Departments of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Henricistrasse 92, 45136 Essen, Germany.
Br J Cancer. 2012 Feb 14;106(4):629-32. doi: 10.1038/bjc.2011.608. Epub 2012 Jan 12.
Although most patients with advanced gynaecologic malignancies respond to first-line treatment with platinum-taxane doublets, a significant proportion of patients relapse. Combining targeted agents that have non-overlapping mechanisms of action with chemotherapy may potentially increase the disease-free interval. Accordingly, this study evaluated the feasibility of combining pazopanib, an oral angiogenesis inhibitor, with paclitaxel and carboplatin.
This open-label, phase I/II study planned to evaluate the safety and efficacy of paclitaxel 175 mg m(-2) plus carboplatin (AUC5 (Arm A) or AUC6 (Arm B)) once in every 3 weeks for up to six cycles with either 800 or 400 mg per day pazopanib.
Dose-limiting toxicities (DLTs) were observed in two of the first six patients enrolled at pazopanib 800 mg plus paclitaxel 175 mg m(-2) plus carboplatin AUC5. Of the six patients enrolled in the next and lowest dosing level planned in the study, pazopanib 400 mg plus paclitaxel 175 mg m(-2) plus carboplatin AUC5, two patients also experienced DLTs and the study was terminated. Two of the 4 DLTs observed overall were gastrointestinal perforations. Severe myelotoxicity was reported in 6 of 12 patients.
Combining either 800 or 400 mg per day pazopanib with standard carboplatin/paclitaxel chemotherapy is not a feasible treatment option.
尽管大多数晚期妇科恶性肿瘤患者对含铂类药物和紫杉烷类药物的一线治疗有反应,但仍有相当一部分患者复发。将具有非重叠作用机制的靶向药物与化疗联合使用可能会增加无病间期。因此,本研究评估了将口服血管生成抑制剂帕唑帕尼与紫杉醇和卡铂联合使用的可行性。
这是一项开放标签、I/II 期研究,计划评估紫杉醇 175mg/m²加卡铂(AUC5(臂 A)或 AUC6(臂 B))每 3 周一次,最多 6 个周期,同时给予 800 或 400mg/天帕唑帕尼。
在接受帕唑帕尼 800mg 联合紫杉醇 175mg/m²加卡铂 AUC5 的前 6 例患者中,有 2 例出现剂量限制毒性(DLT)。在研究计划的下一个和最低剂量水平(帕唑帕尼 400mg 联合紫杉醇 175mg/m²加卡铂 AUC5)中,有 6 例患者中有 2 例出现 DLT,因此研究终止。观察到的 4 例 DLT 中有 2 例为胃肠道穿孔。6 例患者中有 2 例出现严重骨髓抑制。
帕唑帕尼 800 或 400mg/天联合标准卡铂/紫杉醇化疗不是一种可行的治疗选择。