Phase I study of gemcitabine, docetaxel and imatinib in refractory and relapsed solid tumors

Abstract

Purpose: In a phase I study, the combination of gemcitabine and imatinib was well tolerated with broad anticancer activity. This phase I trial evaluated the triplet of docetaxel, gemcitabine and imatinib.

Experimental design: Imatinib was administered at 400 mg daily on days 1-5, 8-12 and 15-19. Gemcitabine was started at 600 mg/m(2) at a rate of 10 mg/min on days 3 and 10 and docetaxel at 30 mg/m(2) on day 10, on a 21-day cycle. Diffusion and dynamic contrast-enhanced perfusion MRI was performed in selected patients.

Results: Twenty patients with relapsed/refractory solid tumors were enrolled in this IRB-approved study. The mean age was 64, and mean ECOG PS was 1. Two patients were evaluated by diffusion/perfusion MRI. After two grade 3 hematological toxicities at dose level 1, the protocol was amended to reduce the dose of imatinib. MTDs were 600 mg/ m(2) on days 3 and 10 for gemcitabine, 30 mg/ m(2) on day 10 for docetaxel, and 400 mg daily on days 1-5 and 8-12 for imatinib. Dose limiting toxicities after one cycle were neutropenic fever, and pleural and pericardial effusions. The best response achieved was stable disease, for six cycles, in one patient each with mesothelioma and non small cell lung cancer (NSCLC) at the MTD. Two patients with NSCLC had stable disease for four cycles.

Discussion: An unexpectedly low MTD for this triplet was identified. Our results suggest drug-drug interactions that amplify toxicities with little evidence of improved tumor control.

Fig. 1

MRI imaging with conventional (top row) and perfusion (bottom row) sequences in a patient with uterine leiomyosarcoma showing variable microvascular permeability (Ktrans) at baseline (left), cycle 1 day 10 (middle), and on cycle 2 day 3 (right) of therapy

Fig. 2

MRI images in the same patient with uterine leiomyosarcoma showing conventional (top row) and diffusion sequences (bottom row) prior to(left), on cycle 1 day 10 (middle), and on cycle 2 day 3 (right) of therapy. Images reveal an increase in diffusion (ADC or water mobility) as therapy progresses