Phase II and pharmacokinetic trial of rebeccamycin analog in advanced biliary cancers

Afshin Dowlati, James Posey, Ramesh K. Ramanathan, Linda Rath, Pingfu Fu, Amitabh Chak, Smitha Krishnamurthi, Joanna Brell, Stephen Ingalls, Charles L. Hoppel, Percy Ivy, Scot C. Remick

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Purpose: Advanced cancers of the bile duct and gallbladder carry an ominous prognosis. Rebeccamycin analogue (RA) is a novel antitumor antibiotic where phase I trials suggested clinical efficacy in patients with biliary cancers. Methods: The primary objective was to determine the response rate to RA in patients with advanced gallbladder and bile duct tumors. Secondary endpoints were survival and pharmacokinetic characterization. RA was given at a dose 165 mg/(m2 day) × 5 days every 3 weeks. Results: Forty-six patients were enrolled. Nine patients were removed from study before their first planned imaging study for response. Two patients had partial responses and 16 had stable disease. On an intent-to-treat analysis the median survival was 6.3 months. A >20% drop in CA19.9 was seen in 43% of patients with initial high levels. Grade 4 neutropenia and thrombocytopenia were seen in 35 and 5% of patients, respectively. Febrile neutropenia occurred in 16% of patients. The pharmacokinetic profile of this trial closely resembles those of prior phase I trials. Measured biliary concentrations of RA were as much as 100× greater than simultaneous plasma concentration. Conclusion: Although RA has a response rate of 5% in advanced biliary cancers, it is associated with significant numbers of patients experiencing prolonged stable disease. Biliary concentrations of RA are significantly greater than plasma concentrations.

Original languageEnglish (US)
Pages (from-to)73-78
Number of pages6
JournalCancer chemotherapy and pharmacology
Volume65
Issue number1
DOIs
StatePublished - Apr 28 2009

Keywords

  • Biliary cancer
  • Gallbladder cancer
  • Phase II trial

ASJC Scopus subject areas

  • Oncology
  • Toxicology
  • Pharmacology
  • Cancer Research
  • Pharmacology (medical)

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    Dowlati, A., Posey, J., Ramanathan, R. K., Rath, L., Fu, P., Chak, A., Krishnamurthi, S., Brell, J., Ingalls, S., Hoppel, C. L., Ivy, P., & Remick, S. C. (2009). Phase II and pharmacokinetic trial of rebeccamycin analog in advanced biliary cancers. Cancer chemotherapy and pharmacology, 65(1), 73-78. https://doi.org/10.1007/s00280-009-1005-x