title: Disposition of total and unbound etoposide following high-dose therapy.
abstract: Total and unbound etoposide pharmacokinetics were studied in 16 adult patients (median age, 34 years; range, 18-61 years) undergoing autologous bone marrow transplantation for advanced lymphoma after receiving high-dose etoposide (35-60 mg/kg) as a single intravenous infusion. Pretreatment values for mean serum albumin and total bilirubin were 3.0 +/- 0.4 g/dl and 0.5 +/- 0.4 mg/dl, respectively. Etoposide plasma concentrations and protein binding (%unbound) were determined by high-performance liquid chromatography (HPLC) and equilibrium dialysis, respectively. Pharmacokinetic parameters for unbound and total etoposide were calculated by nonlinear regression analysis using a two-compartment model. The mean (+/- SD) parameters for total etoposide included: clearance (CL), 31.8 +/- 17.7 ml min-1 m-2; volume of distribution (Vss), 11.5 +/- 5.9 l/m2, and terminal half-life (t1/2 beta), 7.2 +/- 3.7 h. Mean unbound CL was 209.6 +/- 62.7 ml min-1 m-2 and %unbound was 16% +/- 5%. The mean etoposide %unbound was inversely related to serum albumin (r2 = 0.45, P = 0.0043). The mean %unbound at the end of the etoposide infusion was higher than that at the lowest measured concentration (21% vs 13%, respectively; P = 0.017), suggesting that concentration-dependent binding may occur after high etoposide doses. The median total CL was higher in patients with serum albumin concentrations of < or = 3.0 g/dl than in those with levels of > 3.0 g/dl (34.6 vs 23.5 ml min-1 m-2, P = 0.05). Total CL was directly related to %unbound (r2 = 0.61, P = 0.0004). Unbound CL was unrelated to either serum albumin or %unbound. These results demonstrate that hypoalbuminemia is independently associated with an increased etoposide %unbound and rapid total CL after the administration of high-dose etoposide. Unbound CL in hypoalbuminemic patients is unchanged in the presence of normal total bilirubin values.
authors.affiliation: School of Pharmacy, University of Pittsburgh, Pennsylvania.
authors.forename: T L
authors.initials: TL
authors.lastname: Schwinghammer
authors.forename: R A
authors.initials: RA
authors.lastname: Fleming
authors.forename: C S
authors.initials: CS
authors.lastname: Rosenfeld
authors.forename: D
authors.initials: D
authors.lastname: Przepiorka
authors.forename: R K
authors.initials: RK
authors.lastname: Shadduck
authors.forename: E J
authors.initials: EJ
authors.lastname: Bloom
authors.forename: C F
authors.initials: CF
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D005047:Etoposide / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D005260:Female; D006207:Half-Life; D006801:Humans; D008297:Male; D008875:Middle Aged; D011485:Protein Binding; D012044:Regression Analysis; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin; D005047:Etoposide