Cefixime Allows Greater Dose Escalation of Oral Irinotecan: A Phase I Study in Pediatric Patients With Refractory Solid Tumors
- 1 February 2006
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 24 (4), 563-570
- https://doi.org/10.1200/jco.2005.03.2847
Abstract
Purpose: Irinotecan is active against a variety of malignancies; however, severe diarrhea limits its usefulness. In our phase I study, the intravenous formulation of irinotecan was administered orally daily for 5 days for 2 consecutive weeks (repeated every 21 days) to children with refractory solid tumors. Our objectives were to determine the maximum-tolerated dose (MTD), dose-limiting toxicity, and pharmacokinetics of oral irinotecan and to evaluate whether coadministration of cefixime (8 mg/kg/d beginning 5 days before irinotecan and continuing throughout the course) ameliorates irinotecan-induced diarrhea. Patients and Methods: In separate cohorts, irinotecan doses were escalated from 15 to 45 mg/m2/d without cefixime and then from 45 to 60 and 75 mg/m2/d with cefixime. Results: Without cefixime, diarrhea was dose limiting at irinotecan 45 mg/m2/d. Myelotoxicity was not significant at any dose. The MTD was 40 mg/m2/d without cefixime but 60 mg/m2/d with cefixime. Systemic exposure to SN-38 at the MTD was significantly higher with cefixime than without cefixime (mean SN-38 area under the curve: 19.5 ng×h/mL; standard deviation [SD], 6.8 ng × h/mL v 10.4 ng × h/mL; SD, 4.3 ng × h/mL, respectively; P = .030). Conclusion: Cefixime administered with oral irinotecan is well tolerated in children and allows greater dose escalation of irinotecan. Because diarrhea is a major adverse effect of both intravenous and oral irinotecan, further evaluation of the use of cefixime to ameliorate this adverse effect is warranted.Keywords
This publication has 33 references indexed in Scilit:
- Phase I study of an oral formulation of irinotecan administered daily for 14 days every 3 weeks in patients with advanced solid tumoursCancer Chemotherapy and Pharmacology, 2004
- Discovery of Novel Selective Inhibitors of Human Intestinal Carboxylesterase for the Amelioration of Irinotecan-Induced Diarrhea: Synthesis, Quantitative Structure-Activity Relationship Analysis, and Biological ActivityMolecular Pharmacology, 2004
- A Phase I and Pharmacokinetic Study of Irinotecan Given as a 7-Day Continuous Infusion in Metastatic Colorectal Cancer Patients Pretreated with 5-Fluorouracil or RaltitrexedClinical Cancer Research, 2004
- A Phase I Study of Irinotecan As a 3-Week Schedule in Children With Refractory or Recurrent Solid TumorsJournal of Clinical Oncology, 2003
- Methods for testing equality of means of health care costs in a paired design studyStatistics in Medicine, 2001
- Irinotecan plus Fluorouracil and Leucovorin for Metastatic Colorectal CancerNew England Journal of Medicine, 2000
- The clinical status of irinotecan (CPT-11), a novel water soluble camptothecin analogue: 1996Critical Reviews in Oncology/Hematology, 1996
- Irinotecan (CPT-11) and Characteristic Mucosal Changes in the Mouse Ileum and CecumJNCI Journal of the National Cancer Institute, 1995
- Efficacy of topoisomerase I inhibitors, topotecan and irinotecan, administered at low dose levels in protracted schedules to mice bearing xenografts of human tumorsCancer Chemotherapy and Pharmacology, 1995
- Safety profile of cefiximeThe Pediatric Infectious Disease Journal, 1987