Phase I Trial and Pharmacokinetic Evaluation of Fazarabine in Children

Abstract

A phase I trial of fazarabine (1-β-d-arabinofuranosyl-5-azacytosine, NSC 281272) administered as a 24-h continuous infusion was performed in 16 children with refractory malignancies. Dose-limiting toxicity consisting of reversible granulocytopenia and thrombocytopenia was observed in 4 of 4 solid tumor patients treated at the starting dose of 20 mg/m²/h. Subsequent patients were treated at a dose of 15 mg/m²/h which was determined to be the maximum tolerated dose. Moderate nausea and vomiting were the only other toxicities observed. Plasma steady-state concentrations of fazarabine were attained by 2–4 h in all patients and were 1.8 and 2.5 µm at the 15- and 20-mg/m²/h doses, respectively. The total body clearance of fazarabine was 571 and 550 ml/min/m² at the 15- and 20-mg/m²/h doses, respectively. In three of four patients evaluated, fazarabine was detectable in the cerebrospinal fluid (CSF). Steady-state CSF concentrations ranged from 0.29 to 0.74 µm in these three individuals and the steady-state CSF:plasma ratios ranged from 0.22–0.25. Both the plasma and CSF steady-state concentrations were within the 0.1 to 1 µm range reported to be cytotoxic in vitro against the Molt-4 human T-lymphoblastic leukemia cell line. Based on the above, the optimal dose for phase II trials of fazarabine administered as a 24-h infusion is 15 mg/m²/h (360 mg/m²/day).