Abstract
Purpose
This study evaluated pharmacokinetics (PK) and safety profiles of single agent arsenic trioxide (ATO, As2O3) administrated as continuous slow-rate infusion in patients with newly diagnosed acute promyelocytic leukemia.
Patients and methods
Patients received 0.16 mg/kg ATO per day. ATO was given for 40 min infusion on the first day followed by 18–20 h daily at a very slow rate with infusion speed of 8 drips/min. During the first week, plasma samples were collected immediately before next administration on each day, and 0.5, 1, 2, 4, 8, 12 h after administration, at the end of infusion (18 h) on day 7. Total arsenic was determined by ICPMS. Arsenic species, arsenious acid (AsIII) and its metabolites, monomethylarsonic acid (MMAV) and dimethylarsinic acid (DMAV), were quantified by UHPLC-ICPMS. Safety assessment and PK analysis was conducted.
Results
Hyperleukocytosis occurred in two patients and no severe toxicity was observed. Total arsenic gradually accumulated from 15.84 to 34.12 ng/mL during the first week of therapy. MMAV/iAs increased and remained stable at value about 0.6 after day 4, while DMAV/MMAV declined under 2 after day 4. Compared with 2 h infusion, clearance (CL) of AsIII was significantly lower (0.8 ± 0.2 vs. 2.7 ± 1.7 L/kg/h, P = 0.002) while AUC0–t of AsIII was significantly increased (213.9 ± 38.6 vs. 82.6 ± 55.7 L/kg/h, P = 0.028).
Conclusion
Continuous slow-rate ATO infusion provided an alternative administration for ATO therapy with few toxic effects. Degree of methylation from MMA to DMA is inconsistent with that from iAs to MMA. PK of arsenic species is considered important for clinical use of ATO.
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Funding
This study was funded by the National Natural Science Foundation of China (Grant No. 81430088 and 81700151).
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Gao, C., Hu, S., Guo, M. et al. Clinical pharmacokinetics and safety profile of single agent arsenic trioxide by continuous slow-rate infusion in patients with newly diagnosed acute promyelocytic leukemia. Cancer Chemother Pharmacol 82, 229–236 (2018). https://doi.org/10.1007/s00280-018-3606-8
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DOI: https://doi.org/10.1007/s00280-018-3606-8