Population Pharmacokinetics and Pharmacodynamics of Paclitaxel and Carboplatin in Ovarian Cancer Patients: A Study by the European Organization for Research and Treatment of Cancer-Pharmacology and Molecular Mechanisms Group and New Drug Development Group

Purpose: Paclitaxel and carboplatin are frequently used in advanced ovarian cancer following cytoreductive surgery. Threshold models have been used to predict paclitaxel pharmacokinetic-pharmacodynamics, whereas the time above paclitaxel plasma concentration of 0.05 to 0.2 μmol/L ( t C > 0.05−0.2...

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Published in:	Clinical cancer research Vol. 13; no. 21; pp. 6410 - 6418
Main Authors:	JOERGER, Markus, HUITEMA, Alwin D. R, SLEEBOOM, Henk P, IZQUIERDO, Miguel A, JODRELL, Duncan I, CALVERT, Hilary, BODDY, Alan V, HOLLEMA, Harry, FETY, Regine, VAN DER VIJGH, Wjfj. F, HEMPEL, Georg, CHATELUT, Etienne, RICHEL, Dick J, KARLSSON, Mats, WILKINS, Justin, TRANCHAND, Brigitte, SCHRIJVERS, Ad H. G. J, TWELVES, Christian, BEIJNEN, Jos H, SCHELLENS, Jan H. M, DITTRICH, Christian, PAVLIDIS, Nikolas, BRIASOULIS, Evangelos, VERMORKEN, Jan B, STROCCHI, Elena, MARTONI, Andrea, SORIO, Roberto
Format:	Journal Article
Language:	English
Published:	Philadelphia, PA American Association for Cancer Research 01-11-2007
Subjects:	Antineoplastic agents Antineoplastic Agents - therapeutic use Antineoplastic Combined Chemotherapy Protocols - therapeutic use Area Under Curve Biological and medical sciences Carboplatin - pharmacokinetics Carboplatin - pharmacology clinical pharmacology Disease Progression Drug Design Europe Female gynecologic cancers: ovarian Humans Kinetics Medical sciences MEDICIN MEDICINE Neutropenia Ovarian Neoplasms - drug therapy Ovarian Neoplasms - genetics Ovarian Neoplasms - pathology Paclitaxel - pharmacokinetics Paclitaxel - pharmacology pharmacokinetics and pharmacodynamics Pharmacology. Drug treatments Predictive Value of Tests Thrombocytopenia Treatment Outcome Europe Antineoplastic agent Human Drug Population pharmacokinetics Pharmacokinetic pharmacodynamic relationship Ovary cancer Pharmacology Malignant tumor Research and development Female genital diseases Ovarian diseases Taxane derivatives Paclitaxel Carboplatin Mechanism of action Antimitotic Cancer Platinum II Complexes European Organization for Research and Treatment of Cancer
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Summary:	Purpose: Paclitaxel and carboplatin are frequently used in advanced ovarian cancer following cytoreductive surgery. Threshold models have been used to predict paclitaxel pharmacokinetic-pharmacodynamics, whereas the time above paclitaxel plasma concentration of 0.05 to 0.2 μmol/L ( t C > 0.05−0.2 ) predicts neutropenia. The objective of this study was to build a population pharmacokinetic-pharmacodynamic model of paclitaxel/carboplatin in ovarian cancer patients. Experimental Design: One hundred thirty-nine ovarian cancer patients received paclitaxel (175 mg/m 2 ) over 3 h followed by carboplatin area under the concentration-time curve 5 mg/mL*min over 30 min. Plasma concentration-time data were measured, and data were processed using nonlinear mixed-effect modeling. Semiphysiologic models with linear or sigmoidal maximum response and threshold models were adapted to the data. Results: One hundred five patients had complete pharmacokinetic and toxicity data. In 34 patients with measurable disease, objective response rate was 76%. Neutrophil and thrombocyte counts were adequately described by an inhibitory linear response model. Paclitaxel t C > 0.05 was significantly higher in patients with a complete (91.8 h) or partial (76.3 h) response compared with patients with progressive disease (31.5 h; P = 0.02 and 0.05, respectively). Patients with paclitaxel t C > 0.05 > 61.4 h (mean value) had a longer time to disease progression compared with patients with paclitaxel t C > 0.05 < 61.4 h (89.0 versus 61.9 weeks; P = 0.05). Paclitaxel t C > 0.05 was a good predictor for severe neutropenia ( P = 0.01), whereas carboplatin exposure ( C max and area under the concentration-time curve) was the best predictor for thrombocytopenia ( P < 10 −4 ). Conclusions: In this group of patients, paclitaxel t C > 0.05 is a good predictive marker for severe neutropenia and clinical outcome, whereas carboplatin exposure is a good predictive marker for thrombocytopenia.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1078-0432 1557-3265 1557-3265
DOI:	10.1158/1078-0432.CCR-07-0064