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Gándara-Mireles JA, Lares-Asseff I, Reyes Espinoza EA, Fierro IV, Castañeda VL, Cordova Hurtado LP, González CD, Romero LP, Reyes HA. Impact of single-nucleotide variants and nutritional status on population pharmacokinetics of Doxorubicin, and its effect on cardiotoxicity in children with leukemia. J Oncol Pharm Pract 2023; 29:1290-1305. [PMID: 36113156 DOI: 10.1177/10781552221117810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE Doxorubicin is an important antineoplastic agent with wide interindividual variability in response to treatment and in its cardiotoxic effects. To determine the effect of genotypic status of three single-nucleotide variants in ABCC1, NCF4, and CBR3 genes and nutritional status assessed by body mass index, on the population pharmacokinetics of Doxorubicin and its cardiotoxic effects in pediatric patients with leukemia. PATIENTS AND METHODS Seventy pediatric patients treated with Doxorubicin were studied, in which 189 biological samples were obtained to determine Doxorubicin concentrations (1 to 3 samples per patient) at different times, for 20 h. RESULTS Low body mass index and age ≤ 7 years were associated with decreased clearance of Doxorubicin, and female gender was associated with increased clearance of Doxorubicin. Low BMI and low height were associated with a decrease and increase, respectively, in the intercompartmental clearance (Q) of Doxorubicin. TT homozygosity of the single-nucleotide variant rs3743527 of the ABCC1 gene was associated with an increase in clearance and decreased area under the curve, AA homozygosity of the single-nucleotide variant rs1883112 of the NCF4 gene was associated with a decrease in the volume of distribution in the peripheral compartment (V2), and GG homozygosity of CBR3 rs1056892 with increasing area under the curve. CONCLUSION Some covariates studied are directly related to the increase or decrease of the pharmacokinetic parameters of Doxorubicin. Decreased clearance, V2, and increased area under the curve were associated with systolic dysfunction, and decreased Q and V2 were associated with diastolic dysfunction. These results may contribute to the effective and safe use of Doxorubicin in pediatric patients with leukemia.
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Affiliation(s)
- Jesús Alonso Gándara-Mireles
- Academia de Genómica/Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Dgo., México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
| | - Ismael Lares-Asseff
- Academia de Genómica/Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Dgo., México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
| | | | - Ignacio Villanueva Fierro
- Academia de Genómica/Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Dgo., México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
| | - Verónica Loera Castañeda
- Academia de Genómica/Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Dgo., México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
| | | | - Carla Díaz González
- Servicio de Onco-Hematología Pediátrica/Centro Estatal de Cancerología, CECAN Durango, Dgo., México
| | - Leslie Patrón Romero
- Facultad de Medicina y Psicología/Universidad Autónoma de Baja California, TJ, México
| | - Horacio Almanza Reyes
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
- Facultad de Medicina y Psicología/Universidad Autónoma de Baja California, TJ, México
- Universidad Tecnológica de Tijuana, TJ, México
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Methaneethorn J, Tengcharoen K, Leelakanok N, AlEjielat R. Population pharmacokinetics of doxorubicin: A systematic review. Asia Pac J Clin Oncol 2023; 19:9-26. [PMID: 35415961 DOI: 10.1111/ajco.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/21/2021] [Accepted: 03/03/2022] [Indexed: 01/20/2023]
Abstract
Because of the high interindividual pharmacokinetic variability, several population pharmacokinetic (PopPK) models of doxorubicin (DOX) were developed to characterize factors influencing such variability. However, significant predictors for DOX pharmacokinetics identified using PopPK models varied across studies. Thus, this review aims to summarize PopPK models of DOX and its metabolites (if any) as well as significant covariates influencing DOX (and its metabolites) pharmacokinetic variability. A systematic search from PubMed, CINAHL Complete, Science Direct, and SCOPUS databases identified 503 studies. Of these, 16 studies met the inclusion criteria and were included in this review. DOX pharmacokinetics was described with two- or three-compartment models. Most studies found a significant increase in DOX clearance with an increase in body surface area from the median value of 1.8 m2 . Moreover, this review identified that while a 10-year increase in patient age resulted in a decrease in DOX clearance in adults and the elderly, younger children had lower DOX clearance compared to older children. Further, low DOX exposure was observed in pregnant women, and thus dosage adjustment is required. Concerning model applicability, predictive performance assessment of these published models should be performed before implementing such models in clinical practice.
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Affiliation(s)
- Janthima Methaneethorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand
| | - Kanokkan Tengcharoen
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Nattawut Leelakanok
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Sean Suk, Thailand
| | - Rowan AlEjielat
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
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Nanoliposomes in Cancer Therapy: Marketed Products and Current Clinical Trials. Int J Mol Sci 2022; 23:ijms23084249. [PMID: 35457065 PMCID: PMC9030431 DOI: 10.3390/ijms23084249] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/12/2022] Open
Abstract
The drugs used for cancer treatment have many drawbacks, as they damage both tumor and healthy cells and, in addition, they tend to be poorly soluble drugs. Their transport in nanoparticles can solve these problems as these can release the drug into tumor tissues, as well as improve their solubility, bioavailability, and efficacy, reducing their adverse effects. This article focuses on the advantages that nanotechnology can bring to medicine, with special emphasis on nanoliposomes. For this, a review has been made of the nanoliposomal systems marketed for the treatment of cancer, as well as those that are in the research phase, highlighting the clinical trials being carried out. All marketed liposomes studied are intravenously administered, showing a reduced intensity of side-effects compared with the nonliposomal form. Doxorubicin is the active ingredient most frequently employed. Ongoing clinical trials expand the availability of liposomal medicines with new clinical indications. In conclusion, the introduction of drugs in nanoliposomes means an improvement in their efficacy and the quality of life of patients. The future focus of research could be directed to develop multifunctional targeted nanoliposomes using new anticancer drugs, different types of existing drugs, or new standardized methodologies easily translated into industrial scale.
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García-Castillo V, López-Urrutia E, Villanueva-Sánchez O, Ávila-Rodríguez MÁ, Zentella-Dehesa A, Cortés-González C, López-Camarillo C, Jacobo-Herrera NJ, Pérez-Plasencia C. Targeting Metabolic Remodeling in Triple Negative Breast Cancer in a Murine Model. J Cancer 2017; 8:178-189. [PMID: 28243322 PMCID: PMC5327367 DOI: 10.7150/jca.16387] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/12/2016] [Indexed: 12/31/2022] Open
Abstract
Background: Chemotherapy is the backbone of systemic treatment for triple negative breast cancer (TNBC), which is one of the most relevant breast cancers molecular types due to the ability of tumor cells to develop drug resistance, highlighting the urgent need to design newer and safer drug combinations for treatment. In this context, to overcome tumor cell drug resistance, we employed a novel combinatorial treatment including Doxorubicin, Metformin, and Sodium Oxamate (DoxMetOx). Such pharmacological combination targets indispensable hallmarks of cancer-related to aerobic glycolysis and DNA synthesis. Materials and Methods: Thirty-five female nude mice were transplanted subcutaneously with MDA-MB-231 triple negative human cancer cell line. Once tumors were visible, mice were treated with doxorubicin, metformin, oxamate or all possible pharmacologic combinations. Treatments were administered daily for 15 days and tumors were measured by calipers every day. MicroPET images were taken in three different occasions, basal state, in the middle of the treatment, and at the end of treatment. Western blot analyses, qRT-PCR, flow cytometry, and cytotoxicity assays were performed to elucidate the mechanism of cell death promoted by the drugs in vitro. Results: In this work we assessed the proof of concept of metabolic correction in solid tumors as an effective drug treatment; hence, mice bearing tumors treated with the DoxMetOx therapy showed a complete inhibition of the tumor mass growing in 15 days of treatment depicted by the micro PET images. In vitro studies displayed that the three drugs together act by inhibiting both, mTOR-phosphorylation and expression of LDH-A gene, promoting apoptosis via dependent on the caspase-3 pathway, accompanied by cleavage of PARP. Moreover, induction of autophagy process was observed by the accumulation of LC3-II, a primordial protein implicated in the conformation and elongation of the autophagolysosome. Conclusions: The lack of effective drugs to inhibit TNBC growth is the main cause of therapy failure and tumor relapse. We have showed that targeting crucial molecular pathways in cancer by the combination of Doxorubicin, Metformin, and Oxamate resulted as an efficient and rapid tumor growth inhibitor in a triple negative xenograft model. Our findings are promising for patients diagnosed with TNBC tumors, for which unfortunately there are no reliable drug therapies.
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Affiliation(s)
- Verónica García-Castillo
- Posgrade in Experimental Biology, Metropolitan University of Mexico
- FES-Iztacala, UBIMED, National Autonomous University of Mexico, UNAM, Tlalnepantla, Mexico
| | | | | | | | | | | | | | | | - Carlos Pérez-Plasencia
- FES-Iztacala, UBIMED, National Autonomous University of Mexico, UNAM, Tlalnepantla, Mexico
- Genomics Lab, National Cancer Institute of Mexico, Mexico
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Pérez-Blanco JS, Santos-Buelga D, Fernández de Gatta MDM, Hernández-Rivas JM, Martín A, García MJ. Population pharmacokinetics of doxorubicin and doxorubicinol in patients diagnosed with non-Hodgkin's lymphoma. Br J Clin Pharmacol 2016; 82:1517-1527. [PMID: 27447545 DOI: 10.1111/bcp.13070] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/29/2016] [Accepted: 07/18/2016] [Indexed: 01/07/2023] Open
Abstract
AIMS The aims of the study were: (i) to characterize the pharmacokinetics (PK) of doxorubicin (DOX) and doxorubicinol (DOXol) in patients diagnosed with non-Hodgkin's lymphoma (NHL) using a population approach; (ii) to evaluate the influence of various covariates on the PK of DOX; and (iii) to evaluate the role of DOX and DOXol exposure in haematological toxicity. METHODS Population PK modelling (using NONMEM) was performed using DOX and DOXol plasma concentration-time data from 45 NHL patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). The influence of drug exposure on haematological toxicity was analysed using the Mann-Whitney-Wilcoxon test. RESULTS A five-compartment model, three for DOX and two for DOXol, with first-order distribution and elimination for both entities best described the data. Population estimates for parent drug (CL) and metabolite (CLm ) clearance were 62 l h-1 and 27 l h-1 , respectively. The fraction metabolized to DOXol (Fm ) was estimated at 0.22. While bilirubin and aspartate aminotransferase showed an influence on the CL and CLm , the objective function value decrease was not statistically significant. A trend towards an association between the total area under the concentration-time curve (AUCtotal ), the area under the concentration-time curve for DOX (AUC) plus the area under the concentration-time curve for DOXol (AUCm ), and the neutropenia grade (P = 0.068) and the neutrophil counts (P = 0.089) was observed, according to an exponential relationship. CONCLUSIONS The PK of DOX and DOXol were well characterized by the model developed, which could be used as a helpful tool to optimize the dosage of this drug. The results suggest that the main active metabolite of DOX, DOXol, is involved in the haematological toxicity of the parent drug.
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Affiliation(s)
- Jonás Samuel Pérez-Blanco
- Department of Pharmaceutical Sciences - Pharmacy and Pharmaceutical Technology, University of Salamanca, Spain.,Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain
| | - Dolores Santos-Buelga
- Department of Pharmaceutical Sciences - Pharmacy and Pharmaceutical Technology, University of Salamanca, Spain.,Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain
| | - María Del Mar Fernández de Gatta
- Department of Pharmaceutical Sciences - Pharmacy and Pharmaceutical Technology, University of Salamanca, Spain.,Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain
| | - Jesús María Hernández-Rivas
- Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain.,Haematology Department, University Hospital of Salamanca and IBMCC, Cancer Research Centre, Salamanca, Spain
| | - Alejandro Martín
- Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain.,Haematology Department, University Hospital of Salamanca and IBMCC, Cancer Research Centre, Salamanca, Spain
| | - María José García
- Department of Pharmaceutical Sciences - Pharmacy and Pharmaceutical Technology, University of Salamanca, Spain.,Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain
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Pérez-Blanco JS, Fernández de Gatta MDM, Hernández-Rivas JM, García Sánchez MJ, Sayalero Marinero ML, González López F. Validation and clinical evaluation of a UHPLC method with fluorescence detector for plasma quantification of doxorubicin and doxorubicinol in haematological patients. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 955-956:93-7. [PMID: 24631816 DOI: 10.1016/j.jchromb.2014.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/30/2014] [Accepted: 02/17/2014] [Indexed: 11/18/2022]
Abstract
A rapid and simple UHPLC-fluorescence detection method for the quantification of doxorubicin and its main metabolite, doxorubicinol, in human plasma has been developed. The method was also validated for its application in therapeutic drug monitoring, a clinical approach used in the optimization of oncologic treatments. Following a single protein precipitation step, chromatographic separation was achieved using a C18 column (50mm×2.10mm, particle size 1.7μm) at 50°C with a mobile phase consisting of water (containing 0.4% triethylamine and 0.4% orthophosphoric acid)/acetonitrile (77:23, v/v). Flow rate was 0.50mL/min and fluorescence detection with an excitation wavelength of 470nm and an emission wavelength of 548nm was used. The method met the specifications of linearity, selectivity, sensitivity, accuracy, precision and stability of the FDA and EMA guidelines for the validation of bioanalytical methods. Linearity for the drug (8-3000ng/mL) and the metabolite (3-150ng/mL) was observed (R(2)>0.992) and the maximum intra-day and inter-day precision coefficients of variation were less than 14% for both. The lower limits of quantification were 8 and 3ng/mL for doxorubicin and doxorubicinol, respectively. The method was successfully applied to the quantify plasma concentrations of doxorubicin and doxorubicinol in 33 patients diagnosed with haematological malignancies in which broad ranges for drug (8.3-2766.0ng/mL) and metabolite (4.8-104.9ng/mL) levels were measured adequately.
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Affiliation(s)
- Jonás Samuel Pérez-Blanco
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Avda Lcdo Méndez Nieto s/n, 37007 Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), University Hospital of Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain.
| | - María del Mar Fernández de Gatta
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Avda Lcdo Méndez Nieto s/n, 37007 Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), University Hospital of Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain
| | - Jesús María Hernández-Rivas
- Haematology Service, University Hospital of Salamanca and IBMCC, Cancer Research Center, University of Salamanca-CSIC, Campus Miguel de Unamuno, 37007 Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), University Hospital of Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain
| | - María José García Sánchez
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Avda Lcdo Méndez Nieto s/n, 37007 Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), University Hospital of Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain
| | - María Luisa Sayalero Marinero
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Avda Lcdo Méndez Nieto s/n, 37007 Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), University Hospital of Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain
| | - Francisco González López
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Avda Lcdo Méndez Nieto s/n, 37007 Salamanca, Spain
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