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Chraibi S, Rosière R, De Prez E, Gérard P, Antoine MH, Langer I, Nortier J, Remmelink M, Amighi K, Wauthoz N. Preclinical tolerance evaluation of the addition of a cisplatin-based dry powder for inhalation to the conventional carboplatin-paclitaxel doublet for treatment of non-small cell lung cancer. Biomed Pharmacother 2021; 139:111716. [PMID: 34243618 DOI: 10.1016/j.biopha.2021.111716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022] Open
Abstract
Despite the advances in targeted therapies and immunotherapy for non-small cell lung cancer (NSCLC) patients, the intravenous administration of carboplatin (CARB) and paclitaxel (PTX) in well-spaced cycles is widely indicated for the treatment of NSCLC from stage II to stage IV. Our strategy was to add a controlled-release cisplatin-based dry-powder for inhalation (CIS-DPI-ET) to the conventional CARB-PTX-IV doublet, administered during the treatment off-cycles to intensify the therapeutic response while avoiding the impairment of pulmonary, renal and haematological tolerance of these combinations. The co-administration of CIS-DPI-ET (0.5 mg/kg) and CARB-PTX-IV (17-10 mg/kg) the same day showed a higher proportion of neutrophils in BALF (35 ± 7% vs 1.3 ± 0.8%), with earlier regenerative anaemia than with CARB-PTX-IV alone. A first strategy of CARB-PTX-IV dose reduction by 25% also induced neutrophil recruitment, but in a lower proportion than with the first combination (20 ± 6% vs 0.3 ± 0.3%) and avoiding regenerative anaemia. A second strategy of delaying CIS-DPI-ET and CARB-PTX-IV administrations by 24 h avoided both the recruitment of neutrophils in BALF and regenerative anaemia. Moreover, all these groups showed higher cytotoxicity (LDH activity, protein content) with no higher renal toxicities. These two strategies seem interesting to be assessed in terms of antitumor efficacy in mice.
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Affiliation(s)
- S Chraibi
- Unit of Pharmaceutics and Biopharmaceutics, Faculty of Pharmacy, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - R Rosière
- Unit of Pharmaceutics and Biopharmaceutics, Faculty of Pharmacy, Université libre de Bruxelles (ULB), Brussels, Belgium; InhaTarget Therapeutics, Rue Auguste Piccard 37, 6041 Gosselies, Belgium
| | - E De Prez
- Laboratory of Experimental Nephrology, Faculty of Medicine, ULB, Brussels, Belgium
| | - P Gérard
- InhaTarget Therapeutics, Rue Auguste Piccard 37, 6041 Gosselies, Belgium
| | - M H Antoine
- Laboratory of Experimental Nephrology, Faculty of Medicine, ULB, Brussels, Belgium
| | - I Langer
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), ULB, Brussels, Belgium
| | - J Nortier
- Laboratory of Experimental Nephrology, Faculty of Medicine, ULB, Brussels, Belgium
| | - M Remmelink
- Department of Pathology, ULB, Hôpital Erasme, Brussels, Belgium
| | - K Amighi
- Unit of Pharmaceutics and Biopharmaceutics, Faculty of Pharmacy, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - N Wauthoz
- Unit of Pharmaceutics and Biopharmaceutics, Faculty of Pharmacy, Université libre de Bruxelles (ULB), Brussels, Belgium
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Miyake M, Ohbayashi Y, Iwasaki A, Sawai F, Toyama Y, Nishiyama Y. Superselective Intra-arterial Infusion Chemotherapy with Nedaplatin for Oral Cancer: A Pharmacological Study of the Dose Clearance. J Maxillofac Oral Surg 2015. [PMID: 26225053 DOI: 10.1007/s12663-014-0730-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Nedaplatin (cis-diammine-glycolate platinum) is a new anticancer agent developed in Japan. It is especially designed to reduce adverse side effects of CDDP such as renal toxicity and neurotoxicity. AIM We used nedaplatin as a superselective intra-arterial infusion chemotherapy for oral cancers and carried out a pharmacological study of the dose clearance of nedaplatin based on renal function as well as evaluating its efficacy, including hematological side effects. PATIENTS AND METHODS Typical regimens of this chemotherapy consisted of 5-days straight of 24-h continuous intravenous infusion of 5-Fu with a single shot of nedaplatin via transfemoral artery on day 4. The dose of nedaplatin was calculated based on the 24-h creatine clearance. A total of 37 patients who had oral cancer and had received 68 courses (total) of chemotherapy were found to be eligible for this study. RESULTS Total and free platinum concentrations in the plasma were measured at each of the time points, and the area under the curve (AUC, measured in units of µg h/ml) was calculated based on the platinum concentration with the following formula: CL (clearance of free platinum: l/h) = 0.042 × CCr (ml/min) + 5.84. The response rate was 70.1 % (in CR 51 %, in PR 19 %). Histological CR was seen in 28.6 % of surgical specimens. Moderate hematological side effects were seen. However, severe adverse events were not observed, including those associated with cannulation of the femoral artery. CONCLUSION The dose-clearance formula that was established by our study can most likely be utilized to accurately predict the optimal administered dose of nedaplatin for arterial infusion chemotherapy.
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Affiliation(s)
- Minoru Miyake
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793 Japan
| | - Yumiko Ohbayashi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793 Japan
| | - Akinori Iwasaki
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793 Japan
| | - Fumi Sawai
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793 Japan
| | - Yoshihiro Toyama
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Griggs JJ, Mangu PB, Anderson H, Balaban EP, Dignam JJ, Hryniuk WM, Morrison VA, Pini TM, Runowicz CD, Rosner GL, Shayne M, Sparreboom A, Sucheston LE, Lyman GH. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2012; 30:1553-61. [PMID: 22473167 DOI: 10.1200/jco.2011.39.9436] [Citation(s) in RCA: 353] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer. METHODS The American Society of Clinical Oncology convened a Panel of experts in medical and gynecologic oncology, clinical pharmacology, pharmacokinetics and pharmacogenetics, and biostatistics and a patient representative. MEDLINE searches identified studies published in English between 1996 and 2010, and a systematic review of the literature was conducted. A majority of studies involved breast, ovarian, colon, and lung cancers. This guideline does not address dosing for novel targeted agents. RESULTS Practice pattern studies demonstrate that up to 40% of obese patients receive limited chemotherapy doses that are not based on actual body weight. Concerns about toxicity or overdosing in obese patients with cancer, based on the use of actual body weight, are unfounded. RECOMMENDATIONS The Panel recommends that full weight-based cytotoxic chemotherapy doses be used to treat obese patients with cancer, particularly when the goal of treatment is cure. There is no evidence that short- or long-term toxicity is increased among obese patients receiving full weight-based doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese who are administered full weight-based doses. Clinicians should respond to all treatment-related toxicities in obese patients in the same ways they do for non-obese patients. The use of fixed-dose chemotherapy is rarely justified, but the Panel does recommend fixed dosing for a few select agents. The Panel recommends further research into the role of pharmacokinetics and pharmacogenetics to guide appropriate dosing of obese patients with cancer.
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Abstract
Adjuvant treatment options for stage I seminoma include surveillance, radiation, and hemotherapy. Despite excellent results for both adjuvant chemotherapy and radiotherapy, many concerns have been raised in regards to the potential long-term toxicities of these treatments. To minimize the burden of treatment, there has been a shift away from adjuvant treatments for stage I testicular seminomas toward surveillance protocols for seminoma survivors. This article reviews the evidence for all adjuvant treatment options for stage I testicular seminomas with a particular focus on surveillance.
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Allen S, Wilson MW, Watkins A, Billups C, Qaddoumi I, Haik BH, Rodriguez-Galindo C. Comparison of two methods for carboplatin dosing in children with retinoblastoma. Pediatr Blood Cancer 2010; 55:47-54. [PMID: 20486170 PMCID: PMC2921445 DOI: 10.1002/pbc.22467] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Carboplatin is the most effective drug in retinoblastoma but systemic clearance is variable in young patients. While most regimens use a flat dose, individualized targeting may provide a more adjusted systemic exposure. PATIENTS AND METHODS We compared carboplatin doses between two groups of children with retinoblastoma that were treated using a flat dose of 560 mg/m(2) or a targeted AUC of 6.5 using a modified Calvert formula. RESULTS Ninety-eight patients with retinoblastoma received a total of 576 cycles of carboplatin (median 8 cycles). Fifty patients (51%) received a fixed dose per m(2), 32 (33%) received a dose based on AUC, 1 patient received fixed dose per kilogram, and in 15 patients a combination AUC and fixed doses was used. The median cumulative carboplatin dose (mg/m(2)) for patients who received eight cycles using fixed per m(2) dosing was 2151.8 (range, 1414.2-2852.0), compared to 1104.1 for nine patients who received eight cycles using Calvert dosing (range, 779.0-1992.7) (P < 0.001). For cycles given using AUC, the median percentage of the hypothetical fixed per m(2) dose was 70% (range, 48-134%). Younger patients had larger differences. Patients receiving carboplatin based on fixed per m(2) dosing were 3.0 times more likely to have a platelet transfusion (95% confidence interval, 1.3-7.3). CONCLUSIONS Carboplatin administration needs to consider the changes in renal function occurring during the first months of life. The use of a targeted AUC provides the most accurate method; however, mg per kg of body weight dosing is a very reliable alternative method.
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Affiliation(s)
- Steven Allen
- Department of Oncology, St. Jude Children’s Research Hospital Memphis, TN
| | - Matthew W. Wilson
- Department of Surgery, St. Jude Children’s Research Hospital Memphis, TN, Department of Ophthalmology (Hamilton Eye Institute), University of Tennessee Health Sciences Center Memphis, TN
| | - Amy Watkins
- Department of Biostatistics, St. Jude Children’s Research Hospital Memphis, TN
| | - Catherine Billups
- Department of Biostatistics, St. Jude Children’s Research Hospital Memphis, TN
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital Memphis, TN, Department of Pediatrics, University of Tennessee Health Sciences Center Memphis, TN
| | - Barrett H. Haik
- Department of Surgery, St. Jude Children’s Research Hospital Memphis, TN, Department of Ophthalmology (Hamilton Eye Institute), University of Tennessee Health Sciences Center Memphis, TN
| | - Carlos Rodriguez-Galindo
- Department of Oncology, St. Jude Children’s Research Hospital Memphis, TN, Department of Pediatrics, University of Tennessee Health Sciences Center Memphis, TN
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Determination of carboplatin dose by area under the curve in combination chemotherapy for senile non-small cell lung cancer. ACTA ACUST UNITED AC 2008; 27:710-2. [PMID: 18231750 DOI: 10.1007/s11596-007-0624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Indexed: 10/19/2022]
Abstract
To preliminarily determine the appropriate dosage of carboplatin (CBP) at AUC of 5 mg.Ml(-1).min(-1) in the combination chemotherapy for Chinese senile patients with non-small cell lung cancer (NSCLC). Thirty-five Chinese senile patients with NSCLC in advanced stage (III/IV) were given 96 cycles of combination chemotherapy. Chemotherapy schedules included Taxol+CBP, Gemzar+CBP and NVB+CBP. The dose of CBP was at 5 mg.mL(-1).min(-1) of area under the concentration-time curve (AUC). Side effects and quality of life were observed before and after the chemotherapy. Myelosuppression was severe and commonly observed. Grade 3/4 of granulocytopenia was found in 47.9% (46/96) of the patients and grade 3/4 of thrombocytopenia was noted in 28.1% (27/96) of the subjects. However, other side effects were slight. The mean score of quality of life (QOL), according to the criteria of QOL for Chinese cancer patients had reduced 6.8. At 5 mg.mL(-1).min(-1) by AUC, the hematological toxicity of CBP was severe and it had some negative effects on the QOL. The administration of CBP at 5 mg.mL(-1).min(-1) by AUC may be too high for Chinese senile patients with non-small cell lung cancer.
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García Palomo M, Castellanos Clemente Y, Díez Fernández R, Martínez Sesmero JM, Iglesias Bolaños AM, Hernández Muniesa B. [Retrospective analysis of the carboplatin dosage and relationship with toxicity in cancer patients]. FARMACIA HOSPITALARIA 2007; 31:218-22. [PMID: 18052616 DOI: 10.1016/s1130-6343(07)75377-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To analyse carboplatin dosage in cancer patients in order to establish whether they are over- or underdosed in comparison to the theoretical dose calculations during the first cycle of chemotherapy and to find a relationship between the dosage in the first cycle and dose reduction in subsequent cycles, as a result of adverse effects related to the same. METHOD Retrospective analysis over a one year period of prescriptions of chemotherapy with carboplatin. Patients were stratified into 4 groups according to body mass index and serum creatinine values. The mean percent error (MPE) was used to determine the relationship between the dose received and the theoretical dose calculation during the first cycle. The Mann-Whitney U test was used to study the possible relationship between patients dosage during the first cycle and dose reduction in subsequent cycles. RESULTS A total of 86 patients were selected. Only the cohort of patients who were overweight/obese showed significant differences between the theoretical dose calculation and the dose actually received. The mean MPE value with the standard error for this group was 7.963 +- 2.610%. No links were found with the dose reduction in subsequent cycles for this cohort of patients. CONCLUSIONS Not using adjusted weight or serum creatinine values in the Cockcroft-Gault equation may lead to incorrect doses of carboplatin in obese patients. Studies including a larger number of patients are required to confirm the relationship between overdosing during the first cycle and dose reduction in subsequent cycles, as a result of carboplatin toxicity.
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Affiliation(s)
- M García Palomo
- Servicio de Farmacia, Hospital Universitario Getafe, Madrid, Spain.
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Chemotherapy dose--response relationships in non-small cell lung cancer and implied resistance mechanisms. Cancer Treat Rev 2007; 33:101-37. [PMID: 17276603 DOI: 10.1016/j.ctrv.2006.12.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 12/05/2006] [Accepted: 12/06/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND We hypothesized excess resistance factor ("active resistance") gives a dose--response curve (DRC) shoulder, deficiency of a factor required for drug sensitivity ("saturable passive resistance") gives a DRC terminal plateau, and alteration of a factor gives decreased DRC slope. METHOD We used response rates from published non-small cell lung cancer (NSCLC) clinical studies to estimate mean percent tumor cell kill in each study (assuming cell kill is proportional to tumor volume change) and performed regression and meta-regression analyses of percent cell survival and patient survival vs planned dose-intensity. RESULTS As single agents, cell kill approached that of combinations only at highest doses. While DRC shape varied between single agents, DRCs for all combinations tested flattened at higher doses. Patient median survival times also failed to vary significantly with dose for any combination. CONCLUSIONS DRC flattening at higher doses suggests therapy efficacy is limited by deficiency/saturation of factors required for cell killing. Based on this and other clinical observations, we hypothesize: (1) active resistance may modulate cell killing at lower doses, but ability to overcome this by increasing doses is limited by saturable passive resistance (e.g. by non-cycling cells). (2) Cells surviving initial chemotherapy may upregulate active resistance mechanisms (permitting growth despite therapy). (3) If active resistance mechanisms are insufficient for growth/survival, cells may survive until therapy cessation by downregulating metabolism/cycling, becoming temporarily quiescent. This could help explain broad cross-resistance between agents and would imply that improved targeting of non-cycling cells will be required for major improvement in therapy efficacy.
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Schuette W, Blankenburg T, Schneider CP, von Weikersthal LF, Guetz S, Laier-Groeneveld G, Virchow JC, Chemaissani A, Reck M. Randomized, Multicenter, Open-Label Phase II Study of Gemcitabine plus Single-Dose Versus Split-Dose Carboplatin in the Treatment of Patients with Advanced-Stage Non-Small-Cell Lung Cancer. Clin Lung Cancer 2006; 8:135-9. [PMID: 17026815 DOI: 10.3816/clc.2006.n.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gemcitabine/carboplatin is a convenient and effective treatment for advanced-stage non-small-cell lung cancer (NSCLC), but modification of the schedule to diminish thrombocytopenia is worthwhile. PATIENTS AND METHODS One hundred fifty-eight chemotherapy-naive patients with stage IIIB/IV NSCLC were randomized from 15 centers in Germany to receive gemcitabine 1250 mg/m(2) on days 1 and 8 plus carboplatin area under the curve 5 on day 1 (arm A) or carboplatin area under the curve 2.5 on days 1 and 8 (arm B), every 21 days for 4 cycles. RESULTS The 2 arms (A vs. B) were well balanced with regard to patient baseline characteristics: stage IV 72.5% versus 69%, median Eastern Cooperative Oncology Group performance status 1 versus 1. The incidence of grade 3/4 hematologic toxicity was as follows (percentage of patients in arm A vs. B): leukopenia 37.5% versus 27% (P = 0.075), granulocytopenia 36% versus 36%, and thrombocytopenia 51% versus 35% (P = 0.017). Nonhematologic toxicity was modest and comparable with both schedules. The overall response rate was 46% versus 36% (P = 0.12), and 24% versus 42% had stable disease. Median progression-free survival (5.8 months vs. 6.1 months) and overall survival (11.7 months vs. 10.7 months) were not significantly different between arms A and B. CONCLUSION Splitting the dose of carboplatin between days 1 and 8 on the same days as gemcitabine results in a significantly decreased incidence of severe thrombocytopenia, without compromising the activity of the combination.
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Affiliation(s)
- Wolfgang Schuette
- City Hospital Martha-Maria Halle Doelau, 2nd Medical Department, Roentgenstrasse 1, D-06120 Halle, Germany.
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Abstract
The evidence for the importance of maintaining full dose on schedule chemotherapy for lung cancer varies considerably by histologic type. Several studies have evaluated chemotherapy dose and dose intensity in small cell lung cancer; fewer studies have evaluated the importance of chemotherapy in non-small cell lung cancer. The current guidelines of the National Comprehensive Cancer Network recommend adjuvant chemotherapy in most patients with resectable disease, and there is increasing evidence that chemotherapy benefits elderly patients as much as younger patients. Clinical trials in the setting of palliative treatment of advanced non-small cell lung cancer have focused on testing new regimens rather than evaluating the impact of maintaining the dose and schedule of standard chemotherapy regimens. However, in light of the potential curative role of chemotherapy in the adjuvant setting, the optimal doses and schedules of these regimens may have an important impact on outcomes. In addition, data suggest that responses in the neoadjuvant setting correlate with survival, and this may also be an appropriate setting in which to test the effect of the chemotherapy dose and schedule. Survival is the primary measure of treatment efficacy, but other end points, such as quality of life and disease stability, should also be considered in advanced disease. Because new regimens will shape the choice of treatment in the adjuvant and neoadjuvant settings, it is important to determine the significance of maintaining full dose on schedule with conventional chemotherapy regimens to ensure optimal outcomes in the treatment of lung cancer.
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Affiliation(s)
- Jeffrey Crawford
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Sculier JP, Lafitte JJ, Berghmans T, Van Houtte P, Lecomte J, Thiriaux J, Efremidis A, Koumakis G, Giner V, Richez M, Corhay JL, Wackenier P, Lothaire P, Paesmans M, Mommen P, Ninane V. A phase III randomised study comparing two different dose-intensity regimens as induction chemotherapy followed by thoracic irradiation in patients with advanced locoregional non-small-cell lung cancer. Ann Oncol 2004; 15:399-409. [PMID: 14998841 DOI: 10.1093/annonc/mdh105] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to determine the role of chemotherapy dose intensity in patients with initially unresectable non-metastatic non-small-cell lung cancer (NSCLC), with survival as primary end point, by testing two different regimens as induction chemotherapy followed by thoracic irradiation. PATIENTS AND METHODS Patients had pathologically proven NSCLC, an initially unresectable non-metastatic tumour without homolateral malignant pleural effusion, no prior history of malignancy and had received no prior therapy. Treatment was randomised for chemotherapy between three courses of MIP (mitomycin C 6 mg/m2; ifosfamide 3 g/m2; cisplatin 50 mg/m2) or SuperMIP (mitomycin C 6 mg/m2; ifosfamide 4.5 g/m2; cisplatin 60 mg/m2, carboplatine 200 mg/m2), followed by chest irradiation (60 Gy; five times per week, for 6 weeks). If the tumour became resectable after chemotherapy, surgery was performed, followed by mediastinal irradiation. RESULTS A total of 351 patients were eligible: 176 in the MIP arm and 175 in the SuperMIP arm, with 43% and 51% stages IIIA and IIIB, respectively. There was a significantly higher objective response rate with SuperMIP (46%) compared with MIP (35%) (P=0.03) [95% confidence interval (CI) for the difference between the response rates, 1% to 22%]. After induction chemotherapy, surgery was performed in 54 (15%) patients (27 per arm) and chest irradiation in 203 (57%) patients (102 in the MIP arm and 101 in the SuperMIP). In terms of survival, there was no statistically significant difference between the two study arms (P=0.16), with median survival times of, for MIP and SuperMIP, respectively, 12.5 (95% CI 10.1-14.9) and 11.2 (95% CI 9.7-12.8) months. Haematological toxicity and dosage reductions were higher with SuperMIP, which was nevertheless associated with a significantly increased absolute dose intensity. CONCLUSIONS High dose-intensity induction chemotherapy does not improve survival in initially unresectable non metastatic NSCLC.
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Etienne MC, Leger F, Pivot X, Chatelut E, Bensadoun RJ, Guardiola E, Renée N, Magné N, Canal P, Milano G. Pharmacokinetics of low-dose carboplatin and applicability of a method of calculation for estimating individual drug clearance. Ann Oncol 2003; 14:643-7. [PMID: 12649114 DOI: 10.1093/annonc/mdg162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Carboplatin is the only cancer drug for which conventional doses are individually adjusted according to estimated clearance and target area under the curve (AUC). The aim of this prospective study was (i) to evaluate intra- and interpatient variability of ultrafilterable (UF) carboplatin AUC(0-)(infinity) and (ii) to test whether the prediction of carboplatin clearance according to the Chatelut formula established for conventional carboplatin doses was accurate for low carboplatin doses. MATERIALS AND METHODS Thirty-one head and neck cancer patients (29 men, two women, mean age 55.9 years) received concomitant radiotherapy (Rgamma 2 Gy/day) and chemotherapy (carboplatin 50 mg/m(2)/day i.v.) for 7 weeks: Rgamma was administered 5 days/week (days 1-5) and carboplatin 2 days/week (days 1 and 4). Pharmacokinetics was performed once per week. A limited sample strategy based on Bayesian analysis was first validated and blood was subsequently taken 1 and 4 h after the end of carboplatin administration. RESULTS A total of 143 cycles was analyzed. Ultrafilterable carboplatin AUC(0-)(infinity) ranged from 0.360 to 4.200 mg.min/ml (mean 0.830, median 0.670). As a corollary, UF carboplatin clearance ranged from 19.1 to 244.7 ml/min. Ultrafilterable carboplatin concentrations were very stable over time: AUC(0-)(infinity) variability due to treatment duration contributed to <1% of the total variance, while interpatient variability contributed to 68.6%. Accordingly, intrasubject effect was not significant (P = 0.38) whereas intersubject effect was highly significant (P <0.001). These results suggest that optimal dosage for targeting a given AUC may vary within a 13-fold range between patients. The Chatelut formula, based on creatininemia, body weight, age and sex, over estimates carboplatin clearance by 40% on average (bias 95% CI 29.6% to 51.1%). No significant relationship was observed between either bone marrow toxicity or creatinine clearance decrease and carboplatin pharmacokinetics. CONCLUSIONS The Chatelut carboplatin clearance model established for conventional carboplatin dosages (>100 mg/m(2)) is not applicable for targeting low AUC (<1 mg x min/ml).
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Tuinstra N. Outpatient administration of radiolabeled monoclonal antibodies. Clin J Oncol Nurs 2003; 7:106-8. [PMID: 12629945 DOI: 10.1188/03.cjon.104-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using AUC-based dosing compensates for variations in renal function between and within individual patients. It does not adjust for other factors such as previous chemotherapy, previous radiotherapy, or performance status. One empiric method to adjust for these factors would be reduction of the ideal AUC. However, because AUC-based dosing accounts for variations in renal function, this would not be an appropriate method to adjust dosing based solely on renal function changes.
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Sculier JP, Lafitte JJ, Lecomte J, Berghmans T, Thiriaux J, Van Cutsem O, Efremidis A, Ninane V, Paesmans M, Mommen P, Klastersky J. A phase II randomised trial comparing the cisplatin-etoposide combination chemotherapy with or without carboplatin as second-line therapy for small-cell lung cancer. Ann Oncol 2002; 13:1454-9. [PMID: 12196372 DOI: 10.1093/annonc/mdf244] [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: 11/13/2022] Open
Abstract
BACKGROUND A phase II randomised trial was performed with patients with SCLC to determine if the addition of carboplatin to cisplatin-etoposide might improve the response rate in second-line therapy. PATIENTS AND METHODS Sixty-five eligible patients were randomised: 31 for CE (cisplatin 20 mg/m(2) and etoposide 100 mg/m(2) on days 1-3) and 34 for CCE (carboplatin 200 mg/m(2) on day 1, cisplatin 30 mg/m(2) on days 2-3, etoposide 100 mg/m(2) on days 1-3). RESULTS Eighty-two per cent of these patients had an objective response to first-line therapy and, among responders, 63% had a treatment-free interval of >3 months after previous therapy. The best response rates were 29% [95% confidence interval (CI) 13-45] and 47% (95% CI 30-64) for CE and CCE, respectively, with median survival times of 4.3 and 7.6 months. Dose-intensity analysis revealed a significant improvement in the relative dose-intensity and etoposide absolute dose-intensity for CE. Toxicity was tolerable and comparable between the two study arms. CONCLUSION CCE appears to be associated with a high objective response rate. The phase II randomised study design suggests that a comparison between the two regimens in a phase III trial would be interesting, but will probably be difficult to perform for reasons of accrual.
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Affiliation(s)
- J P Sculier
- Department of Medicine, Institut Jules Bordet, Bruxelles, Belgium.
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Poole SG, Dooley MJ, Rischin D. A comparison of bedside renal function estimates and measured glomerular filtration rate (Tc99mDTPA clearance) in cancer patients. Ann Oncol 2002; 13:949-55. [PMID: 12123341 DOI: 10.1093/annonc/mdf236] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was to compare measured glomerular filtration rate (GFR) with estimates of GFR derived from the population pharmacokinetic methods of Martin and Wright, and the creatinine clearance (CrCl) estimates of Cockcroft and Gault, and Jelliffe. PATIENTS AND METHODS GFR was determined by technetium-99m diethyl triamine penta-acetic acid (Tc99DTPA) clearance in adult cancer patients. Height, actual body weight and serum creatinine were measured, and GFR and CrCl estimates calculated. RESULTS One hundred and twenty-two patients were included. The mean measured GFR was 87 ml/min (range 30-174 ml/min). The mean bias (mean percentage error) was 2, 1, -10 and -17%, and the mean precision (mean absolute percentage error) was 18, 19, 21 and 23% for the Wright, Martin, Cockcroft and Gault, and Jelliffe formulas, respectively. The Martin formula significantly underestimates GFR for females (mean bias -10%) and overestimates GFR for males (mean bias 8%) (P <0.001 for bias of males versus females). The Wright and Martin formulas significantly overestimate GFR <50 ml/min (mean bias 39 and 30%; P = 0.03 and 0.05, respectively) and all formulas underestimate GFR >100 ml/min (mean bias -18, -16, -24 and -32% for Wright, Martin, Cockcroft and Gault, and Jelliffe formulas, respectively; P <0.001). CONCLUSIONS All the assessed estimates for renal function were found to have significant limitations.
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Affiliation(s)
- S G Poole
- Department of Pharmacy, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia.
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Sculier JP, Lafitte JJ, Lecomte J, Berghmans T, Thiriaux J, Florin MC, Efremidis A, Alexopoulos CG, Recloux P, Ninane V, Mommen P, Paesmans M, Klastersky J. A three-arm phase III randomised trial comparing combinations of platinum derivatives, ifosfamide and/or gemcitabine in stage IV non-small-cell lung cancer. Ann Oncol 2002; 13:874-82. [PMID: 12123332 DOI: 10.1093/annonc/mdf154] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine, in stage IV non-small-cell lung cancer (NSCLC), if the combination of gemcitabine-a new active drug-with ifosfamide (IG) or with the cisplatin-carboplatin association (CCG) will improve survival (primary end point) in comparison with a first-generation regimen, cisplatin-carboplatin-ifosfamide (CCI). PATIENTS AND METHODS A total of 284 chemotherapy-naïve patients with metastatic NSCLC were randomised. Four were ineligible and 16 were not assessable for responses. Cisplatin was given at 60 mg/m2 on day 1, carboplatin AUC 3 mg.min/ml on day 1, ifosfamide 4.5 g/m2 on day 1 and gemcitabine 1 g/m2 on days 1, 8 and 15. Courses were repeated every 4 weeks. Response was assessed after three courses and chemotherapy was continued in responding patients until best response. There were 94 eligible patients in the CCI arm, 92 in CCG and 94 in the IG arm. RESULTS The objective response rates for CCI, CCG and IG were 23% [95% confidence interval (CI) 15% to 32%], 29% (95% CI 20% to 39%) and 25% (95% CI 16% to 33%), respectively ( P = 0.61). Median survival time was 24, 34 and 30 weeks, respectively (P = 0.20). One-year survival was 23, 33 and 35%, and 2-year survival was 11, 14 and 17%, respectively. In some subgroups (older patients, women), there was a significant survival advantage for CCG and IG compared with CCI. Toxicity was tolerable: severe alopecia was less frequent in the CCG arm, and IG was associated with significantly more thrombopenia while CCG was associated with more leucopenia. CONCLUSION In stage IV NSCLC, treatment with regimens including the new drug gemcitabine were associated with a better but not statistically significant observed survival compared with a classical first-generation cisplatin-containing regimen. The non-platinum combination of gemcitabine was as effective as its combination with platinum.
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Calvert AH, Egorin MJ. Carboplatin dosing formulae: gender bias and the use of creatinine-based methodologies. Eur J Cancer 2002; 38:11-6. [PMID: 11750834 DOI: 10.1016/s0959-8049(01)00340-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dooley MJ, Poole SG, Rischin D, Webster LK. Carboplatin dosing: gender bias and inaccurate estimates of glomerular filtration rate. Eur J Cancer 2002; 38:44-51. [PMID: 11750838 DOI: 10.1016/s0959-8049(00)00455-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim was to compare doses of carboplatin calculated using the Calvert formula and Chatelut formula and also to compare doses calculated using Calvert formula, modified with non-isotopic estimation of GFR, using the Cockcroft and Gault formula or the Jelliffe formula. For formulae comparison, doses were calculated to target an AUC of 7 mg/ml x min. When compared with the dose derived from the Calvert formula, the doses calculated in 122 adult cancer patients using the Chatelut formula were significantly higher for males and significantly lower for females. There was a statistically significant difference between the dose per kg calculated for males and females (P<0.0001). The mean percentage difference in dose calculated with substituted measures of renal function with the Cockcroft and Gault formula and Jelliffe formula was -8% (standard deviation (S.D.) 17%) and -14% (S.D. 16%), respectively. Further prospective evaluation of the Chatelut formula is required before it can be recommended for routine clinical application.
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Affiliation(s)
- M J Dooley
- Pharmacy, Peter MacCallum Cancer Institute, St Andrew's Place, East Melbourne, 3002, Australia.
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Berghmans T, Paesmans M, Sculier JP. Cisplatin or carboplatin for the treatment of non-small cell lung cancer: do they have equivalent efficacy? Lung Cancer 2001; 34:15-7. [PMID: 11557108 DOI: 10.1016/s0169-5002(01)00240-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- T Berghmans
- Department of Medicine, Institut Jules Bordet, 1000 Brussels, Belgium
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van den Bongard HJ, Mathôt RA, Beijnen JH, Schellens JH. Pharmacokinetically guided administration of chemotherapeutic agents. Clin Pharmacokinet 2000; 39:345-67. [PMID: 11108434 DOI: 10.2165/00003088-200039050-00004] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The current practice for the dose calculation of most anticancer agents is based on body surface area in m2, although lower interpatient variation in pharmacokinetic parameters has been reported with pharmacokinetically guided administration. As chemotherapeutic agents have a narrow therapeutic window, pharmacokinetically guided administration may lead to less toxicity and higher efficacy than administration on the basis of body surface area. Pharmacokinetically guided administration, using parameters such as area under the plasma concentration-time curve (AUC), steady-state plasma drug concentration and drug exposure time above a certain plasma concentration, has been studied for many antineoplastic agents. Assessment of pharmacokinetic profiles allows the characterisation of relationships between pharmacokinetic parameters and efficacy and toxicity. AUC appears to be more closely correlated with pharmacodynamics than does the dose per unit of body surface area. In particular, the AUC-guided administration of carboplatin has been extensively studied, based on the close relationship between the renal clearance of the drug and glomerular filtration rate. Several formulae and limited sampling models have been derived to predict the AUC of carboplatin. The relationship between AUC and pharmacodynamics has also been studied for other anticancer agents, for example fluorouracil, topotecan, etoposide, cisplatin and busulfan, but all less extensively than for carboplatin. The pharmacokinetically guided administration of these agents needs to be investigated further before the use of alternative administration formulae can become standard clinical practice. Prospective studies of pharmacokinetically guided versus surface area-based administration should be performed to validate pharmacokinetic-pharmacodynamic relationships and to facilitate optimal dosage of anticancer agents in the clinic.
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Affiliation(s)
- H J van den Bongard
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam.
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