Etoposide admixed with cisplatin. Phase I clinical investigation of 72-hour infusion

A study of the feasibility and accuracy of pharmacokinetically guided etoposide dosing in children

Pharmacokinetically guided dosing was performed in nine paediatric patients receiving etoposide. Doses on day 2 of a 2- or 3-day schedule were adapted on the basis of the day-1 area under the plasma etoposide concentration vs time curve (AUC). The day-1 AUC was estimated using a limited sampling model and the day-2 target AUC defined by the etoposide dose-AUC relationship observed in 33 children. Target AUC values (4.6-8.2 mg ml(-1) x min) were achieved with a high degree of precision and with little bias (mean error 11% and root mean squared error 15% respectively). Pharmacokinetic parameters were similar to those reported previously in children, although interpatient pharmacokinetic variability was less than that observed previously: plasma clearance, 23 (18-26) ml min(-1) m(-2); volume of distribution at steady state (Vdss), 6.0 (3.9-8.9) l m(-2); t(1/2) 254 (127-550) min (median and range). This study has demonstrated that pharmacokinetically guided dosing with etoposide is feasible. However, pharmacokinetically guided dosing is likely to be of most benefit in patients with abnormalities of renal or hepatic function, or in children with prior exposure to cisplatin.

Infusional cancer chemotherapy: historical evolution and future development at the Cancer Center of Boston

Clinical studies of infusional chemotherapy at The Cancer Center of Boston began in 1980 at the New England Deaconess Hospital and from 1986 to the present have continued under the auspices of a network of free-standing ambulatory cancer treatment centers in Massachusetts. Over 50 peer-reviewed articles on infusional chemotherapy and 3 textbooks on the topic have been published by clinical investigators associated with The Center, including phase I, II, and III trials, multidrug infusion programs, and combined chemo/radiotherapy programs. Bringing together the total experience in this review provides a perspective to address those areas that have been inadequately explored and a framework for future development in the field. This paper represents a comprehensive synthesis and analysis of clinical infusional studies carried out at The Center to the present with the goal of achieving those objectives.

A review of the stability and compatibility of antineoplastic drugs for multiple-drug infusions

It is important that the stability of reconstituted parenteral antineoplastic agents be established, particularly in the context of ambulatory infusion systems for delivery. The stability of selected agents within each of the five classes of compounds (antimetabolites, alkylating agents, antibiotics, alkaloids and glycosides, and metals) is reviewed from the literature together with additional data from studies carried out using high-performance liquid chromatographic (HPLC) technology in clinically applicable volumes and concentrations for ambulatory infusion. The stability of reconstituted drugs varies from a few minutes (mecloethamine) to many months (FU). Compatibility data on two- and three-drug admixtures of cytotoxic agents are reported for a number of common multidrug regimens. Tabular presentation of the drug-drug compatibilities and incompatibilities is included along with a discussion of the mechanisms for drug-drug interaction. The use of a broad spectrum of compatible cytotoxic drugs is possible, including fluoropyrimidine-, anthracycline-, and platinum-based combinations, providing the capability of carrying out multidrug infusions for 4-7 days in an ambulatory delivery system.

Infusion of floxuridine plus etoposide plus cisplatin in human malignancies

36 patients with advanced malignancy were studied in a phase I trial of continuous 24-h infusion of floxuridine (FUdR) plus etoposide plus cisplatin (FEP) administered for 5 consecutive days at 4-week intervals. Study design fixed the dose rate of etoposide and cisplatin with escalation of FUdR only. Dose rate-limiting toxicity related to the FUdR component was stomatitis and diarrhoea and was invariably associated with leukopenia and thrombocytopenia when grade 3 or 4 level gastrointestinal toxicity was observed. Only 3 of 64 courses were associated with transient renal failure related to cisplatin. Drug-related deaths occurred (leukopenia-associated sepsis) in 4 patients with poor performance status (ECOG 3 and 4). Responses occurred in 15 of 26 evaluable patients (all previously treated minimally or untreated) including 5/11 non-small cell lung cancer; 3/3 oesophageal; 2/2 breast; 4/5 gastric; 1 osteogenic sarcoma; and 1 unknown primary (probably ovary). The recommended dose rates for a 5-day infusion of the three agents for good risk patients is 20 mg/m2 per day of each drug. For poor risk patients including age greater than 65 years; performance status 2 or greater; or extensive bone metastases or prior radiation; the recommended starting dose rates are: FUdR 15 mg/m2 per day; etoposide 15 mg/m2 per day; and cisplatin 20 mg/m2 per day. Dose escalation of FUdR to a maximum of 25 mg/m2 daily is feasible in selected patients demonstrating optimal tolerance.

Five-day continuous infusion of cisplatin and etoposide in non-small cell lung cancer. A phase II trial

Cisplatin (CDDP) and etoposide are synergistic in vitro: the aim of this study was to evaluate the efficacy of a continuous infusion (C.I.) of these 2 drugs in inoperable non-small cell lung cancer. Patients were to receive 3 courses of CDDP 20 mg/m2/d in 1 l saline x 5d and etoposide 50 mg/m2/d in 21 saline x 5d--both in C.I.--every 3-4 weeks. Thirty patients have entered the study. Four were inevaluable for response. One patient got complete remission, 15 partial remission, 8 no change and 2 progressive disease. The response rate was 53.3% overall (95% confidence interval: 35-71%), and 61.5% for 26 assessable patients. Toxicity appeared to be acceptable despite 52% transient neutropenia--one patient died during aplasia--and 78% grade 1 to 3 nausea or vomiting. Treatment was stopped in only one case, and modified in 6 others. The high response rate that we observed, supports the idea of potentiation of the antineoplastic effect of CDDP and etoposide by C.I., in non-small cell lung cancer. These results must be confirmed in larger series before definitive conclusions can be drawn.