Phase I clinical trial of weekly combretastatin A4 phosphate: Clinical and pharmacokinetic results

Purpose: A phase I trial was performed with combretastatin A4 phosphate (CA4P), a novel tubulin-binding agent that has been shown to rapidly reduce blood flow in animal tumors. Patients and Methods: The drug was delivered by a 10-minute weekly infusion for 3 weeks followed by a week gap, with intrapatient dose escalation. Dose escalation was accomplished by doubling until grade 2 toxicity was seen. The starting dose was 5 mg/m(2). Results: Thirty-four patients received 167 infusions. CA4P was rapidly converted to the active combretastatin A4 (CA4), which was further metabolized to the glucuronide. CA4 area under the curve (AUC) increased from 0.169 at 5 mg/m(2) to 3.29 mumol . h/L at 114 mg/m(2). The mean CA4 AUC in eight patients at 68 mg/m(2) was 2.33 mumol . h/L compared with 5.8 mumol . h/L at 25 mg/kg (the lowest effective dose) in the mouse. The only toxicity that possibly was related to the drug dose up to 40 mg/m(2) was tumor pain. Dose-limiting toxicity was reversible ataxia at 114 mg/m(2), vasovagal syncope and motor neuropathy at 88 mg/m(2), and fatal ischemia in previously irradiated bowel at 52 mg/m(2). Other drug-related grade 2 or higher toxicities seen in more than one patient were pain, lymphopenia, fatigue, anemia, diarrhea, hypertension, hypotension, vomiting, visual disturbance, and dyspnea. One patient at 68 mg/m(2) had improvement in liver metastases of adrenocortical carcinoma. Conclusion: CA4P was well tolerated in 14 of 16 patients at 52 or 68 mg/m(2); these are doses at which tumor blood flow reduction has been recorded.