Safety and pharmacology of paclitaxel in patients with impaired liver function: a population pharmacokinetic-pharmacodynamic study.
OBJECTIVE
To assess quantitatively the safety and pharmacology of paclitaxel in patients with moderate to severe hepatic impairment.


METHODS
Solid tumour patients were enrolled into five liver function cohorts as defined by liver transaminase and total bilirubin concentrations. Paclitaxel was administered as a 3-h intravenous infusion at doses ranging from 110 to 175 mg m(-2), depending on liver impairment. Covariate and semimechanistic pharmacokinetic-pharmacodynamic (PK-PD) population modelling was used to describe the impact of liver impairment on the pharmacology and safety of paclitaxel.


RESULTS
Thirty-five patients were included in the study, and PK data were assessed for 59 treatment courses. Most patients had advanced breast cancer (n = 22). Objective responses to paclitaxel were seen in four patients (11%). Patients in higher categories of liver impairment had a significantly lower paclitaxel elimination capacity (R2 = -0.38, P = 0.05), and total bilirubin was a significant covariate to predict decreased elimination capacity with population modelling (P = 0.002). Total bilirubin was also a significant predictor of increased haematological toxicity within the integrated population PK-PD model (P < 10(-4)). Data simulations were used to calculate safe initial paclitaxel doses, which were lower than the administered doses for liver impairment cohorts III-V.


CONCLUSIONS
Total bilirubin is a good predictor of paclitaxel elimination capacity and of individual susceptibility to paclitaxel-related myelosuppression in cancer patients with moderate to severe liver impairment. The proposed, adapted paclitaxel doses need validation in prospective trials.
Joerger
M
M
Department of Pharmacy & Pharmacology, the Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands. markus.joerger@kssg.ch
Huitema
A D R
AD
Huizing
M T
MT
Willemse
P H B
PH
de Graeff
A
A
Rosing
H
H
Schellens
J H M
JH
Beijnen
J H
JH
Vermorken
J B
JB
D000328:Adult; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects* / Q000493:pharmacokinetics; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000503:physiopathology; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000009:adverse effects* / Q000493:pharmacokinetics; D012737:Sex Factors; D016896:Treatment Outcome
D000972:Antineoplastic Agents, Phytogenic; D015415:Biomarkers; D017239:Paclitaxel; D001663:Bilirubin