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Published in: Cancer Chemotherapy and Pharmacology 1/2007

01-06-2007 | Clinical Trial Report

A phase II trial of continuous low-dose oral cyclophosphamide and celecoxib in patients with renal cell carcinoma

Authors: Monika K. Krzyzanowska, Ian F. Tannock, Gina Lockwood, Jennifer Knox, Malcolm Moore, Georg A. Bjarnason

Published in: Cancer Chemotherapy and Pharmacology | Issue 1/2007

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Abstract

Purpose

The lack of effective systemic therapies for patients with advanced renal cell carcinoma (RCC) has stimulated interest in evaluating novel treatment strategies for this disease.

Methods

This was a two-institution, two-stage, phase II trial of continuous low-dose oral cyclophosphamide (50 mg daily) in combination with celecoxib (400 mg twice daily) in patients with progressive, locally advanced or metastatic RCC. The primary endpoint was disease control rate (DCR) defined as the number of patients with complete (CR) or partial response (PR) or prolonged (≥6 months) stable disease (SD). Secondary endpoints included time to progression and toxicity.

Results

Between May 2001 and January 2003, 36 patients were enrolled onto the trial of which 32 were evaluable for response. One patient had a PR and three others had SD for longer than 6 months (DCR 12.5%, 95% CI 3.5–29.0%). The median progression free survival was 3.5 months (95% CI, 1.9–4.1 months) and the median overall survival was 14.5 months (95% CI, 8.4–20.8 months). One patient experienced grade five gastrointestinal bleeding. Otherwise, the treatment was well tolerated.

Conclusions

Although generally well tolerated, continuous therapy with low-dose cyclophosphamide and celecoxib had limited activity in RCC.
Literature
1.
go back to reference Yagoda A, Abi-Rached B, Petrylak D (1995) Chemotherapy for advanced renal-cell carcinoma: 1983–1993. Semin Oncol 22:42–60PubMed Yagoda A, Abi-Rached B, Petrylak D (1995) Chemotherapy for advanced renal-cell carcinoma: 1983–1993. Semin Oncol 22:42–60PubMed
2.
go back to reference Fojo AT, Shen DW, Mickley LA et al (1987) Intrinsic drug resistance in human kidney cancer is associated with expression of a human multidrug-resistance gene. J Clin Oncol 5:1922–1927PubMed Fojo AT, Shen DW, Mickley LA et al (1987) Intrinsic drug resistance in human kidney cancer is associated with expression of a human multidrug-resistance gene. J Clin Oncol 5:1922–1927PubMed
3.
go back to reference Negrier S, Escudier B, Lasset C et al (1998) Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Francais d’Immunotherapie. N Engl J Med 338:1272–1278PubMedCrossRef Negrier S, Escudier B, Lasset C et al (1998) Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Francais d’Immunotherapie. N Engl J Med 338:1272–1278PubMedCrossRef
4.
go back to reference Bukowski RM (1997) Natural history and therapy of metastatic renal cell carcinoma: the role of interleukin-2. Cancer 80:1198–1220PubMedCrossRef Bukowski RM (1997) Natural history and therapy of metastatic renal cell carcinoma: the role of interleukin-2. Cancer 80:1198–1220PubMedCrossRef
5.
go back to reference Medical Research Council Renal Cancer Collaborators (1999) Interferon-alpha, survival in metastatic renal carcinoma: early results of a randomised controlled trial. Lancet 353:14–17 Medical Research Council Renal Cancer Collaborators (1999) Interferon-alpha, survival in metastatic renal carcinoma: early results of a randomised controlled trial. Lancet 353:14–17
6.
go back to reference Brown LF, Berse B, Jackman RW et al (1993) Increased expression of vascular permeability factor (vascular endothelial growth factor) and its receptors in kidney and bladder carcinomas. Am J Pathol 143:1255–1262PubMed Brown LF, Berse B, Jackman RW et al (1993) Increased expression of vascular permeability factor (vascular endothelial growth factor) and its receptors in kidney and bladder carcinomas. Am J Pathol 143:1255–1262PubMed
7.
go back to reference Nicol D, Hii SI, Walsh M et al (1997) Vascular endothelial growth factor expression is increased in renal cell carcinoma. J Urol 157:1482–1486PubMedCrossRef Nicol D, Hii SI, Walsh M et al (1997) Vascular endothelial growth factor expression is increased in renal cell carcinoma. J Urol 157:1482–1486PubMedCrossRef
8.
go back to reference Wechsel HW, Bichler KH, Feil G et al (1999) Renal cell carcinoma: relevance of angiogenetic factors. Anticancer Res 19:1537–1540PubMed Wechsel HW, Bichler KH, Feil G et al (1999) Renal cell carcinoma: relevance of angiogenetic factors. Anticancer Res 19:1537–1540PubMed
9.
go back to reference Linehan WM, Lerman MI, Zbar B (1995) Identification of the von Hippel-Lindau (VHL) gene. Its role in renal cancer. JAMA 273:564–570PubMedCrossRef Linehan WM, Lerman MI, Zbar B (1995) Identification of the von Hippel-Lindau (VHL) gene. Its role in renal cancer. JAMA 273:564–570PubMedCrossRef
10.
go back to reference Mulders P, Figlin R, deKernion JB et al (1997) Renal cell carcinoma: recent progress and future directions. Cancer Res 57:5189–5195PubMed Mulders P, Figlin R, deKernion JB et al (1997) Renal cell carcinoma: recent progress and future directions. Cancer Res 57:5189–5195PubMed
11.
go back to reference Gnarra JR, Zhou S, Merrill MJ et al (1996) Post-transcriptional regulation of vascular endothelial growth factor mRNA by the product of the VHL tumor suppressor gene. Proc Natl Acad Sci USA 93:10589–10594PubMedCrossRef Gnarra JR, Zhou S, Merrill MJ et al (1996) Post-transcriptional regulation of vascular endothelial growth factor mRNA by the product of the VHL tumor suppressor gene. Proc Natl Acad Sci USA 93:10589–10594PubMedCrossRef
12.
go back to reference Schirner M, Hoffmann J, Menrad A et al (1998) Antiangiogenic chemotherapeutic agents: characterization in comparison to their tumor growth inhibition in human renal cell carcinoma models. Clin Cancer Res 4:1331–1336PubMed Schirner M, Hoffmann J, Menrad A et al (1998) Antiangiogenic chemotherapeutic agents: characterization in comparison to their tumor growth inhibition in human renal cell carcinoma models. Clin Cancer Res 4:1331–1336PubMed
13.
go back to reference Vacca A, Iurlaro M, Ribatti D et al (1999) Antiangiogenesis is produced by nontoxic doses of vinblastine. Blood 94:4143–4155PubMed Vacca A, Iurlaro M, Ribatti D et al (1999) Antiangiogenesis is produced by nontoxic doses of vinblastine. Blood 94:4143–4155PubMed
14.
go back to reference Browder T, Butterfield CE, Kraling BM et al (2000) Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res 60:1878–1886PubMed Browder T, Butterfield CE, Kraling BM et al (2000) Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res 60:1878–1886PubMed
15.
go back to reference Dana BW, Alberts DS (1981) Combination chemoimmunotherapy for advanced renal carcinoma with Adriamycin, bleomycin, vincristine, cyclophosphamide, plus BCG. Cancer Clin Trials 4:205–207PubMed Dana BW, Alberts DS (1981) Combination chemoimmunotherapy for advanced renal carcinoma with Adriamycin, bleomycin, vincristine, cyclophosphamide, plus BCG. Cancer Clin Trials 4:205–207PubMed
16.
go back to reference Lupera H, Theodore C, Ghosn M et al (1989) Phase II trial of combination chemotherapy with dacarbazine, cyclophosphamide, cisplatin, doxorubicin, and vindesine (DECAV) in advanced renal cell cancer. Urology 34:281–283PubMedCrossRef Lupera H, Theodore C, Ghosn M et al (1989) Phase II trial of combination chemotherapy with dacarbazine, cyclophosphamide, cisplatin, doxorubicin, and vindesine (DECAV) in advanced renal cell cancer. Urology 34:281–283PubMedCrossRef
17.
go back to reference Lindemann A, Hoeffken K, Schmidt RE et al (1989) A multicenter trial of interleukin-2 and low-dose cyclophosphamide in highly chemotherapy-resistant malignancies. Cancer Treat Rev 16(Suppl A):53–57PubMedCrossRef Lindemann A, Hoeffken K, Schmidt RE et al (1989) A multicenter trial of interleukin-2 and low-dose cyclophosphamide in highly chemotherapy-resistant malignancies. Cancer Treat Rev 16(Suppl A):53–57PubMedCrossRef
18.
go back to reference Glover D, Trump D, Kvols L et al (1986) Phase II trial of misonidazole (MISO) and cyclophosphamide (CYC) in metastatic renal cell carcinoma. Int J Radiat Oncol Biol Phys 12:1405–1408PubMed Glover D, Trump D, Kvols L et al (1986) Phase II trial of misonidazole (MISO) and cyclophosphamide (CYC) in metastatic renal cell carcinoma. Int J Radiat Oncol Biol Phys 12:1405–1408PubMed
19.
go back to reference Berd D, Mastrangelo MJ (1988) Effect of low dose cyclophosphamide on the immune system of cancer patients: depletion of CD4+, 2H4+ suppressor-inducer T-cells. Cancer Res 48:1671–1675PubMed Berd D, Mastrangelo MJ (1988) Effect of low dose cyclophosphamide on the immune system of cancer patients: depletion of CD4+, 2H4+ suppressor-inducer T-cells. Cancer Res 48:1671–1675PubMed
20.
go back to reference Motoyoshi Y, Kaminoda K, Saitoh O et al (2006) Different mechanisms for anti-tumor effects of low- and high-dose cyclophosphamide. Oncol Rep 16:141–146PubMed Motoyoshi Y, Kaminoda K, Saitoh O et al (2006) Different mechanisms for anti-tumor effects of low- and high-dose cyclophosphamide. Oncol Rep 16:141–146PubMed
21.
go back to reference Klement G, Baruchel S, Rak J et al (2000) Continuous low-dose therapy with vinblastine and VEGF receptor-2 antibody induces sustained tumor regression without overt toxicity. J Clin Invest 105:R15–R24PubMedCrossRef Klement G, Baruchel S, Rak J et al (2000) Continuous low-dose therapy with vinblastine and VEGF receptor-2 antibody induces sustained tumor regression without overt toxicity. J Clin Invest 105:R15–R24PubMedCrossRef
22.
go back to reference Colleoni M, Rocca A, Sandri MT et al (2002) Low-dose oral methotrexate and cyclophosphamide in metastatic breast cancer: antitumor activity and correlation with vascular endothelial growth factor levels. Ann Oncol 13:73–80PubMedCrossRef Colleoni M, Rocca A, Sandri MT et al (2002) Low-dose oral methotrexate and cyclophosphamide in metastatic breast cancer: antitumor activity and correlation with vascular endothelial growth factor levels. Ann Oncol 13:73–80PubMedCrossRef
23.
go back to reference Fosslien E (2000) Molecular pathology of cyclooxygenase-2 in neoplasia. Ann Clin Lab Sci 30:3–21PubMed Fosslien E (2000) Molecular pathology of cyclooxygenase-2 in neoplasia. Ann Clin Lab Sci 30:3–21PubMed
24.
go back to reference Chen Q, Shinohara N, Abe T et al (2004) Significance of COX-2 expression in human renal cell carcinoma cell lines. Int J Cancer 108:825–832PubMedCrossRef Chen Q, Shinohara N, Abe T et al (2004) Significance of COX-2 expression in human renal cell carcinoma cell lines. Int J Cancer 108:825–832PubMedCrossRef
25.
go back to reference Miyata Y, Koga S, Kanda S et al (2003) Expression of cyclooxygenase-2 in renal cell carcinoma: correlation with tumor cell proliferation, apoptosis, angiogenesis, expression of matrix metalloproteinase-2, and survival. Clin Cancer Res 9:1741–1749PubMed Miyata Y, Koga S, Kanda S et al (2003) Expression of cyclooxygenase-2 in renal cell carcinoma: correlation with tumor cell proliferation, apoptosis, angiogenesis, expression of matrix metalloproteinase-2, and survival. Clin Cancer Res 9:1741–1749PubMed
26.
go back to reference Hashimoto Y, Kondo Y, Kimura G et al (2004) Cyclooxygenase-2 expression and relationship to tumour progression in human renal cell carcinoma. Histopathology 44:353–359PubMedCrossRef Hashimoto Y, Kondo Y, Kimura G et al (2004) Cyclooxygenase-2 expression and relationship to tumour progression in human renal cell carcinoma. Histopathology 44:353–359PubMedCrossRef
27.
go back to reference Tuna B, Yorukoglu K, Gurel D et al (2004) Significance of COX-2 expression in human renal cell carcinoma. Urology 64:1116–1120PubMedCrossRef Tuna B, Yorukoglu K, Gurel D et al (2004) Significance of COX-2 expression in human renal cell carcinoma. Urology 64:1116–1120PubMedCrossRef
28.
go back to reference Masferrer JL, Leahy KM, Koki AT et al (2000) Antiangiogenic and antitumor activities of cyclooxygenase-2 inhibitors. Cancer Res 60:1306–1311PubMed Masferrer JL, Leahy KM, Koki AT et al (2000) Antiangiogenic and antitumor activities of cyclooxygenase-2 inhibitors. Cancer Res 60:1306–1311PubMed
29.
go back to reference Reddy BS, Hirose Y, Lubet R et al (2000) Chemoprevention of colon cancer by specific cyclooxygenase-2 inhibitor, celecoxib, administered during different stages of carcinogenesis. Cancer Res 60:293–297PubMed Reddy BS, Hirose Y, Lubet R et al (2000) Chemoprevention of colon cancer by specific cyclooxygenase-2 inhibitor, celecoxib, administered during different stages of carcinogenesis. Cancer Res 60:293–297PubMed
30.
go back to reference Moore RJ, Zweifel BS, Heuvelman DM et al (2000) Enhanced antitumor activity by co-administration of celecoxib and the chemotherapeutic agents cyclophosphamide and 5-FU. Proc Am Assoc Cancer Res 41:409 (abstr 2600) Moore RJ, Zweifel BS, Heuvelman DM et al (2000) Enhanced antitumor activity by co-administration of celecoxib and the chemotherapeutic agents cyclophosphamide and 5-FU. Proc Am Assoc Cancer Res 41:409 (abstr 2600)
31.
go back to reference Steinbach G, Lynch PM, Phillips RK et al (2000) The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis. N Engl J Med 342:1946–1952PubMedCrossRef Steinbach G, Lynch PM, Phillips RK et al (2000) The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis. N Engl J Med 342:1946–1952PubMedCrossRef
32.
go back to reference Simon R (1989) Optimal two-stage designs for phase II clinical trials. Control Clin Trials 10:1–10PubMedCrossRef Simon R (1989) Optimal two-stage designs for phase II clinical trials. Control Clin Trials 10:1–10PubMedCrossRef
33.
go back to reference Psaty BM, Furberg CD (2005) COX-2 inhibitors–lessons in drug safety. N Engl J Med 352:1133–1135PubMedCrossRef Psaty BM, Furberg CD (2005) COX-2 inhibitors–lessons in drug safety. N Engl J Med 352:1133–1135PubMedCrossRef
34.
go back to reference Escudier B, Lassau N, Couanet D et al (2002) Phase II trial of thalidomide in renal-cell carcinoma. Ann Oncol 13:1029–1035PubMedCrossRef Escudier B, Lassau N, Couanet D et al (2002) Phase II trial of thalidomide in renal-cell carcinoma. Ann Oncol 13:1029–1035PubMedCrossRef
35.
go back to reference Stadler WM, Kuzel T, Shapiro C et al (1999) Multi-institutional study of the angiogenesis inhibitor TNP-470 in metastatic renal carcinoma. J Clin Oncol 17:2541–2545PubMed Stadler WM, Kuzel T, Shapiro C et al (1999) Multi-institutional study of the angiogenesis inhibitor TNP-470 in metastatic renal carcinoma. J Clin Oncol 17:2541–2545PubMed
36.
go back to reference Rini BI, Weinberg V, Dunlap S et al (2006) Maximal COX-2 immunostaining and clinical response to celecoxib and interferon alpha therapy in metastatic renal cell carcinoma. Cancer 106:566–575PubMedCrossRef Rini BI, Weinberg V, Dunlap S et al (2006) Maximal COX-2 immunostaining and clinical response to celecoxib and interferon alpha therapy in metastatic renal cell carcinoma. Cancer 106:566–575PubMedCrossRef
37.
go back to reference Escudier B, Szczylik C, Eisen T et al (2005) Randomized phase III trial of the Raf kinase and VEGFR inhibitor sorafenib (BAY 43–9006) in patients with advanced renal cell carcinoma (RCC). J Clin Oncol 23(suppl 16S):1093s (abstr 4510) Escudier B, Szczylik C, Eisen T et al (2005) Randomized phase III trial of the Raf kinase and VEGFR inhibitor sorafenib (BAY 43–9006) in patients with advanced renal cell carcinoma (RCC). J Clin Oncol 23(suppl 16S):1093s (abstr 4510)
38.
go back to reference Motzer RJ, Michaelson MD, Redman BG et al (2006) Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol 24:16–24PubMedCrossRef Motzer RJ, Michaelson MD, Redman BG et al (2006) Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol 24:16–24PubMedCrossRef
39.
go back to reference Yang JC, Haworth L, Sherry RM et al (2003) A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med 349:427–434PubMedCrossRef Yang JC, Haworth L, Sherry RM et al (2003) A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med 349:427–434PubMedCrossRef
40.
go back to reference Motzer RJ, Mazumdar M, Bacik J et al (1999) Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 17:2530–2540PubMed Motzer RJ, Mazumdar M, Bacik J et al (1999) Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 17:2530–2540PubMed
Metadata
Title
A phase II trial of continuous low-dose oral cyclophosphamide and celecoxib in patients with renal cell carcinoma
Authors
Monika K. Krzyzanowska
Ian F. Tannock
Gina Lockwood
Jennifer Knox
Malcolm Moore
Georg A. Bjarnason
Publication date
01-06-2007
Publisher
Springer-Verlag
Published in
Cancer Chemotherapy and Pharmacology / Issue 1/2007
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-006-0347-x

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