Abstract | OBJECTIVES: Our objective was to build population pharmacokinetic models that describe plasma concentrations of irinotecan (CPT-11) and its metabolites 7-ethyl-10-hydroxycamptothecin (SN-38) and SN-38 glucuronide (SN-38G) and to investigate the pharmacokinetic-pharmacodynamic relationships between drug exposure and diarrhea, the major dose-limiting toxicity. METHODS: Data were obtained from 109 patients (65 men and 44 women) who received 1.5-hour (range, 0.75- to 2.25-hour) intravenous infusions of irinotecan at doses that ranged from 100 to 350 mg/m(2); 44 patients had a second course. The population pharmacokinetic models were developed to describe plasma concentration-time profiles. The area under the concentration-time curve from time zero to 60 hours [AUC (0-60)] was used as a measure of drug exposure to model the probabilities of diarrhea with use of a logistic regression model. RESULTS: A 3-compartment pharmacokinetic model best described the disposition of irinotecan, whereas SN-38 and SN-38G showed 2-compartmental characteristics. The population estimate of clearance for irinotecan was 31.6 L/h, and the volume of distribution at steady-state (V(SS)) was 263 L. The clearance divided by formation fraction (F(m)) was 712 L/h and 66.8 L/h for SN-38 and SN-38G, respectively. The V(SS)/F(m) was 72,000 L for SN-38 and 85.4 L for SN-38G. The frequencies of diarrhea scores in this study were 46% (grade 0), 28% (grade 1), 20% (grade 2), 4% (grade 3), and 2% (grade 4). Significant correlations between AUC(0-60) and diarrhea scores were found for irinotecan (P <.05) and SN-38G (P <.01) but not for SN-38 or the biliary index. CONCLUSIONS: In this population analysis, irinotecan and SN-38G AUC values were appropriate predictors of the risk for diarrhea, and SN-38G AUC showed the stronger relationship of the two. The developed population models may be useful in further clinical development of this agent.
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Authors | Rujia Xie, Ron H J Mathijssen, Alex Sparreboom, Jaap Verweij, Mats O Karlsson |
Journal | Clinical pharmacology and therapeutics
(Clin Pharmacol Ther)
Vol. 72
Issue 3
Pg. 265-75
(Sep 2002)
ISSN: 0009-9236 [Print] United States |
PMID | 12235447
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- 7-ethyl-10-hydroxycamptothecin beta-glucuronide
- Antineoplastic Agents
- Glucuronates
- Irinotecan
- Camptothecin
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Topics |
- Adult
- Aged
- Antineoplastic Agents
(adverse effects, blood, pharmacokinetics)
- Area Under Curve
- Camptothecin
(adverse effects, analogs & derivatives, blood, pharmacokinetics)
- Chi-Square Distribution
- Diarrhea
(blood, chemically induced)
- Dose-Response Relationship, Drug
- Female
- Glucuronates
(adverse effects, blood, pharmacokinetics)
- Humans
- Irinotecan
- Male
- Middle Aged
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