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Published in: Clinical Pharmacokinetics 2/2006

01-02-2006 | Original Research Article

Pharmacokinetics of Darbepoetin Alfa after Intravenous or Subcutaneous Administration in Patients with Non-myeloid Malignancies Undergoing Chemotherapy

Authors: Anne C. Heatherington, Christian Dittrich, Dr John T. Sullivan, Greg Rossi, Johannes Schneller

Published in: Clinical Pharmacokinetics | Issue 2/2006

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Abstract

Background and objective

The pharmacokinetics of darbepoetin alfa after intravenous (IV) administration in the oncology setting have not been previously reported. The objective of this study was to evaluate the pharmacokinetics of IV or subcutaneous (SC) darbepoetin alfa in patients with non-myeloid malignancies undergoing multicycle chemotherapy.

Methods

Fifty-six patients (haemoglobin <13.0 g/dL) received weekly darbepoetin alfa 2.25 µg/kg administered either IV (n = 27) or SC (n = 29) during up to three cycles of chemotherapy. Noncompartmental pharmacokinetic analysis was performed, including analysis of intensive pharmacokinetic profiles collected over 168 hours during week 1 of both the first and third cycles of chemotherapy.

Results

Darbepoetin alfa serum concentrations exhibited a biphasic profile (a rapid distributive phase followed by a slower terminal elimination phase) after IV administration, whereas darbepoetin alfa was slowly absorbed after SC administration. Darbepoetin alfa exhibited limited extravascular distribution after IV administration, with both initial and steady-state mean volumes of distribution (36.1 mL/kg and 55.2 mL/kg, respectively, after a single IV dose) approximating the plasma volume. After a single IV dose, darbepoetin alfa exhibited a mean clearance of 1.05 mL/h/kg, with a mean terminal half-life of 38.8 hours. Similar pharmacokinetic results were observed after single and multiple doses of darbepoetin alfa, for both SC and IV administration.

Conclusion

Darbepoetin alfa is cleared slowly after IV administration to patients with cancer receiving chemotherapy, resulting in a terminal half-life of 38.8 hours. No evidence of accumulation and no changes in pharmacokinetic profiles after repeated administration were observed in cancer patients undergoing cyclic chemotherapy, for both IV and SC dosing.
Footnotes
1
The use of trade names is for product identification purposes only and does not imply endorsement.
 
Literature
1.
go back to reference Groopman JE, Itri LM. Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst 1999 Oct 6; 91(19): 1616–34PubMedCrossRef Groopman JE, Itri LM. Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst 1999 Oct 6; 91(19): 1616–34PubMedCrossRef
2.
go back to reference Koury MJ, Bondurant MC. Control of red cell production: the roles of programmed cell death (apoptosis) and erythropoietin. Transfusion 1990; 30: 673–4PubMedCrossRef Koury MJ, Bondurant MC. Control of red cell production: the roles of programmed cell death (apoptosis) and erythropoietin. Transfusion 1990; 30: 673–4PubMedCrossRef
3.
go back to reference Ludwig H, Pecherstorfer M, Leitgeb C, et al. Recombinant human erythropoietin for the treatment of chronic anemia in multiple myeloma and squamous cell carcinoma. Stem Cells 1993; 11: 348–55PubMedCrossRef Ludwig H, Pecherstorfer M, Leitgeb C, et al. Recombinant human erythropoietin for the treatment of chronic anemia in multiple myeloma and squamous cell carcinoma. Stem Cells 1993; 11: 348–55PubMedCrossRef
4.
go back to reference Beguin Y. Prediction of response to optimize outcome of treatment with erythropoietin. Semin Oncol 1998 Jun; 25 (3 Suppl. 7): 27–34PubMed Beguin Y. Prediction of response to optimize outcome of treatment with erythropoietin. Semin Oncol 1998 Jun; 25 (3 Suppl. 7): 27–34PubMed
5.
go back to reference Miller CB, Jones RJ, Piantadosi S, et al. Decreased erythropoietin response in patients with the anemia of cancer. N Engl J Med 1990 Jun 14; 322: 1689–92PubMedCrossRef Miller CB, Jones RJ, Piantadosi S, et al. Decreased erythropoietin response in patients with the anemia of cancer. N Engl J Med 1990 Jun 14; 322: 1689–92PubMedCrossRef
6.
go back to reference Curt GA. Impact of fatigue on quality of life in oncology patients. Semin Hematol 2000; 37 Suppl. 6: 14–7PubMedCrossRef Curt GA. Impact of fatigue on quality of life in oncology patients. Semin Hematol 2000; 37 Suppl. 6: 14–7PubMedCrossRef
7.
go back to reference Walker RH. Special report: transfusion risks. Am J Clin Pathol 1987; 88: 374–8PubMed Walker RH. Special report: transfusion risks. Am J Clin Pathol 1987; 88: 374–8PubMed
8.
go back to reference Goodnough LT, Brecher ME, Kanter MH, et al. Transfusion medicine: first of two parts: blood transfusion. N Engl J Med 1999 Feb 11; 340: 438–47PubMedCrossRef Goodnough LT, Brecher ME, Kanter MH, et al. Transfusion medicine: first of two parts: blood transfusion. N Engl J Med 1999 Feb 11; 340: 438–47PubMedCrossRef
9.
go back to reference Elliott S, Lorenzini T, Asher S, et al. Enhancement of therapeutic protein in vivo activities through glycoengineering. Nat Biotechnol 2003; 21: 414–21PubMedCrossRef Elliott S, Lorenzini T, Asher S, et al. Enhancement of therapeutic protein in vivo activities through glycoengineering. Nat Biotechnol 2003; 21: 414–21PubMedCrossRef
10.
go back to reference Glaspy J, Jadeja JS, Justice G, et al. Darbepoetin alfa given every 1 or 2 weeks alleviates anaemia associated with cancer chemotherapy. Br J Cancer 2002; 87: 268–76PubMedCrossRef Glaspy J, Jadeja JS, Justice G, et al. Darbepoetin alfa given every 1 or 2 weeks alleviates anaemia associated with cancer chemotherapy. Br J Cancer 2002; 87: 268–76PubMedCrossRef
11.
go back to reference Glaspy J, Tchekmedyian NS. Darbepoetin alfa administered every 2 weeks alleviates anemia in cancer patients receiving chemotherapy. Oncology (Huntingt) 2002; 16 (10 Suppl. 12): 23–9 Glaspy J, Tchekmedyian NS. Darbepoetin alfa administered every 2 weeks alleviates anemia in cancer patients receiving chemotherapy. Oncology (Huntingt) 2002; 16 (10 Suppl. 12): 23–9
12.
go back to reference Kotasek D, Steger G, Faught W, et al. Darbepoetin alfa administered every 3 weeks alleviates anaemia in patients with solid tumours receiving chemotherapy; results of a double-blind, placebo-controlled, randomized study. Eur J Cancer 2003; 39: 2026–34PubMedCrossRef Kotasek D, Steger G, Faught W, et al. Darbepoetin alfa administered every 3 weeks alleviates anaemia in patients with solid tumours receiving chemotherapy; results of a double-blind, placebo-controlled, randomized study. Eur J Cancer 2003; 39: 2026–34PubMedCrossRef
13.
go back to reference Hedenus M, Adriansson M, San Miguel J, et al. Efficacy and safety of darbepoetin alfa in anaemic patients with lymphoproliferative malignancies: a randomized, double-blind, placebocontrolled study. Br J Haematol 2003; 122: 394–403PubMedCrossRef Hedenus M, Adriansson M, San Miguel J, et al. Efficacy and safety of darbepoetin alfa in anaemic patients with lymphoproliferative malignancies: a randomized, double-blind, placebocontrolled study. Br J Haematol 2003; 122: 394–403PubMedCrossRef
14.
go back to reference Vansteenkiste J, Pirker R, Massuti B, et al. Double-blind, placebo-controlled, randomized phase 3 trial of darbepoetin alfa in lung cancer patients receiving chemotherapy. J Natl Cancer Inst 2002 Aug 21; 94(16): 1211–20PubMedCrossRef Vansteenkiste J, Pirker R, Massuti B, et al. Double-blind, placebo-controlled, randomized phase 3 trial of darbepoetin alfa in lung cancer patients receiving chemotherapy. J Natl Cancer Inst 2002 Aug 21; 94(16): 1211–20PubMedCrossRef
15.
go back to reference Cases A. Darbepoetin alfa: a novel erythropoiesis-stimulating protein. Drugs Today (Barc) 2003 Jul; 39(7): 477–95CrossRef Cases A. Darbepoetin alfa: a novel erythropoiesis-stimulating protein. Drugs Today (Barc) 2003 Jul; 39(7): 477–95CrossRef
16.
go back to reference Abels RI. Use of recombinant human erythropoietin in the treatment of anemia in patients who have cancer. Semin Oncol 1992 Jun; 19 (3 Suppl. 8): 29–35PubMed Abels RI. Use of recombinant human erythropoietin in the treatment of anemia in patients who have cancer. Semin Oncol 1992 Jun; 19 (3 Suppl. 8): 29–35PubMed
17.
go back to reference Platanias LC, Miller CB, Mick R, et al. Treatment of chemotherapy-induced anemia with recombinant human erythropoietin in cancer patients. J Clin Oncol 1991; 9: 2021–6PubMed Platanias LC, Miller CB, Mick R, et al. Treatment of chemotherapy-induced anemia with recombinant human erythropoietin in cancer patients. J Clin Oncol 1991; 9: 2021–6PubMed
18.
go back to reference Oberhoff C, Neri B, Amadori D, et al. Recombinant human erythropoietin in the treatment of chemotherapy-induced anemia and prevention of transfusion requirement associated with solid tumors: a randomized, controlled study. Ann Oncol 1998; 9: 255–60PubMedCrossRef Oberhoff C, Neri B, Amadori D, et al. Recombinant human erythropoietin in the treatment of chemotherapy-induced anemia and prevention of transfusion requirement associated with solid tumors: a randomized, controlled study. Ann Oncol 1998; 9: 255–60PubMedCrossRef
19.
go back to reference Macdougall I, Gray SJ, Elston O, et al. Pharmacokinetics of novel erythropoiesis stimulating protein compared with epoetin alfa in dialysis patients. J Am Soc Nephral 1999; 10: 2392–5 Macdougall I, Gray SJ, Elston O, et al. Pharmacokinetics of novel erythropoiesis stimulating protein compared with epoetin alfa in dialysis patients. J Am Soc Nephral 1999; 10: 2392–5
20.
go back to reference Allon M, Kleinman K, Walczyk M, et al. Pharmacokinetics and pharmacodynamics of darbepoetin alfa and epoetin in patients undergoing dialysis. Clin Pharmacol Ther 2002; 72(5): 546–55PubMedCrossRef Allon M, Kleinman K, Walczyk M, et al. Pharmacokinetics and pharmacodynamics of darbepoetin alfa and epoetin in patients undergoing dialysis. Clin Pharmacol Ther 2002; 72(5): 546–55PubMedCrossRef
21.
go back to reference Egrie JC, Dwyer E, Lykos M, et al. Novel erythropoiesis stimulating protein (NESP) has a longer serum half-life and greater in vivo biological activity than recombinant human erythropoietin (rHuEPO). Blood 1997; 90: 56–7a Egrie JC, Dwyer E, Lykos M, et al. Novel erythropoiesis stimulating protein (NESP) has a longer serum half-life and greater in vivo biological activity than recombinant human erythropoietin (rHuEPO). Blood 1997; 90: 56–7a
22.
go back to reference Egrie JC, Dwyer E, Browne JK, et al. Darbepoetin alfa has a longer circulating half-life and greater in vivo potency than recombinant human erythropoietin. Exp Hematol 2003 Apr; 31(4): 290–9PubMedCrossRef Egrie JC, Dwyer E, Browne JK, et al. Darbepoetin alfa has a longer circulating half-life and greater in vivo potency than recombinant human erythropoietin. Exp Hematol 2003 Apr; 31(4): 290–9PubMedCrossRef
23.
go back to reference Glaspy J, Colowick AB, Heatherington A, et al. Novel erythropoiesis stimulating protein (NESP) exhibits a prolonged serum half-life (T1/2) in oncology patients (Pts). Proc Am Soc Clin Oncol 2000; 19: 54a Glaspy J, Colowick AB, Heatherington A, et al. Novel erythropoiesis stimulating protein (NESP) exhibits a prolonged serum half-life (T1/2) in oncology patients (Pts). Proc Am Soc Clin Oncol 2000; 19: 54a
24.
go back to reference Sawabe Y, Takiguchi Y, Kikuno K, et al. Changes in levels of serum erythropoietin, serum iron and unsaturated iron binding capacity during chemotherapy for lung cancer. Jpn J Clin Oncol 1998; 28: 182–6PubMedCrossRef Sawabe Y, Takiguchi Y, Kikuno K, et al. Changes in levels of serum erythropoietin, serum iron and unsaturated iron binding capacity during chemotherapy for lung cancer. Jpn J Clin Oncol 1998; 28: 182–6PubMedCrossRef
25.
go back to reference Dunphy FR, Harrison BR, Dunleavy TL, et al. Erythropoietin reduces anemia and transfusions: a randomized trial with or without erythropoietin during chemotherapy. Cancer 1999; 86: 1362–7PubMedCrossRef Dunphy FR, Harrison BR, Dunleavy TL, et al. Erythropoietin reduces anemia and transfusions: a randomized trial with or without erythropoietin during chemotherapy. Cancer 1999; 86: 1362–7PubMedCrossRef
26.
go back to reference Heatherington AC, Schuller J, Mercer AJ. Pharmacokinetics of novel erythropoiesis stimulating protein (NESP) in cancer patients: preliminary report. Br J Cancer 2001; 84 Suppl. 1: 11–6PubMedCrossRef Heatherington AC, Schuller J, Mercer AJ. Pharmacokinetics of novel erythropoiesis stimulating protein (NESP) in cancer patients: preliminary report. Br J Cancer 2001; 84 Suppl. 1: 11–6PubMedCrossRef
27.
go back to reference Elliott S, Lorenzini T, Chang D, et al. Fine-structure epitope mapping of antierythropoietin monoclonal antibodies reveals a model of recombinant human erythropoietin structure. Blood 1996; 87: 2702–13PubMed Elliott S, Lorenzini T, Chang D, et al. Fine-structure epitope mapping of antierythropoietin monoclonal antibodies reveals a model of recombinant human erythropoietin structure. Blood 1996; 87: 2702–13PubMed
28.
go back to reference Elliott S, Chang D, Delorme E, et al. Isolation and characterization of conformation sensitive antierythropoietin monoclonal antibodies: effect of disulfide bonds and carbohydrate on recombinant human erythropoietin structure. Blood 1996; 87: 2714–22PubMed Elliott S, Chang D, Delorme E, et al. Isolation and characterization of conformation sensitive antierythropoietin monoclonal antibodies: effect of disulfide bonds and carbohydrate on recombinant human erythropoietin structure. Blood 1996; 87: 2714–22PubMed
29.
go back to reference Glaspy J, Henry D, Patel R, et al. Effects of chemotherapy on endogenous erythropoietin levels and the pharmacokinetics and erythropoietic response of darbepoetin alfa: a randomised clinical trial of synchronous versus asynchronous dosing of darbepoetin alfa. Eur J Cancer 2005 May; 41(8): 1140–9. Epub 2005 Apr 8PubMedCrossRef Glaspy J, Henry D, Patel R, et al. Effects of chemotherapy on endogenous erythropoietin levels and the pharmacokinetics and erythropoietic response of darbepoetin alfa: a randomised clinical trial of synchronous versus asynchronous dosing of darbepoetin alfa. Eur J Cancer 2005 May; 41(8): 1140–9. Epub 2005 Apr 8PubMedCrossRef
30.
go back to reference Piroso E, Erslev AJ, Caro J. Inappropriate increase in erythropoietin titers during chemotherapy. Am J Hematol 1999; 32: 248–54CrossRef Piroso E, Erslev AJ, Caro J. Inappropriate increase in erythropoietin titers during chemotherapy. Am J Hematol 1999; 32: 248–54CrossRef
31.
go back to reference Jelkmann W. The enigma of the metabolic fate of circulating erythropoietin (Epo) in view of the pharmacokinetics of the recombinant drugs rhEpo and NESP. Eur J Haematol 2002; 69(5-6): 265–74PubMedCrossRef Jelkmann W. The enigma of the metabolic fate of circulating erythropoietin (Epo) in view of the pharmacokinetics of the recombinant drugs rhEpo and NESP. Eur J Haematol 2002; 69(5-6): 265–74PubMedCrossRef
32.
go back to reference Chapel S, Veng-Pedersen P, Hohl RJ, et al. Changes in erythropoietin pharmacokinetics following busulfan-induced bone marrow ablation in sheep: evidence for bone marrow as a major erythropoietin elimination pathway. J Pharmacol Exp Ther 2001; 298(2): 820–4PubMed Chapel S, Veng-Pedersen P, Hohl RJ, et al. Changes in erythropoietin pharmacokinetics following busulfan-induced bone marrow ablation in sheep: evidence for bone marrow as a major erythropoietin elimination pathway. J Pharmacol Exp Ther 2001; 298(2): 820–4PubMed
Metadata
Title
Pharmacokinetics of Darbepoetin Alfa after Intravenous or Subcutaneous Administration in Patients with Non-myeloid Malignancies Undergoing Chemotherapy
Authors
Anne C. Heatherington
Christian Dittrich
Dr John T. Sullivan
Greg Rossi
Johannes Schneller
Publication date
01-02-2006
Publisher
Springer International Publishing
Published in
Clinical Pharmacokinetics / Issue 2/2006
Print ISSN: 0312-5963
Electronic ISSN: 1179-1926
DOI
https://doi.org/10.2165/00003088-200645020-00005

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