Purpose: This study examined the response and toxicity rates of antine
oplastic drugs evaluated in phase I clinical trials in children to ide
ntify trends in response and toxicity over time. Patients and Methods:
Full length, peer-reviewed articles describing the results of single
agent phase I therapy trials in children younger than 21 years with ca
ncer were reviewed. Tumor-specific response data and doses of drugs th
at resulted in objective responses were noted. Deaths that occurred on
study caused by drug toxicity, progressive disease (PD), or complicat
ions of marrow aplasia were identified, along with drug doses that res
ulted in toxic death. Temporal trends in response rates, toxicity, and
number of patients entered in trials were examined. Results: A total
of 1,606 patients with cancer were enrolled in 56 single-agent pediatr
ic phase I therapy trials published between 1978 and 1996. Of these, 1
,257 were evaluated far response by tumor type. The overall objective
response rate was 7.9%. Response rates were highest for patients with
neuroblastoma (17.7%) and acute myelogenous leukemia (11.6%). Patients
with osteosarcoma and rhabdomyosarcoma had response rates of <3%. Six
ty percent of responses in patients with solid tumors occurred at 81 t
o 100% of the maximum tolerated dose (MTD), although 42% of responses
in patients with leukemia occurred at >100% of the MTD. Death on study
was noted in 7.0% of all patients entered in trials. Only 0.7% of pat
ients experienced a death related to drug toxicity. PD accounted for t
he death of 5.6% of study participants. A trend of increasing response
rate despite smaller trial size was noted over the last 7 years of th
is period. Conclusion: Phase I trials in children with cancer represen
t a safe mechanism to determine the MTD, toxicity profile, and pharmac
okinetics of new agents for use in children with cancer.