1. Multicenter phase 2 study of patupilone for recurrent or progressive brain metastases from non–small cell lung cancer
- Author
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Nayak, Lakshmi, DeAngelis, Lisa M, Robins, H Ian, Govindan, Ramaswamy, Gadgeel, Shirish, Kelly, Karen, Rigas, James R, Peereboom, David M, Rosenfeld, Steven S, Muzikansky, Alona, Zheng, Ming, Urban, Patrick, Abrey, Lauren E, Omuro, Antonio, and Wen, Patrick Y
- Subjects
Brain Cancer ,Lung ,Clinical Research ,Neurosciences ,Rare Diseases ,Brain Disorders ,Clinical Trials and Supportive Activities ,Lung Cancer ,Cancer ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Administration ,Intravenous ,Adult ,Aged ,Antineoplastic Agents ,Brain Neoplasms ,Carcinoma ,Non-Small-Cell Lung ,Disease Progression ,Drug Administration Schedule ,Epothilones ,Female ,Humans ,Lung Neoplasms ,Male ,Middle Aged ,Neoplasm Recurrence ,Local ,Prospective Studies ,Survival Analysis ,Treatment Outcome ,brain metastases ,chemotherapy ,non-small cell lung cancer ,patupilone ,recurrent metastases ,Oncology and Carcinogenesis ,Public Health and Health Services ,Oncology & Carcinogenesis - Abstract
BackgroundTreatment options for patients with non-small cell lung cancer (NSCLC) with brain metastases are limited. Patupilone (EPO906), a blood-brain barrier-penetrating, microtubule-targeting, cytotoxic agent, has shown clinical activity in phase 1/2 studies in patients with NSCLC. This study evaluates the efficacy, pharmacokinetics, and safety of patupilone in NSCLC brain metastases.MethodsAdult patients with NSCLC and confirmed progressive brain metastases received patupilone intravenously at 10 mg/m(2) every 3 weeks. The primary endpoint of this multinomial 2-stage study combined early progression (EP; death or progression within 3 weeks) and progression-free survival at 9 weeks (PFS9w) to determine drug activity.ResultsFifty patients with a median age of 60 years (range, 33-74 years) were enrolled; the majority were men (58%), and most had received prior therapy for brain metastases (98%). The PFS9w rate was 36%, and the EP rate was 26%. Patupilone blood pharmacokinetic analyses showed mean areas under the concentration-time curve from time zero to 504 hours for cycles 1 and 3 of 1544 and 1978 ng h/mL, respectively, and a mean steady state distribution volume of 755 L/m(2) . Grade 3/4 adverse events (AEs), regardless of their relation with the study drug, included diarrhea (24%), pulmonary embolisms (8%), convulsions (4%), and peripheral neuropathy (4%). All patients discontinued the study drug: 31 (62%) for disease progression and 13 (26%) for AEs. Twenty-five of 32 deaths were due to brain metastases. The median time to progression and the overall survival were 3.2 and 8.8 months, respectively.ConclusionsThis is the first prospective study of chemotherapy for recurrent brain metastases from NSCLC. In this population, patupilone demonstrated activity in heavily treated patients.
- Published
- 2015