A phase i study of Triapine® in combination with doxorubicin in patients with advanced solid tumors

William R. Schelman; Sherry Morgan-Meadows; Rebecca Marnocha; Fred Lee; Jens Eickhoff; Wei Huang; Marcia Pomplun; Zhisheng Jiang; Dona Alberti; Jill M. Kolesar; Percy Ivy; George Wilding; Anne M. Traynor

doi:10.1007/s00280-008-0890-8

A phase i study of Triapine^® in combination with doxorubicin in patients with advanced solid tumors

William R. Schelman, Sherry Morgan-Meadows, Rebecca Marnocha, Fred Lee, Jens Eickhoff, Wei Huang, Marcia Pomplun, Zhisheng Jiang, Dona Alberti, Jill M. Kolesar, Percy Ivy, George Wilding, Anne M. Traynor

Research output: Contribution to journal › Article › peer-review

34 Scopus citations

Abstract

Purpose: To assess the maximum-tolerated dose (MTD), dose-limiting toxicity (DLT), pharmacokinetics and antitumor activity of Triapine^® administered in combination with doxorubicin. Study design: Patients were treated with doxorubicin intravenously (IV) on day 1 and Triapine ^® IV on days 1-4 of a 21-day cycle. The starting dose (level 1) was doxorubicin 60 mg/m² and Triapine^® 25 mg/m ². PK analysis was performed at various time-points before and after treatment. Results: Twenty patients received a total of 49 courses of treatment on study. At dose level 2 (doxorubicin 60 mg/m², Triapine ^® 45 mg/m²), two patients experienced DLTs (febrile neutropenia, grade 4 thrombocytopenia). An additional three patients were enrolled at dose level 1 without initial toxicity. Enrollment then resumed at dose level 2a with a decreased dose of doxorubicin (45 mg/m²) with Triapine^® 45 mg/m². The two patients enrolled on this level had two DLTs (diarrhea, CVA). Enrollment was planned to resume at dose level 1; however, the sixth patient enrolled to this cohort developed grade 5 heart failure (ejection fraction 20%, pretreatment EF 62%) after the second course. Thus, doxorubicin and Triapine^® were reduced to 45 and 25 mg/m², respectively (level 1a), prior to resuming enrollment at dose level 1, the MTD. The main drug-related toxicity was myelosuppression. Non-hematologic toxicities included mild-to-moderate fatigue, grade 3 diarrhea and grade 4 CVA. There was one treatment-related death due to heart failure. While no objective responses were observed, subjective evidence of clinical activity was observed in patients with refractory melanoma and prostate cancer. Conclusions: Pretreated patients with advanced malignancies can tolerate the combination of Triapine^® and doxorubicin at doses that achieve subjective clinical benefit with the main treatment-related toxicities being myelosuppression and fatigue. The MTD was determined to be doxorubicin 60 mg/m² on day 1 and Triapine^® 25 mg/m² on days 1-4 of a 21-day cycle.

Original language	English
Pages (from-to)	1147-1156
Number of pages	10
Journal	Cancer Chemotherapy and Pharmacology
Volume	63
Issue number	6
DOIs	https://doi.org/10.1007/s00280-008-0890-8
State	Published - May 2009

Bibliographical note

Funding Information:
Acknowledgments The authors would like to thank the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center (UWC-CC) Analytical Instrumentation Laboratory for Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics (3P Lab) for support in the acquisition of pharmacokinetic data for this research. The authors also would like to thank the patients who participated in this clinical trial, and the nurses and research specialist of the UWCCC phase I program for their eVorts in conducting and managing this trial. UO1 CA062491, Early Clinical Trials of Anti-Cancer Agents with PhaseI Emphasis, NCI; CTEP Translational Research Initiative, Contract 24XS090; and 1UL1RR025011, Clinical and Translational Science Award, National Center for ResearchResources, NIH.

Keywords

3-Aminopyridine-2-carboxaldehyde thiosemicarbazone
Doxorubicin
Phase I
Ribonucleotide reductase
Triapine

ASJC Scopus subject areas

Oncology
Toxicology
Pharmacology
Cancer Research
Pharmacology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s00280-008-0890-8

Cite this

Schelman, W. R., Morgan-Meadows, S., Marnocha, R., Lee, F., Eickhoff, J., Huang, W., Pomplun, M., Jiang, Z., Alberti, D., Kolesar, J. M., Ivy, P., Wilding, G., & Traynor, A. M. (2009). A phase i study of Triapine^® in combination with doxorubicin in patients with advanced solid tumors. Cancer Chemotherapy and Pharmacology, 63(6), 1147-1156. https://doi.org/10.1007/s00280-008-0890-8

@article{e519ebbb14914517b2ecc50f47ba8a72,

title = "A phase i study of Triapine{\textregistered} in combination with doxorubicin in patients with advanced solid tumors",

abstract = "Purpose: To assess the maximum-tolerated dose (MTD), dose-limiting toxicity (DLT), pharmacokinetics and antitumor activity of Triapine{\textregistered} administered in combination with doxorubicin. Study design: Patients were treated with doxorubicin intravenously (IV) on day 1 and Triapine {\textregistered} IV on days 1-4 of a 21-day cycle. The starting dose (level 1) was doxorubicin 60 mg/m2 and Triapine{\textregistered} 25 mg/m 2. PK analysis was performed at various time-points before and after treatment. Results: Twenty patients received a total of 49 courses of treatment on study. At dose level 2 (doxorubicin 60 mg/m2, Triapine {\textregistered} 45 mg/m2), two patients experienced DLTs (febrile neutropenia, grade 4 thrombocytopenia). An additional three patients were enrolled at dose level 1 without initial toxicity. Enrollment then resumed at dose level 2a with a decreased dose of doxorubicin (45 mg/m2) with Triapine{\textregistered} 45 mg/m2. The two patients enrolled on this level had two DLTs (diarrhea, CVA). Enrollment was planned to resume at dose level 1; however, the sixth patient enrolled to this cohort developed grade 5 heart failure (ejection fraction 20%, pretreatment EF 62%) after the second course. Thus, doxorubicin and Triapine{\textregistered} were reduced to 45 and 25 mg/m2, respectively (level 1a), prior to resuming enrollment at dose level 1, the MTD. The main drug-related toxicity was myelosuppression. Non-hematologic toxicities included mild-to-moderate fatigue, grade 3 diarrhea and grade 4 CVA. There was one treatment-related death due to heart failure. While no objective responses were observed, subjective evidence of clinical activity was observed in patients with refractory melanoma and prostate cancer. Conclusions: Pretreated patients with advanced malignancies can tolerate the combination of Triapine{\textregistered} and doxorubicin at doses that achieve subjective clinical benefit with the main treatment-related toxicities being myelosuppression and fatigue. The MTD was determined to be doxorubicin 60 mg/m2 on day 1 and Triapine{\textregistered} 25 mg/m2 on days 1-4 of a 21-day cycle.",

keywords = "3-Aminopyridine-2-carboxaldehyde thiosemicarbazone, Doxorubicin, Phase I, Ribonucleotide reductase, Triapine",

author = "Schelman, {William R.} and Sherry Morgan-Meadows and Rebecca Marnocha and Fred Lee and Jens Eickhoff and Wei Huang and Marcia Pomplun and Zhisheng Jiang and Dona Alberti and Kolesar, {Jill M.} and Percy Ivy and George Wilding and Traynor, {Anne M.}",

note = "Funding Information: Acknowledgments The authors would like to thank the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center (UWC-CC) Analytical Instrumentation Laboratory for Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics (3P Lab) for support in the acquisition of pharmacokinetic data for this research. The authors also would like to thank the patients who participated in this clinical trial, and the nurses and research specialist of the UWCCC phase I program for their eVorts in conducting and managing this trial. UO1 CA062491, Early Clinical Trials of Anti-Cancer Agents with PhaseI Emphasis, NCI; CTEP Translational Research Initiative, Contract 24XS090; and 1UL1RR025011, Clinical and Translational Science Award, National Center for ResearchResources, NIH.",

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doi = "10.1007/s00280-008-0890-8",

language = "English",

volume = "63",

pages = "1147--1156",

number = "6",

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Schelman, WR, Morgan-Meadows, S, Marnocha, R, Lee, F, Eickhoff, J, Huang, W, Pomplun, M, Jiang, Z, Alberti, D, Kolesar, JM, Ivy, P, Wilding, G & Traynor, AM 2009, 'A phase i study of Triapine^® in combination with doxorubicin in patients with advanced solid tumors', Cancer Chemotherapy and Pharmacology, vol. 63, no. 6, pp. 1147-1156. https://doi.org/10.1007/s00280-008-0890-8

TY - JOUR

T1 - A phase i study of Triapine® in combination with doxorubicin in patients with advanced solid tumors

AU - Schelman, William R.

AU - Morgan-Meadows, Sherry

AU - Marnocha, Rebecca

AU - Lee, Fred

AU - Eickhoff, Jens

AU - Huang, Wei

AU - Pomplun, Marcia

AU - Jiang, Zhisheng

AU - Alberti, Dona

AU - Kolesar, Jill M.

AU - Ivy, Percy

AU - Wilding, George

AU - Traynor, Anne M.

N1 - Funding Information: Acknowledgments The authors would like to thank the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center (UWC-CC) Analytical Instrumentation Laboratory for Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics (3P Lab) for support in the acquisition of pharmacokinetic data for this research. The authors also would like to thank the patients who participated in this clinical trial, and the nurses and research specialist of the UWCCC phase I program for their eVorts in conducting and managing this trial. UO1 CA062491, Early Clinical Trials of Anti-Cancer Agents with PhaseI Emphasis, NCI; CTEP Translational Research Initiative, Contract 24XS090; and 1UL1RR025011, Clinical and Translational Science Award, National Center for ResearchResources, NIH.

PY - 2009/5

Y1 - 2009/5

N2 - Purpose: To assess the maximum-tolerated dose (MTD), dose-limiting toxicity (DLT), pharmacokinetics and antitumor activity of Triapine® administered in combination with doxorubicin. Study design: Patients were treated with doxorubicin intravenously (IV) on day 1 and Triapine ® IV on days 1-4 of a 21-day cycle. The starting dose (level 1) was doxorubicin 60 mg/m2 and Triapine® 25 mg/m 2. PK analysis was performed at various time-points before and after treatment. Results: Twenty patients received a total of 49 courses of treatment on study. At dose level 2 (doxorubicin 60 mg/m2, Triapine ® 45 mg/m2), two patients experienced DLTs (febrile neutropenia, grade 4 thrombocytopenia). An additional three patients were enrolled at dose level 1 without initial toxicity. Enrollment then resumed at dose level 2a with a decreased dose of doxorubicin (45 mg/m2) with Triapine® 45 mg/m2. The two patients enrolled on this level had two DLTs (diarrhea, CVA). Enrollment was planned to resume at dose level 1; however, the sixth patient enrolled to this cohort developed grade 5 heart failure (ejection fraction 20%, pretreatment EF 62%) after the second course. Thus, doxorubicin and Triapine® were reduced to 45 and 25 mg/m2, respectively (level 1a), prior to resuming enrollment at dose level 1, the MTD. The main drug-related toxicity was myelosuppression. Non-hematologic toxicities included mild-to-moderate fatigue, grade 3 diarrhea and grade 4 CVA. There was one treatment-related death due to heart failure. While no objective responses were observed, subjective evidence of clinical activity was observed in patients with refractory melanoma and prostate cancer. Conclusions: Pretreated patients with advanced malignancies can tolerate the combination of Triapine® and doxorubicin at doses that achieve subjective clinical benefit with the main treatment-related toxicities being myelosuppression and fatigue. The MTD was determined to be doxorubicin 60 mg/m2 on day 1 and Triapine® 25 mg/m2 on days 1-4 of a 21-day cycle.

AB - Purpose: To assess the maximum-tolerated dose (MTD), dose-limiting toxicity (DLT), pharmacokinetics and antitumor activity of Triapine® administered in combination with doxorubicin. Study design: Patients were treated with doxorubicin intravenously (IV) on day 1 and Triapine ® IV on days 1-4 of a 21-day cycle. The starting dose (level 1) was doxorubicin 60 mg/m2 and Triapine® 25 mg/m 2. PK analysis was performed at various time-points before and after treatment. Results: Twenty patients received a total of 49 courses of treatment on study. At dose level 2 (doxorubicin 60 mg/m2, Triapine ® 45 mg/m2), two patients experienced DLTs (febrile neutropenia, grade 4 thrombocytopenia). An additional three patients were enrolled at dose level 1 without initial toxicity. Enrollment then resumed at dose level 2a with a decreased dose of doxorubicin (45 mg/m2) with Triapine® 45 mg/m2. The two patients enrolled on this level had two DLTs (diarrhea, CVA). Enrollment was planned to resume at dose level 1; however, the sixth patient enrolled to this cohort developed grade 5 heart failure (ejection fraction 20%, pretreatment EF 62%) after the second course. Thus, doxorubicin and Triapine® were reduced to 45 and 25 mg/m2, respectively (level 1a), prior to resuming enrollment at dose level 1, the MTD. The main drug-related toxicity was myelosuppression. Non-hematologic toxicities included mild-to-moderate fatigue, grade 3 diarrhea and grade 4 CVA. There was one treatment-related death due to heart failure. While no objective responses were observed, subjective evidence of clinical activity was observed in patients with refractory melanoma and prostate cancer. Conclusions: Pretreated patients with advanced malignancies can tolerate the combination of Triapine® and doxorubicin at doses that achieve subjective clinical benefit with the main treatment-related toxicities being myelosuppression and fatigue. The MTD was determined to be doxorubicin 60 mg/m2 on day 1 and Triapine® 25 mg/m2 on days 1-4 of a 21-day cycle.

KW - 3-Aminopyridine-2-carboxaldehyde thiosemicarbazone

KW - Doxorubicin

KW - Phase I

KW - Ribonucleotide reductase

KW - Triapine

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