Infusion of floxuridine plus etoposide plus cisplatin in human malignancies

36 patients with advanced malignancy were studied in a phase I trial of continuous 24-h infusion of floxuridine (FUdR) plus etoposide plus cisplatin (FEP) administered for 5 consecutive days at 4-week intervals. Study design fixed the dose rate of etoposide and cisplatin with escalation of FUdR only. Dose rate-limiting toxicity related to the FUdR component was stomatitis and diarrhoea and was invariably associated with leukopenia and thrombocytopenia when grade 3 or 4 level gastrointestinal toxicity was observed. Only 3 of 64 courses were associated with transient renal failure related to cisplatin. Drug-related deaths occurred (leukopenia-associated sepsis) in 4 patients with poor performance status (ECOG 3 and 4). Responses occurred in 15 of 26 evaluable patients (all previously treated minimally or untreated) including $\text{5}\text{11}$ non-small cell lung cancer; $\text{3}\text{3}$ oesophageal; $\text{2}\text{2}$ breast; $\text{4}\text{5}$ gastric; 1 osteogenic sarcoma; and 1 unknown primary (probably ovary). The recommended dose rates for a 5-day infusion of the three agents for good risk patients is 20 mg/m² per day of each drug. For poor risk patients including age > 65 years; performance status 2 or greater; or extensive bone metastases or prior radiation; the recommended starting dose rates are: FUdR 15 mg/m² per day; etoposide 15 mg/m² per day; and cisplatin 20 mg/m² per day. Dose escalation of FUdR to a maximum of 25 mg/m² daily is feasible in selected patients demonstrating optimal tolerance.