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Öman M, Wettergren Y, Odin E, Westermark S, Naredi P, Hemmingsson O, Taflin H. Pharmacokinetics of preoperative intraperitoneal 5-FU in patients with pancreatic ductal adenocarcinoma. Cancer Chemother Pharmacol 2021; 88:619-631. [PMID: 34132895 PMCID: PMC8367903 DOI: 10.1007/s00280-021-04318-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim was to investigate the pharmacokinetics of preoperatively administered intraperitoneal (IP) 5-FU in patients with resectable pancreatic ductal adenocarcinoma (PDAC) by analyzing levels of 5-FU and target metabolites in peritoneal fluid, plasma, liver, lymph nodes, pancreatic tumour, and pancreatic tissue. These results were correlated to expression of genes encoding enzymes of the 5-FU pathway and cell membrane transporters of 5-FU and FdUMP. METHODS Twenty-two patients with PDAC were treated with IP 5-FU before surgery. The postoperative treatment followed a routine clinical protocol. 5-FU and its metabolites were analyzed by LC-MS/MS. The expression of genes encoding enzymes and transporters in the 5-FU pathway was analyzed by qPCR. RESULTS After IP treatment, 5-FU could be detected in plasma, lymph nodes, liver, pancreatic tumour, and pancreatic tissue. The highest 5-FU concentration was found in the liver, also expressing high levels of the 5-FU transporter OAT2. 5-FU was converted to active FdUMP in all tissues and the highest concentration was measured in lymph nodes, liver and pancreatic tumour (18.5, 6.1 and 6.7 pmol/g, respectively). There was a correlation between the FdUMP and dUr levels in lymph nodes (r = 0.70, p = 0.0076). In tumours, there was an association between OAT2 expression and FdUMP concentration. CONCLUSION The study shows uptake of IP 5-FU and drug metabolism to active FdUMP in pancreatic tumour, liver, and lymph nodes. Extended studies are warranted to evaluate the IP route for 5-FU administration in PDAC patients.
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Affiliation(s)
- Mikael Öman
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University Faculty of Medicine, Umeå University, 90185, Umeå, Sweden.
| | - Yvonne Wettergren
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital/Östra, 41345, Göteborg, Sweden
| | - Elisabeth Odin
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital/Östra, 41345, Göteborg, Sweden
| | - Sofia Westermark
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University Faculty of Medicine, Umeå University, 90185, Umeå, Sweden.,Department of Surgery, Örnsköldsviks sjukhus, 89135, Örnsköldsvik, Sweden
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital/Östra, 41345, Göteborg, Sweden
| | - Oskar Hemmingsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University Faculty of Medicine, Umeå University, 90185, Umeå, Sweden
| | - Helena Taflin
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital/Östra, 41345, Göteborg, Sweden
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Lagast N, Carlier C, Ceelen WP. Pharmacokinetics and Tissue Transport of Intraperitoneal Chemotherapy. Surg Oncol Clin N Am 2018; 27:477-494. [PMID: 29935684 DOI: 10.1016/j.soc.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The presence of a peritoneal barrier results in a pharmacokinetic advantage associated with intraperitoneal (IP) delivery of anticancer drugs. The anticancer efficacy of IP chemotherapy depends, however, on its ability to penetrate the tumor stroma. Tumor tissue transport is governed by diffusion and convection and is affected by numerous physical, biological, and pharmaceutical variables. From preclinical and clinical studies, it appears that tissue penetration after IP chemotherapy delivery is very limited. Several approaches are studied in order to improve tissue penetration of small molecular and macromolecular anticancer drugs after IP instillation.
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Affiliation(s)
- Nick Lagast
- Department of Surgery, Ghent University, Cancer Research Institute Ghent (CRIG), Ghent B-9000, Belgium
| | - Charlotte Carlier
- Department of Surgery, Ghent University, Cancer Research Institute Ghent (CRIG), Ghent B-9000, Belgium
| | - Wim P Ceelen
- Department of Surgery, Ghent University, Cancer Research Institute Ghent (CRIG), Ghent B-9000, Belgium.
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Carlier C, Mathys A, De Jaeghere E, Steuperaert M, De Wever O, Ceelen W. Tumour tissue transport after intraperitoneal anticancer drug delivery. Int J Hyperthermia 2018; 33:534-542. [PMID: 28540828 DOI: 10.1080/02656736.2017.1312563] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Intraperitoneal (IP) drug delivery, either as an intraoperative chemoperfusion or as an adjuvant, repeated instillation, is an established treatment modality in patients with peritoneal carcinomatosis. The efficacy of IP drugs depends on its ability to penetrate the tumour stroma in order to reach their (sub)cellular target. It is known, that drug penetration after IP delivery is limited to a few millimetres. Here, we review the basic tissue transport mechanisms after IP delivery and discuss the biophysical barriers and obstacles that limit penetration distance. In addition, we review the physical and pharmaceutical interventions that have been studied in order to improve delivery of small molecular and macromolecular drugs after IP instillation. These interventions could inform the design of future clinical trials aiming at an improved efficacy of IP-based drug delivery in carcinomatosis patients.
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Affiliation(s)
- Charlotte Carlier
- a Laboratory for Experimental Surgery, Department of Surgery , Ghent University , Ghent , Belgium
| | - Ada Mathys
- a Laboratory for Experimental Surgery, Department of Surgery , Ghent University , Ghent , Belgium
| | - Emiel De Jaeghere
- b Department of Radiation Oncology and Experimental Cancer Research , Ghent University , Ghent , Belgium
| | - Margo Steuperaert
- c Biofluid, Tissue and Solid Mechanics for Medical Applications (bioMMeda), Department of Electronics and Information Systems, iMinds Medical IT Department , Ghent University , Ghent , Belgium
| | - Olivier De Wever
- b Department of Radiation Oncology and Experimental Cancer Research , Ghent University , Ghent , Belgium.,d Cancer Research Institute Ghent (CRIG), Ghent University , Ghent , Belgium
| | - Wim Ceelen
- a Laboratory for Experimental Surgery, Department of Surgery , Ghent University , Ghent , Belgium.,d Cancer Research Institute Ghent (CRIG), Ghent University , Ghent , Belgium
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Ashdown ML, Robinson AP, Yatomi-Clarke SL, Ashdown ML, Allison A, Abbott D, Markovic SN, Coventry BJ. Chemotherapy for Late-Stage Cancer Patients: Meta-Analysis of Complete Response Rates. F1000Res 2015; 4:232. [PMID: 26834979 PMCID: PMC4706056 DOI: 10.12688/f1000research.6760.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 12/15/2022] Open
Abstract
Complete response (CR) rates reported for cytotoxic chemotherapy for late-stage cancer patients are generally low, with few exceptions, regardless of the solid cancer type or drug regimen. We investigated CR rates reported in the literature for clinical trials using chemotherapy alone, across a wide range of tumour types and chemotherapeutic regimens, to determine an overall CR rate for late-stage cancers. A total of 141 reports were located using the PubMed database. A meta-analysis was performed of reported CR from 68 chemotherapy trials (total 2732 patients) using standard agents across late-stage solid cancers—a binomial model with random effects was adopted. Mean CR rates were compared for different cancer types, and for chemotherapeutic agents with different mechanisms of action, using a logistic regression. Our results showed that the CR rates for chemotherapy treatment of late-stage cancer were generally low at 7.4%, regardless of the cancer type or drug regimen used. We found no evidence that CR rates differed between different chemotherapy drug types, but amongst different cancer types small CR differences were evident, although none exceeded a mean CR rate of 11%. This remarkable concordance of CR rates regardless of cancer or therapy type remains currently unexplained, and motivates further investigation.
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Affiliation(s)
- Martin L Ashdown
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew P Robinson
- Department of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Andrew Allison
- Centre for Biomedical Engineering (CBME), University of Adelaide, South Australia, Australia; School of Electrical & Electronic Engineering, University of Adelaide, South Australia, Australia
| | - Derek Abbott
- Centre for Biomedical Engineering (CBME), University of Adelaide, South Australia, Australia; School of Electrical & Electronic Engineering, University of Adelaide, South Australia, Australia
| | | | - Brendon J Coventry
- Department of Surgery & Tumour Immunology Laboratory, University of Adelaide, South Australia, Australia; Breast, Endocrine & Surgical Oncology Unit, Royal Adelaide Hospital, South Australia, Australia
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Palmer JA, Smith AM, Egnash LA, Conard KR, West PR, Burrier RE, Donley ELR, Kirchner FR. Establishment and assessment of a new human embryonic stem cell-based biomarker assay for developmental toxicity screening. ACTA ACUST UNITED AC 2013; 98:343-63. [PMID: 24123775 DOI: 10.1002/bdrb.21078] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/12/2013] [Indexed: 01/07/2023]
Abstract
A metabolic biomarker-based in vitro assay utilizing human embryonic stem (hES) cells was developed to identify the concentration of test compounds that perturbs cellular metabolism in a manner indicative of teratogenicity. This assay is designed to aid the early discovery-phase detection of potential human developmental toxicants. In this study, metabolomic data from hES cell culture media were used to assess potential biomarkers for development of a rapid in vitro teratogenicity assay. hES cells were treated with pharmaceuticals of known human teratogenicity at a concentration equivalent to their published human peak therapeutic plasma concentration. Two metabolite biomarkers (ornithine and cystine) were identified as indicators of developmental toxicity. A targeted exposure-based biomarker assay using these metabolites, along with a cytotoxicity endpoint, was then developed using a 9-point dose-response curve. The predictivity of the new assay was evaluated using a separate set of test compounds. To illustrate how the assay could be applied to compounds of unknown potential for developmental toxicity, an additional 10 compounds were evaluated that do not have data on human exposure during pregnancy, but have shown positive results in animal developmental toxicity studies. The new assay identified the potential developmental toxicants in the test set with 77% accuracy (57% sensitivity, 100% specificity). The assay had a high concordance (≥75%) with existing in vivo models, demonstrating that the new assay can predict the developmental toxicity potential of new compounds as part of discovery phase testing and provide a signal as to the likely outcome of required in vivo tests.
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Hasovits C, Clarke S. Pharmacokinetics and Pharmacodynamics of Intraperitoneal Cancer Chemotherapeutics. Clin Pharmacokinet 2012; 51:203-224. [DOI: 10.2165/11598890-000000000-00000] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
BACKGROUND The syndrome of 5-fluorouracil (5-FU)-associated cardiotoxicity remains poorly defined. PATIENTS AND METHODS We performed a literature review (1969 - 2007) and compiled data derived from 377 evaluable cases out of 448 reported cases. RESULTS Patient age ranged from 14 to 86 years. Of the patients 65% were 55 years old and the male:female ratio was 1.5:1. The most commonly treated tumors were gastrointestinal (60%), head and neck (22%) and breast (4%). Of the patients 14% had a history of heart disease whereas cardiac risk factors were found in 37%. Mode of administration included: continuous infusion (72%); bolus (22.5%); intermediate infusion (3%); oral (2%); and intraperitoneal (1 patient). The dosages of 5-FU used were < 750 mg/m(2)/day (36%), 751 - 999 (16%), 1,000 (26%), 1,001 - 1,499 (4%) and 1,500 (16%). Of the patients 54% received 5-FU in combination with other chemotherapeutic agents (cisplatin 44%) whereas 51% received 5-FU alone or with leucovorin. Only 4% patients had undergone previous or concomitant radiation therapy to the mediastinum. Of cardiac incidents that happened 69% were seen during or within 72 h of the first cycle of 5-FU. Angina occurred in 45% of patients whereas myocardial infarction was seen in 22%, arrhythmias in 23, acute pulmonary edema in 5, cardiac arrest and pericarditis in 1.4 and heart failure in 2. Electro-cardiographic evidence of ischemia or ST-T changes were recorded in 69% of patients, but abnormal cardiac enzymes were found in only 12%. The cardiac symptoms were reproducible in 47%, including in one patient subsequently treated with 5-FU p.o. Symptoms were also elicited when the same patients were treated with lower doses or different schedules. Of the patients 68% responded to conservative anti-anginal therapy, although prophylactic coronary vasodilators had limited efficacy. Overall, 8% of patients showing cardiotoxicity on 5-FU administration died. Furthermore, 13% reexposed to 5-FU died. CONCLUSIONS Our review suggests that 5-FU cardiotoxicity is an infrequent but real phenomenon that is independent of dose and may be related to a continuous infusion schedule. The presence of cardiac risk factors is not predictive. Patients should be observed closely and 5-FU administration discontinued if cardiac symptoms develop. A rechallenge with 5-FU should be reserved only for those patients in whom there is no reasonable alternative therapy and should be performed in the setting of aggressive prophylaxis and close monitoring.
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Affiliation(s)
- M Wasif Saif
- Yale University School of Medicine, FMP 116, CT 06520, New Haven, USA.
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Ohlund D, Ardnor B, Oman M, Naredi P, Sund M. Expression pattern and circulating levels of endostatin in patients with pancreas cancer. Int J Cancer 2008; 122:2805-10. [PMID: 18360823 DOI: 10.1002/ijc.23468] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Endostatin is a potent inhibitor of angiogenesis that is cleaved from the basement membrane protein type XVIII collagen. Expression of endostatin has recently been shown by Western blot analysis of tissue lysates in normal pancreas and pancreas cancer tissue. We show here that the expression pattern of type XVIII collagen/endostatin is shifted from a general basement membrane staining and is mainly located in the vasculature during tumor progression. This shift in type XVIII collagen/endostatin expression pattern coincides with an up-regulation of MMPs involved in endostatin processing in the tumor microenvironment, such as MMP-3, MMP-9 and MMP-13. The circulating levels of endostatin was analyzed in patients with pancreas cancer and compared to that of healthy controls, as well as after surgical treatment or in a group of nonoperable patients after intraperitoneal fluorouracil (5-FU) chemotherapy. The results show that patients with pancreas cancer have increased circulating levels of endostatin and that these levels are normalized after surgery or intraperitoneal chemotherapy. These findings indicate that endostatin could be used as a biomarker for pancreas cancer progression.
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Affiliation(s)
- Daniel Ohlund
- Department of Surgery, Umeå University Hospital, SE Umeå, Sweden
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Abstract
Chemotherapy resistance is one of the most prevalent obstacles to the treatment of cancer, resulting in increased mortality and prolonged exposure to cytotoxic agents with no treatment benefit. One of the tools utilized in the study of mechanisms of chemotherapy resistance are established cell lines derived from human neoplasms. These cell lines can be challenged in vitro with controlled chemotherapy doses to produce chemotherapy-resistant variants. Analysis of these novel chemotherapy-resistant cell lines may then identify genetic and proteomic changes which are associated with the resistant phenotype. Two very important mediators of chemotherapy resistance (P-glycoprotein and multidrug resistance protein-1) were initially identified in chemotherapy-resistant cell lines. To make these in-vitro studies clinically relevant it is, however, necessary to duplicate as far as possible the treatment conditions used in vivo. Considerations should include clinically relevant drug concentrations, such as those derived from peak plasma values, and the type of treatment schedule to be employed.
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Affiliation(s)
- Mark B Watson
- Cancer Biology Proteomics Group, Postgraduate Medical Institute of the University of Hull, Hull, UK
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