Paclitaxel poliglumex (PPX-xyotax) and concurrent radiation for esophageal and gastric cancer - A phase I study

Objectives: To determine the maximal tolerated dose (MTD) and dose limiting toxicities of poly(L-glutamic acid)-paclitaxel (PPX) and concurrent radiation (PPX/RT) for patients with esophageal and gastric cancer. Methods: Patients with esophageal or gastric cancer receiving chemoradiation for loco-regional, adjuvant, or palliative intent were eligible. The initial dose of PPX was 40 mg/m(2)/wk, for 6 weeks with 50.4 Gy radiation. Dose levels were increased in increments of 10 mg/m(2)/wk of PPX. Results: Twenty-one patients were enrolled over 5 dose levels. Sixteen patients had esophageal cancer and 5 had gastric cancer. Twelve patients received PPX/RT as definitive loco-regional therapy, 4 patients had undergone resection and received adjuvant PPX/RT, and 5 patients had metastatic disease and received PPX/RT for palliation of dysphagia. Dose limiting toxicities of gastritis, esophagitis, neutropenia, and dehydration developed in 3 of 4 patients treated at the 80 mg/m(2) dose level. Four of 12 patients (33%) with loco-regional disease had a complete clinical response. Conclusions: The maximally tolerated dose of PPX with concurrent radiotherapy is 70 mg/m2/wk for patients with esophageal and gastric cancer.