Plasmafiltration as a possible contributor to kinetic targeting of pegylated liposomal doxorubicin (PLD) in order to prevent organ toxicity and immunosuppression
Abstrakt
To examine the removal of pegylated liposomal doxorubicin during plasmafiltration and determine whether the drug could be withheld prior to its organ distribution responsible for mucocutaneous toxicity. Six patients suffering from platinum-resistant ovarian cancer were treated with a1-h IV infusion 50mg/m2of PLD/cycle-for three cycles q4w.
Over 44-47h postinfusion, five patients underwent PF using a cascade PF method consisted of plasma separation by centrifugation and plasma treatment using filtration based one volume of plasma treatment, i.e.3.18 L and plasma flow 1.0 L/h. Doxorubicin concentration in blood was monitored by a high-performance liquid chromatography method for 116 h postinfusion.
Pharmacokinetic parameters determined from plasma concentration included volume of distribution, total body clearance, half-life of elimination, and area under the plasma concentration versus time. The amount of doxorubicin in the body eliminated by the patient and via extracorporeal treatment was evaluated.
Toxicity was tested using CTCAE v4.0. The efficacy of PF and early responses to PLD/PF combination strategywere as follows: over 44(46)h postinfusion considered necessary for target distribution of PLD to tumor, patients eliminated 46 % of the dose administered.
Over (44- 47)h postinfusion, a single one-volume plasma filtration removed 40 % of the remaining doxorubicin amount in the body. Total fraction eliminated attained 81 %.
The most common treatment-related adverse events such as nauzea and vomiting appeared during 44h postinfusion. Hematological toxicity-anemia was reported after cycle II termination.
Symptoms of PPE-like syndrome appeared in one patient concomitantly with thrombophlebitis and malignant effusion. In this study only one adverse reaction as short-term malaise and nausea was reported by the investigator as probably related to PF.