Mathematical modeling for Phase I cancer trials: A study of metronomic vinorelbine for advanced non-small cell lung cancer (NSCLC) and mesothelioma patients
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Fabrice Barlesi1,2, Diane-Charlotte Imbs2, Pascale Tomasini1, Laurent Greillier1, Melissa Galloux1, Albane Testot-Ferry1, Mélanie Garcia3, Xavier Elharrar1, Annick Pelletier1, Nicolas André2,4, Céline Mascaux1, Bruno Lacarelle2,3, Raouf El Cheikh2, Raphaël Serre2, Joseph Ciccolini2,3 and Dominique Barbolosi2
1Aix Marseille University, APHM, Marseille Early Phases Cancer Trials Center CLIP, Marseille, France
2Aix Marseille University, SMARTc Unit, INSERM U911, Marseille, France
3Aix Marseille University, APHM, Department of Pharmacology, Marseille, France
4Aix Marseille University, APHM, Department of Pediatric Hematology and Oncology, Marseille, France
Fabrice Barlesi, email: firstname.lastname@example.org
Keywords: lung cancer, mesothelioma, mathematical modeling, vinorelbine, metronomic
Received: March 24, 2017 Accepted: April 19, 2017 Published: May 02, 2017
Introduction: Using mathematical modelling allows to select a treatment’s regimen across infinite possibilities. Here, we report the phase I assessment of a new schedule for metronomic vinorelbine in treating refractory advanced NSCLC and mesothelioma patients.
Results: Overall, 13 patients were screened and 12 were treated (50% male, median age: 68yrs), including 9 NSCLC patients. All patients received at least one week (3 doses) of treatment. At data cut-off, the median length of treatment was 6.5 weeks (1–32+). All the patients presented with at least one adverse event (AE) and six patients with a severe AE (SAE). One partial response and 5 stable diseases were observed. The median OS was 6.4 months (95% CI, 4.8 to 12 months). The median and mean vinorelbine’s AUC were 122 ng/ml*h and 159 ng/ml*h, respectively, with the higher plasmatic vinorelbine exposure associated with the best ORR (difference of AUC comparison between responders and non-responders, p-value 0.017).
Materials and Methods: The mathematical modelling determined the administration of vinorelbine, 60 mg on Day 1, 30 mg on Day 2 and 60 mg on Day 4 weekly until progression, as the best schedule. Advanced NSCLC or mesothelioma patients progressing after standard treatment were eligible for the trial. NCT02555007.
Conclusions: Responses with acceptable safety profile were observed in heavily pretreated NSCLC and mesothelioma patients using oral vinorelbine at this metronomic dosage based on a mathematic modeling. This study demonstrates the feasibility of this new type of approach, as mathematical modeling may help to rationally decide the better regimen to be clinically tested across infinite possibilities.
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