Abstract
Purpose
Hematoprotective strategies may offer new approaches to prevent chemotherapy-induced hematotoxicity. The present study was undertaken to investigate the chemoprotective effects of dexamethasone and its optimal dose and the underlying mechanisms.
Methods
Lethal toxicity and hematotoxicity of carboplatin were compared in CD-1 mice with or without dexamethasone pretreatment. Plasma and tissue pharmacokinetics of carboplatin were determined in CD-1 mice. Carboplatin was quantified by HPLC. Gemcitabine was analyzed by radioactivity counting.
Results
Pretreatment with dexamethasone prevented lethal toxicity of carboplatin in a dose- and schedule-dependent manner. The best protective effects of dexamethasone pretreatment as measured by survival were observed at the dose level of 0.1 mg/mouse per day for 5 days (80% vs 10% in controls). In contrast, posttreatment with dexamethasone had no protective effects. Pretreatment with dexamethasone significantly prevented the decrease in granulocyte counts. To elucidate the mechanisms by which dexamethasone pretreatment reduces hematotoxicity, we examined the effects of dexamethasone pretreatment on the pharmacokinetics of carboplatin and gemcitabine in CD-1 mice. No significant differences in plasma pharmacokinetics of carboplatin or gemcitabine were observed between control and mice pretreated with dexamethasone. However, dexamethasone pretreatment significantly decreased carboplatin and gemcitabine uptake in spleen and bone marrow with significant decreases in AUC, T1/2, and Cmax, and an increase in CL.
Conclusions
To our knowledge, this is the first time that dexamethasone has been shown to significantly decrease host tissue uptake of chemotherapeutic agents, suggesting a mechanism responsible for the chemoprotective effects of dexamethasone. This study provides a basis for future study to evaluate dexamethasone as a chemoprotectant in cancer patients.
Similar content being viewed by others
References
Kaufman D, Chabner BA (1996) Clinical strategies for cancer treatment: the role of drugs. In: Chabner BA, Longo DL (eds) Cancer chemotherapy and biotherapy. Lippincott-Raven, Philadelphia, pp 1–16
Demetri GD, Anderson KC (1995) Bone marrow failure. In: Clinical oncology. Churchill Livingstone, NY, p 443
Mackal CL (2000) T-cell immunodeficiency following cytotoxic antineoplastic therapy: a review. Stem Cells 18:10
Ganser A, Karthaus M (1996) Clinical use of hematopoietic growth factors. Curr Opin Oncol 8:265
Griffin JD (1997) Hematopoietic growth factors. In: DeVita VT, Hellman S, Rosenberg SA (eds)Cancer: Principles and practice of oncology, 5th edn. Lippincott, Philadelphia, p 2639
Joyce R, Chervenick P (1977) Corticosteroid effect on granulopoiesis in mice after cyclophosphamide. J Clin Invest 60:277
Kriegler A, Bernardo D, Verschoor S (1994) Protection of murine bone marrow by dexamethasone during cytotoxic chemotherapy. Blood 83:65
Rinehart J, Delamater E, Keville L (1994) Corticosteroid modulation of interleukin-1 hematopoietic effects and toxicity in a murine system. Blood 84:1457
Rinehart J, Keville L, Measel J (1995) Corticosteroid alteration of carboplatin-induced hematopoietic toxicity in a murine model. Blood 86:4493
Rinehart JJ, Keville L (1997) Corticosteroid alteration of carboplatin induced hematopoietic toxicity: comparison of efficacy in normal and hematopoietically impaired tumor bearing mice. Cancer Radiopharm 2:101
Aman MJ, Keller U, Derigs G (1994) Regulation of cytokine expression by interferon-α in human bone marrow stromal cells: inhibition of hematopoietic growth factors and induction of interleukin-a receptor antagonist. Blood 84:4142
Chudgar UH, Rundus CH, Peterson VM (1995) Recombinant human interleukin-1 receptor antagonist protects early myeloid progenitors in a murine model of cyclophosphamide-induced myelotoxicity. Blood 85:2393
Cashman JD, Eaves AC, Raines EW (1990) Mechanisms that regulate the cell cycle status of very primitive hematopoietic cells in long-term human marrow cultures. I. stimulatory role of a variety of mesenchymal cell activators and inhibitory role of TGF-β. Blood 75:96
Futami H, Jansen R, MacPhee M (1990) Chemoprotective effects of recombinant human IL-1α in cyclophosphamide-treated normal and tumor-bearing mice. Protection from acute toxicity, hematologic effects, development of late mortality, and enhanced therapeutic efficacy. J Immunol 145:4121
Dunlop D, Wright E, Lorimore S (1992) Demonstration of stem cell inhibition and myeloprotective effects of SCI-rhMIP-Iα in vivo. Blood 79:2221
Grzegorzewski K, Ruscetti F, Usui N (1994) Recombinant transforming growth factor β1 and β2 protect mice from acutely lethal doses of 5-fluorouracil and doxorubicin. J Exp Med 180:1047
Peters G, Van der Vijgh W (1995) Protection of normal tissues from the cytotoxic effects of chemotherapy and radiation by amifostine (WR-2721): preclinical aspects. Eur J Cancer [Suppl] 31A:S1
Podda S, Ward M, Himelstein A, Richardson C, Flor-Weiss EDL, Smith L, Gottesman M, Pastan I, Bond A (1992) Transfer and expression of the human multiple drug resistance gene in live mice. Proc Natl Acad Sci U S A 89:9676
Rinehart J, Keville L, Neidhart J, Wong L, DiNunno L, Kinney P, Aberle M, Tadlock L, Cloud G (2003) Hematopoietic protection by dexamethasone or granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients treated with carboplatin and ifosfamide. Am J Clin Oncol 26:448
Vadhan-Raj S, Broxmeyer H, Hittelman W (1992) Abrogating chemotherapy-induced myelosuppression by recombinant granulocyte-macrophage colony-stimulating factor in patients with sarcoma: protection at the progenitor cell level. J Clin Oncol 10:1266
Broxmeyer H, Benningre L, Patel S (1994) Kinetic response of human marrow myeloid progenitor cells to in vivo treatment of patients with granulocyte colony-stimulating factor is different from the response to treatment with granulocyte-macrophage colony-stimulating factor. Exp Hematol 22:100
Janik J, Miller L, Smith J II (1993) Prechemotherapy granulocyte-macrophage colony stimulating factor (GM-CSF) prevents topotecan-induced neutropenia. Proc ASCO 12:1507
Aglietta M, Monzeglio C, Pasquino P (1993) Short-term administration of granulocyte-macrophage colony stimulating factor decreases hematopoietic toxicity of cytostatic drugs. Cancer 72:2970
Betticher D, Anderson H, Ranson M (1995) Carboplatin combined with amifostine, a bone marrow protectant, in the treatment of non-small-cell lung cancer: a randomized phase II study. Br J Cancer 72:1551
Duffull SB, Robinson BA (1997) Clinical pharmacokinetics and dose optimisation of carboplatin. Clin Pharmacokinet 33:161
Heinemann V (2002) Gemcitabine in the treatment of advanced pancreatic cancer: a comparative analysis of randomized trials. Semin Oncol 29:9
Wang H, Cai Q, Zeng X, Yu D, Agrawal S, Zhang R (1999) Anti-tumor activity and pharmacokinetics of a mixed-backbone antisense oligonucleotide targeted to RIα subunit of protein kinase A after oral administration. Proc Natl Acad Sci U S A 96:13989
Zhang R, Lu Z, Liu T, Soong SJ, Diasio RB (1993) Relationship between circadian-dependent toxicity of 5-fluorodeoxyuridine and circadian rhythms of pyrimidine enzymes: possible relevance to fluoropyrimidine chemotherapy. Cancer Res 53:2816
Bullen WW, Andress LD, Chang T, Whitfield LR, Welch ML, Newman RA (1992) A high-performance liquid chromatographic assay for CI-973, a new anticancer platinum diamine complex, in human plasma and urine ultrafiltrates. Cancer Chemother Pharmacol 30:193
Zhang R, Diasio RB, Lu Z, Liu T, Jiang Z, Galbraith WM, Agrawal S (1995) Pharmacokinetics and tissue distribution in rats of an oligodeoxynucleotide phosphorothioate (GEM91) developed as a therapeutic agent for human immunodeficiency virus type-1. Biochem Pharmacol 49:929
Matsukado K, Nakano S, Bartus RT, Black KL (1997) Steroids decrease uptake of carboplatin in rat gliomas—uptake improved by intracarotid infusion of bradykinin analog, RMP-7. J Neurooncol 34:131
Wang H, Li M, Rinehart JJ, Zhang R (2003) Dexamethasone increases anti-tumor activity and alters pharmacokinetics of carboplatin and gemcitabine in vivo (abstract 609). Proceedings of the 94th Annual Meeting AACR, vol. 44, p 140
Acknowledgements
We would like to thank Jie Hang, Zhuo Zhang, Gautam Prasad, Zhenqi Shi, Bing Pang, and Lin Lin for their excellent technical assistance. We also thank Dr. Al LoBuglio and Dr. Donald L. Hill for helpful discussions.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was partly supported by funds for the Cancer Pharmacology Laboratory from UAB Comprehensive Cancer Center.
Rights and permissions
About this article
Cite this article
Wang, H., Li, M., Rinehart, J.J. et al. Dexamethasone as a chemoprotectant in cancer chemotherapy: hematoprotective effects and altered pharmacokinetics and tissue distribution of carboplatin and gemcitabine. Cancer Chemother Pharmacol 53, 459–467 (2004). https://doi.org/10.1007/s00280-003-0759-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00280-003-0759-9