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01-11-2016 | Original Article

Population pharmacokinetics of Daunorubicin in adult patients with acute myeloid leukemia

Authors: Savitha Varatharajan, John C. Panetta, Ajay Abraham, Sreeja Karathedath, Ezhilpavai Mohanan, Kavitha M. Lakshmi, Nancy Arthur, Vivi M. Srivastava, Sandeep Nemani, Biju George, Alok Srivastava, Vikram Mathews, Poonkuzhali Balasubramanian

Published in: Cancer Chemotherapy and Pharmacology | Issue 5/2016

Abstract

Purpose

Chemotherapy drug resistance and relapse of the disease have been the major factors limiting the success of acute myeloid leukemia (AML) therapy. Several factors, including the pharmacokinetics (PK) of Cytarabine (Ara-C) and Daunorubicin (Dnr), could contribute to difference in treatment outcome in AML.

Methods

In the present study, we evaluated the plasma PK of Dnr, the influence of genetic polymorphisms of genes involved in transport and metabolism of Dnr on the PK, and also the influence of these factors on clinical outcome. Plasma levels of Dnr and its major metabolite, Daunorubicinol (DOL), were available in 70 adult de novo AML patients. PK parameters (Area under curve (AUC) and clearance (CL)) of Dnr and DOL were calculated using nonlinear mixed-effects modeling analysis performed with Monolix. Genetic variants in ABCB1, ABCG2, CBR1, and CBR3 genes as well as RNA expression of CBR1, ABCB1, and ABCG2 were compared with Dnr PK parameters.

Results

The AUC and CL of Dnr and DOL showed wide inter-individual variation. Patients with an exon1 variant of rs25678 in CBR1 had significantly higher plasma Dnr AUC [p = 0.05] compared to patients with wild type. Patients who achieved complete remission (CR) had significantly lower plasma Dnr AUC, Cmax, and higher CL compared to patients who did not achieve CR.

Conclusion

Further validation of these findings in a larger cohort of AML patients is warranted before establishing a therapeutic window for plasma Dnr levels and targeted dose adjustment.

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Title: Population pharmacokinetics of Daunorubicin in adult patients with acute myeloid leukemia
Authors: Savitha Varatharajan
John C. Panetta
Ajay Abraham
Sreeja Karathedath
Ezhilpavai Mohanan
Kavitha M. Lakshmi
Nancy Arthur
Vivi M. Srivastava
Sandeep Nemani
Biju George
Alok Srivastava
Vikram Mathews
Poonkuzhali Balasubramanian
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: Cancer Chemotherapy and Pharmacology / Issue 5/2016
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI: https://doi.org/10.1007/s00280-016-3166-8

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Abstract

Purpose

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Results

Conclusion

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