Abstract
Objective: This study was undertaken in order to evaluate the impact of pharmacokinetics on the toxicity of oral etoposide administered daily for 21 days. Methods: The daily dose was 50 mg/m2. Thirty-two patients 24 males and eight females, 36–76 years old, treated for various tumour types), were evaluated. Blood samples were obtained on day 1 for all patients, and on day 21 for 16 patients. Plasma etoposide concentrations were determined by high-performance liquid chromatography, and etoposide plasma protein binding by equilibrium dialysis.
Results: On day 1, the mean value (with coefficient of variation for interindividual variability) for the unbound fraction (fu), area under the concentration versus time curve (AUC), and unbound AUC was 9.8% (59%), 34 mg · h/l (39%), and 3.5 mg · h/l (92%), respectively. The ratio between AUC on day 1 and day 21 ranged between 0.5 and 1.8 (mean 0.9, with CV 33%). The plasma trough unbound concentrations and the unbound AUCs both corresponding to the first administration were significantly higher in the 11 patients who had a severe neutropenia than in the 21 patients who had no or moderate toxicity. However, total etoposide concentrations did not differ between these two groups. A limited sampling strategy using the NONMEM program and a database of 89 patients previously studied was performed. The optimal sampling schedule (i.e. 1, 4, and 24 h after oral etoposide administration) allowed to obtain the AUC accurately on day 1.
Conclusion: Individual adjustment of oral etoposide based on unbound pharmacokinetics after the first administration appears relevant and feasible.
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Received: 29 June 1998 / Accepted in revised form: 8 September 1998
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Perdaems, N., Bachaud, J., Rouzaud, P. et al. Relation between unbound plasma concentrations and toxicity in a prolonged oral etoposide schedule. E J Clin Pharmacol 54, 677–683 (1998). https://doi.org/10.1007/s002280050534
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DOI: https://doi.org/10.1007/s002280050534