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A population pharmacokinetic/toxicity model for the reduction of platelets during a 48-h continuous intravenous infusion of the histone deacetylase inhibitor belinostat

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Abstract

Purpose

Belinostat is a second-generation histone deacetylase inhibitor (HDI) predominantly metabolized by UGT1A1-mediated glucuronidation. Two common polymorphisms (UGT1A1*28 and UGT1A1*60) were previously associated with impaired drug clearance and thrombocytopenia risk, likely from increased drug exposure. This latter phenomenon has been observed with other HDIs such as abexinostat, panobinostat, romidepsin, and vorinostat. It was the intention of this brief report to expand a population pharmacokinetic (PPK) model to include a pharmacodynamic (PD) model describing the change in platelet levels in patients with cancer administered belinostat as a 48-h continuous intravenous infusion, along with cisplatin and etoposide.

Methods

The PPK/PD model developed here introduced an additional rate constant to a commonly used mechanistic myelosuppression model to better describe the maturation of megakaryocytes into platelets before degradation and a feedback mechanism. The model employed a proportional error model to describe the observed circulating platelet data.

Results

Several covariates were explored, including sex, body weight, UGT1A1 genotype status, liver, and kidney function, but none significantly improved the model. Platelet levels rebounded to baseline within 21 days, before the next cycle of therapy. Simulations predicted that higher belinostat drug exposure does cause lower thrombocyte nadirs compared to lower belinostat levels. However, platelet levels rebound by the start of the next belinostat cycle.

Conclusions

This model suggests a q3week schedule allows for sufficient platelet recovery before the next belinostat infusion is optimal.

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Acknowledgements

We thank all of the nurses and clinical support staff for their patient care, the Blood Processing Core of the NCI for their sample handling/processing. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Funding

This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health. This work was supported by the Intramural Research Program of the NIH, National Cancer Institute, Center for Cancer Research (Grant # ZIC BC 010548).

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Authors and Affiliations

  1. Clinical Pharmacology Program, CCR, National Cancer Institute, NIH, 10 Center Drive, Room 5A01, Bethesda, MD, 20892, USA

    Cody J. Peer, Oliver M. Hall, Tristan M. Sissung & William D. Figg

  2. Cancer Therapy Evaluation Program, National Cancer Institute, NIH, Bethesda, MD, 20892, USA

    Richard Piekarz

  3. Office of Hematology Oncology Products, US Food and Drug Administration, Silver Spring, MD, 20993, USA

    Sanjeeve Balasubramaniam

  4. Department of Hematology and Oncology, Columbia University Medical Center, New York, NY, 10032, USA

    Susan E. Bates

  5. Genitourinary Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, 20892, USA

    William D. Figg

Authors
  1. Cody J. Peer
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  2. Oliver M. Hall
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  3. Tristan M. Sissung
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  4. Richard Piekarz
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  5. Sanjeeve Balasubramaniam
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  6. Susan E. Bates
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  7. William D. Figg
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Corresponding author

Correspondence to William D. Figg.

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Conflict of interest

Author CJP declares that he has no conflict of interest. OMH declares that he has no conflict of interest. TMS declares that he has no conflict of interest. RP declares that he has no conflict of interest. SB declares that he has no conflict of interest. SEB declares that she has no conflict of interest. WDF declares that he has no conflict of interest.

Ethics approval

All clinical data presented in this manuscript was obtained from a clinical trial (NCT 00926640) that was approved by the IRB of the National Cancer Institute. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Peer, C.J., Hall, O.M., Sissung, T.M. et al. A population pharmacokinetic/toxicity model for the reduction of platelets during a 48-h continuous intravenous infusion of the histone deacetylase inhibitor belinostat. Cancer Chemother Pharmacol 82, 565–570 (2018). https://doi.org/10.1007/s00280-018-3631-7

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  • DOI: https://doi.org/10.1007/s00280-018-3631-7

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