An open-label study to evaluate dose and cycle dependence of the pharmacokinetics of pegylated liposomal doxorubicin
There are no definitive data in humans on the dose dependence and/or cycle dependence of the pharmacokinetics (PK) of pegylated liposomal doxorubicin (PLD). This study examined the PK of PLD across a twofold dose variation and along 3 cycles. Fifteen patients received PLD in successive doses of 60, 30, and 45 mg/m2 (Arm A) and 30, 60, and 45 mg/m2 (Arm B), every 4 weeks. Twelve patients, six on each arm, completed all three cycles and were fully evaluable. Plasma levels of doxorubicin were analyzed by HPLC and fluorimetry. PK analysis was done by non-compartmental method. Repeated measures ANOVA and paired tests were used for statistical analysis. There was no significant difference in the PK parameters examined when the dose was increased from 30 to 60 mg/m2. However, when we analyzed the effect of cycle number on the PK, we found a gradual and significant inhibition of clearance (P < 0.0001) from the 1st through the 3rd cycle of PLD, with a geometric mean increase of 43% in dose-normalized AUC (P = 0.0003). Dose-normalized Cmax and T½ mean values increased by 17 and 18%, respectively between the 1st and 3rd cycles, but only the increase in T½ was statistically significant (P = 0.0017). While the PK of PLD is not dose-dependent within the dose range of 30–60 mg/m2, there is evidence of a cycle-dependent effect that results in inhibition of clearance when patients receive successive cycles of PLD. These results suggest the need for dose adjustments of PLD upon retreatment to minimize the risk of toxicity.