Assessment of the Release of Daunorubicin from Liposomes after Administration of DaunoXome using Population Pharmacokinetics
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1 Assessment of the Release of Daunorubicin from Liposomes after Administration of DaunoXome using Population Pharmacokinetics 2 nd International Workshop on Clinical Pharmacology of Anticancer Drugs, 13 th 14 th Sep 17, Madrid, Spain Martina Liebich, Pharmacist
2 DaunoXome 2 mg/ml, InterGal Pharma Limited - small unilamellar vesicles (SUV) containing daunorubicin citrate in the aqueous core - since 1996, approved for treatment of severe Kaposi sarcoma in patients suffering from AIDS - off-label use in childhood AML protocols (e.g. AML-BFM 2012, MyeChild 01) - pharmacokinetics of daunorubicin altered due to liposomal formulation 1 aqueous core containing entrapped daunorubicin citrate liposome phospholipid bilayer DaunoXome liposome is between 35 and 65 nm 1. Hempel G et al. Br J Clin Pharmacol, (4): Martina Liebich ICPAD
3 Pharmacokinetics of liposomes - pore size blood capillary ~5 nm liposomes don t cross the endothelium 1 - threshold for glomerular filtration ~8 nm no renal clearance of liposomes 1 - BUT: - phagocytosis by macrophages in the liver 2 - depletion of macrophages - opsonisation by proteins assembly of membrane attack complex (MAC) 3 - release of daunorubicin 1. Longmire M et al. Nanomedicine (Lond) Oct;3(5): Daemen T et al. Int J Cancer May 29;61(5): Silversmith RE, Nelsestuen GL. Biochemistry Feb 25;25(4): Martina Liebich ICPAD
4 Data sets Lowis et al. 1 Bellot et al. 2 patients [n] dose DaunoXome [mg/m²] number of infusions [n] 1 up to 4 age [years] median: 10 (2 18) not specified liposomal daunorubicin samples [n] free daunorubicin samples [n] Lowis, S. et al. Br J Cancer (5): Bellot, R. et al. Cancer Chemother Pharmacol (1):15-21 Martina Liebich ICPAD
5 Plasma concentrations of liposomal and free daunorubicin Martina Liebich ICPAD
6 Methods 1. structural model for liposomal daunorubicin 2. combined structural model for liposomal and free daunorubicin 3. assessment of the fraction released Modelling: - NONMEM 7.3 Diagnostic plots: - R 3.3.2, xpose4 package Model selection: - objective function values - goodness-of-fit plots - visual predictive check - bootstrap - physiological plausibility Martina Liebich ICPAD
7 Structural model for liposomal daunorubicin DaunoXome (i.v. injection, 1h) 94.3% 1 liposomal daunorubicin (V 1 ) CL lip 1. determined experimentally with an in-house validated HPLC method: free amount of daunorubicin in DaunoXome 5.7% ±0.3%, n=30 Martina Liebich ICPAD
8 Final parameter estimates and bootstrap results Liposomal daunorubicin parameter estimate (RSE) estimate bootstrap 90% confidence interval CL lip [L/h/m²] (5.4%) V 1 [L/m²] 2.17 (5.6%) additive error [mg/l] (17.9%) proportional error 36% (5.5%) 36.1% 32.6% 39.8% IIV CL lip 42.2% (8.4%) 41.8% 35.2% 47.5% IIV V % (9%) 42.3% 36.1% 49.3% Martina Liebich ICPAD
9 Goodness-of-fit plots for liposomal daunorubicin Martina Liebich ICPAD
10 pcvpc for liposomal daunorubicin Martina Liebich ICPAD
11 Structural model for liposomal and free daunorubicin DaunoXome (i.v. injection, 1h) 94.3% 1 5.7% 1 liposomal daunorubicin (V 1 ) F rel * CL lip free daunorubicin (central compartment, V 2 ) CL free (1-F rel ) * CL lip Q free daunorubicin (peripheral compartment, V 3 ) 1. determined experimentally with an in-house validated HPLC method: free amount of daunorubicin in DaunoXome 5.7% ±0.3%, n=30 Martina Liebich ICPAD
12 Final parameter estimates and bootstrap results Free Daunorubicin parameter estimate (RSE) estimate bootstrap 90% confidence interval CL free [L/h/m²] 38.2 (17%) V 2 [L/m²] FIX Q [L/h/m²] 4.76 (30%) V 3 [L/m²] 85.2 (22%) F rel 63.5% (16%) 63.3% 46.4% 79.9% additive error [mg/l] (22%) proportional error 47.6% (7%) 47.2% 41.4% 52.7% IIV CL free 87.6% (23%) 84.9% 42.4% 116% IIV V 2 46% 1 FIX IIV F rel 4.15 on logit scale poppk DaunoXome 1. Hempel, G. et al. Pediatr Blood Cancer (3): Martina Liebich ICPAD
13 Goodness-of-fit plots of free daunorubicin Martina Liebich ICPAD
14 pcvpc for the combined structural model LDAUN FDAUN Martina Liebich ICPAD
15 Influence of dose on F rel two dosing groups: mg/m² mg/m² parameter estimate (RSE) F rel ( mg/m²) 63.5% (16%) F rel ( 100 mg/m²) 39% (25%) F rel ( 120 mg/m²) 91.1% (7%) Martina Liebich ICPAD
16 Reduced unexplained variability in F rel Martina Liebich ICPAD
17 pcvpc for free daunorubicin base model inclusion of dosing groups Martina Liebich ICPAD
18 Conclusion - first poppk model describing the PK of liposomal and free daunorubicin taking the liberation of daunorubicin from the liposomes into account - F rel increases with dose - hypothesis: saturation of liver macrophages resulting in more circulating DaunoXome and thus higher relative liberation of daunorubicin from the liposomes Outlook - MyeChild 01: currently recruiting participants - investigation of covariate effects on PK with established base model Martina Liebich ICPAD
19 Thanks to - Prof. Georg Hempel - Prof. Jacques Robert - Dr. Gudrun Würthwein - Silke Gastine - all other members of my working group Martina Liebich ICPAD
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