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Ifosfamide - History, efficacy, toxicity and encephalopathy. Pharmacol Ther 2023; 243:108366. [PMID: 36842616 DOI: 10.1016/j.pharmthera.2023.108366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
In this review we trace the passage of fundamental ideas through 20th century cancer research that began with observations on mustard gas toxicity in World War I. The transmutation of these ideas across scientific and national boundaries, was channeled from chemical carcinogenesis labs in London via Yale and Chicago, then ultimately to the pharmaceutical industry in Bielefeld, Germany. These first efforts to checkmate cancer with chemicals led eventually to the creation of one of the most successful groups of cancer chemotherapeutic drugs, the oxazaphosphorines, first cyclophosphamide (CP) in 1958 and soon thereafter its isomer ifosfamide (IFO). The giant contributions of Professor Sir Alexander Haddow, Dr. Alfred Z. Gilman & Dr. Louis S. Goodman, Dr. George Gomori and Dr. Norbert Brock step by step led to this breakthrough in cancer chemotherapy. A developing understanding of the metabolic disposition of ifosfamide directed efforts to ameliorate its side-effects, in particular, ifosfamide-induced encephalopathy (IIE). This has resulted in several candidates for the encephalopathic metabolite, including 2-chloroacetaldehyde, 2-chloroacetic acid, acrolein, 3-hydroxypropionic acid and S-carboxymethyl-L-cysteine. The pros and cons for each of these, together with other IFO metabolites, are discussed in detail. It is concluded that IFO produces encephalopathy in susceptible patients, but CP does not, by a "perfect storm," involving all of these five metabolites. Methylene blue (MB) administration appears to be generally effective in the prevention and treatment of IIE, in all probability by the inhibition of monoamine oxidase in brain potentiating serotonin levels that modulate the effects of IFO on GABAergic and glutamatergic systems. This review represents the authors' analysis of a large body of published research.
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Skarbek C, Delahousse J, Pioche-Durieu C, Baconnais S, Deroussent A, Renevret P, Rivard M, Desmaele D, Martens T, Le Cam E, Couvreur P, Paci A. Poly-isoprenylated ifosfamide analogs: Preactivated antitumor agents as free formulation or nanoassemblies. Int J Pharm 2017; 532:748-756. [PMID: 28546071 DOI: 10.1016/j.ijpharm.2017.05.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/19/2017] [Accepted: 05/20/2017] [Indexed: 01/28/2023]
Abstract
Oxazaphosphorines including cyclophosphamide, trofosfamide and ifosfamide (IFO) belong to the alkylating agent class and are indicated in the treatment of numerous cancers. However, IFO is subject to limiting side-effects in high-dose protocols. To circumvent IFO drawbacks in clinical practices, preactivated IFO analogs were designed to by-pass the toxic metabolic pathway. Among these IFO analogs, some of them showed the ability to self-assemble due to the use of a poly-isoprenyloxy chain as preactivating moiety. We present here, the in vitro activity of the nanoassembly formulations of preactivated IFO derivatives with a C-4 geranyloxy, farnesyloxy and squalenoxy substituent on a large panel of tumor cell lines. The chemical and colloidal stabilities of the geranyloxy-IFO (G-IFO), farnesyloxy-IFO (F-IFO) and squalenoxy-IFO (SQ-IFO) NAs were further evaluated in comparison to their free formulation. Finally, pharmacokinetic parameters and maximal tolerated dose of the most potent preactivated IFO analog (G-IFO) were determined and compared to IFO, paving the way to in vivo studies.
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Affiliation(s)
- Charles Skarbek
- Vectorologie des anticancéreux et des acides nucléiques, UMR 8203, CNRS, Université Paris-Sud, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Julia Delahousse
- Vectorologie des anticancéreux et des acides nucléiques, UMR 8203, CNRS, Université Paris-Sud, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France; Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, 94805 Villejuif, France
| | - Catherine Pioche-Durieu
- Signalisations, Noyaux et Innovations en Cancérologie, UMR 8126, CNRS, Université Paris-Sud, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Sonia Baconnais
- Signalisations, Noyaux et Innovations en Cancérologie, UMR 8126, CNRS, Université Paris-Sud, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Alain Deroussent
- Vectorologie des anticancéreux et des acides nucléiques, UMR 8203, CNRS, Université Paris-Sud, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Patrice Renevret
- Institut de Chimie et des Matériaux Paris Est Créteil (ICMPE), UMR 7182, CNRS, Université Paris Est (UPEC), 94320 Thiais, France
| | - Michael Rivard
- Institut de Chimie et des Matériaux Paris Est Créteil (ICMPE), UMR 7182, CNRS, Université Paris Est (UPEC), 94320 Thiais, France
| | - Didier Desmaele
- Institut Galien Paris-Sud, UMR 8612, CNRS, Université Paris-Saclay, Faculté de Pharmacie, 92296, Châtenay-Malabry, France
| | - Thierry Martens
- Institut de Chimie et des Matériaux Paris Est Créteil (ICMPE), UMR 7182, CNRS, Université Paris Est (UPEC), 94320 Thiais, France
| | - Eric Le Cam
- Signalisations, Noyaux et Innovations en Cancérologie, UMR 8126, CNRS, Université Paris-Sud, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Patrick Couvreur
- Institut Galien Paris-Sud, UMR 8612, CNRS, Université Paris-Saclay, Faculté de Pharmacie, 92296, Châtenay-Malabry, France
| | - Angelo Paci
- Vectorologie des anticancéreux et des acides nucléiques, UMR 8203, CNRS, Université Paris-Sud, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France; Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, 94805 Villejuif, France; Département de Pharmacocinétique & Pharmacie Clinique, Université Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, 92296 Châtenay-Malabry, France.
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Torres LM, Rivera-Espinosa L, Chávez-Pacheco JL, Navas CF, Demetrio JA, Alemón-Medina R, Trujillo F, Pérez M, Zapata MM, Cárdenas R, Salinas C, Aquino A, Velázquez-Cruz R, Castillejos MDJ. A New Method to Quantify Ifosfamide Blood Levels Using Dried Blood Spots and UPLC-MS/MS in Paediatric Patients with Embryonic Solid Tumours. PLoS One 2015; 10:e0143421. [PMID: 26600181 PMCID: PMC4657950 DOI: 10.1371/journal.pone.0143421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/04/2015] [Indexed: 11/18/2022] Open
Abstract
Ifosfamide blood concentrations are necessary to monitor its therapeutic response, avoiding any adverse effect. We developed and validated an analytical method by UPLC-MS/MS to quantify ifosfamide in dried blood spots (DBS). Blood samples were collected on Whatman 903® filter paper cards. Five 3 mm disks were punched out from each dried blood spot. Acetonitrile and ethyl acetate were used for drug extraction. Chromatographic separation was carried out in an Acquity UPLC equipment with a BEH-C18 column, 2.1 x 100 mm, 1.7 μm (Waters®). The mobile phase consisted in 5 mM ammonium formate and methanol:acetonitrile (40:48:12 v/v/v) at 0.2 mL/min. LC-MS/MS detection was done by ESI+ and multiple reaction mode monitoring, ionic transitions were m/z1+ 260.99 > 91.63 for ifosfamide and 261.00 > 139.90 for cyclophosphamide (internal standard). This method was linear within a 100–10000 ng/mL range and it was accurate, precise and selective. Ifosfamide samples in DBS were stable for up to 52 days at -80°C. The procedure was tested in 14 patients, ages 1 month to 17 years (9 males and 5 females), with embryonic tumours treated with ifosfamide, alone or combined, at a public tertiary referral hospital. Ifosfamide blood levels ranged from 11.1 to 39.7 μmol/L at 12 hours after the last infusion, while 24-hour levels ranged from 0.7–19.7 μmol/L. The median at 12 hours was 19.5 μmol/L (Q25 14.4–Q75 29.0) and 3.8 μmol/L (Q25 1.5–Q75 9.9) at 24 hours, p<0.001. This method is feasible to determine ifosfamide plasma levels in paediatric patients.
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Affiliation(s)
- Luz-María Torres
- Laboratorio de Farmacología, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Juan L. Chávez-Pacheco
- Laboratorio de Farmacología, Instituto Nacional de Pediatría, Mexico City, Mexico
- * E-mail: (JLCP); (MJC)
| | - Carlos F. Navas
- Laboratorio de Farmacología, Instituto Nacional de Pediatría, Mexico City, Mexico
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Joel A. Demetrio
- Laboratorio de Farmacología, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Francisca Trujillo
- Laboratorio de Farmacología, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Martín Pérez
- Servicio de Oncología, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Martha M. Zapata
- Servicio de Oncología, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Rocío Cárdenas
- Servicio de Oncología, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Citlaltepetl Salinas
- Laboratorio de Neuropatología, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Arnoldo Aquino
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Rafael Velázquez-Cruz
- Laboratorio de Genómica del Metabolismo Óseo, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Manuel-de-Jesús Castillejos
- Unidad de Vigilancia Epidemiológica, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
- * E-mail: (JLCP); (MJC)
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Simultaneous quantification of preactivated ifosfamide derivatives and of 4-hydroxyifosfamide by high performance liquid chromatography–tandem mass spectrometry in mouse plasma and its application to a pharmacokinetic study. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 992:30-5. [DOI: 10.1016/j.jchromb.2015.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/09/2015] [Accepted: 04/11/2015] [Indexed: 10/23/2022]
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Skarbek C, Lesueur LL, Chapuis H, Deroussent A, Pioche−Durieu C, Daville A, Caron J, Rivard M, Martens T, Bertrand JR, Le Cam E, Vassal G, Couvreur P, Desmaele D, Paci A. Preactivated Oxazaphosphorines Designed for Isophosphoramide Mustard Delivery as Bulk Form or Nanoassemblies: Synthesis and Proof of Concept. J Med Chem 2014; 58:705-17. [DOI: 10.1021/jm501224x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Charles Skarbek
- Université
Paris-Sud, Centre National de la Recherche
Scientifique (CNRS), and Gustave Roussy Cancer
Campus Grand Paris, Laboratoire de Vectorologie et Thérapeutiques Anticancéreuses, UMR 8203, Villejuif, France-94805
| | - Lea L. Lesueur
- Université
Paris-Sud, Centre National de la Recherche
Scientifique (CNRS), and Gustave Roussy Cancer
Campus Grand Paris, Laboratoire de Vectorologie et Thérapeutiques Anticancéreuses, UMR 8203, Villejuif, France-94805
| | - Hubert Chapuis
- Université Paris-Sud, Institut Galien, UMR 8612, Châtenay-Malabry, France-92296
| | - Alain Deroussent
- Université
Paris-Sud, Centre National de la Recherche
Scientifique (CNRS), and Gustave Roussy Cancer
Campus Grand Paris, Laboratoire de Vectorologie et Thérapeutiques Anticancéreuses, UMR 8203, Villejuif, France-94805
| | | | - Aurore Daville
- Université
Paris-Sud, Centre National de la Recherche
Scientifique (CNRS), and Gustave Roussy Cancer
Campus Grand Paris, Laboratoire de Vectorologie et Thérapeutiques Anticancéreuses, UMR 8203, Villejuif, France-94805
| | - Joachim Caron
- Université Paris-Sud, Institut Galien, UMR 8612, Châtenay-Malabry, France-92296
| | - Michael Rivard
- Université Paris Est Créteil, Institut de Chimie et des Matériaux Paris-Est (ICMPE), UMR 7182, Thiais, France-94320
| | - Thierry Martens
- Université Paris Est Créteil, Institut de Chimie et des Matériaux Paris-Est (ICMPE), UMR 7182, Thiais, France-94320
| | - Jean-Rémi Bertrand
- Université
Paris-Sud, Centre National de la Recherche
Scientifique (CNRS), and Gustave Roussy Cancer
Campus Grand Paris, Laboratoire de Vectorologie et Thérapeutiques Anticancéreuses, UMR 8203, Villejuif, France-94805
| | - Eric Le Cam
- CNRS UMR8126, Université Paris Sud 11, Institut Gustave Roussy, Villejuif, France-94805
| | - Gilles Vassal
- Université
Paris-Sud, Centre National de la Recherche
Scientifique (CNRS), and Gustave Roussy Cancer
Campus Grand Paris, Laboratoire de Vectorologie et Thérapeutiques Anticancéreuses, UMR 8203, Villejuif, France-94805
| | - Patrick Couvreur
- Université Paris-Sud, Institut Galien, UMR 8612, Châtenay-Malabry, France-92296
| | - Didier Desmaele
- Université Paris-Sud, Institut Galien, UMR 8612, Châtenay-Malabry, France-92296
| | - Angelo Paci
- Université
Paris-Sud, Centre National de la Recherche
Scientifique (CNRS), and Gustave Roussy Cancer
Campus Grand Paris, Laboratoire de Vectorologie et Thérapeutiques Anticancéreuses, UMR 8203, Villejuif, France-94805
- Gustave Roussy Cancer Campus Grand Paris, Service Interdépartemental de Pharmacologie et d’Analyse du Médicament (SIPAM), Villejuif, France-94805
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Pharmacokinetic study of perioperative intravenous Ifosfamide. Int J Surg Oncol 2011; 2011:185092. [PMID: 22312496 PMCID: PMC3263669 DOI: 10.1155/2011/185092] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/27/2011] [Accepted: 07/13/2011] [Indexed: 01/19/2023] Open
Abstract
The use of cancer chemotherapy and hyperthermia as part of a surgical procedure in the management of patients with peritoneal carcinomatosis has gained prominence in recent years with selected patients showing benefit. Patients with peritoneal surface malignancy following cancer resection were treated with intraperitoneal hyperthermic (41.5–42.5°C) cisplatin and doxorubicin combined with the infusion of systemic ifosfamide chemotherapy. The concentrations of ifosfamide and 4-hydroxyifosfamide were determined in plasma, peritoneal fluid, urine, and when possible, within small tumor nodules less than 1 cm. Plasma concentrations of ifosfamide exceeded peritoneal fluid levels of ifosfamide during the 90 minutes of chemotherapy infusion. Both ifosfamide and 4-hydroxyifosfamide could be recovered from peritoneal tumor nodules throughout the 90 minutes of ifosfamide continuous infusion and exceeded plasma concentrations. 4-Hydroxyifosfamide within peritoneal surface cancer nodules suggested a favorable pharmacologic endpoint in the study of ifosfamide administered in the operating room.
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Huitema ADR, Tibben MM, Kerbusch T, Kettenes-van den Bosch JJ, Rodenhuis S, Beijnen JH. HIGH PERFORMANCE LIQUID CHROMATOGRAPHIC DETERMINATION OF THE STABILIZED CYCLOPHOSPHAMIDE METABOLITE 4-HYDROXYCYCLOPHOSPHAMIDE IN PLASMA AND RED BLOOD CELLS. J LIQ CHROMATOGR R T 2007. [DOI: 10.1081/jlc-100100448] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A. D. R. Huitema
- a Department of Pharmacy and Pharmacology , The Netherlands Cancer Institute/Slotervaart Hospital , Louwesweg 6, Amsterdam, 1066 EC, The Nertherlands
| | - M. M. Tibben
- a Department of Pharmacy and Pharmacology , The Netherlands Cancer Institute/Slotervaart Hospital , Louwesweg 6, Amsterdam, 1066 EC, The Nertherlands
| | - T. Kerbusch
- a Department of Pharmacy and Pharmacology , The Netherlands Cancer Institute/Slotervaart Hospital , Louwesweg 6, Amsterdam, 1066 EC, The Nertherlands
| | - J. J. Kettenes-van den Bosch
- b Division of Drug Toxicology , Faculty of Pharmacy Utrecht University , Sorbonnelaan 16, Utrecht, 3508 TG, The Netherlands
| | - S. Rodenhuis
- c Department of Medical Oncology , The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital , Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - J. H. Beijnen
- a Department of Pharmacy and Pharmacology , The Netherlands Cancer Institute/Slotervaart Hospital , Louwesweg 6, Amsterdam, 1066 EC, The Nertherlands
- b Division of Drug Toxicology , Faculty of Pharmacy Utrecht University , Sorbonnelaan 16, Utrecht, 3508 TG, The Netherlands
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Kerbusch T, Groenewegen G, Mathôt RAA, Herben VMM, ten Bokkel Huinink WW, Swart M, Ambaum B, Rosing H, Jansen S, Voest EE, Beijnen JH, Schellens JHM. Phase I and pharmacokinetic study of the combination of topotecan and ifosfamide administered intravenously every 3 weeks. Br J Cancer 2004; 90:2268-77. [PMID: 15150579 PMCID: PMC2409520 DOI: 10.1038/sj.bjc.6601861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To determine the maximum-tolerated dose (MTD), dose-limiting toxicities, and pharmacokinetics of topotecan administered as a 30-min intravenous (i.v.) infusion over 5 days in combination with a 1-h i.v. infusion of ifosfamide (IF) for 3 consecutive days every 3 weeks. Patients with advanced malignancies refractory to standard therapy were entered into the study. The starting dose of topotecan was 0.4 mg m−2 day−1 × 5 days. Ifosfamide was administered at a fixed dose of 1.2 g m−2 day−1 × 3 days. In all, 36 patients received 144 treatment courses. Owing to toxicities, the schedule of topotecan administration was reduced from 5 to 3 days. The MTD was reached at topotecan 1.2 mg m−2 day−1 × 3 days with IF 1.2 g m−2 day−1 × 3 days. Haematological toxicities were dose limiting. Neutropenia was the major toxicity. Thrombocytopenia and anaemia were rare. Nonhaematological toxicities were relatively mild. Partial responses were documented in three patients with ovarian cancer dosed below the MTD. Topotecan and IF did not appear to interact pharmacokinetically. The relationships between the exposure to topotecan lactone and total topotecan, and the decrease in absolute neutrophil count and the decrease in thrombocytes, were described with sigmoidal–Emax models. The combination of 1.0 mg m−2 day−1 topotecan administered as a 30-min i.v. infusion daily times three with 1.2 g m−2 day−1 IF administered as a 1-h i.v. infusion daily times three every 3 weeks was feasible. However, the combination schedule of topotecan and IF did result in considerable haematological toxicity and in conjunction with previously reported pronounced nonhaematological toxicities and treatment related deaths, it may be concluded that this is not a favourable combination.
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Affiliation(s)
- T Kerbusch
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands.
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Wang G, Hsieh Y, Lau Y, Cheng KC, Ng K, Korfmacher WA, White RE. Semi-automated determination of plasma stability of drug discovery compounds using liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2002; 780:451-7. [PMID: 12401373 DOI: 10.1016/s1570-0232(02)00467-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A simple procedure for the measurement of stability of drug candidates in plasma was developed to eliminate the traditional labor-intensive and time-consuming sample preparation procedures that are typically used for these studies. The procedure makes use of a thermostatic autosampler as an incubator combined with the direct plasma injection method based on high-performance liquid chromatography (HPLC) coupled to tandem mass spectrometry (MS-MS). Untreated human, monkey, mouse and rat plasma containing the test compound was directly injected into a mixed-function column for on-line protein removal and chromatography. The test compound and its biotransformation product were separated via HPLC and monitored using the tandem mass spectrometer. The need for adequate chromatographic separation of the test compound (M) from its carboxylic acid metabolite (M+1) is demonstrated. Plasma samples from four different species at specified incubation temperatures were sequentially assayed in one analytical procedure. The injection-to-injection time was about 6 min. The peak responses of the test compound in individual plasma samples were repeatedly determined every 24 min. The retention times and peak shape of all analytes were found to be consistent throughout the experiments. The stability of the test compound in plasma was found to be a function of animal species, incubation time and temperature. The test compound was rapidly degraded in rat plasma at 37 degrees C, but it could be stabilized by adding sodium thiosulfate.
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Affiliation(s)
- Gangfeng Wang
- Drug Metabolism and Pharmacokinetics Department, Schering Plough Research Institute, 2015 Galloping Hill Rd, Kenilworth, NJ 07033, USA
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Kerbusch T, de Kraker J, Mathĵt RA, Beijnen JH. Population pharmacokinetics of ifosfamide and its dechloroethylated and hydroxylated metabolites in children with malignant disease: a sparse sampling approach. Clin Pharmacokinet 2002; 40:615-25. [PMID: 11523727 DOI: 10.2165/00003088-200140080-00005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess the feasibility of a sparse sampling approach for the determination of the population pharmacokinetics of ifosfamide, 2- and 3-dechloroethyl-ifosfamide and 4-hydroxy-ifosfamide in children treated with single-agent ifosfamide against various malignant tumours. DESIGN Pharmacokinetic assessment followed by model fitting. PATIENTS The analysis included 32 patients aged between 1 and 18 years receiving a total of 45 courses of ifosfamide 1.2, 2 or 3 g/m2 in 1 or 3 hours on 1, 2 or 3 days. METHODS A total of 133 blood samples (median of 3 per patient) were collected. Plasma concentrations of ifosfamide and its dechloroethylated metabolites were determined by gas chromatography. Plasma concentrations of 4-hydroxy-ifosfamide were measured by high-performance liquid chromatography. The models were fitted to the data using a nonlinear mixed effects model as implemented in the NONMEM program. A cross-validation was performed. RESULTS Population values (mean +/- standard error) for the initial clearance and volume of distribution of ifosfamide were estimated at 2.36 +/- 0.33 L/h/m2 and 20.6 +/- 1.6 L/m2 with an interindividual variability of 43 and 32%, respectively. The enzyme induction constant was estimated at 0.0493 +/- 0.0104 L/h2/m2. The ratio of the fraction of ifosfamide metabolised to each metabolite to the volume of distribution of that metabolite, and the elimination rate constant, of 2- and 3-dechloroethyl-ifosfamide and 4-hydroxy-ifosfamide were 0.0976 +/- 0.0556, 0.0328 +/- 0.0102 and 0.0230 +/- 0.0083 m2/L and 3.64 +/- 2.04, 0.445 +/- 0.174 and 7.67 +/- 2.87 h(-1), respectively. Interindividual variability of the first parameter was 23, 34 and 53%, respectively. Cross-validation indicated no bias and minor imprecision (12.5 +/- 5.1%) for 4-hydroxy-ifosfamide only. CONCLUSIONS We have developed and validated a model to estimate ifosfamide and metabolite concentrations in a paediatric population by using sparse sampling.
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Affiliation(s)
- T Kerbusch
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam.
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11
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Paci A, Rieutord A, Brion F, Prognon P. Separation methods for alkylating antineoplastic compounds. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 2001; 764:255-87. [PMID: 11817031 DOI: 10.1016/s0378-4347(01)00280-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The separating method for alkylating neoplastic compounds were reviewed based on the classification of the Merck Index (12th Edition). Each section, whenever available or relevant, was subdivided according to the following approach: stability studies, extraction methods, gas chromatography, high-performance liquid chromatography and capillary electrophoresis. At the end of each chapter a separate table summarizing the main characteristics of the separating method were established. In particular LODs and/or LOQs were expressed as quantity to facilitate comparison between methods. This review highlights the problems to measure trace levels of these compounds into biological fluids with respect to their instability, adsorption to glass and plastic or derivatization requirements. Over the last decades, HPLC seems to be more popular than GC for separating the alkylating agents. The development of narrow- or microbore LC coupled to MS is certainly the way to further improve both separation and sensitivity obtained in the different papers surveyed for this review.
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Affiliation(s)
- A Paci
- Service de Pharmacie et Laboratoire de Toxico-Pharmacologie, Hôpital Robert Debré, Paris, France.
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12
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Baumann F, Preiss R. Cyclophosphamide and related anticancer drugs. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 2001; 764:173-92. [PMID: 11817027 DOI: 10.1016/s0378-4347(01)00279-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article presents an overview of the methods of bioanalysis of oxazaphosphorines, in particular, cyclophosphamide, ifosfamide, and trofosfamide as well as their metabolites. The metabolism of oxazaphosphorines is complex and leads to a large variety of metabolites and therefore the spectrum of methods used is relatively broad. The various methods used are shown in a table and the particularly important assays are described.
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Affiliation(s)
- F Baumann
- Institute of Clinical Pharmacology, University of Leipzig, Germany.
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van Putten JW, Kerbush T, Smit EF, van Rijswijk R, Beijnen JH, Sleijfer DT, Groen HJ. Dose-finding and pharmacological study of ifosfamide in combination with paclitaxel and carboplatin in resistant small-cell lung cancer. Ann Oncol 2001; 12:787-92. [PMID: 11484953 DOI: 10.1023/a:1011101026135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To find the maximum tolerated dose for ifosfamide in combination with paclitaxel and carboplatin in small-cell lung cancer patients (SCLC), who are resistant to cyclophosphamide, doxorubicin and etoposide (CDE). PATIENTS AND METHODS Different dose schedules of ifosfamide were combined with fixed doses of paclitaxel 175 mg/m2 and carboplatin AUC 6 mg/ml min. Included were 30 patients, with a median age of 60 years, and median time off prior cytotoxic treatment of 8 weeks. All patients were previously treated with CDE and 11 had received re-induction CDE. RESULTS Dose limiting toxicity of our schedule was persistent thrombocytopenia. None of the patients developed neutropenic fever. Non-haematological toxicity was mild, although two treatment-related deaths occurred. Fifty-four percent of patients had a partial response and median survival time was twenty-five weeks. CONCLUSIONS The maximum tolerated dose of this combination for patients with resistant SCLC is ifosfamide 2000 mg/m2 in combination with paclitaxel 175 mg/m2 and carboplatin AUC 6 mg/ml min administered on the first day of a 21-day cycle.
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Affiliation(s)
- J W van Putten
- Department of Pulmonary Diseases, University Hospital, Groningen, The Netherlands.
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Kerbusch T, Herben VM, Jeuken MJ, Ouwerkerk J, Keizer HJ, Beijnen JH. Distribution of ifosfamide and metabolites between plasma and erythrocytes. Biopharm Drug Dispos 2001; 22:99-108. [PMID: 11745912 DOI: 10.1002/bdd.257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The distribution of ifosfamide (IF) and its metabolites 2-dechloroethylifosfamide (2DCE), 3-dechloroethylifosfamide (3DCE), 4-hydroxyifosfamide (4OHIF) and ifosforamide mustard (IFM) between plasma and erythrocytes was examined in vitro and in vivo. In vitro distribution was investigated by incubating blood with various concentrations of IF and its metabolites. In vivo distribution of IF, 2DCE, 3DCE and 4OHIF was determined in 7 patients receiving 9 g/m(2)/72 h intravenous continuous IF infusion. In vitro distribution equilibrium between erythrocytes and plasma was obtained quickly after drug addition. Mean (+/-sem) in vitro and in vivo erythrocyte (e)-plasma (p) partition coefficients (P(e/p)) were 0.75+/-0.01 and 0.81+/-0.03, 0.62+/-0.09 and 0.73+/-0.05, 0.76+/-0.10 and 0.93+/-0.05 and 1.38+/-0.04 and 0.98+/-0.09 for IF, 2DCE, 3DCE and 4OHIF, respectively. These ratios were independent of concentration and unaltered with time. The ratios of the area under the erythrocyte and plasma concentration--time curves (AUC(e/p)) were 0.96+/-0.03, 0.87+/-0.07, 0.98+/-0.06 and 1.34+/-0.39, respectively. A time- and concentration-dependent distribution--equilibrium phenomenon was observed with the relative hydrophilic IFM. It is concluded that IF and metabolites rapidly reach distribution equilibrium between erythrocytes and plasma; the process is slower for IFM. Drug distribution to the erythrocyte fraction ranged from about 38% for 2DCE to 58% for 4OHIF, and was stable over a wide range of clinically relevant concentrations. A strong parallelism in the erythrocyte and plasma concentration profiles was observed for all compounds. Thus, pharmacokinetic assessment using only plasma sampling yields direct and accurate insights into the whole blood kinetics of IF and metabolites and may be used for pharmacokinetic-pharmacodynamic studies.
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Affiliation(s)
- T Kerbusch
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands.
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Kerbusch T, de Kraker J, Keizer HJ, van Putten JW, Groen HJ, Jansen RL, Schellens JH, Beijnen JH. Clinical pharmacokinetics and pharmacodynamics of ifosfamide and its metabolites. Clin Pharmacokinet 2001; 40:41-62. [PMID: 11236809 DOI: 10.2165/00003088-200140010-00004] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This review discusses several issues in the clinical pharmacology of the antitumour agent ifosfamide and its metabolites. Ifosfamide is effective in a large number of malignant diseases. Its use, however, can be accompanied by haematological toxicity, neurotoxicity and nephrotoxicity. Since its development in the middle of the 1960s, most of the extensive metabolism of ifosfamide has been elucidated. Identification of specific isoenzymes responsible for ifosfamide metabolism may lead to an improved efficacy/toxicity ratio by modulation of the metabolic pathways. Whether ifosfamide is specifically transported by erythrocytes and which activated ifosfamide metabolites play a key role in this transport is currently being debated. In most clinical pharmacokinetic studies, the phenomenon of autoinduction has been observed, but the mechanism is not completely understood. Assessment of the pharmacokinetics of ifosfamide and metabolites has long been impaired by the lack of reliable bioanalytical assays. The recent development of improved bioanalytical assays has changed this dramatically, allowing extensive pharmacokinetic assessment, identifying key issues such as population differences in pharmacokinetic parameters, differences in elimination dependent upon route and schedule of administration, implications of the chirality of the drug and interpatient pharmacokinetic variability. The mechanisms of action of cytotoxicity, neurotoxicity, urotoxicity and nephrotoxicity have been pivotal issues in the assessment of the pharmacodynamics of ifosfamide. Correlations between the new insights into ifosfamide metabolism, pharmacokinetics and pharmacodynamics will rationalise the further development of therapeutic drug monitoring and dose individualisation of ifosfamide treatment.
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Affiliation(s)
- T Kerbusch
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/ Slotervaart Hospital, Amsterdam.
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Abstract
The 2 most commonly used oxazaphosphorines are cyclophosphamide and ifosfamide, although other bifunctional mustard analogues continue to be investigated. The pharmacology of these agents is determined by their metabolism, since the parent drug is relatively inactive. For cyclophosphamide, elimination of the parent compound is by activation to the 4-hydroxy metabolite, although other minor pathways of inactivation also play a role. Ifosfamide is inactivated to a greater degree by dechloroethylation reactions. More robust assay methods for the 4-hydroxy metabolites may reveal more about the clinical pharmacology of these drugs, but at present the best pharmacodynamic data indicate an inverse relationship between plasma concentration of parent drug and either toxicity or antitumour effect. The metabolism of cyclophosphamide is of particular relevance in the application of high dose chemotherapy. The activation pathway of metabolism is saturable, such that at higher doses (greater than 2 to 4 g/m2) a greater proportion of the drug is eliminated as inactive metabolites. However, both cyclophosphamide and ifosfamide also act to induce their own metabolism. Since most high dose regimens require a continuous infusion or divided doses over several days, saturation of metabolism may be compensated for, in part, by auto-induction. Although a quantitative distinction may be made between the cytochrome P450 isoforms responsible for the activating 4-hydroxylation reaction and those which mediate the dechloroethylation reactions, selective induction of the activation pathway, or inhibition of the inactivating pathway, has not been demonstrated clinically. Mathematical models to describe and predict the relative contributions of saturation and autoinduction to the net activation of cyclophosphamide have been developed. However, these require careful validation and may not be applicable outside the exact regimen in which they were derived. A further complication is the chiral nature of these 2 drugs, with some suggestion that one enantiomer may have a favourable profile of metabolism over the other. That the oxazaphosphorines continue to be the subject of intensive investigation over 30 years after their introduction into clinical practice is partly because of their antitumour activity. Further advances in analytical and molecular pharmacological techniques may further optimise their use and allow rational design of more selective analogues.
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Affiliation(s)
- A V Boddy
- Cancer Research Unit, Medical School, University of Newcastle upon Tyne, England.
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