title: Dose-escalation study of carboplatin (day 1) and cisplatin (day 3): tolerance and relation to leukocyte and buccal cell platinum--DNA adducts.
abstract: Carboplatin and cisplatin have similar antitumor activities but different toxicities. Combining these two analogs may be expected to balance the toxicities and allow higher doses of platinum compounds to be administered with tolerable toxicity. To test this concept, a Phase I trial of carboplatin in combination with cisplatin was performed. Thirty-three eligible patients received carboplatin doses ranging from 200-480 mg/m2 on day 1 and cisplatin doses ranging from 50-100 mg/m2 on day 3 of the 28 day cycle. A 2-day interval ensured no interference in renal excretion of carboplatin by cisplatin. Myelosuppression was the dose limiting toxicity. With the usual full dose of carboplatin, 480 mg/m2, patients tolerated 50 mg/m2 of cisplatin, without apparent additional toxicity. At 100 mg/m2 of cisplatin, non-hematologic as well as hematologic toxicities frequently precluded administration of more than 300 mg/m2 of carboplatin. Platinum-DNA adduct quantitation was done in leukocytes and buccal cells during cycle 1 in most patients. The adduct-specific immunosignal in buccal cells was always increased after carboplatin and in all but one after cisplatin. The level of adducts in buccal cells increased with increasing doses of carboplatin and cisplatin. In leukocytes, measurable levels of adducts were formed after carboplatin with further contribution made by cisplatin but not obviously in a dose dependent fashion. We conclude from the toxicities observed, that combinations of carboplatin with cisplatin may have advantages over either drug alone in certain clinical situations; and that further study of platinum-DNA adducts may shed light on platinum dose-response relationships.
authors.affiliation: Norris Cancer Center, University of Southern California, Los Angeles.
authors.forename: I
authors.initials: I
authors.lastname: Gill
authors.forename: F M
authors.initials: FM
authors.lastname: Muggia
authors.forename: P M
authors.initials: PM
authors.lastname: Terheggen
authors.forename: C
authors.initials: C
authors.lastname: Michael
authors.forename: R J
authors.initials: RJ
authors.lastname: Parker
authors.forename: V
authors.initials: V
authors.lastname: Kortes
authors.forename: S
authors.initials: S
authors.lastname: Grunberg
authors.forename: M C
authors.initials: MC
authors.lastname: Christian
authors.forename: E
authors.initials: E
authors.lastname: Reed
authors.forename: L
authors.initials: L
authors.lastname: den Engelse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000378:metabolism / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000378:metabolism; D002610:Cheek; D002945:Cisplatin / Q000008:administration & dosage / Q000378:metabolism; D004247:DNA / Q000187:drug effects / Q000378:metabolism*; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007962:Leukocytes / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000187:drug effects / Q000378:metabolism; D010984:Platinum / Q000378:metabolism*
chemical_list: D010984:Platinum; D004247:DNA; D016190:Carboplatin; D002945:Cisplatin