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Marcelletti JF, Sikic BI. Continuous 72-h infusion of zosuquidar with chemotherapy in patients with newly diagnosed acute myeloid leukemia stratified for leukemic blast P-glycoprotein phenotype. Cancer Chemother Pharmacol 2024; 93:595-604. [PMID: 38407601 DOI: 10.1007/s00280-024-04656-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To evaluate the safety, tolerability, pharmacodynamics (PD), and potential efficacy of zosuquidar (Zos) in combination with daunorubicin and cytarabine in elderly patients with newly diagnosed acute myeloid leukemia (AML). METHODS Patients with AML (N = 106) were treated with Zos as a 72-h continuous intravenous (CIV) infusion along with chemotherapy. Leukemic blasts from the patients were assessed for P-glycoprotein (P-gp) function using ex vivo bioassays for screening and PD analyses. Patient outcomes were categorized according to primary (N = 56) and secondary (N = 50) AML cohorts (pAML and sAML, respectively) and stratified into P-gp-high and P-gp-low subgroups. RESULTS Patients with P-gp-high blasts exhibited comparable overall remission rates (ORR) to those with P-gp-low blasts in both the pAML and sAML cohorts. The P-gp-high and P-gp-low subgroups in the pAML cohort exhibited similar overall survival (OS). Patients with sAML and P-gp-high blasts exhibited significantly better OS than those in the P-gp-low subgroup. PD analyses revealed that Zos infusion provided 82 h of uninterrupted effective ≥ 90% inhibition of P-gp functional activity in leukemic blasts. CONCLUSIONS These observations provide evidence of Zos efficacy with the 72-h CIV infusion approach. The similarity of ORR in the P-gp-high and P-gp-low subgroups is consistent with Zos-mediated neutralization of P-gp as verified by PD analyses. The bioassay identified sAML patients most likely to respond favorably to Zos co-therapy indicating feasibility as a Zos companion diagnostic. A follow-up placebo-controlled trial is needed to verify these promising results. CLINICALTRIALS GOV IDENTIFIER NCT00129168; First posted on August 11, 2005.
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Affiliation(s)
| | - Branimir I Sikic
- Clinical and Translational Research Unit, Stanford Cancer Institute, Stanford, CA, USA
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Marcelletti JF, Sikic BI. A clinical trial of zosuquidar plus gemtuzumab ozogamicin (GO) in relapsed or refractory acute myeloid leukemia (RR AML): evidence of efficacy based on leukemic blast P-glycoprotein functional phenotype. Cancer Chemother Pharmacol 2023; 92:369-380. [PMID: 37603048 DOI: 10.1007/s00280-023-04578-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE To evaluate safety, tolerability, potential efficacy, and pharmacodynamics (PD) of zosuquidar (Zos) in combination with gemtuzumab ozogamicin (GO) in elderly patients with relapsed or refractory (RR) acute myeloid leukemia (AML). METHODS Patients with RR AML (N = 41) were treated with Zos as a 48-h continuous intravenous infusion initiated 4 h prior to a 2-h infusion of GO on days 1 and 15. P-glycoprotein (P-gp) status of the patients' leukemic blasts and PD determinations were assessed with ex vivo bioassays. Patient outcomes were analyzed for the total cohort and as stratified into P-gp-positive (P-gp +) and P-gp-negative (P-gp‒) subgroups. RESULTS The eligible cohort exhibited a 34% overall remission rate (ORR), a composite of patients that exhibited complete remission (CR), CR with incomplete platelet recovery, or morphologic remission. Patients with 1st relapsed disease exhibited 40% ORR. P-gp phenotype did not significantly predict ORR. However, the P-gp + subgroup exhibited a greater median overall survival (OS) of 6.0 months vs. 1.8 months for patients in the P-gp‒ subgroup (p = 0.01). PD analyses revealed 90-95% inhibition of blast P-gp function during Zos infusion. Treatment related toxicities were observed and resolved with decrease or discontinued Zos or GO dosages. CONCLUSIONS Zos plus GO elicited appreciable ORR for an elderly patient population with RR AML. The greater OS of the P-gp + subgroup vs. the P-gp‒ subgroup suggests that patients with P-gp + leukemic blasts were being more effectively targeted by GO with Zos co-therapy. The poorer OS of the P-gp‒ subgroup suggests activity of Zos-insensitive multidrug resistant mechanisms. CLINICAL TRIALS GOV IDENTIFIER NCT00233909; First posted October 06, 2005.
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Affiliation(s)
| | - Branimir I Sikic
- Kanisa Pharmaceuticals, San Diego, CA, USA
- Clinical and Translational Research Unit, Stanford Cancer Institute, Stanford, CA, USA
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Drevin G, Briet M, Bazzoli C, Gyan E, Schmidt A, Dombret H, Orvain C, Giltat A, Recher C, Ifrah N, Guardiola P, Hunault-Berger M, Abbara C. Daunorubicin and Its Active Metabolite Pharmacokinetic Profiles in Acute Myeloid Leukaemia Patients: A Pharmacokinetic Ancillary Study of the BIG-1 Trial. Pharmaceutics 2022; 14:pharmaceutics14040792. [PMID: 35456626 PMCID: PMC9029035 DOI: 10.3390/pharmaceutics14040792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023] Open
Abstract
Daunorubicin pharmacokinetics (PK) are characterised by an important inter-individual variability, which raises questions about the optimal dose regimen in patients with acute myeloid leukaemia. The aim of the study is to assess the joint daunorubicin/daunorubicinol PK profile and to define an optimal population PK study design. Fourteen patients were enrolled in the PK ancillary study of the BIG-1 trial and 6–8 samples were taken up to 24 h after administration of the first dose of daunorubicin (90 mg/m2/day). Daunorubicin and daunorubicinol quantifications were assessed using a validated liquid chromatography technique coupled with a fluorescence detector method. Data were analysed using a non-compartmental approach and non-linear mixed effects modelling. Optimal sampling strategy was proposed using the R function PFIM. The median daunorubicin and daunorubicinol AUC0-tlast were 577 ng/mL·hr (Range: 375–1167) and 2200 ng/mL·hr (range: 933–4683), respectively. The median metabolic ratio was 0.32 (range: 0.1–0.44). Daunorubicin PK was best described by a three-compartment parent, two-compartment metabolite model, with a double first-order transformation of daunorubicin to metabolite. Body surface area and plasma creatinine had a significant impact on the daunorubicin and daunorubicinol PK. A practical optimal population design has been derived from this model with five sampling times per subject (0.5, 0.75, 2, 9, 24 h) and this can be used for a future population PK study.
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Affiliation(s)
- Guillaume Drevin
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire d’Angers, F-49100 Angers, France; (G.D.); (M.B.)
- UFR Santé, Université Angers, F-49100 Angers, France; (A.S.); (N.I.); (P.G.); (M.H.-B.)
| | - Marie Briet
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire d’Angers, F-49100 Angers, France; (G.D.); (M.B.)
- UFR Santé, Université Angers, F-49100 Angers, France; (A.S.); (N.I.); (P.G.); (M.H.-B.)
- MITOVASC, Equipe CarMe, SFR ICAT, INSERM, CNRS, F-49000 Angers, France
| | - Caroline Bazzoli
- Grenoble INP, TIMC-IMAG, Université Grenoble Alpes, CNRS, F-38000 Grenoble, France;
| | - Emmanuel Gyan
- Service d’Hématologie et Thérapie Cellulaire, Equipe LNOx, ERL CNRS 7001, Centre Hospitalier Universitaire, Université de Tours, F-37000 Tours, France;
- Fédération Hospitalo-Universitaire GOAL, F-49033 Angers, France; (C.O.); (A.G.)
| | - Aline Schmidt
- UFR Santé, Université Angers, F-49100 Angers, France; (A.S.); (N.I.); (P.G.); (M.H.-B.)
- Fédération Hospitalo-Universitaire GOAL, F-49033 Angers, France; (C.O.); (A.G.)
- Service des Maladies du Sang, Centre Hospitalo-Universitaire d’Angers, F-49100 Angers, France
- Inserm, CRCINA, SFR ICAT, Université Angers, Université de Nantes, F-49000 Angers, France
| | - Hervé Dombret
- Blood Disease Department, University Hospital Saint Louis AP-HP, F-75010 Paris, France;
| | - Corentin Orvain
- Fédération Hospitalo-Universitaire GOAL, F-49033 Angers, France; (C.O.); (A.G.)
- Service des Maladies du Sang, Centre Hospitalo-Universitaire d’Angers, F-49100 Angers, France
| | - Aurelien Giltat
- Fédération Hospitalo-Universitaire GOAL, F-49033 Angers, France; (C.O.); (A.G.)
- Service des Maladies du Sang, Centre Hospitalo-Universitaire d’Angers, F-49100 Angers, France
| | - Christian Recher
- Insitut Universitaire du Cancer de Toulouse Oncolpole, Unversité Toulouse III Paul Sabatier, F-31000 Toulouse, France;
| | - Norbert Ifrah
- UFR Santé, Université Angers, F-49100 Angers, France; (A.S.); (N.I.); (P.G.); (M.H.-B.)
- Fédération Hospitalo-Universitaire GOAL, F-49033 Angers, France; (C.O.); (A.G.)
- Service des Maladies du Sang, Centre Hospitalo-Universitaire d’Angers, F-49100 Angers, France
| | - Philippe Guardiola
- UFR Santé, Université Angers, F-49100 Angers, France; (A.S.); (N.I.); (P.G.); (M.H.-B.)
| | - Mathilde Hunault-Berger
- UFR Santé, Université Angers, F-49100 Angers, France; (A.S.); (N.I.); (P.G.); (M.H.-B.)
- Fédération Hospitalo-Universitaire GOAL, F-49033 Angers, France; (C.O.); (A.G.)
- Service des Maladies du Sang, Centre Hospitalo-Universitaire d’Angers, F-49100 Angers, France
- Inserm, CRCINA, SFR ICAT, Université Angers, Université de Nantes, F-49000 Angers, France
| | - Chadi Abbara
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire d’Angers, F-49100 Angers, France; (G.D.); (M.B.)
- Correspondence:
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Marcelletti JF, Sikic BI, Cripe LD, Paietta E. Evidence of a role for functional heterogeneity in multidrug resistance transporters in clinical trials of P-glycoprotein modulation in acute myeloid leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:57-66. [PMID: 30334334 DOI: 10.1002/cyto.b.21737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/08/2018] [Accepted: 08/28/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multidrug resistance (MDR) transporter proteins such as P-glycoprotein (P-gp) efflux a variety of chemotherapeutic drugs from acute myeloid leukemia (AML) blasts leading to clinical drug resistance. METHODS This study examined heterogeneity of MDR functional efflux by AML blasts using two flow cytometry bioassays. Bone marrow specimens (N = 50) from elderly patients with newly diagnosed AML were analyzed for CD34+ blasts with MDR efflux function. Efflux was measured with a fluorescent dye (DiOC2 ) as a surrogate for oncology drugs that are substrates for MDR efflux. P-gp-mediated efflux was differentiated from non-P-gp MDR activities using zosuquidar, a highly selective P-gp modulator. The bioassays included a zosuquidar-dependent DiOC2 accumulation bioassay that measured only P-gp. The second method, termed the efflux bioassay, could detect P-gp and other non-P-gp efflux depending on bioassay culture conditions. RESULTS Sixty-two percent of the specimens were considered positive for blasts with P-gp function, and 26% of such P-gp-positive specimens also exhibited zosuquidar-resistant (i.e., non-P-gp) MDR efflux activity; 37% of P-gp-negative AML blast specimens displayed zosuquidar-resistant MDR function in the efflux bioassay. CONCLUSIONS These results confirm the heterogeneous nature of MDR efflux pumps in AML blasts, and provide support for the hypothesis that non-P-gp MDR contributed to negative results with zosuquidar in AML trials like ECOG-ACRIN E3999. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- John F Marcelletti
- Department of Clinical Development, Kanisa Pharmaceuticals, San Diego, California
| | - Branimir I Sikic
- Department of Medicine, Stanford University, Stanford, California.,Oncology Division, Stanford University, Stanford, California
| | - Larry D Cripe
- Department of Hematology/Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Elisabeth Paietta
- Oncology Department, Albert Einstein College of Medicine, Bronx, New York
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Model-based drug development: application of modeling and simulation in drug development. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2017. [DOI: 10.1007/s40005-017-0371-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Thompson P, Wheeler HE, Delaney SM, Lorier R, Broeckel U, Devidas M, Reaman GH, Scorsone K, Sung L, Dolan ME, Berg SL. Pharmacokinetics and pharmacogenomics of daunorubicin in children: a report from the Children's Oncology Group. Cancer Chemother Pharmacol 2014; 74:831-8. [PMID: 25119182 DOI: 10.1007/s00280-014-2535-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 07/09/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE We explored the impact of obesity, body composition, and genetic polymorphisms on the pharmacokinetics (PK) of daunorubicin in children with cancer. PATIENTS AND METHODS Patients ≤21 years receiving daunorubicin as an infusion of any duration <24 h for any type of cancer were eligible. Plasma drug concentrations were measured by high-performance liquid chromatography. Body composition was measured by dual-energy X-ray absorptiometry. Obesity was defined as a BMI >95% for age or as body fat >30%. NONMEM was used to perform PK model fitting. The Affymetrix DMET chip was used for genotyping. The impact of genetic polymorphisms was investigated using SNP/haplotype association analysis with estimated individual PK parameters. RESULTS A total of 107 subjects were enrolled, 98 patients had PK sampling, and 50 patients underwent DNA analysis. Population estimates for daunorubicin clearance and volume of distribution were 116 L/m(2)/h ± 14% and 68.1 L/m(2) ± 24%, respectively. Apparent daunorubicinol clearance and volume of distribution were 26.8 L/m(2)/h ± 5.6% and 232 L/m(2) ± 10%, respectively. No effect of body composition or obesity was observed on PK. Forty-four genes with variant haplotypes were tested for association with PK. FMO3-H1/H3 genotype was associated with lower daunorubicin clearance than FMO3-H1/H1, p = 0.00829. GSTP1*B/*B genotype was also associated with lower daunorubicin clearance compared to GSTP1*A/*A, p = 0.0347. However, neither of these associations was significant after adjusting for multiple testing by either Bonferroni or false discovery rate correction. CONCLUSIONS We did not detect an effect of body composition or obesity on daunorubicin PK. We found suggestive associations between FMO3 and GSTP1 haplotypes with daunorubicin PK that could potentially affect efficacy and toxicity.
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Affiliation(s)
- Patrick Thompson
- Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates Ave., Suite 1570, Houston, TX, 77030, USA
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Affiliation(s)
- Holger Dette
- a Ruhr-Universität Bochum , 44780 , Bochum , Germany
| | - Matthias Trampisch
- b Department of Mathematics , Ruhr-Universität Bochum , 44780 , Bochum , Germany
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Bogason A, Quartino AL, Lafolie P, Masquelier M, Karlsson MO, Paul C, Gruber A, Vitols S. Inverse relationship between leukaemic cell burden and plasma concentrations of daunorubicin in patients with acute myeloid leukaemia. Br J Clin Pharmacol 2011; 71:514-21. [PMID: 21204910 DOI: 10.1111/j.1365-2125.2010.03894.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS It has been shown that the cellular uptake and cytotoxicity of anthracyclines decrease with increasing cell density in vitro, an event termed 'the inocculum effect'. It is not known whether such an effect occurs in vivo. In this study the relationships between white blood cell (WBC) count, plasma and cellular concentrations of daunorubicin (DNR) in patients with acute myeloid leukaemia were investigated. METHODS Plasma and mononuclear blood cells were isolated from peripheral blood from 40 patients with acute myeloid leukaemia at end of infusion (time 1 h), 5 and 24 h following the first DNR infusion. DNR concentrations were determined by high-pressure liquid chromatography and related to the WBC count at diagnosis. A population pharmacokinetic model was used to estimate the correlations between baseline WBC count, volume of distribution and clearance of DNR. RESULTS A clear but weak inverse relationship between the baseline WBC count and plasma concentrations of DNR (r(2)=0.11, P<0.05) at time 1 was found. Furthermore, a clear relationship between baseline WBC count and DNR central volume of distribution using population pharmacokinetic modelling (dOFV 4.77, P<0.05) was also noted. Analysis of plasma DNR and the metabolite daunorubicinol (DOL) concentrations in patients with a high WBC count support that the low DNR/DOL concentrations are due a distribution effect. CONCLUSION This study shows that the leukaemic cell burden influences the plasma concentrations of anthracyclines. Further studies are needed to explore if patients with high a WBC count may require higher doses of anthracyclines.
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Affiliation(s)
- Alex Bogason
- Departments of Medicine, Divisions of Clinical Pharmacology, Karolinska Institute/Karolinska University Hospital, Solna S-171 76, Stockholm, Sweden
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Zosuquidar, a novel modulator of P-glycoprotein, does not improve the outcome of older patients with newly diagnosed acute myeloid leukemia: a randomized, placebo-controlled trial of the Eastern Cooperative Oncology Group 3999. Blood 2010; 116:4077-85. [PMID: 20716770 DOI: 10.1182/blood-2010-04-277269] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Zosuquidar, which modulates P-glycoprotein (P-gp) with minimal delay of anthracycline clearance, may reverse P-gp-mediated resistance in acute myeloid leukemia without increased toxicity. A total of 449 adults older than 60 years with acute myeloid leukemia or high-risk myelodysplastic syndrome enrolled in a randomized placebo-controlled double-blind trial (Eastern Cooperative Oncology Group 3999). Overall survival was compared between patients receiving conventional-dose cytarabine and daunorubicin and either zosuquidar (550 mg; 212 patients) or placebo (221 patients). Median and 2-year overall survival values were 7.2 months and 20% on zosuquidar and 9.4 months and 23% on placebo, respectively (P = .281). Remission rate was 51.9% on zosuquidar and 48.9% on placebo. All cause mortality to day 42 was not different (zosuquidar 22.2% vs placebo 16.3%; P = .158). In vitro modulation of P-gp activity by zosuquidar and expression of P-gp, multidrug resistance-related protein 1, lung resistance protein, and breast cancer resistance protein, were comparable in the 2 arms. Poor-risk cytogenetics were more common in P-gp(+) patients. P-gp expression and cytogenetics were correlated, though independent prognostic factors. We conclude that zosuquidar did not improve outcome in older acute myeloid leukemia, in part, because of the presence P-gp independent mechanisms of resistance. This trial is registered at www.clinicaltrials.gov as #NCT00046930.
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Hempel G, Relling MV, de Rossi G, Stary J, De Lorenzo P, Valsecchi MG, Barisone E, Boos J, Pieters R. Pharmacokinetics of daunorubicin and daunorubicinol in infants with leukemia treated in the interfant 99 protocol. Pediatr Blood Cancer 2010; 54:355-60. [PMID: 19731319 DOI: 10.1002/pbc.22266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is an extreme paucity of pharmacokinetic data for anticancer agents in infants. Therefore, we aimed at characterizing the pharmacokinetics for daunorubicin in infants and examined their relationship to age, body weight, and body surface area. PROCEDURE Leukemia patients treated according to the Interfant 99 protocol received 30 mg/m(2) daunorubicin, with dose reduction to 3/4 for patients 6-12 months old and 2/3 for patients <6 months, respectively. Plasma samples from 21 patients (aged 0.05-1.88 years) were collected and analyzed for daunorubicin and daunorubicinol. Samples from 12 children (age 1.6-18.8 years), who received daunorubicin in an earlier investigation, were used for pharmacokinetic model building using the software NONMEM. RESULTS Plasma concentration time profiles could be described using a two compartment model. Daunorubicin clearance was 43.9 L hr(-1) m(-2) +/- 65% and central volume of distribution 16.4 L m(-2) +/- 46%, whereas apparent clearance of daunorubicinol was 19.1 L hr(-1) m(-2) +/- 32% and apparent volume of distribution 228 L m(-2) +/- 80% (mean +/- interindividual variability). No age-dependency in any of the BSA-normalized pharmacokinetic parameters was observed. Consequently, due to the empirical dose reduction in infants the overall exposure to daunorubicinol in infants was smaller than would be expected from older children. Patients aged <6 months experienced more infections in the induction phase than the group aged 6-12 months at diagnosis. Other toxicities were similar in both groups. CONCLUSION We observed no indication of an age-dependency in the pharmacokinetics of daunorubicin. Pediatr Blood Cancer 2010;54:355-360.
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Affiliation(s)
- Georg Hempel
- Institut für Pharmazeutische und Medizinische Chemie, Klinische Pharmazie, Münster, Germany.
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Morschhauser F, Zinzani PL, Burgess M, Sloots L, Bouafia F, Dumontet C. Phase I/II trial of a P-glycoprotein inhibitor, Zosuquidar.3HCl trihydrochloride (LY335979), given orally in combination with the CHOP regimen in patients with non-Hodgkin's lymphoma. Leuk Lymphoma 2009; 48:708-15. [PMID: 17454628 DOI: 10.1080/10428190701190169] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A phase I/II trial was performed to investigate the safety and tolerance of zosuquidar.3HCL, a potent inhibitor of P-glycoprotein (P-gp), when administered orally alone and in combination with the CHOP regimen in patients with untreated non-Hodgkin's lymphoma and to determine whether zosuquidar.3HCL affects pharmacokinetics of doxorubicin and vincristine. Doses of CHOP remained constant and the doses of zosuquidar.3HCL were increased from 200 to 500 mg per dose. A total of 15 patients were treated at three dose levels. A target dose providing peak and trough levels compatible with prolonged modulation of P-gp function was obtained in patients receiving three doses of 500 mg of zosuquidar.3HCL p.o. At this dose level, toxicity was minimal and no enhancement of CHOP-related toxicity was observed. Zosuquidar.3HCL did not significantly affect the pharmacokinetics of doxorubicin and had moderate effects on the pharmacokinetics of vincristine. Zosuquidar.3HCL can be safely administered with CHOP therapy using a 24-h schedule.
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Lancet JE, Baer MR, Duran GE, List AF, Fielding R, Marcelletti JF, Multani PS, Sikic BI. A phase I trial of continuous infusion of the multidrug resistance inhibitor zosuquidar with daunorubicin and cytarabine in acute myeloid leukemia. Leuk Res 2008; 33:1055-61. [PMID: 19108889 DOI: 10.1016/j.leukres.2008.09.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 09/09/2008] [Accepted: 09/09/2008] [Indexed: 11/26/2022]
Abstract
Zosuquidar is a potent and specific inhibitor of P-glycoprotein (P-gp). In preliminary experiments, blockade of P-gp for at least 12 h was required to reverse daunorubicin resistance. Because of the short half-life of zosuquidar, we performed a phase I trial of this drug as a 72-h infusion (CIV) in 16 patients during leukemic induction with daunorubicin and cytarabine. Study goals were to establish safety and determine the dose required for P-gp inhibition in NK cells and AML blasts. > 90% P-gp inhibition was achieved within 2h at a plasma threshold of 132 ng/ml zosuquidar. The recommended phase II dose of zosuquidar is 700 mg/day.
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Affiliation(s)
- Jeffrey E Lancet
- Hematologic Malignancies Program, H Lee Moffitt Cancer Center, Tampa, FL, USA
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Marcelletti JF, Multani PS, Lancet JE, Baer MR, Sikic BI. Leukemic blast and natural killer cell P-glycoprotein function and inhibition in a clinical trial of zosuquidar infusion in acute myeloid leukemia. Leuk Res 2008; 33:769-74. [PMID: 18976810 DOI: 10.1016/j.leukres.2008.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 09/18/2008] [Accepted: 09/21/2008] [Indexed: 10/21/2022]
Abstract
A bioassay was developed to assess P-glycoprotein (P-gp) function of peripheral blood natural killer (NK) cells and AML blasts during zosuquidar infusion. Cells were incubated with the fluorescent dye DiOC(2)(3) in the presence and absence of zosuquidar, and dye accumulation measured by flow cytometry. The assay performance was assessed using NK cells and the P-gp-positive K562/R7 cell line, and then utilized to determine the function of P-gp and its inhibition by zosuquidar in AML blasts and NK cells from patients enrolled in a Phase I trial. The assay of zosuquidar-inhibitable accumulation of DiOC(2) is robust and reproducible.
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Jiménez-Alonso S, Pérez-Lomas AL, Estévez-Braun A, Martinez FM, Orellana HC, Ravelo AG, Gamarro F, Castanys S, López M. Bis-pyranobenzoquinones as a New Family of Reversal Agents of the Multidrug Resistance Phenotype Mediated by P-Glycoprotein in Mammalian Cells and the Protozoan Parasite Leishmania. J Med Chem 2008; 51:7132-43. [DOI: 10.1021/jm800403b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sandra Jiménez-Alonso
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
| | - Antonio L. Pérez-Lomas
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
| | - Ana Estévez-Braun
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
| | - Francisco Muñoz Martinez
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
| | - Haydee Chávez Orellana
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
| | - Angel G. Ravelo
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
| | - Francisco Gamarro
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
| | - Santiago Castanys
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
| | - Matías López
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez 2, 38206, La Laguna, Tenerife, Spain, Instituto Canario de Investigaciones del Cáncer (ICIC) , Spain, and Instituto de Parasitología y Biomedicina “López-Neyra”, Consejo Superior de Investigaciones Científicas (CSIC), Parque Tecnológico de Ciencias de la Salud, Avda. del Conocimiento s/n, 18100 Armilla, Granada, Spain
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15
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Zandvliet AS, Schellens JHM, Beijnen JH, Huitema ADR. Population Pharmacokinetics and Pharmacodynamics for Treatment Optimization??in Clinical Oncology. Clin Pharmacokinet 2008; 47:487-513. [DOI: 10.2165/00003088-200847080-00001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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16
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Lichtman SM, Wildiers H, Chatelut E, Steer C, Budman D, Morrison VA, Tranchand B, Shapira I, Aapro M. International Society of Geriatric Oncology Chemotherapy Taskforce: evaluation of chemotherapy in older patients--an analysis of the medical literature. J Clin Oncol 2007; 25:1832-43. [PMID: 17488981 DOI: 10.1200/jco.2007.10.6583] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The elderly comprise the majority of patients with cancer and are the recipients of the greatest amount of chemotherapy. Unfortunately, there is a lack of data to make evidence-based decisions with regard to chemotherapy. This is due to the minimal participation of older patients in clinical trials and that trials have not systematically evaluated chemotherapy. This article reviews the available information with regard to chemotherapy and aging provided by a task force of the International Society of Geriatric Oncology (SIOG). Due to the lack of prospective data, the conclusions and recommendations made are a consensus of the participants. Extrapolation of data from younger to older patients is necessary, particularly to those patients older than 80 years, for which data is almost entirely lacking. The classes of drugs reviewed include alkylators, antimetabolites, anthracyclines, taxanes, camptothecins, and epipodophyllotoxins. Clinical trials need to incorporate an analysis of chemotherapy in terms of the pharmacokinetic and pharmacodynamic effects of aging. In addition, data already accumulated need to be reanalyzed by age to aid in the management of the older cancer patient.
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Affiliation(s)
- Stuart M Lichtman
- Memorial Sloan-Kettering Cancer Center, Commack, New York 11725, USA.
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17
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Chien JY, Friedrich S, Heathman MA, de Alwis DP, Sinha V. Pharmacokinetics/Pharmacodynamics and the stages of drug development: role of modeling and simulation. AAPS JOURNAL 2005; 7:E544-59. [PMID: 16353932 PMCID: PMC2751257 DOI: 10.1208/aapsj070355] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pharmacokinetic (PK) and pharmacodynamic (PD) modeling and simulation (M&S) are well-recognized powerful tools that enable effective implementation of the learn-and-confirm paradigm in drug development. The impact of PK/PD M&S on decision making and drug development risk management is dependent on the question being asked and on the availability and quality of data accessible at a particular stage of drug development. For instance, M&S methodologies can be used to capture uncertainty and use the expected variability in PK/PD data generated in preclinical species for projection of the plausible range of clinical dose; clinical trial simulation can be used to forecast the probability of achieving a target response in patients based on information obtained in early phases of development. Framing the right question and capturing the key assumptions are critical components of the "learn-and-confirm" paradigm in the drug development process and are essential to delivering high-value PK/PD M&S results. Selected works of PK/PD modeling and simulation from preclinical to phase III are presented as case examples in this article.
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Affiliation(s)
- Jenny Y Chien
- Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, IN 46285, USA.
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