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Vatandoust S, Bright T, Roy AC, Abbas MN, Watson DI, Gan S, Bull J, Sorich M, Scott-Hoy A, Luu LJ, Karapetis CS. Phase 1 trial of intraperitoneal paclitaxel in combination with intravenous cisplatin and oral capecitabine in patients with advanced gastric cancer and peritoneal metastases (IPGP study). Asia Pac J Clin Oncol 2021; 18:404-409. [PMID: 34811896 DOI: 10.1111/ajco.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/04/2021] [Indexed: 12/24/2022]
Abstract
AIMS Gastric cancer with peritoneal involvement has a poor prognosis. Intraperitoneal (IP) paclitaxel has shown promising results in these patients. However, this approach has only been studied in the Asian population, and in combination with S-1. We investigated the maximum tolerated dose of IP paclitaxel, with a standard chemotherapy combination, in the Australian population. METHODS The study of the population included metastatic human epidermal growth factor receptor 2 (HER2) negative gastric adenocarcinoma with peritoneal involvement. Treatment included six 21-day cycles of cisplatin (80 mg/m2 IV, day 1) plus capecitabine (1000 mg/m2 PO BD, days 1-14) plus IP paclitaxel (days 1 and 8). IP paclitaxel doses for cohort 1-3 were 10, 20, and 30 mg/m2 , respectively, in a 3 + 3 standard dose-escalation design. RESULTS Fifteen patients were enrolled of which 6 were female and the median age was 63. Two patients developed dose-limiting toxicities. No grade 4/5 toxicities were recorded. The maximum tolerated dose was not reached. Therefore, as defined by the study protocol, the recommended phase-2 dose for IP paclitaxel was determined to be 30 mg/m2 . The 12-month survival rate was 46.7%, and the median survival was 11.5 months (interquartile range [IQR]: 15.3-6.9). CONCLUSIONS IP paclitaxel is safe in combination with cisplatin and capecitabine and the recommended phase-2 dose is 30 mg/m2 .
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Affiliation(s)
- Sina Vatandoust
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tim Bright
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Oesophago-Gastric Surgical Unit, Flinders Medical Centre, Bedford Park, Australia
| | - Amitesh Chandra Roy
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Muhammad Nazim Abbas
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - David Ian Watson
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Oesophago-Gastric Surgical Unit, Flinders Medical Centre, Bedford Park, Australia
| | - Susan Gan
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Oesophago-Gastric Surgical Unit, Flinders Medical Centre, Bedford Park, Australia
| | - Jeff Bull
- Oesophago-Gastric Surgical Unit, Flinders Medical Centre, Bedford Park, Australia
| | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alex Scott-Hoy
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia
| | - Lee-Jen Luu
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia
| | - Christos Stelios Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Willoughby SR, Luu LJ, Cameron JD, Nelson AJ, Schultz CD, Worthley SG, Worthley MI. Clopidogrel improves microvascular endothelial function in subjects with stable coronary artery disease. Heart Lung Circ 2014; 23:534-41. [PMID: 24529502 DOI: 10.1016/j.hlc.2014.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/27/2013] [Accepted: 01/10/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Clopidogrel therapy has recently been shown to reduce cardiovascular events in patients with stable vascular disease. This benefit may be due to effects not exclusively related to platelet aggregation. The aim of this study was to evaluate the effect of clopidogrel therapy on microvascular endothelial function in subjects with stable coronary artery disease (CAD). METHODS AND RESULTS Forty subjects with stable CAD were randomised to clopidogrel therapy (75mg/day) or control. Blood and endothelial function testing occurred at baseline, one week and three months following randomisation. Microvascular endothelial function was assessed via reactive hyperaemic index (RHI). Platelet function was assessed by adenosine diphosphate (ADP)-induced whole blood aggregation and the VerifyNow™ system. Plasma markers of endothelial function (asymmetric dimethylarginine, ADMA) and oxidative stress (myeloperoxidase, MPO) were also tested. The primary endpoint was endothelial function assessment (RHI) at three months. At one week RHI increased by 20±10% in the clopidogrel group; this effect was maintained at three months (21±9% increase from baseline; P<0.01). A significant decrease in ADP-induced platelet aggregation and P2Y12 reaction units was observed in the clopidogrel therapy group (P<0.01). There was no correlation between endothelial function and platelet function testing in the clopidogrel therapy group. CONCLUSION Clopidogrel therapy is associated with improved microvascular endothelial function in patients with stable CAD. This effect is independent of its effects on ADP-induced platelet reactivity.
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Affiliation(s)
- Scott R Willoughby
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Lee-Jen Luu
- Monash Cardiovascular Research Centre, MonashHeart and Monash University, Melbourne, Australia; Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, MonashHeart and Monash University, Melbourne, Australia
| | - Adam J Nelson
- Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia
| | - Carlee D Schultz
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia.
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