A Phase I Safety and Pharmacologic Study of a Twice Weekly Dosing Regimen of the Oral Taxane BMS-275183

Abstract

Purpose: BMS-275183, an orally administered C-4 methyl carbonate paclitaxel analogue, showed promising activity in a phase I trial investigating a weekly treatment regimen, but was associated with a relatively high incidence of neuropathic side effects.The current dose escalation phase I trial was initiated to investigate whether twice weekly administration of BMS-275183 would improve its safety and tolerability. Additionally, the pharmacokinetics and possible antitumor activity were studied. Experimental Design: A cycle consisted of 4 weeks (i.e., eight twice weekly oral doses). The starting dose was 60 mg/m 2 and the dose was increased by 20 mg/m 2 increments. Cohorts consisted of three patients and were expanded to at least six patients when toxicity was encountered. Plasma pharmacokinetics were done on days 1and 15. Results: A total of 38 patients were enrolled. The maximum tolerated dose was 100 mg/m 2 twice weekly. Seventeen patients were treated at the maximum tolerated dose; 3 of 17 patients experienced a dose-limiting toxicity, consisting of a combination of neutropenia, neuropathy, and diarrhea. BMS-275183 seemed to have a considerably lower incidence of neuropathic side effects compared with the weekly treatment regimen. Confirmed partial responses were observed in two patients with non^small cell lung cancer, one patient with prostate cancer, and one patient with melanoma. In addition, a long-lasting prostate-specific antigen response was observed in a patient with prostate carcinoma with nonmeasurable disease. Conclusions: BMS-275183 is preferably given in a twice weekly regimen and has considerable antitumor activity. A phase II trial in non^small cell lung cancer using the twice weekly schedule has been initiated.

Effect of Food on the Pharmacokinetic Behavior of the Potent Oral Taxane BMS-275183

“…The relatively high interpatient variability for BMS-275183 observed in this trial is not unprecedented and was also found in our previous studies (1,12). This may be due to variation in the absorption of the drug, combined with individual differences in metabolism.…”

“…This lower dose may explain the apparent better tolerability observed in the present trial. A third phase I trial with BMS-275183 was conducted, investigating a twice-weekly dosing regimen (12). From this latter study, it was concluded that BMS-275183 is preferably given in a twice-weekly schedule.…”

CYP3A4-Mediated Ester Cleavage as the Major Metabolic Pathway of the Oral Taxane 3′-tert-Butyl-3′-N-tert-butyloxycarbonyl-4-deacetyl-3′-dephenyl-3′-N-debenzoyl-4-O-methoxycarbonyl-paclitaxel (BMS-275183)

“…BMS-275183 was synthesized as a part of a program to identify taxanes with potential for oral use in the treatment of cancers (Bröker et al, 2007). The compound is a C-4 methyl carbonate analog of paclitaxel that contains additional modifications in the side chain where the two phenyl groups of paclitaxel were replaced by t-butyl groups (Bröker et al, 2007).…”

“…The compound is a C-4 methyl carbonate analog of paclitaxel that contains additional modifications in the side chain where the two phenyl groups of paclitaxel were replaced by t-butyl groups (Bröker et al, 2007). BMS-275183 exhibited good oral bioavailability in both rat and dog and showed antitumor activity comparable with intravenous paclitaxel (Frapolli et al, 2006).…”

“…Paclitaxel and docetaxel are administered to patients intravenously because of their poor oral bioavailability. Oral treatment with this class of chemotherapy agents would increase convenience to patients, reduce cost of administration, and allow the use of chronic treatment regimens.BMS-275183 was synthesized as a part of a program to identify taxanes with potential for oral use in the treatment of cancers (Bröker et al, 2007). The compound is a C-4 methyl carbonate analog of paclitaxel that contains additional modifications in the side chain where the two phenyl groups of paclitaxel were replaced by t-butyl groups (Bröker et al, 2007).…”