Potential utility of a longitudinal relative dose intensity of molecularly targeted agents in phase 1 dose‐finding trials. Issue 1 (8th December 2017)

• Record Type: Journal Article
• Authors: Hirakawa, Akihiro; Yonemori, Kan; Kinoshita, Fumie; Kobayashi, Yumiko; Okuma, Hitomi S.; Kawachi, Asuka; Tamura, Kenji; Fujiwara, Yasuhiro; Rubinstein, Larry; Harris, Pamela Jo; Takebe, Naoko
• Is Part Of: Cancer science. Volume 109:Issue 1(2018)
• Page Start: 207
• Page End: 214
• Publication Date: 2017-12-08
• Subjects: maximum tolerated dose -- molecularly targeted agent -- phase 1 trial -- recommended phase 2 dose -- relative dose intensity; Cancer -- Periodicals; Neoplasms -- Periodicals; Research -- Periodicals; Electronic journals; 616.994005
• DOI: 10.1111/cas.13436
• Languages: English
• ISSNs: 1347-9032

Abstract

Abstract : Phase 1 trials of molecularly targeted agents (MTA) often do not use toxicity data beyond the first cycle of treatment to determine a recommended phase 2 dose (RP2D). We investigated the potential utility of longitudinal relative dose intensity (RDI) that may be a better new way of determining a more accurate RP2D as a lower dose that is presumably more tolerable over the long term without compromising efficacy. All consecutive patients who were initially treated using a single MTA at the conventional RP2D or at one level lower dose (OLLD) of that RP2D in 9 phase 1 trials sponsored by the National Cancer Institute were included. The associations between longitudinal RDI, time to first progression, and response rate were analyzed. The RDI of the conventional RP2D group were maintained a rate of ≥70% throughout 10 cycles, and were higher than those of the OLLD group, although in both groups the RDI gradually decreased with additional treatment cycles. The RP2D group was similar to the OLLD group with respect to time to first progression and response rate. In both groups, however, the decreasing RDI over time was significantly associated with shorter time to first disease progression; therefore, the longitudinal RDI, which takes into account lower grade toxicity occurrences, may be useful in determining a more desirable dose to use in phase 2 and 3 studies. Abstract : The longitudinal relative dose intensity (RDI), which takes into account lower grade toxicity occurrences, may be useful in determining a more desirable recommended phase 2 dose (RP2D) of molecularly targeted agents (MTA) to use in phase 2 and 3 studies.