A phase I study of pomalidomide (CC-4047) in combination with cisplatin and etoposide in patients with extensive-stage small-cell lung cancer.
BACKGROUND
This phase I/IIA study evaluated the maximum-tolerated dose (MTD), safety, and clinical benefit of pomalidomide, an immunomodulatory drug (IMiD), combined with cisplatin+etoposide chemotherapy, in treatment-naive patients with extensive-stage (ES) small-cell lung cancer (SCLC).


METHODS
In this multicenter, open-label, dose-escalation study, patients received 21-day cycles of oral pomalidomide (1, 3, 5, and 4 mg/day) on days 1 to 14, plus cisplatin 25 mg/m and etoposide 100 mg/m administered intravenously on days 1 to 3; the MTD was determined during cycle 1 (standard 3+3 dose-escalation design), followed by a five-cycle extension phase.


RESULTS
Twenty-two patients with ES SCLC, with a median age of 64.5 years received one or more doses of the study medication. Dose-limiting toxicities included grade 4 cerebral ischemia and grade 5 sepsis (1-mg cohort), grade 4 transient ischemic attack (5-mg cohort), and grade 5 neutropenic infection (5-mg cohort). The MTD for pomalidomide was 4 mg/day. In the MTD phase, the most common pomalidomide-related adverse events (AEs) were fatigue (72.7%), nausea (45.5%), and neutropenia (40.9%); 31.8% of patients experienced pomalidomide-related serious AEs and 40.9% cisplatin/etoposide-related serious AEs. Overall response rate was 31.8% (7 of 22); these were partial responses. Stable disease and progressive disease occurred in four patients (18.2%) each. The median response duration was 12.4 weeks. Median overall survival was 49.6 weeks.


CONCLUSIONS
Pomalidomide at the MTD of 4 mg/day plus standard cisplatin+etoposide seems safe in treatment-naive patients with ES SCLC. However, addition of pomalidomide does not seem to improve the therapeutic index of chemotherapy alone.
Juravinski Cancer Centre, 699 Concession St., Hamilton, Ontario L8V 5C2, Canada. peter.ellis@jcc.hhsc.ca
Peter M
PM
Ellis
Ulf
U
Jungnelius
Jennie
J
Zhang
Abderrahim
A
Fandi
Robert
R
Beck
Frances A
FA
Shepherd
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives
D013792:Thalidomide; D005047:Etoposide; C467566:pomalidomide; D002945:Cisplatin