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First-in-man phase I study assessing the safety and pharmacokinetics of a 1-hour intravenous infusion of the doxorubicin prodrug DTS-201 every 3 weeks in patients with advanced or metastatic solid tumours

Published:October 19, 2017DOI:https://doi.org/10.1016/j.ejca.2017.09.009

      Highlights

      • This first-in-man clinical trial established the safety, pharmacokinetics, maximum tolerated and recommended phase II dose for the doxorubicin (Dox) prodrug DTS-201 in solid tumour patients.
      • DTS-201 was administered at four dose levels ranging from 80 to 400 mg/m2, equivalent to 45–225 mg/m2 of conventional Dox per administration, resulting in high cumulative anthracycline exposure.
      • Diarrhoea, vomiting and neutropenia were dose limiting and 400 mg/m2 DTS-201 was the maximum tolerated and recommended phase II dose for the enzyme-activated prodrug.
      • DTS-201 is well tolerated and safe in solid tumour patients and is not associated with treatment-related severe cardiac adverse events, even at very high acute and cumulative anthracycline doses tested.
      • More than half of the patients derived clinical benefit during treatment with DTS-201, achieving either disease stabilisation or a confirmed partial response.

      Abstract

      Purpose

      DTS-201 is a doxorubicin (Dox) prodrug that shows encouraging data in experimental models in terms of both efficacy and safety compared with conventional Dox. The purpose of this phase I study was to assess the safety profile, to establish the recommended dose (RD) for clinical phase II studies and to assess potential anticancer activity of the compound.

      Experimental design

      DTS-201 was administered as a 1-hour infusion every 3 weeks in eligible patients with advanced solid tumours according to common clinical phase I criteria. Dose escalation was performed according to a modified Fibonacci schema.

      Results

      Twenty-five patients with a median age of 58 years (range, 30–72) were enrolled in the study. The median number of treatment cycles was 2 (range, 1–8). DTS-201 was administered at four dose levels (DLs) ranging from 80 to 400 mg/m2, which is equivalent to 45–225 mg/m2 of conventional Dox. No dose-limiting toxicity (DLT) occurred at the first two DLs. Three DLTs were observed at DL3 and DL4 (diarrhoea for DL3, vomiting and neutropenia for DL4). DL4 (400 mg/m2) was considered the maximum tolerated dose. Myelosuppression was the main toxicity, and NCI-CTC grade III–IV neutropenia was common at RD. Non-haematological adverse reactions were mild to moderate and included nausea, anorexia, asthenia and alopecia. No treatment-related severe cardiac adverse events were observed.

      Conclusions

      DTS-201 is well tolerated and safe in heavily pretreated solid tumour patients. A high equivalent dose of Dox could be delivered without severe drug-related cardiac events. DTS-201 showed evidence of clinical activity with a confirmed partial response in a patient with soft-tissue sarcoma. The recommended phase II dose is 400 mg/m2.

      Keywords

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