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A Phase I Trial of Perifosine (NSC 639966) on a Loading Dose/Maintenance Dose Schedule in Patients with Advanced Cancer
Perifosine (NSC 639966) is a synthetic, substituted heterocyclic alkylphosphocholine that acts primarily at the cell membrane targeting signal transduction pathways. Early clinical trials were limited because of dose-limiting gastrointestinal toxicity, and parenteral dosing of this class of agents i...
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Published in: | Clinical cancer research 2004-11, Vol.10 (22), p.7450-7456 |
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Main Authors: | , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Perifosine (NSC 639966) is a synthetic, substituted heterocyclic alkylphosphocholine that acts primarily at the cell membrane
targeting signal transduction pathways. Early clinical trials were limited because of dose-limiting gastrointestinal toxicity,
and parenteral dosing of this class of agents is not possible because of their hemolytic properties; therefore, related compounds
with an improved therapeutic index were developed. Toxicity was minimized and efficacy improved by using a loading dose/maintenance
dose schedule, and therefore, this schedule was carried into clinical trials. This phase I trial enrolled 42 patients with
incurable solid malignancies. The starting doses were 100 mg p.o. × four doses (every 6 hours) load followed by a 50 mg p.o.
once daily maintenance dose with escalation of either component in successive dose levels. No treatment related deaths occurred.
The maximum-tolerated dose was determined to be 150 mg p.o. × four doses load and 100 mg p.o. once daily maintenance. Dose-limiting
toxicities such as nausea, diarrhea, dehydration, and fatigue were seen early during the loading phase and were surmountable
with the use of prophylactic 5-HT 3 receptor antagonists, dexamethasone, and loperamide. Toxicities during the chronic phase were difficult to manage and, given
that pharmacokinetic data showed biologically active serum concentrations (based on preclinical data), raised the question
of less frequent maintenance dosing. Pharmacokinetic data confirmed the maintenance of stable drug levels with chronic dosing
and the long half-life. One partial response was seen, as were multiple patients with stable disease beyond course 2. These
results suggest perifosine activity in sarcoma and perhaps renal cell carcinoma (stable disease in two patients who continued
for 6 and 14 courses), thus justifying additional investigation of this agent in a phase II sarcoma trial. |
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ISSN: | 1078-0432 1557-3265 |
DOI: | 10.1158/1078-0432.CCR-03-0406 |