A Phase I study of raltitrexed, an antifolate thymidylate synthase inhibitor, in adult patients with advanced solid tumors

Jean L. Grem, J. Mel Sorensen, Ellen Cullen, Chris H. Takimoto, Seth M. Steinberg, Alice P. Chen, J. Michael Hamilton, Susan G. Arbuck, Nanette McAtee, David Lawrence, Barry Goldspiel, Patrick G. Johnston, Carmen J. Allegra

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Abstract

The purpose of this study was to perform a Phase I trial of raltitrexed, a selective inhibitor of thymidylate synthase, and to determine the pharmacokinetic and toxicity profiles as a function of raltitrexed dose. Fifty patients with advanced solid tumors and good performance status were treated with raltitrexed as a 15-min i.v. infusion every 3 weeks, at doses escalating from 0.6 to 4.5 mg/m2. Asthenia, neutropenia, and hepatic toxicity were the most common dose-limiting toxicities in this largely pretreated patient population, but they occurred during the initial cycle in only one of nine patients treated with 4.0 mg/m2 and in two of nine patients treated with 4.5 mg/m2. Only 2 of 13 patients treated with 3.5 mg/m2 ultimately experienced unacceptable toxicity after three and seven cycles, compared with 42 and 56% of patients receiving 4.0 and 4.5 mg/m2 after medians of three and two cycles, respectively. The maximum raltitrexed plasma concentration and the area under the plasma concentration-time curve increased in proportion to dose. Raltitrexed clearance was independent of dose and was associated with the estimated creatinine clearance. Asthenia, neutropenia, and hepatic transaminitis were dose-related and tended to occur more frequently when patients received three or more cycles of therapy. A 3- week treatment interval was feasible in the majority of patients at all doses. Although 4.0 mg/m2 appeared to be a safe starting dose in this pretreated patient population, about half who received two or more courses ultimately experienced dose-limiting toxicity. A dose of 3.5 mg/m2 was well tolerated in most patients.

Original languageEnglish (US)
Pages (from-to)2381-2391
Number of pages11
JournalClinical Cancer Research
Volume5
Issue number9
StatePublished - Sep 1 1999

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Folic Acid Antagonists
Thymidylate Synthase
Neoplasms
Asthenia
Neutropenia
raltitrexed
Liver
Population
Creatinine
Pharmacokinetics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Grem, J. L., Sorensen, J. M., Cullen, E., Takimoto, C. H., Steinberg, S. M., Chen, A. P., ... Allegra, C. J. (1999). A Phase I study of raltitrexed, an antifolate thymidylate synthase inhibitor, in adult patients with advanced solid tumors. Clinical Cancer Research, 5(9), 2381-2391.

A Phase I study of raltitrexed, an antifolate thymidylate synthase inhibitor, in adult patients with advanced solid tumors. / Grem, Jean L.; Sorensen, J. Mel; Cullen, Ellen; Takimoto, Chris H.; Steinberg, Seth M.; Chen, Alice P.; Hamilton, J. Michael; Arbuck, Susan G.; McAtee, Nanette; Lawrence, David; Goldspiel, Barry; Johnston, Patrick G.; Allegra, Carmen J.

In: Clinical Cancer Research, Vol. 5, No. 9, 01.09.1999, p. 2381-2391.

Research output: Contribution to journalArticle

Grem, JL, Sorensen, JM, Cullen, E, Takimoto, CH, Steinberg, SM, Chen, AP, Hamilton, JM, Arbuck, SG, McAtee, N, Lawrence, D, Goldspiel, B, Johnston, PG & Allegra, CJ 1999, 'A Phase I study of raltitrexed, an antifolate thymidylate synthase inhibitor, in adult patients with advanced solid tumors', Clinical Cancer Research, vol. 5, no. 9, pp. 2381-2391.
Grem, Jean L. ; Sorensen, J. Mel ; Cullen, Ellen ; Takimoto, Chris H. ; Steinberg, Seth M. ; Chen, Alice P. ; Hamilton, J. Michael ; Arbuck, Susan G. ; McAtee, Nanette ; Lawrence, David ; Goldspiel, Barry ; Johnston, Patrick G. ; Allegra, Carmen J. / A Phase I study of raltitrexed, an antifolate thymidylate synthase inhibitor, in adult patients with advanced solid tumors. In: Clinical Cancer Research. 1999 ; Vol. 5, No. 9. pp. 2381-2391.
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abstract = "The purpose of this study was to perform a Phase I trial of raltitrexed, a selective inhibitor of thymidylate synthase, and to determine the pharmacokinetic and toxicity profiles as a function of raltitrexed dose. Fifty patients with advanced solid tumors and good performance status were treated with raltitrexed as a 15-min i.v. infusion every 3 weeks, at doses escalating from 0.6 to 4.5 mg/m2. Asthenia, neutropenia, and hepatic toxicity were the most common dose-limiting toxicities in this largely pretreated patient population, but they occurred during the initial cycle in only one of nine patients treated with 4.0 mg/m2 and in two of nine patients treated with 4.5 mg/m2. Only 2 of 13 patients treated with 3.5 mg/m2 ultimately experienced unacceptable toxicity after three and seven cycles, compared with 42 and 56{\%} of patients receiving 4.0 and 4.5 mg/m2 after medians of three and two cycles, respectively. The maximum raltitrexed plasma concentration and the area under the plasma concentration-time curve increased in proportion to dose. Raltitrexed clearance was independent of dose and was associated with the estimated creatinine clearance. Asthenia, neutropenia, and hepatic transaminitis were dose-related and tended to occur more frequently when patients received three or more cycles of therapy. A 3- week treatment interval was feasible in the majority of patients at all doses. Although 4.0 mg/m2 appeared to be a safe starting dose in this pretreated patient population, about half who received two or more courses ultimately experienced dose-limiting toxicity. A dose of 3.5 mg/m2 was well tolerated in most patients.",
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