1
|
Vitale DL, Caon I, Parnigoni A, Sevic I, Spinelli FM, Icardi A, Passi A, Vigetti D, Alaniz L. Initial Identification of UDP-Glucose Dehydrogenase as a Prognostic Marker in Breast Cancer Patients, Which Facilitates Epirubicin Resistance and Regulates Hyaluronan Synthesis in MDA-MB-231 Cells. Biomolecules 2021; 11:biom11020246. [PMID: 33572239 PMCID: PMC7914570 DOI: 10.3390/biom11020246] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022] Open
Abstract
UDP-glucose-dehydrogenase (UGDH) synthesizes UDP-glucuronic acid. It is involved in epirubicin detoxification and hyaluronan synthesis. This work aimed to evaluate the effect of UGDH knockdown on epirubicin response and hyaluronan metabolism in MDA-MB-231 breast cancer cells. Additionally, the aim was to determine UGDH as a possible prognosis marker in breast cancer. We studied UGDH expression in tumors and adjacent tissue from breast cancer patients. The prognostic value of UGDH was studied using a public Kaplan–Meier plotter. MDA-MB-231 cells were knocked-down for UGDH and treated with epirubicin. Epirubicin-accumulation and apoptosis were analyzed by flow cytometry. Hyaluronan-coated matrix and metabolism were determined. Autophagic-LC3-II was studied by Western blot and confocal microscopy. Epirubicin accumulation increased and apoptosis decreased during UGDH knockdown. Hyaluronan-coated matrix increased and a positive modulation of autophagy was detected. Higher levels of UGDH were correlated with worse prognosis in triple-negative breast cancer patients that received chemotherapy. High expression of UGDH was found in tumoral tissue from HER2--patients. However, UGDH knockdown contributes to epirubicin resistance, which might be associated with increases in the expression, deposition and catabolism of hyaluronan. The results obtained allowed us to propose UGDH as a new prognostic marker in breast cancer, positively associated with development of epirubicin resistance and modulation of extracellular matrix.
Collapse
Affiliation(s)
- Daiana L. Vitale
- Laboratorio de Microambiente Tumoral, Centro de Investigaciones Básicas y Aplicadas (CIBA), Universidad Nacional del Noroeste de la Provincia de Buenos Aires, Junín 6000, Argentina; (D.L.V.); (I.S.); (F.M.S.); (A.I.)
- Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires (CITNOBA), UNNOBA-UNSAdA-CONICET, Junín 6000, Argentina
| | - Ilaria Caon
- Dipartimento di Medicina e Chirurgia, Università degli Studio dell’Insubria, 21100 Varese, Italy; (I.C.); (A.P.); (A.P.)
| | - Arianna Parnigoni
- Dipartimento di Medicina e Chirurgia, Università degli Studio dell’Insubria, 21100 Varese, Italy; (I.C.); (A.P.); (A.P.)
| | - Ina Sevic
- Laboratorio de Microambiente Tumoral, Centro de Investigaciones Básicas y Aplicadas (CIBA), Universidad Nacional del Noroeste de la Provincia de Buenos Aires, Junín 6000, Argentina; (D.L.V.); (I.S.); (F.M.S.); (A.I.)
- Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires (CITNOBA), UNNOBA-UNSAdA-CONICET, Junín 6000, Argentina
| | - Fiorella M. Spinelli
- Laboratorio de Microambiente Tumoral, Centro de Investigaciones Básicas y Aplicadas (CIBA), Universidad Nacional del Noroeste de la Provincia de Buenos Aires, Junín 6000, Argentina; (D.L.V.); (I.S.); (F.M.S.); (A.I.)
- Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires (CITNOBA), UNNOBA-UNSAdA-CONICET, Junín 6000, Argentina
| | - Antonella Icardi
- Laboratorio de Microambiente Tumoral, Centro de Investigaciones Básicas y Aplicadas (CIBA), Universidad Nacional del Noroeste de la Provincia de Buenos Aires, Junín 6000, Argentina; (D.L.V.); (I.S.); (F.M.S.); (A.I.)
- Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires (CITNOBA), UNNOBA-UNSAdA-CONICET, Junín 6000, Argentina
| | - Alberto Passi
- Dipartimento di Medicina e Chirurgia, Università degli Studio dell’Insubria, 21100 Varese, Italy; (I.C.); (A.P.); (A.P.)
| | - Davide Vigetti
- Dipartimento di Medicina e Chirurgia, Università degli Studio dell’Insubria, 21100 Varese, Italy; (I.C.); (A.P.); (A.P.)
- Correspondence: (D.V.); (L.A.); Tel.: + 39-332-307170 (D.V.); +54-236-4-407750 (ext. 11625) (L.A.)
| | - Laura Alaniz
- Laboratorio de Microambiente Tumoral, Centro de Investigaciones Básicas y Aplicadas (CIBA), Universidad Nacional del Noroeste de la Provincia de Buenos Aires, Junín 6000, Argentina; (D.L.V.); (I.S.); (F.M.S.); (A.I.)
- Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires (CITNOBA), UNNOBA-UNSAdA-CONICET, Junín 6000, Argentina
- Correspondence: (D.V.); (L.A.); Tel.: + 39-332-307170 (D.V.); +54-236-4-407750 (ext. 11625) (L.A.)
| |
Collapse
|
2
|
Srinivas NR. Understanding the role of tariquidar, a potent Pgp inhibitor, in combination trials with cytotoxic drugs: What is missing? Cancer Chemother Pharmacol 2016; 78:1097-1098. [PMID: 27178178 DOI: 10.1007/s00280-016-3044-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/20/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Nuggehally R Srinivas
- Suramus Bio, Drug Development, 29th Main, 10th Cross, J.P. Nagar I Phase, Bangalore, Karnataka, 560078, India.
| |
Collapse
|
3
|
Tulsyan S, Chaturvedi P, Agarwal G, Lal P, Agrawal S, Mittal RD, Mittal B. Pharmacogenetic influence of GST polymorphisms on anthracycline-based chemotherapy responses and toxicity in breast cancer patients: a multi-analytical approach. Mol Diagn Ther 2014; 17:371-9. [PMID: 23812950 DOI: 10.1007/s40291-013-0045-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Chemotherapeutic drug treatment outcomes are genetically determined. Polymorphisms in genes encoding phase II drug metabolizing enzyme glutathione-S-transferase (GST) can possibly predict treatment outcomes, and can be of prognostic significance in breast cancer patients. The aim of this study was to determine the role of genetic variations in GST in predicting response to, and toxicity of, anthracycline-based chemotherapy in breast cancer patients. METHOD Two hundred and seven patients treated with anthracycline-based chemotherapy were genotyped for GSTM1 and GSTT1 deletion polymorphisms, and GSTP1 Ile105Val (rs1695), by polymerase chain reaction (PCR)/ PCR-restriction fragment length polymorphism (RFLP). Genetic variations were correlated with tumor response to neo-adjuvant chemotherapy (NACT) in 100 patients, and with chemo-toxicity in 207 who received adjuvant chemotherapy or NACT, using Chi-square and logistic regression. Higher order gene-gene interactions with treatment outcomes were characterized by multifactor dimensionality reduction (MDR) analysis. RESULTS In single-locus analysis, Ile/Val and Ile/Val+Val/Val genotypes of the GSTP1 Ile105Val (rs1695) polymorphism reached statistical significance with grade 2-4 anemia (P=0.019, P=0.027). On performing gene-gene interaction analysis, GSTM1 null-GSTP1 Ile/Val was significantly associated with response to NACT (P=0.032). On evaluating higher order gene-gene interaction models by MDR analysis, GSTM1 and GSTP1 Ile105Val; GSTM1 and GSTT1; and GSTT1 and GSTP1 Ile105Val showed significant association with treatment response, grade 2-4 anemia, and dose delay/reduction due to neutropenia (P=0.046, P=0.027, P=0.026), respectively. CONCLUSION Multi-analytical strategies may serve as a better tool for characterization of pharmacogenetic-based breast cancer treatment outcomes.
Collapse
Affiliation(s)
- Sonam Tulsyan
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli road, Lucknow, 226 014, India
| | | | | | | | | | | | | |
Collapse
|
4
|
Weekly epirubicin in the treatment of gestational breast cancer (GBC). Breast Cancer Res Treat 2008; 115:591-4. [DOI: 10.1007/s10549-008-0159-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 08/06/2008] [Indexed: 11/25/2022]
|
5
|
Tchambaz L, Schlatter C, Jakob M, Krähenbühl A, Wolf P, Krähenbühl S. Dose adaptation of antineoplastic drugs in patients with liver disease. Drug Saf 2006; 29:509-22. [PMID: 16752933 DOI: 10.2165/00002018-200629060-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Dose adaptation for liver disease is important in patients treated with antineoplastic drugs because of the high prevalence of impaired liver function in this population and the dose-dependent, frequently serious adverse effects of these drugs. We classified the antineoplastic drugs marketed in Switzerland at the end of 2004 according to their bioavailability and/or hepatic extraction to predict their kinetic behaviour in patients with decreased liver function. This prediction was compared with kinetic studies carried out with these drugs in patients with liver disease. The studies were identified by a structured, computer-based literature search. Of the 69 drugs identified, 52 had a predominant extrarenal (in most cases hepatic) metabolism and/or excretion. For 49 drugs, hepatic extraction could be calculated and/or bioavailability data were available, allowing classification according to hepatic extraction. For 18 drugs, kinetic studies have been reported in patients with impaired liver function, with the findings generally resulting in quantitative recommendations for adaptation of the dosage. In particular, recommendations are precise for 16 drugs excreted by the bile (e.g. doxorubicin and derivatives and vinca alkaloids). Validation studies comparing such recommendations with kinetics and/or dynamics of antineoplastic drugs in patients with decreased liver function have not been published. We conclude that there are currently not enough data for safe use of cyctostatics in patients with liver disease. Pharmaceutical companies should be urged to provide kinetic data (especially hepatic extraction data) for the classification of such drugs and to conduct kinetic studies for drugs with primarily hepatic metabolism in patients with impaired liver function to allow quantitative advice to be given for dose adaptation.
Collapse
Affiliation(s)
- Lydia Tchambaz
- Division of Clinical Pharmacology & Toxicology, University Hopsital, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
6
|
Abraham J, Earl HM, Pharoah PD, Caldas C. Pharmacogenetics of cancer chemotherapy. Biochim Biophys Acta Rev Cancer 2006; 1766:168-83. [PMID: 17141416 DOI: 10.1016/j.bbcan.2006.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 10/10/2006] [Accepted: 10/18/2006] [Indexed: 10/24/2022]
Abstract
Significant heterogeneity in the efficacy and toxicity of chemotherapeutic agents is observed within cancer populations. Pharmacogenetics (PGx) is the study of inheritance in interindividual variation in drug disposition. The allure of pharmacogenetics, in the treatment of cancer patients, comes from the potential for individualisation of cancer therapy, minimizing toxicity, while maximizing efficacy. In this review we will focus on the current and potential clinical applications of pharmacogenetics in cancer therapy by citing relevant examples and discussing the possible approaches which may be used to establish a reliable, reproducible and cost-effective test for clinically relevant genetic polymorphisms, using easily accessible biological samples (e.g., blood and tumour samples). Ideally, routine management of patients would include analysis of their single nucleotide polymorphism linkage disequilibrium (SNP-LD) profile prior to treatment, allowing stratification of patients into treatment groups, thus individualising their therapy. In order to achieve this ambition, a combination of different approaches (candidate gene, genome-wide and pathway driven) will be required from scientists and clinician scientists, as well as an increased understanding and incorporation of pharmacogenetic aims and endpoints into current and future clinical trials.
Collapse
Affiliation(s)
- Jean Abraham
- Cancer Genomics Program, Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Box 197, Hills Road, Cambridge CB2 2XZ, UK.
| | | | | | | |
Collapse
|
7
|
Abstract
The importance of in-depth knowledge about the pharmacokinetics of a drug is evident because pharmacokinetic behaviour may correlate with activity and toxicity. The most elaborate pharmacokinetic investigation is a so-called mass balance study employing a radioactive tracer. A mass balance study investigates the plasma pharmacokinetics and excretion of both the unchanged drug and the total radioactivity (drug and metabolites), and allows elucidation of the metabolic fate of a drug. The main objective is the maximum recovery of the radioactive dose in urine and faeces. However, there is little concrete guidance on how to perform or assess such a mass balance study. Based on a critical review of the available literature and regulation, we discuss the design, conduct and evaluation of mass balance studies. The study must be preceded by pre-clinical studies to optimise the design. Compliance with available regulation (US FDA is more specific than European guidelines), choice of radioisotope (tritium may be lost and is consequently used less often), selection of subjects and safe administration of a relevant dose are critical. The drug (both the labelled and the non-labelled portion of the dose) must be prepared, characterised and administered, and the biological samples must be collected and analysed properly to obtain reliable and meaningful results. A recent development is the use of highly sensitive accelerator mass spectrometry for (14)C-detection, which allows the use of much lower amounts of radioactivity. Calculating the mass balance requires quantification of any possible losses of radioactivity during the study, e.g. during administration (adsorption to tubing). Total recovery should be at least 90% of the administered dose. A lower recovery, which is not uncommon, must be explained by biological factors such as a long decay half-life, irreversible binding to tissue components, or loss through expiration. The extent and relevance of metabolism is determined by comparing the pharmacokinetics of the unchanged drug and the total radioactivity. Metabolic profiling supplements existing knowledge of metabolism. We illustrate the important aspects of a mass balance study with literature on anticancer drugs. This review could serve as guidance for future mass balance studies.
Collapse
Affiliation(s)
- Jan H Beumer
- Department of Pharmacy and Pharmacology, Slotervaart Hospital/The Netherlands Cancer Institute, Louwesweg, Amsterdam, The Netherlands.
| | | | | |
Collapse
|
8
|
Peccatori F, Martinelli G, Gentilini O, Goldhirsch A. Chemotherapy during pregnancy: what is really safe? Lancet Oncol 2004; 5:398. [PMID: 15231245 DOI: 10.1016/s1470-2045(04)01506-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Fedro Peccatori
- Division of Hematology/Oncology, European Institute of Oncology, Milan, Italy
| | | | | | | |
Collapse
|
9
|
Dobbs NA, Twelves CJ, Gregory W, Cruickshanka C, Richards MA, Rubens RD. Epirubicin in patients with liver dysfunction: development and evaluation of a novel dose modification scheme. Eur J Cancer 2003; 39:580-6. [PMID: 12628836 DOI: 10.1016/s0959-8049(02)00669-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to develop an epirubicin dose modification scheme in women with breast cancer and liver dysfunction. We first identified target areas under the concentration-time curve (AUCs) of 2400 and 1600 ng/ml.h from pharmacokinetic studies in 15 women with normal liver tests. In a second group of 16 women with abnormal liver biochemistry, the relationship between raised asparate aminotransferase (AST) and epirubicin clearance was: dose=AUC (97.5-34.2xlog AST). Adaptive dosing was evaluated prospectively in a third group of 41 women with serum AST > or =2xnormal+/-raised bilirubin. The median AUCs were 2444 and 1608 ng/ml.h, close to the high and low target AUCs, respectively. Variability in AUC was lower with adaptive dosing than in a fourth group given an unadjusted dose of epirubicin (coefficient of variation=25.8, 30.0 and 46.5%, respectively; P=0.06). Epirubicin dosing based on AST is safe and may reduce pharmacokinetic variability.
Collapse
Affiliation(s)
- N A Dobbs
- Breast Oncology Unit, GKT School of Medicine, Guy's Hospital, London, UK
| | | | | | | | | | | |
Collapse
|
10
|
Ramanathan-Girish S, Boroujerdi M. Contradistinction between doxorubicin and epirubicin: in-vivo metabolism, pharmacokinetics and toxicodynamics after single- and multiple-dosing in rats. J Pharm Pharmacol 2001; 53:987-97. [PMID: 11480551 DOI: 10.1211/0022357011776234] [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: 10/31/2022]
Abstract
There is compelling in-vitro evidence that the evaluation of doxorubicin or epirubicin pharmacokinetics based solely on plasma concentration may not fully elucidate the differences between the two drugs. Both compounds bind to erythrocytes and their different binding to haemoglobin may influence their disposition in the body. The purpose of the present study was to compare the pharmacokinetics and metabolism of doxorubicin and epirubicin based on the plasma concentration, amount associated with blood cells and simultaneous monitoring of biliary and urinary elimination of unchanged drug and metabolites after single- and multiple-dose injections. The level of sarcoplasmic reticulum Ca2+ATPase in the heart was also measured as a biomarker of cardiotoxicity. Male Sprague-Dawley rats were treated in a parallel design with doxorubicin or epirubicin on a multiple-dosing basis (4 mg kg(-1) per week) or as a single dose injection (20 mg kg(-1)). Blood, urine and bile samples were collected periodically after each dose in the multiple-dosing regimen and the single dose injection, and at the end of each experiment the hearts were removed. The concentrations of each drug in plasma, blood cells, bile and urine samples were determined, and by simultaneous curve-fitting of plasma and bile data according to compartmental analysis, the pharmacokinetic parameters and constants were estimated. The concentration of drug associated with blood cells was analysed according to non-compartmental analysis. The bile and urine samples provided the in-vivo metabolic data. The level of Ca2+ATPase in the heart, determined by Western blotting, was used as the toxicodynamic parameterto correlate with the kinetic data. Multiple-dosing regimens reduced the total plasma clearance and increased the area under the plasma concentration-time curve of both drugs. Also, the area under the curve of doxorubicin associated with blood cells increased with the weekly doses, and the related mean residence time (MRT) and apparent volume of distribution (Vdss) were steadily reduced. In contrast to doxorubicin, the MRT and Vdss of epirubicin increased significantly. Metabolic data indicated significant differences in the level of alcohol and aglycones metabolites. Doxorubicinol and doxorubicin aglycones were significantly greater than epirubicinol and epirubicin aglycone, whereas epirubicinol aglycone was greater than doxorubicinol aglycone. The area under the blood cells concentration-time curve correlated linearly with the changes in Ca2+ATPase net intensity. The results of this study demonstrate the importance of the kinetics of epirubicin and doxorubicin associated with blood cells. Linear correlation between the reduction of net intensity of the biomarker with the area under the curve of doxorubicin associated with blood cells confirms that the differences between the two compounds are related to their interaction with blood cells. This observation together with the observed differences in metabolism may underline a significant role for blood cells in distribution and metabolism of doxorubicin and epirubicin.
Collapse
Affiliation(s)
- S Ramanathan-Girish
- Department of Pharmaceutical Sciences, Northeastern University, Boston, MA 02115, USA
| | | |
Collapse
|
11
|
Dobbs NA, Twelves CJ. Comments on epirubicin. Ann Oncol 1994; 5:98-9. [PMID: 8172804 DOI: 10.1093/oxfordjournals.annonc.a058709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
12
|
Dobbs NA, Twelves CJ, Rizzi P, Warwick JD, Metivier EM, Williams R, Johnson PJ. Epirubicin in hepatocellular carcinoma: pharmacokinetics and clinical activity. Cancer Chemother Pharmacol 1994; 34:405-10. [PMID: 8070007 DOI: 10.1007/bf00685565] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The pharmacokinetics and clinical activity of epirubicin were investigated in 16 patients with hepatocellular carcinoma (HCC) who received epirubicin at 75 mg/m2; the drug was given intravenously to 7 patients and via the hepatic artery to 9 patients (7 of whom also underwent embolisation). Lignocaine (1 mg/kg) was also given intravenously to 15 patients, and the metabolite monoethylglycinexylidide (MEGX) was measured as an indicator of liver function. Epirubicin clearance correlated with serum aspartate aminotransferase (AST), albumin and bilirubin values in patients treated intravenously or intraarterially. Although the route of administration did not affect the median total plasma clearance of epirubicin, early- and intermediate-phase clearance was higher following intraarterial administration. MEGX levels correlated with serum bilirubin levels but there was no correlation with albumin or AST values or epirubicin clearance. The rate of response to epirubicin was 3/13 (23%; 95% confidence interval, 8%-50%). Intravenous epirubicin was tolerated well, but intraarterial treatment was associated with significant morbidity. These data confirm that although current recommended dose adjustments are based primarily on serum bilirubin levels, altered epirubicin pharmacokinetics correlate more strongly with AST and albumin values than with serum bilirubin concentrations. However, at this dose and schedule, epirubicin has only modest activity against HCC.
Collapse
Affiliation(s)
- N A Dobbs
- Imperial Cancer Research Fund, Clinical Oncology Unit, United Medical School, Guy's Hospital, London, UK
| | | | | | | | | | | | | |
Collapse
|
13
|
Launchbury AP, Habboubi N. Epirubicin and doxorubicin: a comparison of their characteristics, therapeutic activity and toxicity. Cancer Treat Rev 1993; 19:197-228. [PMID: 8334677 DOI: 10.1016/0305-7372(93)90036-q] [Citation(s) in RCA: 147] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
14
|
Plosker GL, Faulds D. Epirubicin. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in cancer chemotherapy. Drugs 1993; 45:788-856. [PMID: 7686469 DOI: 10.2165/00003495-199345050-00011] [Citation(s) in RCA: 142] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Epirubicin is the 4' epimer of the anthracycline antibiotic doxorubicin, and has been used alone or in combination with other cytotoxic agents in the treatment of a variety of malignancies. Comparative and noncomparative clinical trials have demonstrated that regimens containing conventional doses of epirubicin achieved equivalent objective response rates and overall median survival as similar doxorubicin-containing regimens in the treatment of advanced and early breast cancer, non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), non-Hodgkin's lymphoma, ovarian cancer, gastric cancer and nonresectable primary hepatocellular carcinoma. Recently, dose-intensive regimens of epirubicin have achieved high response rates in a number of malignancies including early and advanced breast cancer and lung cancer. The major acute dose-limiting toxicity of anthracyclines is myelosuppression. In vitro and clinical studies have shown that, at equimolar doses, epirubicin is less myelotoxic than doxorubicin. The lower haematological toxicity of epirubicin, as well as the recent introduction of supportive measures such as colony-stimulating factors, has allowed dose-intensification of epirubicin-containing regimens, which is particularly significant because of the definite dose-response relationship of anthracyclines. Cardiotoxicity, which is manifested clinically as irreversible congestive heart failure and/or cardiomyopathy, is the most important chronic cumulative dose-limiting toxicity of anthracyclines. Epirubicin has a lower propensity to produce cardiotoxic effects than doxorubicin, and its recommended maximum cumulative dose is almost double that of doxorubicin, thus allowing for more treatment cycles and/or higher doses of epirubicin. In summary, dose-intensive epirubicin-containing regimens, which are feasible due to its lower myelosuppression and cardiotoxicity, have produced high response rates in early breast cancer, a potentially curable malignancy, as well as advanced breast, and lung cancers. Furthermore, there is evidence to suggest that improved response rates can improve quality of life in some clinical settings, but whether this leads to prolonged survival has not yet been determined. Recently implemented supportive measures such as colony-stimulating factors, prophylactic antimicrobials and peripheral blood stem cell support may help achieve other potential advantages of dose-intensive epirubicin-containing regimens such as reductions in morbidity and length of hospital admissions.
Collapse
Affiliation(s)
- G L Plosker
- Adis International Limited, Auckland, New Zealand
| | | |
Collapse
|
15
|
Abstract
The pharmacokinetic properties of epirubicin are characterised by a triphasic plasma clearance, with half-lives for the initial (alpha), intermediate (beta) and terminal (gamma) elimination phases of approximately 3 minutes, 1 hour and 30 hours, respectively. These values are similar to or slightly shorter than the corresponding half-lives of doxorubicin. The total plasma clearance of epirubicin is approximately 50 L/h/m2, which is almost 2-fold higher than that of doxorubicin. This difference is mainly due to the relatively high volume of distribution of epirubicin, and the unique glucuronidation metabolic pathway of epirubicin and epirubicinol, which is not available to doxorubicin or doxorubicinol. Glucuronide metabolites of epirubicin and epirubicinol are not active per se, but could divert epirubicin from free radical formation, which may induce cardiotoxic effects. This may explain, at least in part, the lower cardiotoxicity of this new anthracycline relative to that of the parent compound. There is a linear relationship between the dose administered and area under the plasma concentration-time curve (AUC) values of both unchanged drug and metabolites, so that the total plasma clearance of epirubicin is constant with epirubicin doses ranging from 40 to 140 mg/m2. No variation in total plasma clearance as a function of age in the range of 31 to 74 years has been observed, and this parameter is unaffected by subsequent courses of treatment. Hepatic dysfunction causes an increase in the terminal elimination half-life of epirubicin, which is well correlated with serum bilirubin levels and which necessitates a reduction in epirubicin dosage. Epirubicin is responsible for a dose-dependent neutropenia, which is clearly related to drug exposure as established in pharmacodynamic studies. The maximum tolerated dose (MTD) of epirubicin was first established to be approximately 90 mg/m2 but this was re-examined recently and is now deemed to be approximately 150 mg/m2, which is about 2-fold higher than the MTD of doxorubicin. Cumulative cardiac toxicity occurs for both epirubicin and doxorubicin, but the dose ratio for equal risk is about 1.8 in favour of epirubicin (500 to 550 mg/m2 for doxorubicin vs 900 to 1000 mg/m2 for epirubicin). Consequently, there is not a higher risk of developing cardiotoxicity after administration of high dose epirubicin, since this adverse effect is associated with total cumulative anthracycline dose. In several controlled trials, epirubicin exhibited the same anticancer activity as doxorubicin when administered at equimolar doses to patients with advanced breast cancer.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- J Robert
- Foundation Bergonié, Bordeaux, France
| |
Collapse
|
16
|
Mross K, Hamm K, Hossfeld DK. Effects of verapamil on the pharmacokinetics and metabolism of epirubicin. Cancer Chemother Pharmacol 1993; 31:369-75. [PMID: 8431970 DOI: 10.1007/bf00686150] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Experimental data suggest that multidrug resistance in cancer may be overcome by using an increased dose of anticancer agent(s) in combination with a resistance-modifying agent (RMA). We studied the pharmacokinetics and metabolism of both epirubicin (EPI) and verapamil (VPL) to explore the possible pharmacokinetic interactions between these two drugs. Ten patients with advanced breast cancer were given EPI (40 mg/m2 in a daily i.v. bolus for 3 consecutive days), and five of them also received VPL (4 x 120 mg/daily p.o. for 4 consecutive days). The data indicated a significant interaction between these two drugs that affected their metabolism. The areas under the concentration-time curves (AUC) obtained for epirubicin glucuronide, epirubicinol glucuronide, and both of the 7-deoxy-aglycones were higher in the EPI + VPL group as compared with the EPI group. The AUC, terminal half-life, mean residence time, volume of distribution at steady state, and plasma clearance of EPI alone as compared with EPI + VPL did not differ significantly. These results suggest either an induction of enzymes necessary for drug metabolism or an increase in the liver blood flow, resulting in an enhanced generation of metabolites with time or in an inhibition of excretion processes. Comparisons of the AUC values obtained for EPI and its metabolites after the first, second, and third injections of EPI revealed a cumulative effect for the metabolites that was more pronounced in the EPI + VPL group, being significant (P < 0.05) for epirubicin glucuronide in both treatment groups and for epirubicinol glucuronide in the EPI + VPL group. Maximal concentrations of VPL and nor-VPL reached 705 +/- 473 and 308 +/- 122 ng/ml, respectively, with the steady-state concentrations being 265 +/- 42 ng/ml for VPL and 180 +/- 12 ng/ml for nor-VPL.
Collapse
Affiliation(s)
- K Mross
- University Hospital Eppendorf, Department of Oncology/Hematology, Hamburg, Federal Republic of Germany
| | | | | |
Collapse
|
17
|
Twelves CJ, Dobbs NA, Michael Y, Summers LA, Gregory W, Harper PG, Rubens RD, Richards MA. Clinical pharmacokinetics of epirubicin: the importance of liver biochemistry tests. Br J Cancer 1992; 66:765-9. [PMID: 1419619 PMCID: PMC1977407 DOI: 10.1038/bjc.1992.353] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The influence of liver biochemistry tests on epirubicin pharmacokinetics has been investigated in 52 women with advanced breast cancer, 27 of whom had radiologically proven liver metastases. Patients received epirubicin 12.5-120 mg m-2 given as an i.v. bolus. Epirubicin levels were measured by HPLC following the first cycle of treatment. Epirubicin elimination, expressed as clearance (dose/AUC), in the 22 patients with normal AST and bilirubin was compared with that of 30 patients with a raised AST +/- raised bilirubin. Epirubicin clearance was significantly reduced in the patients with a raised AST, whether their serum bilirubin was normal (22 patients) or elevated (eight patients). In the 30 patients with a raised AST +/- raised bilirubin, epirubicin clearance correlated strongly with the level of AST (r = -0.72) but not with serum bilirubin, alkaline phosphatase, albumin or creatinine. Using a multiple regression analysis, AST was the only one of these biochemical variables predictive of epirubicin clearance (r2 = 0.47, P = 0.0006). We conclude that a raised serum AST is a more sensitive and reliable measure of abnormal epirubicin pharmacokinetics than increased bilirubin. These findings have implications for anthracycline treatment in patients with abnormal liver biochemistry.
Collapse
Affiliation(s)
- C J Twelves
- Imperial Cancer Research Fund Clinical Oncology Unit, United Medical School, Guy's Hospital, London
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Koren G, Beatty K, Seto A, Einarson TR, Lishner M. The effects of impaired liver function on the elimination of antineoplastic agents. Ann Pharmacother 1992; 26:363-71. [PMID: 1554959 DOI: 10.1177/106002809202600311] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To critically review available data on the disposition of cancer chemotherapy in patients with hepatic dysfunction, and to derive at dose recommendation. DATA SOURCES All published studies in English. STUDY SELECTION Both human and animal studies. DATA SYNTHESIS The available studies were sequentially qualitatively described and critically discussed. CONCLUSIONS The liver is responsible for the metabolism and elimination of many anticancer agents. Their accumulation during hepatic insufficiency may expose the patient to increased risk of drug toxicity. A variety of clinical methods have been described to estimate the need to decrease doxorubicin dose according to degree of hepatic failure to avoid serious toxicity. In some studies prospective ascertainment of clinical indices such as hepatic enzymes and bilirubin was successful in preventing doxorubicin-induced hepatotoxicity. Liver dysfunction has a major impact on cyclophosphamide pharmacokinetics. However, because such impairment leads to less production of the active aldophosphamide, fewer adverse effects were observed in hepatically impaired patients. Vinca alkaloids are extensively metabolized by the liver and excreted in the bile. Systemic exposure to these drugs is inversely correlated to the degree of hepatic failure measured by serum alkaline phosphatase. Although hepatic metabolism is a major route of elimination of fluorouracil, the kidney also plays an important role in its elimination. It has been suggested to reduce its dose in cirrhotic patients. Available pharmacokinetic data and their clinical implications are also discussed for azathioprine, mercaptopurine, etoposide, epirubicin, amsacrine, cytarabine, and other less-studied drugs. Recommendations for dose adjustments are presented and discussed.
Collapse
Affiliation(s)
- G Koren
- University of Toronto, Canada
| | | | | | | | | |
Collapse
|
19
|
Greidanus J, Willemse PH, Uges DR, Oremus ET, De Langen ZJ, De Vries EG. Continuous infusion of low-dose doxorubicin, epirubicin and mitoxantrone in cancer chemotherapy: a review. PHARMACEUTISCH WEEKBLAD. SCIENTIFIC EDITION 1988; 10:237-45. [PMID: 3062572 DOI: 10.1007/bf02219662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
With the recent development of reliable portable pumps and safe venous access systems, continuous infusion of chemotherapeutic agents on an out-patient basis has become feasible. Advantages of continuous infusion are the long-term exposure of tumour cells to the drug and the fact that most toxic effects are reduced for doxorubicin, epirubicin and mitoxantrone due to elimination of the high peak plasma levels. Preliminary data for doxorubicin suggest that its antitumour activity is maintained. Pharmacokinetic studies with epirubicin and mitoxantrone showed a linear relationship between drug dose infused and the steady-state plasma level for these drugs. The area under the curve for leukocytes drug level was higher during continuous infusion than after an equitoxic bolus injection of epirubicin and mitoxantrone. Well-randomized clinical trials will be necessary to investigate the role of continuous infusion of antracyclines and mitoxantrone in cancer chemotherapy in the future.
Collapse
Affiliation(s)
- J Greidanus
- Department of Internal Medicine, University Hospital Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
20
|
Pannuti F, Camaggi CM, Strocchi E. The role of pharmacokinetics in the clinical treatment of metastases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1988; 233:443-52. [PMID: 2975917 DOI: 10.1007/978-1-4899-5037-6_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- F Pannuti
- Division of Oncology, M. Malpighi Hospital, Bologna, Italy
| | | | | |
Collapse
|
21
|
Affiliation(s)
- G Powis
- Department of Pharmacology, Mayo Clinic and Foundation, Rochester, Minnesota 55905
| |
Collapse
|
22
|
Pannuti F, Camaggi CM, Strocchi E, Comparsi R, Rossi AP, Angelelli B, Franchini A. Intrahepatic arterial administration of 4'epidoxorubicin (epirubicin) in advanced cancer patients. A pharmacokinetic study. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1986; 22:1309-14. [PMID: 3470178 DOI: 10.1016/0277-5379(86)90138-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Epirubicin (epiDX) pharmacokinetics was followed in 10 advanced cancer patients with hepatic metastases from colorectal carcinoma or primary liver tumor after single bolus administration (20-40 mg) in the hepatic artery, through a surgically implanted catheter and subcutaneous access port. EpiDX plasma and whole blood concentrations follow a triphasic decay qualitatively similar to that observed after IV administration. Blood levels are consistently higher than plasma levels. Plasma clearance (nine patients, mean: 93.4 l/hr; range: 69.3-129.5 l/hr) is higher than the corresponding parameter determined in patients with hepatic metastases after intravenous therapy. The remaining patient is characterised by an abnormally low plasma clearance (13.6 l/hr), due to a hepato-pulmonary shunt. The subjects in this study were exposed to very low drug concentrations, and therefore experienced no relevant adverse side-effects.
Collapse
|