title: A phase I study with an expanded cohort to assess the feasibility of intraperitoneal carboplatin and intravenous paclitaxel in untreated ovarian, fallopian tube, and primary peritoneal carcinoma: A Gynecologic Oncology Group study.
abstract: OBJECTIVE
  This study aimed to determine the first-cycle maximum tolerated dose (MTD) of intraperitoneal carboplatin in combination with intravenous paclitaxel and then assess the feasibility of this dose over multiple cycles.
  
  
  METHODS
  Beginning at an intraperitoneal (IP) carboplatin dose area under the curve (AUC) of 5 and a fixed intravenous dose of 175mg/m(2) paclitaxel, patients were entered on a dose-escalating phase evaluating first-cycle dose-limiting toxicity (DLT). After estimating the MTD, cohorts of 20 patients were then entered in an expanded phase to evaluate DLT over four cycles.
  
  
  RESULTS
  Twenty-one patients were entered on the dose-escalating phase. A first-cycle MTD of carboplatin at AUC 8 was tolerated although thrombocytopenia was dose-limiting over multiple cycles. An additional 69 patients were treated in expanded cohorts. Only 5/90 (5.6%) patients discontinued treatment because of a port problem. Four-cycle DLT required de-escalation to a carboplatin AUC of 6, and even at that dose, there were 14 dose-limiting toxic effects in 40 patients (35%). Seven dose-limiting toxicities were due to neutropenia, and 6 were due to grade 3/4 thrombocytopenia. Six cycles of therapy were completed in 75% of eligible patients, but dose adjustments were required.
  
  
  CONCLUSIONS
  The first-cycle MTD did not predict the tolerability of this regimen over multiple cycles. Using an IP carboplatin dose of AUC 6 in combination with paclitaxel, the regimen can be administered with a high completion rate over multiple cycles. Because neutropenia is a frequent DLT, the addition of hematopoietic growth factors may permit a high completion rate while maintaining this dose.
authors.affiliation: Section of Gynecologic Oncology Fox Chase Cancer Center, Philadelphia, PA 19111, USA. mark.morgan@fccc.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Morgan
authors.forename: Michael W
authors.initials: MW
authors.lastname: Sill
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Benjamin
authors.initials: B
authors.lastname: Greer
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Rubin
authors.forename: Koen
authors.initials: K
authors.lastname: Degeest
authors.forename: S Diane
authors.initials: SD
authors.lastname: Yamada
authors.forename: Steven
authors.initials: S
authors.lastname: Waggoner
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.forename: Robert S
authors.initials: RS
authors.lastname: Mannel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D010534:Peritoneal Neoplasms / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D016190:Carboplatin; D017239:Paclitaxel