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Royer B, Schmitt A, Nguyen T, Paillard MJ, Jary M, Demarchi M, Vernerey D, Henriques J, Jacquin M, Borg C, Kim S. Exposure-response analysis of Raltitrexed assessing liver toxicity. Br J Clin Pharmacol 2020; 87:1327-1337. [PMID: 32789966 DOI: 10.1111/bcp.14519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Raltitrexed (RTX) is a thymidylate synthase inhibitor with large pharmacokinetics (PK) variability that can be administered in case of 5-fluorouracil (5FU) intolerance or dihydropyrimidine dehydrogenase deficiency. While it is a more potent thymidylate synthase inhibitor than 5FU, RTX failed to replace this drug for colorectal cancer patients, mainly due to its toxicity at the recommended dose of 3 mg/m2 every 3 weeks. However, every 2 weeks administration at 2 mg/m2 demonstrated a favourable toxicity profile. METHOD We performed a randomized crossover comparative population PK study between every 2 weeks TOMOX (RTX 2 mg/m2 ) and every 3 weeks TOMOX (RTX 3 mg/m2 ). RESULTS A three-compartment model and a proportional error model best describe the data. Creatinine clearance and sex, but not body surface area (BSA), were covariates of RTX clearance leading to decrease of its interindividual variability of 28%. Weight and body surface area were covariates of central and peripheral volumes of distribution, respectively, leading to decreases of interindividual variability of 34.6% and 100%, respectively. In contrast to the dose, AUC was a good predictor of liver toxicity (P = 0.006, OR = 3.91, 95%CI = [1.48-10.34]). Using covariates to compute individual clearance and a threshold AUC (1.639, determined in this study), a covariates-based dose was calculated, leading to less variability in AUC than observed with the actual BSA-based or fixed doses. CONCLUSION These results advocate for the use of creatinine clearance and sex to determine the RTX dose instead of BSA.
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Affiliation(s)
- Bernard Royer
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU Besançon, Besançon, F-25000, France.,INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France
| | - Antonin Schmitt
- Service Pharmacie, Centre Georges-François Leclerc, Dijon, F-21000, France.,Université Bourgogne Franche-Comté, INSERM U1231, Dijon, F-21000, France
| | - Thierry Nguyen
- Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France
| | - Marie-Justine Paillard
- Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France.,Unité de méthodologie et de qualité de vie en cancérologie, CHU Besançon, Besançon, F-25000, France
| | - Marine Jary
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France.,INSERM CIC-1431, , CHU Besançon, Besançon, F-25000, France
| | - Martin Demarchi
- Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France
| | - Dewi Vernerey
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Unité de méthodologie et de qualité de vie en cancérologie, CHU Besançon, Besançon, F-25000, France
| | - Julie Henriques
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Unité de méthodologie et de qualité de vie en cancérologie, CHU Besançon, Besançon, F-25000, France
| | - Marion Jacquin
- INSERM CIC-1431, , CHU Besançon, Besançon, F-25000, France.,Cancéropôle Grand Est, France
| | - Christophe Borg
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France.,INSERM CIC-1431, , CHU Besançon, Besançon, F-25000, France
| | - Stefano Kim
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France.,INSERM CIC-1431, , CHU Besançon, Besançon, F-25000, France
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