Journal
EBIOMEDICINE
Volume 82, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.ebiom.2022.104151
Keywords
PIPAC; Nanoparticle; Paclitaxel; Peritoneal carcinomatosis; Peritoneal metastases
Funding
- Kom op tegen Kanker (Flemish League against Cancer)
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In this Phase I study, the tolerability, safety, pharmacokinetics, and tumour response of nanoparticle albumin bound paclitaxel (NAB-PTX) during pressurized intraperitoneal aerosolized chemotherapy (PIPAC) were investigated. The results showed a favorable pharmacokinetic profile and promising anticancer activity of PIPAC with NAB-PTX in patients with unresectable peritoneal metastases.
Background Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a novel method to treat patients with peritoneal metastases (PM). We aimed to study the tolerability, safety, pharmacokinetics, and tumour response of nanoparticle albumin bound paditaxel (NAB-PTX) during PIPAC in a Phase I study. Methods Eligible patients with biopsy-proven PM from ovarian, breast, gastric, hepatobiliary, or pancreatic origin underwent three PIPAC treatments using NAB-PTX with a four-week interval. The dose of NAB-PTX was escalated from 35 to 140 mg/m(2) using a Bayesian design to estimate the maximum tolerated dose (MTD). Findings Twenty-three patients were induded; thirteen (65%) patients combined PIPAC therapy with continued systemic chemotherapy. The most frequent toxicities were liver toxicity and anaemia. Treatment resulted in seven (35%) responders, six (30%) non-responders and seven (35%) patients with stable PM. Systemic absorption of NAB-PTX was slow, with median peak plasma concentrations reached after 3 to 4 h. Median NAB-PTX tumour tissue concentrations suggested accumulation: 14.6 ng/mg, 19.2 ng/mg and 40.8 ng/mg after the first, second and third PIPAC procedure respectively. EORTC QoL and VAS scores remained stable. Overall survival after one year was 57%. Interpretation PIPAC with NAB-PTX results in a favourable PK profile and promising anticancer activity in patients with unresectable PM. The MTD and recommended Phase II clinical trial dose are 140 mg/m(2). In patients with impaired hepatobiliary function, a dose of 112.5 mg/m(2) is recommended. Copyright (C) 2022 The Author(s). Published by Elsevier B.V.
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