Pharmacokinetics and pharmacodynamics of a single dose of zoledronate in healthy dogs

An evaluation of the combination effect of zoledronate and chemotherapeutic agents in canine osteosarcoma cells

Introduction

Osteosarcoma (OSA) is an aggressive form of bone cancer in both dogs and humans. The treatment options for metastatic (stage III) OSA are currently limited and the prognosis is poor. Zoledronate, a second generation amino-bisphosphonate, is commonly used for palliation of cancer induced bone pain. Zoledronate has also demonstrated anti-cancer properties and possibly enhances the cytotoxicity of doxorubicin in a canine histiocytosis cell line and human prostatic cancer cell line. The goal of this study was to evaluate the combination effect of zoledronate and various chemotherapeutic drugs in canine OSA cells.

Methods

Canine OSA cell line (D17), cells from two canine primary OSAs, and MDCK, a canine kidney cell line, were used to evaluate the therapeutic potential of these drugs. Carboplatin, doxorubicin, vinorelbine, toceranib, and isophosphoramide mustard (active metabolite of ifosfamide) were used as chemotherapeutic agents. First, cells were treated with either zoledronate or chemotherapy drug alone for 72 hours. Cell viability was assessed using CellTiter Glo and IC5, IC10, IC20, and IC50 were calculated. Second, cells were treated with a combination of zoledronate and each chemotherapeutic agent at their IC5, IC10, IC20, and IC50 concentrations. After 72 hours, cell viability was assessed by CellTiter Glo.

Results and discussion

Zoledronate, carboplatin, doxorubicin, vinorelbine, and isophosphoramide mustard showed concentration dependent decrease in cell viability. Toceranib showed decreased cell viability only at higher concentrations. When zoledronate was used in combination with chemotherapy drugs, while it showed potential synergistic effects with toceranib, potential antagonistic effects with vinorelbine and isophosphoramide mustard were observed. However, the results differed by cell line and thus, further evaluation is warranted to understand the exact mechanism of action.

Evaluation of zoledronate for the treatment of canine stage III osteosarcoma: A phase II study

BACKGROUND

Greater than 90% of dogs with appendicular osteosarcoma will develop pulmonary metastasis despite the standard of care. Available treatments have limited efficacy for stage III disease. Zoledronate, a bisphosphonate, induces apoptosis of canine osteosarcoma cells and appears to modulate the tumour microenvironment.

OBJECTIVES

This prospective, single institutional phase IIa trial investigated the use of single agent zoledronate in dogs with pulmonary metastases from osteosarcoma.

METHODS

Zoledronate was administered once monthly, and thoracic radiographs were used to assess response.

RESULTS

Eleven dogs were enrolled. Stable disease was achieved in two of eight dogs available for response assessment. The median progression-free survival was 28 days (range: 4-93 days). The median stage III-specific survival time was 92 days. Adverse events were reported in four dogs; two dogs developed grade III or higher toxicities. Notable adverse events included conjunctivitis, fever, hypocalcaemia, and hypophosphatemia.

CONCLUSIONS

Zoledronate appears to have limited efficacy as a single agent for stage III osteosarcoma and may be associated with unexpected toxicity in this population. This clinical trial was registered on the AVMA Animal Health Studies Database (AAHSD004396).

Rapid and sensitive determination of four bisphosphonates in rat plasma after MTBSTFA derivatization using liquid chromatography-mass spectrometry

Bisphosphonates (BPs) have broad medical applications against osteoporosis, bone metastasis and Paget's disease. The BP-related jaw osteonecrosis limits their use extensively and has a causal relationship with the process of drug disposition, such as deposition on bone and slow elimination rate. Thus it is imperative to accurately determine BP levels in either clinical or pharmacological/toxicological studies. The ability of trimethylsilyl diazomethane (TMSD) to alkylate the hydroxyls in phosphoric groups is an advantage in terms of decreasing polarity and enhancing mass response of BPs. There are, however, practical limitations to the cumbersome sample preparation procedure, the prolonged reaction time, the by-products and the obstacle to ionization. To overcome these disadvantages, a simplified and rapid precolumn derivatization method with N-(tert-Butyldimethylsilyl)-N-methyl-trifluoroacetamide (MTBSTFA) to quantify etidronate, clodronate, alendronate and zoledronate BPs in rat plasma was established in this work. The derivatization reaction was conducted within 2 min at room temperature, and the unitary di-tert-butyldimethylsilyl (di-tBDMS) derivative was obtained for each BP. Derivatives were separated on a XTerra® MS C₈ column (2.1 × 50 mm, 3.5 μm) with the mobile phase of 5 mM ammonium acetate buffer (pH 8.5) and acetonitrile, then detected using electrospray ionization tandem mass spectrometry in negative mode. An easy extraction process instead of the time-consuming solid-phase extraction (SPE) was employed for plasma treatment. The proposed method showed good linearity for BPs over the range of 2-500 ng/mL in 20 μL plasma and high sensitivity owing to the larger molecular ions, higher ionization capacity and more stable fragments of di-tBDMS derivatives. The intra- and inter-batch precision were <13.1 %, and the accuracy ranged within ±10 %. The extraction recovery varied from 75.4 to 88.0 %. The optimized method was successfully applied to characterize the pharmacokinetic profile of zoledronate in rats. Moreover, it is a promising approach for the determination of other phosphoric acid-containing metabolites.

Bisphosphonate related osteonecrosis of the jaws: a review

Bisphosphonate use has increased in veterinary medicine over the last decade. During this time, bisphosphonate related osteonecrosis of the jaws (BRONJ) in human patients has been identified. Only recently was a dog model for BRONJ developed for human oral surgery and medicine. Veterinary patients treated with bisphosphonates may be at an increased risk for BRONJ There has been little, to no, investigation of potential long term side-effects of bisphosphonate use in veterinary patients; potential sequelae are unknown. The history of bisphosphonates, their use, and BRONJ in veterinary patients are discussed.

Bisphosphonates significantly increase the activity of doxorubicin or vincristine against canine malignant histiocytosis cells

Canine malignant histiocytosis (MH) is an aggressive neoplasm of macrophages and dendritic cells. It carries a poor prognosis because of the development of widespread metastasis and poor sensitivity to chemotherapy. Thus, there is a large need for new treatments for MH. We hypothesized that bisphosphonates might be useful to increase the effectiveness of cytotoxic chemotherapy against MH. To address this question, we conducted in vitro screening studies using MH cell lines and a panel of 6 chemotherapy and 5 bisphosphonate drugs. The combination of clodronate with vincristine was found to elicit synergistic killing which was associated with a significant increase in cell cycle arrest. Second, zoledronate combined with doxorubicin also significantly increased cell killing. Zoledronate significantly increased the uptake of doxorubicin by MH cells. On the basis of these findings, we conclude that certain bisphosphonate drugs may increase the overall effectiveness of chemotherapy for MH in dogs.

The rabbit biodistribution of a therapeutic dose of zoledronic acid labeled with Tc-99m

The aim of the present study was to label a therapeutic dose of zoledronic acid (ZOL) with Tc-99m, evaluate its in vitro stability and compare its biodistribution to (99m)Tc-methylene biphosphonate ((99m)Tc-MDP) in normal rabbits. Preparation of 0.50 mg of (99m)Tc-ZOL was carried out by the reduction of (99m)Tc-pertechnetate in the presence of stannous chloride. The radiolabeling efficiency was found to be greater than 99%. The labeled complex was stable at least up to 6 h at room temperature determined by paper chromatography. (99m)Tc-ZOL and (99m)Tc-MDP were administered intravenously to the rabbits for scintigraphic studies. Between (99m)Tc-ZOL and (99m)Tc-MDP, there were no significant differences in the ratios of femur/BG and lumbar vertebrae/BG, whereas epiphysis/BG and the kidney/BG ratios of (99m)Tc-MDP were higher than (99m)Tc-ZOL at the static studies.

Adjunctive analgesic therapy in veterinary medicine

Adjunctive analgesic therapies are interventions for pain that involve agents or techniques other than the traditional analgesics (opioids, nonsteroidal anti-inflammatory drugs, and local anesthetics). Adjunctive therapies may be pharmacologic or nonpharmacologic in nature. The focus of this article is on pharmacologic interventions with potential utility as adjunctive analgesics in veterinary medicine. Pharmacology of selected agents, including medetomidine, ketamine, amantadine, gabapentin, systemic lidocaine, and pamidronate, is discussed in addition to evidence for their safety and efficacy and guidelines for their use in veterinary patients.

Biodistribution and plasma protein binding of zoledronic acid

The bisphosphonate zoledronic acid is a potent inhibitor of osteoclast-mediated bone resorption. To investigate drug biodistribution and elimination, (14)C-zoledronic acid was administered intravenously to rats and dogs in single or multiple doses and assessed for its in vitro blood distribution and plasma protein binding in rat, dog, and human. Drug exposure in plasma, bones, and noncalcified tissues was investigated up to 240 days in rats and 96 h in dogs using radiometry after dissection. Drug biodistribution in the rat and within selected bones from dog was assessed by autoradiography. Concentrations of radioactivity showed a rapid decline in plasma and noncalcified tissue but only a slow decline in bone, to approximately 50% of peak at 240 days post dose, whereas the terminal half-lives (50-200 days) were similar in bone and noncalcified tissues, suggesting redistribution of drug from the former rather than prolonged retention in the latter. Uptake was highest in cancellous bone and axial skeleton. At 96 h after dose, the fraction of dose excreted was 36% in rat and 60% in dog; 94 to 96% of the excreted radioactivity was found in urine. Blood/plasma concentration ratios were 0.52 to 0.59, and plasma protein binding of zoledronic acid was moderate to low in all species. The results suggest that a fraction of zoledronic acid is reversibly taken up by the skeleton, the elimination of drug is mainly by renal excretion, and the disposition in blood and noncalcified tissue is governed by extensive uptake into and slow release from bone.