Phase I study of pegylated liposomal doxorubicin and the multidrug-resistance modulator, valspodar

P. M. Fracasso, K. A. Blum, M. K. Ma, B. R. Tan, L. P. Wright, S. A. Goodner, C. L. Fears, W. Hou, M. A. Arquette, J. Picus, A. Denes, J. E. Mortimer, L. Ratner, S. P. Ivy, H. L. McLeod

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Valspodar, a P-glycoprotein modulator, affects pharmacokinetics of doxorubicin when administered in combination, resulting in doxorubicin dose reduction. In animal models, valspodar has minimal interaction with pegylated liposomal doxorubicin (PEG-LD). To determine any pharmacokinetic interaction in humans, we designed a study to determine maximum tolerated dose, dose-limiting toxicity (DLT), and pharmacokinetics of total doxorubicin, in PEG-LD and valspodar combination therapy in patients with advanced malignancies. Patients received PEG-LD 20-25 mg m-2 intravenously over 1 h for cycle one. In subsequent 2-week cycles, valspodar was administered as 72 h continuous intravenous infusion with PEG-LD beginning at 8 mg m-2 and escalated in an accelerated titration design to 25 mg m-2. Pharmacokinetic data were collected with and without valspodar. A total of 14 patients completed at least two cycles of therapy. No DLTs were observed in six patients treated at the highest level of PEG-LD 25 mg m-2. The most common toxicities were fatigue, nausea, vomiting, mucositis, palmar plantar erythrodysesthesia, diarrhoea, and ataxia. Partial responses were observed in patients with breast and ovarian carcinoma. The mean (range) total doxorubicin clearance decreased from 27 (10-73) ml h-1 m-2 in cycle 1 to 18 (3-37) ml h-1 m-2 with the addition of valspodar in cycle 2 (P = 0.009). Treatment with PEG-LD 25 mg m-2 in combination with valspodar results in a moderate prolongation of total doxorubicin clearance and half-life but did not increase the toxicity of this agent.

Original languageEnglish (US)
Pages (from-to)46-53
Number of pages8
JournalBritish Journal of Cancer
Volume93
Issue number1
DOIs
StatePublished - Jul 11 2005

Keywords

  • Doxil
  • Multidrug resistance
  • PSC 833
  • Pegylated liposomal doxorubicin
  • Valspodar

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Fracasso, P. M., Blum, K. A., Ma, M. K., Tan, B. R., Wright, L. P., Goodner, S. A., Fears, C. L., Hou, W., Arquette, M. A., Picus, J., Denes, A., Mortimer, J. E., Ratner, L., Ivy, S. P., & McLeod, H. L. (2005). Phase I study of pegylated liposomal doxorubicin and the multidrug-resistance modulator, valspodar. British Journal of Cancer, 93(1), 46-53. https://doi.org/10.1038/sj.bjc.6602653