Phase I/II trial of paclitaxel with ifosfamide followed by high-dose paclitaxel, ifosfamide, and carboplatin (TI-TIC) with autologous stem cell reinfusion for salvage treatment of germ cell tumors Journal Article


Authors: Feldman, D. R.; Glezerman, I.; Patil, S.; Van Alstine, L.; Bajorin, D. F.; Fischer, P.; Hughes, A.; Sheinfeld, J.; Bains, M.; Reich, L.; Woo, K.; Giralt, S.; Bosl, G. J.; Motzer, R. J.
Article Title: Phase I/II trial of paclitaxel with ifosfamide followed by high-dose paclitaxel, ifosfamide, and carboplatin (TI-TIC) with autologous stem cell reinfusion for salvage treatment of germ cell tumors
Abstract: In this phase I/II study of paclitaxel with ifosfamide followed by high-dose paclitaxel, ifosfamide, and carboplatin as salvage treatment for patients with relapsed or refractory germ cell tumors, we observed evidence of antitumor activity at all dose levels, particularly the maximum tolerated dose. However, development of chronic progressive renal insufficiency with the highest ifosfamide dose led to premature study closure. Thus, this study adds to the literature regarding the toxicity of combining high-dose ifosfamide with high-dose carboplatin in this population. Background: Salvage high-dose (HD) chemotherapy with autologous stem cell transplant (ASCT), consisting of 2 to 3 sequential cycles of HD carboplatin and etoposide (CE) can achieve durable remissions in approximately half of patients with relapsed germ cell tumors. To improve on these results and based on success with paclitaxel, ifosfamide, and cisplatin (TIP) as salvage conventional-dose chemotherapy, we conducted a phase I/II trial of HD paclitaxel with ifosfamide (TI), substituting carboplatin for cisplatin to allow dose escalation. Patients and Methods: Treatment consisted of 1 to 2 cycles of TI and granulocyte colony-stimulating factor for stem cell mobilization followed by 3 cycles of HD TI with carboplatin (TIC) with ASCT every 21 to 28 days. Twenty-six patients were enrolled. For phase I, a standard 3+3 dose-escalation design was used. Results: With no dose-limiting toxicities observed, the maximum tolerated dose (MTD) was not reached and the highest prespecified dose level (paclitaxel 250 mg/m2, ifosfamide 9990 mg/m2, carboplatin area under the curve 24) was considered the MTD. In phase II, a Simon 2-stage design was used to estimate the complete response (CR) rate at the MTD. With 7 of 11 phase II patients who achieved a CR, efficacy was demonstrated. However, 3 patients developed delayed chronic kidney disease, resulting in premature trial closure. Conclusion: TI-TIC was active in relapsed germ cell tumors but treatment-emergent chronic renal impairment, possibly from overlapping ifosfamide and carboplatin, preclude its further use. TI-CE, consisting of 2 cycles of TI with 3 cycles of HD CE remains the standard of care HD chemotherapy regimen at Memorial Sloan Kettering Cancer Center. © 2015 Elsevier Inc. All rights reserved.
Keywords: adult; clinical article; treatment response; antibiotic agent; antibiotic therapy; fatigue; neutropenia; salvage therapy; cisplatin; area under the curve; cancer combination chemotherapy; drug efficacy; drug withdrawal; hypophosphatemia; unspecified side effect; paclitaxel; drug megadose; carboplatin; multiple cycle treatment; phase 2 clinical trial; anemia; bone marrow suppression; etoposide; blood toxicity; leukopenia; thrombocytopenia; orthostatic hypotension; relapse; stem cell transplant; creatinine; autologous stem cell transplantation; ifosfamide; dyspnea; febrile neutropenia; hyperglycemia; lymphocytopenia; health care quality; alanine aminotransferase; hypokalemia; hyponatremia; hypotension; chronic kidney disease; drug response; testis tumor; stem cell mobilization; remission; teratoma; testicular cancer; maximum tolerated dose; phase 1 clinical trial; prematurity; mesna; drug substitution; malignant transformation; germ cell tumor; granulocyte colony stimulating factor; plerixafor; seminoma; chronic kidney failure; intensive chemotherapy; leukapheresis; mediastinum cancer; second-line; quinolone derivative; human; male; female; article
Journal Title: Clinical Genitourinary Cancer
Volume: 13
Issue: 5
ISSN: 1558-7673
Publisher: Elsevier Inc.  
Date Published: 2015-10-01
Start Page: 453
End Page: 460
Language: English
DOI: 10.1016/j.clgc.2015.05.003
PROVIDER: scopus
PUBMED: 26072101
PMCID: PMC5012646
DOI/URL:
Notes: Export Date: 2 October 2015 -- Source: Scopus
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MSK Authors
  1. Sujata Patil
    386 Patil
  2. Dean Bajorin
    413 Bajorin
  3. Robert Motzer
    762 Motzer
  4. Sergio Andres Giralt
    535 Giralt
  5. Darren Richard Feldman
    172 Feldman
  6. Joel Sheinfeld
    197 Sheinfeld
  7. Patricia Marie Russ Fischer
    19 Fischer
  8. Lilian M Reich
    76 Reich
  9. Manjit S Bains
    229 Bains
  10. George Bosl
    262 Bosl
  11. Amanda Hughes
    10 Hughes
  12. Kaitlin Marie Woo
    97 Woo