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1996-03-09
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Document 0421
DOCN M9650421
TI Cyclosporin A does not reverse clinical resistance to paclitaxel in
patients with relapsed non-Hodgkin's lymphoma.
DT 9605
AU Sarris AH; Younes A; McLaughlin P; Moore D; Hagemeister F; Swan F;
Rodriguez MA; Romaguera J; North L; Mansfield P; Callendar D; Mesina O;
Cabanillas F; Department of Hematology, University of Texas M.D.
Anderson; Cancer Center, Houston 77030, USA.
SO J Clin Oncol. 1996 Jan;14(1):233-9. Unique Identifier : AIDSLINE
MED/96140305
AB PURPOSE: Cyclosporin A has been shown to reverse paclitaxel resistance
in vitro by inhibiting P-gp function. Therefore, we determined whether
addition of cyclosporine to paclitaxel reversed clinical paclitaxel
resistance in patients with non-Hodgkin's lymphoma (NHL). PATIENTS AND
METHODS: Patients with relapsed NHL were eligible if they had no
intervening treatment after failure to respond to paclitaxel (200 mg/m2
over 3 hours), and if they had adequate marrow, renal, and hepatic
function, no serious cardiac disease, no CNS involvement, and no
antibodies to human immunodeficiency virus-1. A cyclosporin A bolus dose
(5 mg/kg over 3 hours) was followed by intravenous infusion (15 mg/kg)
over 24 hours. Six hours after the beginning of cyclosporin A, the
immediately preceding paclitaxel dose was administered over 3 hours. All
patients were premedicated with dexamethasone, diphenhydramine, and
cimetidine. Response was assessed after two cycles, and those patients
who achieved at least a partial response received a maximum of six
courses. RESULTS: All 26 patients entered were assessable for toxicity
and 25 were assessable for response. One patient whose disease had
progressed during paclitaxel treatment had a partial remission after the
addition of cyclosporin A (response rate, 4%; 95% confidence interval,
1% to 20%). Disease progressed in 17 patients (71%) and did not respond
in seven (25%). Serum cyclosporin A A levels measured at the time of
initiation of paclitaxel infusion were greater than 2,000 ng/mL during
81% of cycles. Treatment toxicity included peripheral neuropathy in 57%,
myalgia or arthralgia in 30%, neutropenia in 53%, neutropenic fever in
8%, and thrombocytopenia in 42% of patients. One patient with
preexisting asthma had an acute bronchospasm during the first cycle and
was removed from the study. There were no renal or hepatic toxicity and
no infectious or hemorrhagic deaths. CONCLUSION: Cyclosporin A
administered on this schedule did not reverse established clinical
resistance to paclitaxel, which suggests that P-gp-mediated drug efflux
is unlikely to be the only cause of paclitaxel resistance in this
patient population.
DE Adult Aged Antineoplastic Agents, Combined/ADVERSE
EFFECTS/*THERAPEUTIC USE Cimetidine/ADMINISTRATION & DOSAGE Cross-Over
Studies Cyclosporine/BLOOD/*THERAPEUTIC USE
Dexamethasone/ADMINISTRATION & DOSAGE Diphenhydramine/ADMINISTRATION &
DOSAGE Drug Administration Schedule Drug Resistance, Neoplasm Female
Human Infusions, Intravenous Lymphoma, Non-Hodgkin's/*DRUG THERAPY
Male Membrane Glycoproteins/ANTAGONISTS & INHIB Middle Age Neoplasm
Proteins/ANTAGONISTS & INHIB Paclitaxel/*THERAPEUTIC USE Premedication
Propoxyphene/THERAPEUTIC USE Recurrence Remission Induction CLINICAL
TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).