Repetitive high-dose therapy with cyclophosphamide, thiotepa and docetaxel with peripheral blood progenitor cell and filgrastim support for metastatic and locally advanced breast cancer: results of a phase I study.
This phase I study was designed to determine the optimal dosages of a novel repetitive high-dose therapy regimen for patients with metastatic breast cancer (MBC). The planned treatment was three cycles of high-dose cyclophosphamide, thiotepa and docetaxel delivered every 35 days with progressive dose-escalation in successive cohorts. Each cycle was supported by peripheral blood progenitor cells (PBPC) and filgrastim. Eighteen patients were entered into this trial. Of the planned 54 treatment cycles, 44 were delivered and 11 patients completed all three cycles. The dose-limiting toxicities were interstitial pneumonitis and mucositis with moderately severe diarrhea (n = 3) and rash (n = 3). There were no treatment-related deaths. Of the 17 patients with evaluable disease, 16 patients responded with six patients achieving a complete remission and an additional four patients achieving no detectable disease (negative restaging including PET scan) but a persistently abnormal bone scan. At a median follow-up of 12 months, median progression-free survival was 11 months with the median overall survival not reached. The recommended doses for phase II/III studies are cyclophosphamide (4 g/m2), thiotepa (300 mg/m2) and docetaxel (100 mg/m2).
Prince
H M
HM
Blood and Marrow Transplant Service, Peter MacCallum Cancer Institute, Victoria, Australia.
Rischin
D
D
Toner
G C
GC
Seymour
J F
JF
Blakey
D
D
Gates
P
P
Eerhard
S
S
Chapple
P
P
Quinn
M
M
Brettell
M
M
Juneja
S
S
Wolf
M
M
Januszewicz
E H
EH
Richardson
G
G
Scarlett
J
J
Briggs
P
P
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003967:Diarrhea / Q000209:etiology; D018450:Disease Progression; D000077143:Docetaxel; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000209:etiology; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009503:Neutropenia / Q000209:etiology; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D011994:Recombinant Proteins; D012074:Remission Induction; D013280:Stomatitis / Q000209:etiology; D016019:Survival Analysis; D043823:Taxoids; D013852:Thiotepa / Q000008:administration & dosage / Q000009:adverse effects; D013921:Thrombocytopenia / Q000209:etiology; D019172:Transplantation Conditioning / Q000009:adverse effects
D011994:Recombinant Proteins; D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D000077143:Docetaxel; D003520:Cyclophosphamide; D013852:Thiotepa; D017239:Paclitaxel; D000069585:Filgrastim