Phase I trial of sorafenib in combination with gefitinib in patients with refractory or recurrent non - Small cell lung cancer

Alex A. Adjei, Julian R. Molina, Sumithra J. Mandrekar, Randolph Marks, Joel R. Reid, Gary Croghan, Lorelei J. Hanson, Ames R. Jett, Chenghua Xia, Chetan Lathia, Ronit Simantov

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Abstract

Purpose: To evaluate the combination of sorafenib and gefitinib in patients with advanced non-small cell lung cancer. Experimental Design: In this dose-escalation trial, patients received oral sorafenib (200-400 mg) twice daily with gefitinib (250 mg orally) once daily to identify the recommended dose for phase II trials (RDP; part A). The pharmacokinetics of the RDP were characterized further in additional patients (part B) receiving single-agent gefitinib or sorafenib for 21 days followed by a 7-day washout with crossover to the other agent for an additional 21 days. Patients then received the combination of sorafenib plus gefitinib in 28-day cycles. Safety, pharmacokinetics, and anti-tumor efficacy were evaluated. Potential drug-drug interactions and the relationship between pharmacokinetics and toxicity were also assessed. Results: Thirty-one patients were treated (n = 12, part A; n = 19, part B). Most adverse events were grade 1/2. The most frequent grade 3/4 events included diarrhea and elevated alanine aminotransferase (both 9.7%). One dose-limiting toxicity occurred (part A: elevated alanine amino-transferase at 400 mg twice daily). Gefitinib had no effect on sorafenib pharmacokinetics. However, gefitinib Cmax (26%) and area under the curve (38%) were reduced by concomitant sorafenib. One patient had a partial response; 20 (65%; n = 8, part A; n = 12, part B) had stable disease ≥4 months. The RDP was sorafenib 400 mg twice daily with gefitinib 250 mg once daily. Conclusions: Sorafenib combined with gefitinib is well tolerated, with promising efficacy in patients with advanced non - small cell lung cancer. Studies to further investigate the significance of the reduction in gefitinib exposure by sorafenib are warranted.

Original languageEnglish (US)
Pages (from-to)2684-2691
Number of pages8
JournalClinical Cancer Research
Volume13
Issue number9
DOIs
StatePublished - May 1 2007

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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