Summary
Temozolomide (TMZ) has shown modest efficacy in the treatment of recurrent brain metastasis (BM). We designed a new regimen utilizing dose-intensified, protracted course of TMZ in combination with vinorelbine, a lipophilic large-spectrum agent, in an attempt to improve the efficacy of TMZ. This phase I study was conducted to establish the maximum tolerated dose (MTD) of vinorelbine for this combination. Patients with recurrent or progressive BM were eligible. Chemotherapy consisted of 28-day cycles with TMZ (150 mg/m2, days 1–7 and 15–21) and vinorelbine (days one and eight at escalating doses). The starting dose was 15 mg/m2, with increments of 5 mg/m2 for each cohort of 3–6 patients, until MTD was reached (30 mg/m2). A total of 21 patients were enrolled; the median age was 59 (41–77). The primary tumor was lung cancer in 13 patients (NSCLC in 10, SCLC in 3), breast in 6, renal in 1 and endometrial in 1. Vinorelbine dose was 15 mg/m2 in seven patients, 20 mg/m2 in five, 25 mg/m2 in four and 30 mg/m2 in six. Grades 3 and 4 neutropenia developed in six patients, lymphopenia in nine, and thrombocytopenia in six; other toxicities were rare. No dose-limiting toxicity was seen. Out of 18 evaluable patients 2 had a radiographic response (one partial and one minor). Disease was stable in 6 of 18 patients and the median survival was 27 weeks. This regimen was well tolerated and a phase II trial using a dose of 30 mg/m2 of vinorelbine is warranted.
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Acknowledgement
Dr. Abrey has received honoraria and grant support from Schering Plough, Inc. This study was supported in part by an unrestricted educational grant from Schering Plough, Inc.
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Omuro, A., Raizer, J., Demopoulos, A. et al. Vinorelbine combined with a protracted course of temozolomide for recurrent brain Metastases: a phase I trial. J Neurooncol 78, 277–280 (2006). https://doi.org/10.1007/s11060-005-9095-8
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DOI: https://doi.org/10.1007/s11060-005-9095-8