title: Clinical pharmacokinetics of the new oral camptothecin gimatecan: the inter-patient variability is related to alpha1-acid glycoprotein plasma levels.
abstract: OBJECTIVE
  To determine the pharmacokinetics of gimatecan, a camptothecin with a lipophilic substitution in position 7, given orally to patients participating in the phase I study.
  
  
  METHODS
  Pharmacokinetics was evaluated in 78 patients after oral daily dose for 5 days a week for 1, 2 or 3 weeks by HPLC with a fluorescence detector.
  
  
  RESULTS
  Gimatecan was mainly present in plasma as lactone (>85%), the active form as DNA-topoisomerase I poison. The AUC(0-24) on the first day of treatment normalised per daily dose (mg/m(2)), ranged from 194 to 2909 ng h/mL/mg/m(2). The half-life was 77.1+/-29.6h, consequently C(max) and AUC rose 3-6-fold after multiple dosing. Multivariate analysis indicated the daily dose (p<0.0001) and the alpha(1)-acid glycoprotein (AGP) plasma levels (p<0.0001) as main predictors of gimatecan AUC(0-24). In the overall analysis, daily dose and AGP plasma levels explained 85% of the deviance. The hydroxy metabolite ST1698 was present in plasma at low levels with AUC values of 5-15% of gimatecan. In mice, orally treated with gimatecan, plasma and tissue levels were 2-fold higher after treatment with a pro-inflammatory agent causing AGP induction.
  
  
  CONCLUSIONS
  Gimatecan is orally absorbed and its variable plasma levels seem to be related to AGP plasma concentrations. Data obtained in mice, together with the fact that AGP levels largely exceeded gimatecan plasma concentrations, suggest that the increased gimatecan levels in patients with high AGP levels are not related to the binding of the drug to AGP with consequent reduced tissue drug distribution, but possibly to other mechanism associated with inflammation being AGP simply a marker of the inflammation process.
authors.affiliation: Istituto di Ricerche Farmacologiche Mario Negri, via La Masa 19, 20156 Milan, Italy. frapolli@marionegri.it
authors.forename: Roberta
authors.initials: R
authors.lastname: Frapolli
authors.forename: Massimo
authors.initials: M
authors.lastname: Zucchetti
authors.forename: Cristiana
authors.initials: C
authors.lastname: Sessa
authors.forename: Silvia
authors.initials: S
authors.lastname: Marsoni
authors.forename: Lucia
authors.initials: L
authors.lastname: Viganò
authors.forename: Alberta
authors.initials: A
authors.lastname: Locatelli
authors.forename: Eliana
authors.initials: E
authors.lastname: Rulli
authors.forename: Anna
authors.initials: A
authors.lastname: Compagnoni
authors.forename: Ezia
authors.initials: E
authors.lastname: Bello
authors.forename: Claudio
authors.initials: C
authors.lastname: Pisano
authors.forename: Paolo
authors.initials: P
authors.lastname: Carminati
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Incalci
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001800:Blood Specimen Collection / Q000379:methods; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006207:Half-Life; D006801:Humans; D051379:Mice; D008819:Mice, Nude; D008875:Middle Aged; D009961:Orosomucoid / Q000378:metabolism*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D023041:Xenograft Model Antitumor Assays; D055815:Young Adult
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D009961:Orosomucoid; C433984:ST 1481; C544699:ST 1698; D002166:Camptothecin