NEW YORKPreliminary data presented at the Chemotherapy
Foundation Symposium XVI suggest that the toposiomerase I inhibitor
irinotecan (Camptosar) in combination with other chemotherapy agents
may be effective in multiple tumor types, including advanced
non-small-cell lung cancer (NSCLC) and advanced esophageal cancer.
Camptosar is approved for use in patients with metastatic colorectal
cancer whose disease has recurred or spread after standard
In a phase II study at Memorial Sloan-Kettering, 36 patients with
metastatic or recurrent esophageal cancer received weekly irinotecan
(65 mg/m²) and cisplatin (Platinol) (30 mg/m²) for 4 weeks
followed by a 2-week break. None of the patients had received prior
chemotherapy or radiotherapy, and only two had undergone esophagectomy.
David Ilson, MD, reported that this combination achieved a 58%
response rate (21/36), including 2 complete responses. Of the 25
patients who reported dysphagia before treatment, 22 (88%) had
resolution or improvement of their symptoms after treatment. Also,
stable quality of life was maintained during treatment as assessed by
the EORTC QLQ-C30.
The most commonly reported grade3-4 toxicities were neutropenia
(30%), diarrhea (11%), nausea and vomiting (6%), and fatigue (3%).
The preliminary data suggest that a weekly regimen of cisplatin
and irinote-can has promising activity in esophageal cancer with
relatively little toxicity and good palliation of dysphagia, he
said. Phase II/III comparative trials against other cisplatin
or paclitaxel [Taxol]-containing regimens are indicated.
The symposium included reports of two trials of irinotecan in NSCLC.
Alan Sandler, MD, of Indiana University School of Medicine, reported
data from a phase I/II multicenter study in which a three-drug
combination was given in a sequence of paclitaxel, 175 mg/m²
over 3 hours; carboplatin (Paraplatin), AUC 5 over 0.5 hours; and
escalating doses of irinotecan (40 to 125 mg/m²) over 1.5 hours,
with all drugs given once every 3 weeks. The median number of cycles
given was 6.
The 31 patients, all with stage IIIB/IV NSCLC, had a response rate of
64.5%, including two complete responses, and half were alive at 1
year, with a median survival of 16.1 months. Adverse effects included
diarrhea, neuropathy, neutropenia, and infection.
While further studies are ongoing, these trials suggest that
combination therapy with Camptosar, paclitaxel, and carboplatin may
be effective in advanced or metastatic non-small-cell lung cancer and
may help improve overall survival rates, Dr. Sandler said.
Russell F. DeVore III, MD, director of Thoracic Oncology, Vanderbilt
University Cancer Center, reported results using the Saltz regimen
(developed at Memorial Sloan-Kettering)cisplatin (30 mg/m²)
plus irinotecan (65 mg/m²) given weekly for 4 to 6 weeks.
This multicenter phase II trial of 50 chemotherapy-naïve
patients with advanced NSCLC showed a 49% response rate (18 of 37
evaluable patients), with median survival of 44 weeks. The most
commonly reported adverse events included manageable symptoms of
diarrhea, neutropenia, vomiting/nausea, and neurosensory deficit.
Overall, this study showed that a weekly cisplatin/Camptosar
regimen appears to be active in patients with non-small-cell lung
cancer, he said.