Determining the maximum tolerated dose of paclitaxel combined with fixed dose of cisplatin for hyperthermic intraperitoneal chemotherapy in ovarian cancer: A multicenter phase I trial.

Objective: To determine the maximum tolerated dose (MTD) of paclitaxel combined with a fixed dose of cisplatin (75 mg/m) delivered via hyperthermic intraperitoneal chemotherapy (HIPEC) to patients with ovarian cancer.

Methods: This multicenter Phase I trial employed a Bayesian Optimal Interval (BOIN) design. The MTD was determined to have a target dose-limiting toxicity (DLT) rate of 25%. The starting dose was 175 mg/m. The Data and Safety Monitoring Board made decisions regarding dose escalation or de-escalation in increments of 25 mg/m for subsequent patient cohorts, up to a maximum sample size of 30 or 12 patients treated at a given dose.

Results: Twenty-one patients participated in this study. Among the three evaluable patients who received 150 mg/m paclitaxel, no DLTs were observed. Among the 12 evaluable patients who received 175 mg/m paclitaxel, two reported DLTs: one had grade 4 neutropenia and one had grade 4 anemia, neutropenia, and leukopenia. Four of the six evaluable patients who received 200 mg/m paclitaxel reported DLTs: one patient had grade 4 diarrhea, one had grade 3 kidney injury, and two had grade 4 anemia. The isotonic estimate of the DLT rate in the 175 mg/m dose group was 0.17 (95% confidence interval, 0.02-0.42), and this dose was selected as the MTD.

Conclusion: Paclitaxel, when combined with a fixed dose of cisplatin (75 mg/m), can be safely administered intraperitoneally at a dose of 175 mg/m in patients with ovarian cancer who received HIPEC (43 °C, 90 min) following cytoreductive surgery.