Purpose: This phase I study evaluated the feasibility, safety, pharmacokinetics (PK), and preliminary evidence of anticancer activity of the sequential administration of paclitaxel and trabectedin on an every-2-week schedule in patients with refractory solid malignancies. The study also sought to determine the maximum tolerated dose (MTD) level on this schedule, as well as to recommend doses for diseasedirected studies.Experimental Design: Twenty-seven patients were treated with paclitaxel (80-120 mg/m 2 ; 1-hour i.v.infusion, day 1) and trabectedin (0.525-0.775 mg/m 2 ; 3-hour i.v. infusion, day 2) with doses increased in successive cohorts. Blood sampling for PK and drug-drug interaction studies was done.Results: Neutropenia, which resulted in treatment delay exceeding 1 week, was the principal doselimiting toxicity for this paclitaxel-trabectedin regimen and precluded dose escalation above 120 mg/m 2 paclitaxel and 0.650 mg/m 2 trabectedin. At the MTD (120 mg/m 2 paclitaxel and 0.650 mg/m 2 trabectedin), the safety profile was favorable in patients receiving cumulative treatment. Relevant drug-drug PK interactions between paclitaxel and trabectedin were not identified. A patient with soft tissue sarcoma had a complete response and several patients with various refractory solid malignancies showed protracted stable disease as their best response.
Conclusions:The MTD level of sequential paclitaxel 1-hour infusion (day 1) and trabectedin 3-hour infusion (day 2) administered every 2 weeks is 120 and 0.650 mg/m 2 , respectively. The manageable toxicities at the MTD, preliminary evidence of antitumor activity, and lack of notable PK drug-drug interactions warrant further disease-directed studies of this regimen in relevant tumor types and settings.Clin Cancer Res; 16(9); 2656-65. ©2010 AACR.Trabectedin, a marine-derived antineoplastic agent initially isolated from the tunicate Ecteinascidia turbinata and currently produced synthetically, is a first-in-class antitumor agent with a complex mechanism of action at the level of transcription (1-3). As a single agent, trabectedin has shown antitumor activities in soft tissue sarcoma (STS; ref. 4) as well as in patients with several types of cancer, such as ovarian (5-7) and breast cancer (8), in which paclitaxel plays a principal role in therapeutic management and confers robust clinical benefit.In addition to clinical pragmatism as support for evaluating the combination of trabectedin and paclitaxel in the clinical settings, in which there is relevant single-agent activity, several preclinical studies have shown favorable interactions between these agents. For example, treatment of human CALU-3 lung and MCF-7 breast carcinoma xenografts with the combination of trabectedin and paclitaxel resulted in at least additive cytotoxicity (9). Furthermore, sequence-dependent cytotoxic synergism between trabectedin and paclitaxel has been noted in human HT-1080 and HS-18 sarcoma in vitro (10). Cytotoxic synergism was apparent when paclitaxel treatment occurred before trabe...