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Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study
PURPOSE: A phase I/II study of intrathecal pemetrexed (IP) combined with involved-field radiotherapy (IFRT) was performed to determine feasibility, safety, and antitumor activity for leptomeningeal metastases (LM) from solid tumors. METHODS: Participants first received induction IP administration, f...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370561/ https://www.ncbi.nlm.nih.gov/pubmed/32733606 http://dx.doi.org/10.1177/1758835920937953 |
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author | Pan, Zhenyu Yang, Guozi He, Hua Cui, Jiuwei Li, Wei Yuan, Tingting Chen, Kunzhi Jiang, Tongchao Gao, Pengxiang Sun, Yanan Cong, Xiaofeng Li, Zhi Wang, Yongxiang Pang, Xiaochuan Song, Yuanyuan Zhao, Gang |
author_facet | Pan, Zhenyu Yang, Guozi He, Hua Cui, Jiuwei Li, Wei Yuan, Tingting Chen, Kunzhi Jiang, Tongchao Gao, Pengxiang Sun, Yanan Cong, Xiaofeng Li, Zhi Wang, Yongxiang Pang, Xiaochuan Song, Yuanyuan Zhao, Gang |
author_sort | Pan, Zhenyu |
collection | PubMed |
description | PURPOSE: A phase I/II study of intrathecal pemetrexed (IP) combined with involved-field radiotherapy (IFRT) was performed to determine feasibility, safety, and antitumor activity for leptomeningeal metastases (LM) from solid tumors. METHODS: Participants first received induction IP administration, followed by concomitant radiotherapy within 3 days. The concomitant regimen consisted of IP (pemetrexed 10 mg, dexamethasone 5 mg, once per week, 4 times in 4 weeks) and IFRT (40 Gy in 20 fractions). Six participants were recruited to assess feasibility in phase I, and then 28 patients were recruited further. All patients were assessed to investigate safety, efficacy, and outcomes. RESULTS: Between April 2018 and December 2018, 34 patients (male: 15; female: 19; median age: 56 years) were enrolled, including non-small-cell lung cancer (21), small-cell lung cancer (5), breast cancer (4), and others (4). Thirty-two patients received concurrent therapy and 25 (74%) patients completed the treatment. Major adverse events (AEs) consisted of myelosuppression, the elevation of hepatic aminotransferases, and radiculitis. Total AEs rate was 53% (18/34), including 6 (18%) patients with grade 3 and 1 (3%) with grade 4 AEs. The response rate was 68% (23/34). The median overall survival was 5.5 (0.3–16.6) months. Median neurological progression-free survival (NPFS) was 3.5 (0.3–15.2) months. Six-month NPFS rate was 47%. One-year survival rate was 21.6%. CONCLUSION: IP at a 10 mg dose on a schedule of 1–2 times per week presented good efficacy and safety in CSF. The concomitant regimen is an efficacious therapeutic option for LM patients with solid tumors. TRIAL REGISTRATION: This study (IPLM) was registered at https://register.clinicaltrials.gov [ClinicalTrials.gov identifier: NCT03507244]. |
format | Online Article Text |
id | pubmed-7370561 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-73705612020-07-29 Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study Pan, Zhenyu Yang, Guozi He, Hua Cui, Jiuwei Li, Wei Yuan, Tingting Chen, Kunzhi Jiang, Tongchao Gao, Pengxiang Sun, Yanan Cong, Xiaofeng Li, Zhi Wang, Yongxiang Pang, Xiaochuan Song, Yuanyuan Zhao, Gang Ther Adv Med Oncol Original Research PURPOSE: A phase I/II study of intrathecal pemetrexed (IP) combined with involved-field radiotherapy (IFRT) was performed to determine feasibility, safety, and antitumor activity for leptomeningeal metastases (LM) from solid tumors. METHODS: Participants first received induction IP administration, followed by concomitant radiotherapy within 3 days. The concomitant regimen consisted of IP (pemetrexed 10 mg, dexamethasone 5 mg, once per week, 4 times in 4 weeks) and IFRT (40 Gy in 20 fractions). Six participants were recruited to assess feasibility in phase I, and then 28 patients were recruited further. All patients were assessed to investigate safety, efficacy, and outcomes. RESULTS: Between April 2018 and December 2018, 34 patients (male: 15; female: 19; median age: 56 years) were enrolled, including non-small-cell lung cancer (21), small-cell lung cancer (5), breast cancer (4), and others (4). Thirty-two patients received concurrent therapy and 25 (74%) patients completed the treatment. Major adverse events (AEs) consisted of myelosuppression, the elevation of hepatic aminotransferases, and radiculitis. Total AEs rate was 53% (18/34), including 6 (18%) patients with grade 3 and 1 (3%) with grade 4 AEs. The response rate was 68% (23/34). The median overall survival was 5.5 (0.3–16.6) months. Median neurological progression-free survival (NPFS) was 3.5 (0.3–15.2) months. Six-month NPFS rate was 47%. One-year survival rate was 21.6%. CONCLUSION: IP at a 10 mg dose on a schedule of 1–2 times per week presented good efficacy and safety in CSF. The concomitant regimen is an efficacious therapeutic option for LM patients with solid tumors. TRIAL REGISTRATION: This study (IPLM) was registered at https://register.clinicaltrials.gov [ClinicalTrials.gov identifier: NCT03507244]. SAGE Publications 2020-07-17 /pmc/articles/PMC7370561/ /pubmed/32733606 http://dx.doi.org/10.1177/1758835920937953 Text en © The Author(s), 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Pan, Zhenyu Yang, Guozi He, Hua Cui, Jiuwei Li, Wei Yuan, Tingting Chen, Kunzhi Jiang, Tongchao Gao, Pengxiang Sun, Yanan Cong, Xiaofeng Li, Zhi Wang, Yongxiang Pang, Xiaochuan Song, Yuanyuan Zhao, Gang Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study |
title | Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study |
title_full | Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study |
title_fullStr | Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study |
title_full_unstemmed | Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study |
title_short | Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study |
title_sort | intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-csf therapy for leptomeningeal metastases from solid tumors: a phase i/ii study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370561/ https://www.ncbi.nlm.nih.gov/pubmed/32733606 http://dx.doi.org/10.1177/1758835920937953 |
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