Abstract
Purpose
The aims of the present study were (1) to investigate the impact of great age on pharmacokinetics of capecitabine and its metabolites and (2) to evaluate the exposure–effect relationship of capecitabine in elderly patients.
Methods
Data collected from 20 elderly patients (75–92 years old) with breast or colorectal cancer who received oral capecitabine were analyzed. In order to study the old age effect on pharmacokinetics, data collected from two phase I studies involving 40 younger adults (<75 years old) with metastatic cancer who received oral capecitabine were added in the database. The population pharmacokinetic analysis was based on a four-compartment model describing the sequence of capecitabine and three of its metabolites.
Results
The absorption rate constant was found lower in the oldest patient group (≥75 years) compared with the youngest group, and the constant rate elimination of the 5-fluorouracil metabolite was found decreased over time (i.e., after 2 consecutive weeks of capecitabine administration). This time effect was not found different between the two age groups. In elderly patients, the exposure-safety analysis showed, from the second cycle of chemotherapy, significantly higher median exposures of capecitabine and its metabolites (5′-deoxy-5-fluorocytidine, 5′-deoxy-5-fluorouridine and 5-fluorouracil) in patients who experienced hand-foot syndrome compared with patients who did not.
Conclusion
This study puts forward new arguments for the treatment of elderly cancer patients who could benefit from capecitabine chemotherapy with acceptable toxicity.
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References
Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics. CA Cancer J Clin 60(5):277–300
Wydra J, Kruszewski W, Jasiński W, Szajewski M, Ciesielski M, Szefel J et al (2013) Is age a risk factor of postoperative complications in colorectal cancer? Pol Przegl Chir 85:491–495
Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C et al (2007) Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 8:1101–1115
Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341:2061–2067
Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ et al (2003) Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21:1383–1389
Woodhouse KW (1994) Pharmacokinetics of drugs in the elderly. J R Soc Med 87:2–4
Turnheim K (2003) When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 38:843–853
Twelves C (2001) Vision of the future: capecitabine. Oncologist 6:35–39
Miwa M, Ura M, Nishida M, Sawada N, Ishikawa T, Mori K et al (1998) Design of a novel oral fluoropyrimidine carbamate, capecitabine, which generates 5-fluorouracil selectively in tumours by enzymes concentrated in human liver and cancer tissue. Eur J Cancer 34:1274–1281
Gieschke R, Burger H-U, Reigner B, Blesch KS, Steimer J-L (2003) Population pharmacokinetics and concentration-effect relationships of capecitabine metabolites in colorectal cancer patients. Br J Clin Pharmacol 55:252–263
Judson IR, Beale PJ, Trigo JM, Aherne W, Crompton T, Jones D et al (1999) A human capecitabine excretion balance and pharmacokinetic study after administration of a single oral dose of 14C-labelled drug. Invest New Drugs 17:49–56
Reigner B, Blesch K, Weidekamm E (2001) Clinical pharmacokinetics of capecitabine. Clin Pharmacokinet 40:85–104
Louie SG, Ely B, Lenz H-J, Albain KS, Gotay C, Coleman D et al (2013) Higher capecitabine AUC in elderly patients with advanced colorectal cancer (SWOGS0030). Br J Cancer 109:1744–1749
Gieschke R, Reigner B, Blesch KS, Steimer JL (2002) Population pharmacokinetic analysis of the major metabolites of capecitabine. J Pharmacokinet Pharmacodyn 29:25–47
Urien S, Rezaí K, Lokiec F (2005) Pharmacokinetic modelling of 5-FU production from capecitabine—a population study in 40 adult patients with metastatic cancer. J Pharmacokinet Pharmacodyn 32:817–833
Grande C, Quintero G, Candamio S, París Bouzas L, Villanueva MJ, Campos B et al (2013) Biweekly XELOX (capecitabine and oxaliplatin) as first-line treatment in elderly patients with metastatic colorectal cancer. J Geriatr Oncol 4:114–121
Cunningham D, Lang I, Marcuello E, Lorusso V, Ocvirk J, Shin DB et al (2013) Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): an open-label, randomised phase 3 trial. Lancet Oncol 14:1077–1085
Freedman RA, Pitcher B, Keating NL, Ballman KV, Mandelblatt J, Kornblith AB et al (2013) Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907. Breast Cancer Res Treat 139:607–616
Zandvliet AS, Siegel-Lakhai WS, Beijnen JH, Copalu W, Etienne-Grimaldi M-C, Milano G et al (2008) PK/PD model of indisulam and capecitabine: interaction causes excessive myelosuppression. Clin Pharmacol Ther 83:829–839
Beal SL, Sheiner LB, Boeckmann A, Bauer RJ (1998) NONMEM User’s Guide; NONMEM project group. University of California, San Francisco
Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41
Etienne MC, Chatelut E, Pivot X, Lavit M, Pujol A, Canal P et al (1998) Co-variables influencing 5-fluorouracil clearance during continuous venous infusion. A NONMEM analysis. Eur J Cancer 34:92–97
Parke J, Holford NH, Charles BG (1999) A procedure for generating bootstrap samples for the validation of nonlinear mixed-effects population models. Comput Methods Programs Biomed 59:19–29
Terret C, Erdociain E, Guimbaud R, Boisdron-Celle M, McLeod HL, Féty-Deporte R et al (2000) Dose and time dependencies of 5-fluorouracil pharmacokinetics. Clin Pharmacol Ther 68:270–279
Fety R, Rolland F, Barberi-Heyob M, Hardoin A, Campion L, Conroy T et al (1998) Clinical impact of pharmacokinetically-guided dose adaptation of 5-fluorouracil: results from a multicentric randomized trial in patients with locally advanced head and neck carcinoma. Clin Cancer Res 4:2039–2045
Poole C, Gardiner J, Twelves C, Johnston P, Harper P, Cassidy J et al (2002) Effect of renal impairment on the pharmacokinetics and tolerability of capecitabine (Xeloda) in cancer patients. Cancer Chemother Pharmacol 49:225–234
Blum JL, Jones SE, Buzdar AU, LoRusso PM, Kuter I, Vogel C et al (1999) Multicenter phase II study of capecitabine in paclitaxel-refractory metastatic breast cancer. J Clin Oncol 7:485–493
Abushullaih S, Saad ED, Munsell M, Hoff PM (2002) Incidence and severity of hand-foot syndrome in colorectal cancer patients treated with capecitabine: a single-institution experience. Cancer Invest 20:3–10
Bruno R, Hille D, Riva A, Vivier N, ten Bokkel Huinnink WW, van Oosterom AT et al (1998) Population pharmacokinetics/pharmacodynamics of docetaxel in phase II studies in patients with cancer. J Clin Oncol 16:187–196
Acknowledgments
The CAPAGEC study was funded by the Limoges University Hospital. We thank Fabrice Béavogui, Karine Bariller, Franck Giraudie and Jean Louis Dupuy for their technical assistance, and Karen for her complete English and grammatical review of this paper. Pierre Marquet has received research grants and honoraria from ROCHE.
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Z. Daher Abdi, S Lavau-Denes and A Prémaud equally contributed to this work as the second authors.
N Tubiana-Mathieu and A Rousseau equally contributed to this work as the last authors.
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Daher Abdi, Z., Lavau-Denes, S., Prémaud, A. et al. Pharmacokinetics and exposure–effect relationships of capecitabine in elderly patients with breast or colorectal cancer. Cancer Chemother Pharmacol 73, 1285–1293 (2014). https://doi.org/10.1007/s00280-014-2466-0
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DOI: https://doi.org/10.1007/s00280-014-2466-0