Jekyll and Hyde of chemotherapy treatment: Method for patient-specific dosing of chemotherapy medications

Dosing Adjustments in Cases of Altered Plasma Protein Binding are Most Needed for Drugs with a Volume of Distribution Below 1.3 L/kg

BACKGROUND

The present literature offers conflicting views on the importance of changes in plasma protein binding in clinical therapeutics. Furthermore, there are no methods to calculate a new dosing regimen when such changes occur.

METHODS

Previous models developed by Balaz et al. and Greenblat et al. were used to calculate a plasma protein binding (PPB) score for individual drugs based on the volume of distribution for total concentration and the bound fraction of drug. The models were further used to calculate a new drug dosing interval for cases of altered plasma protein binding. The equations apply best for drugs with fast absorption and fast distribution; they can be used as approximations for drugs with slow distribution by using the volume of distribution at steady state and the rate constant of the elimination phase.

RESULTS

The newly developed equations show that changes in plasma protein binding are relevant only for drugs with a positive PPB score; such drugs must have a volume of distribution for total concentration below 1.3 L/kg and high protein binding. It is further shown that the drug dosing interval should be reduced when the remaining fraction of plasma protein binding is below the PPB score.

CONCLUSION

A new method to rank drugs according to the impact of changes in plasma protein binding on their pharmacokinetic profile was developed. The new method was applied to show that drugs with high PPB scores need reductions in their dosing interval when the level of protein binding decreases.

Multifunctional MoS2 nanosheets with Au NPs grown in situ for synergistic chemo-photothermal therapy

The treatment of cancer has always been a worldwide problem. The combination of chemotherapy and other therapies would be a promising therapy strategy. Photothermal therapy (PTT) does not cause serious side effects and has dual control of time and space, which was considered to be a good method for combination with chemotherapy. Here, we modified multifunctional nanosheets based on in-situ gold nanoparticles (Au NPs) grown molybdenum disulfide (MoS₂) to combine their excellent photothermal conversion and drug loading capabilities. More importantly, the target peptide cRGD modified nanosheets have good selectivity to tumor cells rich in integrin receptors, and drug loading and drug release tests showed that it could carry enough chemotherapeutic drugs and had excellent photo controlled release performance. In vitro cell experiments showed that the drug-loaded multifunctional nanosheets had good anti-tumor effect under 808 nm laser irradiation. Therefore, the multifunctional nanosheets designed in this paper have great potential in the study of targeted drug release and chemo-photothermal therapy combined therapy, and are of great significance for in vivo and clinical research.