Phase 1 Study of Tirapazamine in Combination With Radiation and Weekly Cisplatin in Patients With Locally Advanced Cervical Cancer. Issue 5 (1st June 2010)

• Record Type: Journal Article
• Authors: Rischin, Danny; Narayan, Kailash; Oza, Amit M.; Mileshkin, Linda; Bernshaw, David; Choi, Jimin; Hicks, Rodney; McClure, Bev; Fyles, Anthony
• Is Part Of: International journal of gynecological cancer. Volume 20:Issue 5(2010)
• Page Start: 827
• Page End: 833
• Publication Date: 2010-06-01
• Subjects: Tirapazamine -- Cervical cancer -- Chemoradiation -- Hypoxia -- Clinical trials; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1111/IGC.0b013e3181dc827e
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Introduction: Hypoxia is an adverse prognostic factor in locoregionally advanced cervical cancer treated with radiation. The aim of this phase I study was to develop a well-tolerated regimen that added tirapazamine to the standard regimen of radiation and weekly low-dose cisplatin. Methods: Eligible patients had previously untreated carcinoma of the cervix, stages IB2 to IVA. The starting schedule was radiotherapy (45-50.4 Gy external beam radiation followed by brachytherapy), with concomitant weekly intravenous cisplatin, 40 mg/m 2 on weeks 1 to 6 and weekly intravenous tirapazamine, 290 mg/m 2 in weeks 1 to 5. Results: Eleven patients were enrolled. The median age was 52 years (range, 31-65 years). Ten patients had squamous cell carcinoma and 1 patient had adenocarcinoma; 5 patients had stage 1B2 disease, 1 had stage IIA, 3 had stage IIB-3, 1 had stage IIIB, and 1 had stage IVA. The first 2 patients on dose level 1 experienced a dose-limiting toxicity (DLT): 1 experienced grade 3 alanine amino transferase elevation and grade 4 pulmonary embolism, and 1 experienced grade 3 ototoxicity. Doses were decreased to dose level −1 with a 30-mg/m 2 dose of cisplatin and a 260-mg/m 2 dose of tirapazamine. Three patients were treated without any DLTs. Six patients were then treated on dose level −1a: a 35-mg/m 2 dose of cisplatin and a 260-mg/m 2 doses of tirapazamine with 2 DLTs-grade 3 neutropenia with dose omission and grade 4 pulmonary embolism with major hemodynamic compromise. Three of 10 evaluable patients have experienced locoregional failure. Conclusions: The combination of weekly tirapazamine and cisplatin with radiation for locally advanced cervical cancer was associated with more toxicity than anticipated with the recommended dose level being tirapazamine 260 mg/m 2 and cisplatin 30 mg/m 2 . Further study of this weekly schedule is not warranted.