Intrapleural etoposide for malignant effusion.
The pharmacology, toxicity, and therapeutic effectiveness of etoposide (VP-16) given by the intrapleural route were examined in a phase I trial. Ten patients with malignant pleural effusion received 100, 150, or 225 mg/m2 VP-16 infused over 2 h into the pleural space after drainage of pleural fluid. The administration of VP-16 was tolerated well, with no local pain, increase in cough, dyspnea, or infection. Myelosuppression was mild at doses of 150 mg/m2 or less but severe at 225 mg/m2. Drug levels were followed in both plasma and pleural fluid for up to 12 h. Clearance of VP-16 from the pleural cavity was low at 2 ml/min m2. Peak pleural-fluid drug levels in patients receiving 225 mg/m2 exceeded 300 micrograms/ml, whereas peak drug concentrations in corresponding plasma samples obtained at the same time amounted to less than 10 micrograms/ml. Serial chest X-rays showed no disappearance of pleural effusion in nine evaluable patients. However, follow-up investigation of pleural fluid characteristics [carcinoembryonic antigen (CEA), lactic dehydrogenase (LDH), and cytologic examination] suggested some evidence of local therapeutic benefit.
Department of Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030.
P Y
PY
Holoye
D G
DG
Jeffries
H M
HM
Dhingra
F A
FA
Holmes
M
M
Raber
M S
MS
Engineer
R A
RA
Newman
D000328:Adult; D000368:Aged; D001826:Body Fluids / Q000378:metabolism; D002986:Clinical Trials as Topic; D004341:Drug Evaluation; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010994:Pleura / Q000378:metabolism; D010996:Pleural Effusion / Q000188:drug therapy*; D013902:Radiography, Thoracic
D005047:Etoposide