Zafra, A. (Ana)
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- Phase I and pharmacokinetic study of gemcitabine administered at fixed-dose rate, combined with docetaxel/melphalan/carboplatin, with autologous hematopoietic progenitor-cell support, in patients with advanced refractory tumors(Elservier, 2007) Nieto, Y. (Yago); Aldaz, A. (Azucena); Rifon, J. J. (Jose J.); Perez-Calvo, J. (Javier); Zafra, A. (Ana); Zufía, L. (Laura); Viudez, A. (Antonio); Viteri, S. (S.); Aramendia, J.M. (José Manuel); Aristu, J. (Javier); Centeno, C. (Carlos); Moreno, M. (Marta); Sayar, O. (Onintza); Hernandez, M. (Milagros)The purpose of this trial was to define the maximum tolerated duration (MTD), dose-limiting toxicity (DLT), regimen-related toxicities (RRT), and pharmacokinetics of gemcitabine infused at a fixed dose rate (FDR) of 10 mg/m2/min, combined with docetaxel/melphalan/carboplatin, using autologous stem cell transplantation (ASCT). The duration of gemcitabine infusion was incrementally escalated as a single treatment on day −6 or as 4 daily infusions on days −5 to −2. Gemcitabine was followed by docetaxel (300 or 350 mg/m2) on day −5, and then melphalan (50 mg/m2/day) and carboplatin (333 mg/m2/day) on days −4 to −2. Fifty-two patients with refractory tumors were accrued with a median age of 40 (range: 6-66), a median of 3 (1-6) prior chemotherapy regimens, and 3 (1-7) organs involved. The gemcitabine MTD was defined at 20 hours (total dose 12,000 mg/m2) on both schedules. The DLT was enteritis. Three patients died from aspiration, catheter-related sepsis, and enteritis, respectively. The tumor response rate was 91%, with 50% complete responses. At current 2-year median follow-up, the event-free and overall survival (EFS, OS) rates are 54% (median 26 months) and 79% (median not reached), respectively. Gemcitabine area under the curve (AUC), but not clearance, increased linearly with infusion duration, and correlated with grade 3 RRT. Docetaxel showed a linear increase of its AUC and similar clearance compared with prior reports at lower doses. In conclusion, ASCT-supported infusions of gemcitabine at FDR could be prolonged up to 20 hours. The resulting gemcitabine/docetaxel/melphalan/carboplatin combination was highly active in refractory cancers and should be further tested in disease-specific trials.