Pemetrexed combined with paclitaxel: a dose-finding study evaluating three schedules in solid tumors

Investigational New Drugs. 2008 Oct 28. [Epub ahead of print] [Link]

Hanauske AR, Dumez H, Piccart M, Yilmaz E, Graefe T, Gil T, Simms L, Musib L, Awada A.

St. Georg Hospital, Ahrensburger Weg 129b, 22359, Hamburg, Germany,


The objectives of this phase I study were to determine the maximum tolerated dose (MTD), recommended phase II dose (RD), antitumor activity, safety, and pharmacokinetics of pemetrexed–paclitaxel combination. Patients (N = 95) with advanced solid tumors were assigned to three schedules (21-day cycles [q21d]). Starting doses for each schedule of pemetrexed and paclitaxel, respectively, were: (S1) 400 and 135 mg/m2 on d1; (S2) 400 mg/m2 d1 and 40 mg/m2 d1 and d8; S3) 400 mg/m2 d8 and 30 mg/m2 d1 and d8. MTD was 500/135 mg/m2 (S1), 400/40 mg/m2 (S2), and 500/120 mg/m2 (S3). Most common dose limiting toxicities were febrile neutropenia, fatigue, and neuromotor toxicities. Most common toxicity was grade 3/4 lymphopenia. Four patients had partial response, 43 patients had stable disease. The RD determined was pemetrexed 500 mg/m2 (d8) and paclitaxel 90 mg/m2 (d1 and d8), q21d. The combination was well tolerated and showed efficacy in thyroid carcinoma and mesothelioma.

Keywords: Pemetrexed – Paclitaxel – Phase I – Combination chemotherapy – Vitamin supplementation