title: Modeling and simulation approaches to evaluate pharmacokinetic sampling contamination from central venous catheters in pediatric pharmacokinetic studies of actinomycin-D: a report from the children's oncology group.
abstract: BACKGROUND
  The binding of drugs to catheters can be a source variation in dosing chemotherapeutics. Drug contamination from the dosing central venous line (CVL) can impact the reporting of pharmacokinetic (PK) results and analysis. Peripheral venipuncture avoids binding complications from the CVL but dissuades patients from enrolling. Our group has developed a catheter clearing procedure to minimize the extent of contamination so that dosing and sampling from the CVL can ensue, promoting patient willingness to participate in phase I pediatric oncology trials.
  
  
  OBJECTIVE
  To develop a population pharmacokinetic model of actinomycin-D (AMD) in children with cancer incorporating expressions for drug contamination from PK samples obtained via indwelling CVLs and to evaluate the efficiency of a catheter clearing procedure in removing contamination as well as the impact of contamination on PK results.
  
  
  METHODS
  A dataset of 199 AMD plasma concentration measurements from 36 patients (age 1.6-20.3 years) was analyzed using nonlinear mixed-effects modeling. Quantitative modeling approaches, including baseline contamination model, covariate model, and catheter clearance model, were evaluated to describe catheter contamination. Monte Carlo simulations mimicking a prospective study in children with cancer were performed to assess the performance of the final model and impact of catheter contamination on PK reporting.
  
  
  RESULTS
  The PK of AMD was best described by a linear 3-compartment model with first-order elimination. A baseline contamination model including a contamination factor proportional to the model-predicted concentration for samples obtained from central catheters was chosen as the most parsimonious and accurate among competing models. The final model parameters were allometrically scaled to a 70 kg person. The estimated mean parameter values were 11 L/h, 5.79, 24.2, 490 L, 17.7, and 42.8 L/h for total clearance, central volume of distribution, peripheral volume 1, peripheral volume 2, inter-compartmental clearance 1, and inter-compartmental clearance 2, respectively. The proportional contamination factor was 19.3 % immediately post-drug administration and decreased at a first-order rate of 0.0932 h(-1). Simulations precisely re-estimated kinetic parameters with catheter contamination adjustment. Large uncertainty and poor estimation were observed when contamination was ignored.
  
  
  CONCLUSIONS
  Drug contamination from sampling catheter can impact AMD PK results and should be accounted for in the analysis. We provide a framework for evaluating catheter contamination and guidance on adjustment in the PK model.
authors.affiliation: Division of Clinical Pharmacology and Therapeutics, The Children's Hospital of Philadelphia, Colket Translational Research Building, Room 4012, Philadelphia, PA, USA.
authors.forename: Alena Y Z
authors.initials: AY
authors.lastname: Edwards
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Skolnik
authors.forename: Erin
authors.initials: E
authors.lastname: Dombrowsky
authors.forename: Dimple
authors.initials: D
authors.lastname: Patel
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Barrett
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000903:Antibiotics, Antineoplastic / Q000493:pharmacokinetics; D002405:Catheterization, Central Venous / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003609:Dactinomycin / Q000493:pharmacokinetics*; D004340:Drug Contamination / Q000517:prevention & control; D004866:Equipment Contamination / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008657:Metabolic Clearance Rate; D008954:Models, Biological; D009010:Monte Carlo Method; D009369:Neoplasms / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D003609:Dactinomycin