Lakshmi Nayak1, Lisa M DeAngelis2, H Ian Robins3, Ramaswamy Govindan4, Shirish Gadgeel5, Karen Kelly6, James R Rigas7, David M Peereboom8, Steven S Rosenfeld9, Alona Muzikansky10, Ming Zheng11, Patrick Urban11, Lauren E Abrey2, Antonio Omuro2, Patrick Y Wen1. 1. Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. 2. Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York. 3. Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin. 4. Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri. 5. Karmanos Cancer Institute/Wayne State University, Detroit, Michigan. 6. Division of Hematology and Oncology, Davis Comprehensive Cancer Center, University of California, Sacramento, California. 7. Norris Cotton Cancer Center/Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 8. Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio. 9. Department of Neurology, Columbia University Medical Center/New York Presbyterian, New York, New York. 10. Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts. 11. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey.
Abstract
BACKGROUND: Treatment options for patients with non-small cell lung cancer (NSCLC) with brain metastases are limited. Patupilone (EPO906), a blood-brain barrier-penetrating, microtubule-targeting, cytotoxic agent, has shown clinical activity in phase 1/2 studies in patients with NSCLC. This study evaluates the efficacy, pharmacokinetics, and safety of patupilone in NSCLC brain metastases. METHODS: Adult patients with NSCLC and confirmed progressive brain metastases received patupilone intravenously at 10 mg/m(2) every 3 weeks. The primary endpoint of this multinomial 2-stage study combined early progression (EP; death or progression within 3 weeks) and progression-free survival at 9 weeks (PFS9w) to determine drug activity. RESULTS: Fifty patients with a median age of 60 years (range, 33-74 years) were enrolled; the majority were men (58%), and most had received prior therapy for brain metastases (98%). The PFS9w rate was 36%, and the EP rate was 26%. Patupilone blood pharmacokinetic analyses showed mean areas under the concentration-time curve from time zero to 504 hours for cycles 1 and 3 of 1544 and 1978 ng h/mL, respectively, and a mean steady state distribution volume of 755 L/m(2) . Grade 3/4 adverse events (AEs), regardless of their relation with the study drug, included diarrhea (24%), pulmonary embolisms (8%), convulsions (4%), and peripheral neuropathy (4%). All patients discontinued the study drug: 31 (62%) for disease progression and 13 (26%) for AEs. Twenty-five of 32 deaths were due to brain metastases. The median time to progression and the overall survival were 3.2 and 8.8 months, respectively. CONCLUSIONS: This is the first prospective study of chemotherapy for recurrent brain metastases from NSCLC. In this population, patupilone demonstrated activity in heavily treated patients.
BACKGROUND: Treatment options for patients with non-small cell lung cancer (NSCLC) with brain metastases are limited. Patupilone (EPO906), a blood-brain barrier-penetrating, microtubule-targeting, cytotoxic agent, has shown clinical activity in phase 1/2 studies in patients with NSCLC. This study evaluates the efficacy, pharmacokinetics, and safety of patupilone in NSCLC brain metastases. METHODS: Adult patients with NSCLC and confirmed progressive brain metastases received patupilone intravenously at 10 mg/m(2) every 3 weeks. The primary endpoint of this multinomial 2-stage study combined early progression (EP; death or progression within 3 weeks) and progression-free survival at 9 weeks (PFS9w) to determine drug activity. RESULTS: Fifty patients with a median age of 60 years (range, 33-74 years) were enrolled; the majority were men (58%), and most had received prior therapy for brain metastases (98%). The PFS9w rate was 36%, and the EP rate was 26%. Patupilone blood pharmacokinetic analyses showed mean areas under the concentration-time curve from time zero to 504 hours for cycles 1 and 3 of 1544 and 1978 ng h/mL, respectively, and a mean steady state distribution volume of 755 L/m(2) . Grade 3/4 adverse events (AEs), regardless of their relation with the study drug, included diarrhea (24%), pulmonary embolisms (8%), convulsions (4%), and peripheral neuropathy (4%). All patients discontinued the study drug: 31 (62%) for disease progression and 13 (26%) for AEs. Twenty-five of 32 deaths were due to brain metastases. The median time to progression and the overall survival were 3.2 and 8.8 months, respectively. CONCLUSIONS: This is the first prospective study of chemotherapy for recurrent brain metastases from NSCLC. In this population, patupilone demonstrated activity in heavily treated patients.
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Authors: Wim W Ten Bokkel Huinink; Jozef Sufliarsky; Willem M Smit; Stanislav Spanik; Maria Wagnerova; Hal W Hirte; Stan Kaye; Anandhi R Johri; Amit M Oza Journal: J Clin Oncol Date: 2009-05-18 Impact factor: 44.544