulocyte colony-stimulating factor (G-CSF; 5 µg/kg/day) was administered s.c. from day 6, routinely after 250 mg/m² dose of paclitaxel or after a lower dose of paclitaxel if ANC <500/µl or febrile neutropenia was observed. Patients were treated every 28 days. Plasma and urine samples were collected to determine the pharmacokinetics of paclitaxel. In previously untreated patients, the maximally tolerated dose of paclitaxel in the drug regimen was determined to be 170 mg/m² without and 250 mg/m² with G-CSF support. At the higher dose level, mucositis and thrombocytopenia were dose-limiting. In previously treated patients, these toxicities were observed at all dose levels of paclitaxel 135 mg/m². With increasing doses of paclitaxel, a disproportionate increase in the peak concentrations, as well as the area under plasma concentration time-curve, was seen. This nonlinearity was due to saturable total body clearance and volume of distribution of paclitaxel (P < 0.001). The apparent plasma elimination half-life was unaffected by the dose of paclitaxel. CP and 5-FU had no apparent effect on the metabolism of paclitaxel. Among 32 patients evaluable for response, 22 demonstrated an objective response, including five complete remissions. Therefore, a regimen of 3-h infusion of 250 mg/m² paclitaxel before CP and FU is tolerable with G-CSF (as above) support in previously untreated patients. The regimen also seems to be highly active against breast and esophageal cancers.

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