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Craig M. Towards Quantitative Systems Pharmacology Models of Chemotherapy-Induced Neutropenia. CPT Pharmacometrics Syst Pharmacol 2017; 6:293-304. [PMID: 28418603 PMCID: PMC5445232 DOI: 10.1002/psp4.12191] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 12/22/2022] Open
Abstract
Neutropenia is a serious toxic complication of chemotherapeutic treatment. For years, mathematical models have been developed to better predict hematological outcomes during chemotherapy in both the traditional pharmaceutical sciences and mathematical biology disciplines. An increasing number of quantitative systems pharmacology (QSP) models that combine systems approaches, physiology, and pharmacokinetics/pharmacodynamics have been successfully developed. Here, I detail the shift towards QSP efforts, emphasizing the importance of incorporating systems-level physiological considerations in pharmacometrics.
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Affiliation(s)
- M Craig
- Program for Evolutionary Dynamics, Harvard UniversityCambridgeMassachusettsUSA
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Sun W, O'Dwyer PJ, Finn RS, Ruiz-Garcia A, Shapiro GI, Schwartz GK, DeMichele A, Wang D. Characterization of Neutropenia in Advanced Cancer Patients Following Palbociclib Treatment Using a Population Pharmacokinetic-Pharmacodynamic Modeling and Simulation Approach. J Clin Pharmacol 2017; 57:1159-1173. [DOI: 10.1002/jcph.902] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/01/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Wan Sun
- Global Product Development; Pfizer Inc; San Diego CA USA
| | - Peter J. O'Dwyer
- Abramson Cancer Center; Perelman Center for Advanced Medicine; University of Pennsylvania; Philadelphia PA USA
| | | | | | | | | | - Angela DeMichele
- Abramson Cancer Center; Perelman Center for Advanced Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Diane Wang
- Global Product Development; Pfizer Inc; San Diego CA USA
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Craig M, Humphries AR, Mackey MC. A Mathematical Model of Granulopoiesis Incorporating the Negative Feedback Dynamics and Kinetics of G-CSF/Neutrophil Binding and Internalization. Bull Math Biol 2016; 78:2304-2357. [PMID: 27324993 DOI: 10.1007/s11538-016-0179-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/19/2016] [Indexed: 11/24/2022]
Abstract
We develop a physiological model of granulopoiesis which includes explicit modelling of the kinetics of the cytokine granulocyte colony-stimulating factor (G-CSF) incorporating both the freely circulating concentration and the concentration of the cytokine bound to mature neutrophils. G-CSF concentrations are used to directly regulate neutrophil production, with the rate of differentiation of stem cells to neutrophil precursors, the effective proliferation rate in mitosis, the maturation time, and the release rate from the mature marrow reservoir into circulation all dependent on the level of G-CSF in the system. The dependence of the maturation time on the cytokine concentration introduces a state-dependent delay into our differential equation model, and we show how this is derived from an age-structured partial differential equation model of the mitosis and maturation and also detail the derivation of the rest of our model. The model and its estimated parameters are shown to successfully predict the neutrophil and G-CSF responses to a variety of treatment scenarios, including the combined administration of chemotherapy and exogenous G-CSF. This concomitant treatment was reproduced without any additional fitting to characterize drug-drug interactions.
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Affiliation(s)
- M Craig
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, H3T 1J4, Canada.
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138, USA.
| | - A R Humphries
- Department of Mathematics and Statistics, McGill University, Montréal, QC, H3A 0B9, Canada
| | - M C Mackey
- Departments of Mathematics, Physics and Physiology, McGill University, Montréal, QC, H3G 1Y6, Canada
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Craig M, González-Sales M, Li J, Nekka F. Impact of Pharmacokinetic Variability on a Mechanistic Physiological Pharmacokinetic/Pharmacodynamic Model: A Case Study of Neutrophil Development, PM00104, and Filgrastim. SPRINGER PROCEEDINGS IN MATHEMATICS & STATISTICS 2016. [DOI: 10.1007/978-3-319-31323-8_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Craig M, Humphries AR, Nekka F, Bélair J, Li J, Mackey MC. Neutrophil dynamics during concurrent chemotherapy and G-CSF administration: Mathematical modelling guides dose optimisation to minimise neutropenia. J Theor Biol 2015; 385:77-89. [PMID: 26343861 DOI: 10.1016/j.jtbi.2015.08.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 06/10/2015] [Accepted: 08/20/2015] [Indexed: 11/18/2022]
Abstract
The choice of chemotherapy regimens is often constrained by the patient's tolerance to the side effects of chemotherapeutic agents. This dose-limiting issue is a major concern in dose regimen design, which is typically focused on maximising drug benefits. Chemotherapy-induced neutropenia is one of the most prevalent toxic effects patients experience and frequently threatens the efficient use of chemotherapy. In response, granulocyte colony-stimulating factor (G-CSF) is co-administered during chemotherapy to stimulate neutrophil production, increase neutrophil counts, and hopefully avoid neutropenia. Its clinical use is, however, largely dictated by trial and error processes. Based on up-to-date knowledge and rational considerations, we develop a physiologically realistic model to mathematically characterise the neutrophil production in the bone marrow which we then integrate with pharmacokinetic and pharmacodynamic (PKPD) models of a chemotherapeutic agent and an exogenous form of G-CSF (recombinant human G-CSF, or rhG-CSF). In this work, model parameters represent the average values for a general patient and are extracted from the literature or estimated from available data. The dose effect predicted by the model is confirmed through previously published data. Using our model, we were able to determine clinically relevant dosing regimens that advantageously reduce the number of rhG-CSF administrations compared to original studies while significantly improving the neutropenia status. More particularly, we determine that it could be beneficial to delay the first administration of rhG-CSF to day seven post-chemotherapy and reduce the number of administrations from ten to three or four for a patient undergoing 14-day periodic chemotherapy.
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Affiliation(s)
- Morgan Craig
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada H3C 3J7; Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM), McGill University, Montreal, QC, Canada H3G 1Y6.
| | - Antony R Humphries
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada H3A 0B9; Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM), McGill University, Montreal, QC, Canada H3G 1Y6; Centre de recherches mathématiques, Université de Montréal, Montréal, QC, Canada H3C 3J7.
| | - Fahima Nekka
- Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM), McGill University, Montreal, QC, Canada H3G 1Y6; Centre de recherches mathématiques, Université de Montréal, Montréal, QC, Canada H3C 3J7.
| | - Jacques Bélair
- Département de mathématiques et de statistique, Université de Montréal, Montréal, QC, Canada H3C 3J7; Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM), McGill University, Montreal, QC, Canada H3G 1Y6; Centre de recherches mathématiques, Université de Montréal, Montréal, QC, Canada H3C 3J7.
| | - Jun Li
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada H3C 3J7; Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM), McGill University, Montreal, QC, Canada H3G 1Y6; Centre de recherches mathématiques, Université de Montréal, Montréal, QC, Canada H3C 3J7.
| | - Michael C Mackey
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada H3A 0B9; Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM), McGill University, Montreal, QC, Canada H3G 1Y6; Departments of Physiology and Physics, McGill University, Montreal, QC, Canada H3G 1Y6.
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Khazir J, Riley DL, Pilcher LA, De-Maayer P, Mir BA. Anticancer Agents from Diverse Natural Sources. Nat Prod Commun 2014. [DOI: 10.1177/1934578x1400901130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This review attempts to portray the discovery and development of anticancer agents/drugs from diverse natural sources. Natural molecules from these natural sources including plants, microbes and marine organisms have been the basis of treatment of human diseases since the ancient times. Compounds derived from nature have been important sources of new drugs and also serve as templates for synthetic modification. Many successful anti-cancer drugs currently in use are naturally derived or their analogues and many more are under clinical trials. This review aims to highlight the invaluable role that natural products have played, and continue to play, in the discovery of anticancer agents.
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Affiliation(s)
- Jabeena Khazir
- Department of Chemistry, University of Pretoria, Pretoria 0028, South Africa
| | - Darren L. Riley
- Department of Chemistry, University of Pretoria, Pretoria 0028, South Africa
| | - Lynne A. Pilcher
- Department of Chemistry, University of Pretoria, Pretoria 0028, South Africa
| | - Pieter De-Maayer
- Centre for Microbial Ecology and Genomics, Department of Genetics, University of Pretoria, Pretoria 0028, South Africa
- Genomics Research Institute, University of Pretoria, Pretoria 0028, South Africa
| | - Bilal Ahmad Mir
- Centre for Microbial Ecology and Genomics, Department of Genetics, University of Pretoria, Pretoria 0028, South Africa
- Genomics Research Institute, University of Pretoria, Pretoria 0028, South Africa
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PM00104 (Zalypsis®): a marine derived alkylating agent. Molecules 2014; 19:12328-35. [PMID: 25153860 PMCID: PMC6270769 DOI: 10.3390/molecules190812328] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/11/2014] [Accepted: 08/11/2014] [Indexed: 01/20/2023] Open
Abstract
PM00104 (Zalypsis®) is a synthethic tetrahydroisoquinolone alkaloid, which is structurally similar to many marine organisms. The compound has been proposed as a potential chemotherapeutic agent in the treatment of solid human tumors and hematological malignancies. PM00104 is a DNA binding agent, causing inhibition of the cell cycle and transcription, which can lead to double stranded DNA breaks. After rigorous pre-clinical testing, the drug has been evaluated in a number of phase II clinical trials. This manuscript provides a review of current trials and appraises the efficacy of PM00104 as a future cancer treatment.
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A phase I pharmacokinetic study of PM00104 (Zalypsis) administered as a 24-h intravenous infusion every 3 weeks in patients with advanced solid tumors. Cancer Chemother Pharmacol 2013; 71:1247-54. [PMID: 23455428 DOI: 10.1007/s00280-013-2119-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/01/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE PM00104 (Zalypsis) is a synthetic tetrahydroisoquinoline alkaloid with potent antiproliferative activity against tumor cell lines. This phase I study evaluated the safety, dose-limiting toxicities (DLTs), recommended dose for phase II trials (RD), pharmacokinetics (PK) and preliminary antitumor activity of PM00104 as a 24-h intravenous (i.v.) infusion every 3 weeks (q3wk). METHODS Thirty-seven patients with refractory advanced solid tumors received PM00104 in a toxicity-guided dose escalation study design (3 + 3 patients per cohort). Plasma samples were collected for PK analysis. RESULTS DLTs comprised severe neutropenia lasting >5 days (n = 4 patients), vomiting, thrombocytopenia, transaminase increases (n = 2 each), fatigue, tumor pain, myalgia, muscle stiffness, creatine phosphokinase increase and dosing delay >2 weeks due to moderate fatigue (n = 1 each). The RD was 4.0 mg/m(2). Most PM00104-related adverse events at the RD were mild or moderate; the most common were nausea, vomiting and fatigue. Myelosuppression and transaminase increases were transient and manageable. PK parameters increased linearly with dose. Higher PM00104 PK exposure was related to a decrease in hemoglobin, neutrophils, platelets and white blood cells. Area under the curve was directly correlated with both incidence and severity of nausea and vomiting. Three patients with hepatocellular carcinoma, esophageal adenocarcinoma and prostate adenocarcinoma had response evaluation criteria in solid tumors stable disease ≥3 months. CONCLUSIONS PM00104 given as 24-h i.v. infusion q3wk has predictable and manageable toxicity, but resulted in more myelotoxicity (because of the higher dose level achieved as the RD) and a similar drug clearance compared to 1-h infusion schedules. Preliminary evidence of antitumor activity was observed.
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