title: A phase I study of sequential administration of escalating doses of intravenous paclitaxel, oral topotecan, and fixed-dose oral etoposide in patients with solid tumors.
abstract: BACKGROUND
  Based on preclinical findings and on the clinical antitumor efficacy of sequential paclitaxel/topotecan and topotecan/etoposide, the authors sought to define the maximum tolerated doses (MTDs) and dose-limiting toxicities (DLTs) associated with a sequential combination of paclitaxel, topotecan, and etoposide in patients with solid tumors.
  
  
  METHODS
  The MTDs were determined through standard dose escalation in cohorts of three patients. Patients with refractory solid tumors and performance status < or = 2 were treated with intravenous paclitaxel 50-110 mg/m(2) (Day 1), oral topotecan 0.5-2.0 mg/m(2) (Days 2-4), and oral etoposide 160 mg/m(2) (Days 5-7) during every 21-day cycle. For dose-limiting neutropenia, granulocyte-colony-stimulating factor (G-CSF) was administered on Day 8 in subsequent cohorts. Blood samples were obtained before treatment during Cycle 1 (Days 1, 2, and 5) for topoisomerase I assessment.
  
  
  RESULTS
  Twenty-eight patients received a combined total of 129 cycles. The MTDs were paclitaxel 80 mg/m(2), topotecan 1.5 mg/m(2), and etoposide 160 mg/m(2) without G-CSF. In minimally pretreated patients, G-CSF allowed paclitaxel dose escalation to 110 mg/m(2). Three patients (11%) had radiologic partial responses, and 4 patients (14%) had stable disease. Day 2 topoisomerase I levels increased by 2-15 times relative to baseline levels in 7 of 14 patients analyzed (50%).
  
  
  CONCLUSIONS
  The novel sequential combination that was evaluated generally was well tolerated and active in patients with refractory solid tumors. Based on hematologic DLTs, the authors recommend further evaluation of paclitaxel 110 mg/m(2), topotecan 1.5 mg/m(2), and etoposide 160 mg/m(2) with G-CSF support in minimally pretreated patients.
authors.affiliation: Department of Medicine, University of Miami Sylvester Cancer Center, Miami, Florida 33136, USA. crocha@med.miami.edu
authors.forename: Caio M S
authors.initials: CM
authors.lastname: Rocha Lima
authors.forename: Carlo V
authors.initials: CV
authors.lastname: Catapano
authors.forename: Daniel
authors.initials: D
authors.lastname: Pacheco
authors.forename: Carol A
authors.initials: CA
authors.lastname: Sherman
authors.forename: Greg
authors.initials: G
authors.lastname: Oakhill
authors.forename: Chaudhry
authors.initials: C
authors.lastname: Mushtaq
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Freeman
authors.forename: Mark R
authors.initials: MR
authors.lastname: Green
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004264:DNA Topoisomerases, Type I / Q000097:blood; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007262:Infusions, Intravenous; D008214:Lymphocytes / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects; D019772:Topotecan / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D005047:Etoposide; D019772:Topotecan; D004264:DNA Topoisomerases, Type I; D017239:Paclitaxel