| Title: |
Low-dose metronomic topotecan and pazopanib in children with recurrent or refractory solid tumors: A C17 Canadian phase I trial (TOPAZ) |
| Authors: |
Manji, Arif; Morgenstern, Daniel A; Samson, Yvan; Deyell, Rebecca; Johnston, Donna; Lewis, Victor Anthony; Zorzi, Alexandra Patricia; Berman, Jason N; Brodeur-Robb, Kathy; Morrison, Ellen; Baruchel, Sylvain; Whitlock, James A |
| Publisher Information: |
Lippincott Williams & Wilkins (LWW) |
| Publication Year: |
2021 |
| Collection: |
Griffith University: Griffith Research Online |
| Subject Terms: |
Oncology and carcinogenesis; Clinical sciences; Science & Technology; Life Sciences & Biomedicine |
| Subject Geographic: |
Chicago; Illinois; USA |
| Time: |
2021-06-04 to 2021-06-08 |
| Description: |
Background: Low-dose metronomic topotecan (mTP) represents a novel approach to chemotherapy delivery which, in preclinical models, may work synergistically with pazopanib (PZ) in targeting angiogenesis. This study was designed to determine the recommended phase 2 dose (RP2D) of mTP/PZ in pediatric patients with solid tumors, while describing the safety and toxicity of this regimen. Methods: A phase I dose-escalation, pharmacokinetic (PK) and pharmacodynamic (PD) study of mTP/PZ was conducted at ten sites across Canada, enrolling pediatric patients aged 2-21 years with relapsed/refractory solid tumors. Patients were treated with oral mTP and PZ suspension daily without interruption in 28-day cycles, with dose escalation in accordance with the rolling-six design. Five dose levels (0.12/125, 0.16/125, 0.22/125, 0.22/160, and 0.3/160 mg/m2/day of mTP/PZ) were evaluated. PK studies were performed on day 1 and at steady state, and PD studies included circulating angiogenic factors VEGFR1, VEGFR2, VEGF, endoglin and placental growth factor. Results: Thirty patients (pts) were enrolled, of whom 26 were evaluable for dose-limiting toxicity (DLT), with median age 12 years (3-20). The most common diagnoses included osteosarcoma (8), neuroblastoma (NB, 7), Ewing sarcoma/PNET (4), and rhabdomyosarcoma (4). The most common grade 3/4 adverse events (AEs) related to protocol therapy were neutropenia (18%), thrombocytopenia (11%), lymphocytopenia (11%), AST elevation (11%), and lipase elevation (11%). Only 2 cycle-1 DLTs were observed on study, both at the 0.3/160 mg/m2 mTP/PZ dose level (2/5 pts) comprising persistent grade 3 thrombocytopenia and grade 3 ALT elevation. No AEs experienced beyond cycle-1 required treatment discontinuation. Best response was stable disease in 10/25 pts (40%) for a median duration of 6.4 months (1.7-45.1). One patient with refractory NB achieved stable disease for 45 months and continued on mTP/PZ via compassionate access after study closure. PK and PD results are pending at this time. Conclusions: ... |
| Document Type: |
conference object |
| Language: |
English |
| Relation: |
Journal of Clinical Oncology; 2021 ASCO Annual Meeting; Manji, A; Morgenstern, DA; Samson, Y; Deyell, R; Johnston, D; Lewis, VA; Zorzi, AP; Berman, JN; Brodeur-Robb, K; Morrison, E; Baruchel, S; Whitlock, JA, Low-dose metronomic topotecan and pazopanib in children with recurrent or refractory solid tumors: A C17 Canadian phase I trial (TOPAZ), Journal of Clinical Oncology, 2021, 39 (15); https://hdl.handle.net/10072/412126 |
| DOI: |
10.1200/JCO.2021.39.15_suppl.10020 |
| Availability: |
https://hdl.handle.net/10072/412126; https://doi.org/10.1200/JCO.2021.39.15_suppl.10020 |
| Rights: |
open access |
| Accession Number: |
edsbas.A249E581 |
| Database: |
BASE |