A phase I and pharmacokinetic study of oral perifosine with different loading schedules in patients with refractory neoplasms

William D. Figg*, Manish Monga, Donna Headlee, Avni Shah, Cindy H. Chau, Cody Peer, Richard Messman, Yusri A. Elsayed, Anthony J. Murgo, Giovanni Melillo, Qin C. Ryan, Mikhail Kalnitskiy, Adrian M. Senderowicz, Melinda Hollingshead, Susan G. Arbuck, Edward A. Sausville

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Purpose: To determine the maximum tolerated dose (MTD) of perifosine (NSC 639966), an alkylphospholipid modulator of signal transduction, using different oral loading and maintenance regimens in an effort to avoid gastrointestinal toxicity while seeking maximal sustained plasma concentrations. Methods: Thirty-one patients with advanced neoplasms were treated with monthly cycles of perifosine loading doses of 300, 600, 900, 1,200 and 1,500 mg (dose levels 1 through 5, respectively) on days 1-2 depending on the actual dose of the initial cycle. For subsequent cycles, perifosine loading doses were reduced to 100, 200, 300, 400 and 1,000 mg at the respective corresponding dose levels. Daily perifosine "maintenance" doses of 50, 100, 150, 200 and 250 mg for levels 1 through 5, respectively, commenced on days 2 or 3 and continued for a total of 21 days. No treatment was given for days 22-27. The pharmacokinetics of perifosine with these schedules was characterized. Results: Dose-limiting diarrhea developed at or above dose level 4. The MTD and recommended phase II dose was dose level 3B, with a loading dose of 900 mg on day 1 divided into two doses of 450 mg administered 6 h apart and a maintenance dose of 150 mg on day 2 through 21. On subsequent cycles, the loading dose was reduced to 300 mg. Non-gastrointestinal toxicities included three episodes of gout or gout-like syndromes observed at doses above the MTD. The median peak plasma concentration of perifosine achieved at the MTD was approximately 8.3 μg/ mL. Four patients had stable disease ranging from 167 to 735 days. Conclusions: Perifosine given according to a loading and maintenance schedule can safely sustain concentrations of drug, approaching concentrations achieved in preclinical models with evidence of anti-tumor effect.

Original languageEnglish
Pages (from-to)955-967
Number of pages13
JournalCancer Chemotherapy and Pharmacology
Issue number5
StatePublished - Nov 2014
Externally publishedYes


  • Drug development
  • Loading dose
  • Maintenance dose
  • Perifosine
  • Phase I


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