Validated HILIC-MS/MS assay for determination of vindesine in human plasma: Application to a population pharmacokinetic study.

The first HILIC-tandem mass spectrometry (MS/MS) method for determination of vindesine (VDS) in human plasma using vinorelbine as an internal standard (IS) has been developed and validated. Plasma samples clean-up consisted of solid phase extraction with a strata™-X column. The compounds were separated on a HILIC column with an isocratic mobile phase consisting of acetonitrile and 15mM ammonium acetate buffer containing 0.15% formic acid (80:20, v/v). The detection was performed on a triple quadrupole tandem mass spectrometer via electrospray positive ionization (ESI(+)). The ion transitions recorded in multiple reaction monitoring mode were m/z 754.6→123.8 for VDS and 779.4→323.3 for IS, respectively. Linear calibration curves were obtained in the concentration range of 0.3-28ng/ml and the lower limit of quantification for VDS was 0.3ng/ml. The coefficient of variation of the assay precision was less than 13%, and the accuracy exceeded 96%. The developed assay method was successfully applied for the evaluation of population pharmacokinetics of VDS after intravenous infusion of Xi Ai Ke Vial(®) (3mg of Vindesine Sulfate for Injection) to Chinese Han subjects with hematological malignant disorders.

[Development of a specific and sensitive enzyme-linked immunosorbent assay for vindesine].

This paper reports a specific and sensitive enzyme-linked immunosorbent assay (ELISA) for pharmacokinetic studies of vindesine (VDS). Anti-VDS antibody was obtained by immunizing rabbits with VDS conjugated with bovine serum albumin using N-[ß-(4-diazophenyl) ethyl] maleimide as a heterobifunctional coupling agent. An enzyme marker was similarly prepared by coupling VDS with horseradish peroxidase using N-(4-diazophenyl) maleimide. The detection limit of VDS by ELISA was approximately 24 pg/mL with 50-mL samples. This assay was specific for VDS and showed very slight cross-reactivity with other vinca alkaloids, vincristine (0.18%) and vinblastine (0.11%). The values for the VDS concentrations detected using this assay were comparable with those detected using HPLC. There was a good correlation between the values determined by the two methods. Moreover, ELISA was about 50-fold more sensitive in detecting VDS at lower concentrations. The sensitivity and specificity of ELISA should provide a useful tool for pharmacokinetic studies of VDS.

Achievement of optimal average relative dose intensity and correlation with survival in diffuse large B-cell lymphoma patients treated with CHOP.

The treatment of diffuse large B-cell lymphoma with chemotherapy was retrospectively evaluated in 348 patients who had received at least three cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-like, ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone)-like or CHVmP-BV (cyclophosphamide, hydroxorubicin, Vm-26, prednisone, vincristine and bleomycin) treatment in Belgium between 1995 and 2000. In our sample, the proportion who received each of the three regimens was 78.4, 16.4, and 5.2%, respectively. Of those prescribed CHOP-like regimens, 15% received <80% average relative dose intensity (ARDI). In 210 patients treated with CHOP-21 (77% of the CHOP-like group), median survival was 7.08 years in those who received >90% of the ARDI, significantly longer than in those who received < or = 90% of the ARDI (p = 0.002). Dose reductions and/or delays, mainly due to hematological toxicities, resulted in a reduction in treatment intensity. These data indicate that patient outcome is improved when the intensity of chemotherapy treatment is optimal.

Change in pharmacokinetic and pharmacodynamic behavior of gemcitabine in human tumor xenografts upon entrapment in vesicular phospholipid gels.

PURPOSE: The in vivo pharmacokinetics (PK), biodistribution and antitumor activity of a new liposomal formulation of gemcitabine (GemLip) were compared to the conventional (clinical) formulation of gemcitabine (GemConv). METHODS: Gemcitabine was entrapped in a vesicular phospholipid gel (VPG) consisting of densely packed liposomes. Redispersed VPG containing GemLip consisted of 33% liposomally entrapped and 67% free gemcitabine. The in vivo efficacies of GemLip and GemConv were compared using the subcutaneously growing human soft tissue sarcoma SXF 1301 and the orthotopically growing human bladder cancer BXF 1299T. PK and biodistribution were evaluated using radiolabeled drug and lipid in SXF 1301 tumor-bearing nude mice. RESULTS: GemLip was highly active in SXF 1301 at a gemcitabine dose of 6-9 mg/kg (days 1, 8 and 15; dose near the MTD). In the 6-mg/kg groups, complete tumor remissions were observed in seven of eight mice. Equimolar doses of GemConv resulted in only moderate tumor growth inhibition. Even at equitoxic doses (360 mg/kg given on days 1, 8 and 15, or 120 mg/kg on days 1, 5 and 8) GemConv was less active than GemLip. Furthermore, GemLip was active in the orthotopically growing BXF 1299T bladder cancer model at 6 mg/kg and prevented distant organ metastasis. In the PK study, GemLip achieved a 35-fold higher plasma AUC (1680 mg x h/ml) than GemConv (47.6 mg x h/ml). The serum half-lives were 0.15 h for free gemcitabine and 13.3 h for liposomal gemcitabine (6 mg/kg each i.v.). Moreover, gemcitabine levels in tumors were fourfold higher following injection of GemLip than following injection of GemConv. CONCLUSIONS: GemLip is a highly effective gemcitabine delivery system which results in superior gemcitabine pharmacodynamics and PK than GemConv. The enhanced in vivo efficacy might be explained by sustained release and passive tumor targeting.

Combination of nedaplatin and vindesine for treatment of relapsed or refractory non-small-cell lung cancer.

PURPOSE: A phase II study of nedaplatin and vindesine was conducted to evaluate their efficacy and safety for treatment of relapsed or refractory non-small-cell lung cancer (NSCLC). METHODS: Between August 1996 and September 1998, 48 patients who had previously received chemotherapy, thoracic radiotherapy, and/or surgery were enrolled in the study. Patients were required to have an Eastern Cooperative Oncology Group performance status of 0 to 2 and an age between 20 and 79 years. Treatment consisted of nedaplatin (80 mg/m2, day 1) and vindesine (3 mg/m2, days 1 and 8) every 3 to 4 weeks. RESULTS: Of 48 patients, 7 (14.6%) exhibited an objective response. Four (50%) of eight chemotherapy-naive patients had a partial response. However, of the 40 patients who had received prior chemotherapy, a partial response was observed in only 3 (7.5%). At a median follow-up time of 85.1 weeks, the median survival time was 43.6 weeks (95% confidence interval 34.4-52.7) for patients who had received chemotherapy, with a survival rate of 40% at 1 year. Grade 3 or 4 neutropenia occurred in 43 of 48 patients (90%), and neutropenic fever was observed in 3 of the 43 patients, one of whom died of sepsis. Pharmacokinetic and pharmacodynamic analyses of platinum were performed in 43 patients during the first cycle of chemotherapy. Percent reduction in absolute neutrophil count was correlated not only with the area under the plasma ultrafilterable platinum concentration versus time curve (r = 0.41, P = 0.007) but also with the duration of ultrafilterable platinum concentration above 1 microg/ml (r = 0.41, P = 0.007). Patients with progressive disease exhibited a shorter duration of ultrafilterable platinum concentration over 1 microg/ml (P = 0.046) than those with other responses. CONCLUSION: A combination of nedaplatin and vindesine was unsatisfactory as second-line chemotherapy for NSCLC, although the combination was well tolerated. The duration of ultrafilterable platinum concentration above 1 microg/ml was an important pharmacokinetic parameter for predicting both chemotherapy-induced neutropenia and treatment outcome.

Modulation of vindesine and doxorubicin resistance in multidrug-resistant pleural mesothelioma cells by tumor necrosis factor-alpha.

Tumor necrosis factor-alpha (TNF-alpha) has been shown to enhance the cytotoxicity of a variety of antineoplastic agents. To examine whether multidrug-resistant cells are targets of TNF-alpha, and whether TNF-alpha is capable of modulating chemoresistance of these cells, a pleural mesothelioma cell line (PXF1118L) and two multidrug-resistant sublines thereof were used as experimental models. Drug resistance of these cells was due to P-glycoprotein expression, as confirmed by (1) staining with a monoclonal antibody (MRK16) specific for human P-glycoprotein, (2) decreased accumulation of [3H]vinblastine that was reversed by verapamil, and (3) enhanced cytotoxicity of vindesine in the presence of verapamil. Parental and multidrug-resistant cells exhibited little but comparable sensitivity to TNF-alpha alone. Combining TNF-alpha with vindesine or, to a lesser extent, with doxorubicin, but not with cisplatin, resulted in greater cytotoxicity towards multidrug-resistant cells than seen for each compound alone, indicating a synergism. In contrast, TNF-alpha failed to modulate vindesine or doxorubicin cytotoxicity in parental cells. [3H]Vinblastine accumulation was unaffected by TNF-alpha, and chemoresistance was reduced by TNF-alpha also in the presence of verapamil (10 microM), indicating that TNF-alpha was acting in a way different from calcium-channel blockers. Though the molecular mechanism by which TNF-alpha was enhancing vindesine and doxorubicin cytotoxicity remained undefined in this study, the numbers of TNF-alpha binding sites on parental and on multidrug-resistant cells were similar, and P-glycoprotein expression was unmodulated during the entire 48 h incubation period. In conclusion, we show that TNF-alpha increases the cytotoxicity of anticancer drugs in multidrug-resistant tumor cells by a mechanism that differs from most chemosensitizing agents, including verapamil. Further studies will be needed to clarify the mechanism by which TNF-alpha synergizes with anticancer drugs.

Kinetic analysis of combination effect of navelbine (KW-2307) with cisplatin against human lung adenocarcinoma PC-12 cells in culture.

The combination effect of navelbine (NVB, KW-2307), a newly synthesized vinca alkaloid, and cisplatin (CDDP) was compared with that of vindesine (VDS) and CDDP using human lung adenocarcinoma PC-12 cells. The growth-inhibitory activity of NVB or VDS was time-dependent, whereas that of CDDP was AUC (area under the curve)-dependent. When NVB or VDS was used in combination with CDDP simultaneously for 24 h, antagonism was observed in terms of growth-inhibitory activity. However, additive combination effect was observed when NVB or VDS treatment was followed by CDDP treatment. On this treatment schedule, a synergistic combination effect was observed in terms of the cell-killing activity assessed by colony formation assay. The growth-inhibitory activity of NVB or VDS was detected 24 h after the treatment, whereas that of CDDP became significant 72 h after the treatment. NVB and VDS caused cell accumulation in G2M phase at 10 times their IC80 values, and cells with less than diploid DNA content were detected after 24 h at IC80. CDDP caused accumulation of cells in S phase, and the effect became detectable 16 h after the treatment. The DNA histogram of cells treated with NVB or VDS in combination with CDDP was a superposition of those of cells treated with each drug alone. Significant differences in the characteristics of anticellular activity were not detected between NVB and VDS, although NVB inhibited cell growth at a slightly lower concentration than VDS at the short exposure time of 1-8 h.

[Five-day continuous infusion of vindesine in the treatment of non-small cell lung cancer--clinical pharmacokinetics of vindesine].

We administered vindesine (VDS) as a single agent at a dose of 1.2 mg/m2/day for 5 days by continuous infusion in 6 patients with inoperable non-small cell lung cancer, and studied the pharmacokinetics of VDS. The maximum concentration (Cmax) of VDS was 6.9 ng/ml and the area under the curve (AUC) was 803 ng.hr/ml. The AUC achieved for VDS was 2.5 times higher after continuous infusion than that observed when 3 mg/m2 of VDS was given by bolus iv injection. Among six patients were 2 PR, including one PR achieved using a 5-day continuous infusion of VDS after failure to respond to cisplatin plus VDS (bolus injection). Severe leukopenia was observed, but it was clinically manageable. The AUC exposure of VDS is greater with the longer infusion periods, and this might improve efficacy compared to conventional bolus injection treatments. The need for further studies appears warranted.

In vivo and in vitro pharmacokinetics and metabolism of vincaalkaloids in rat. I. Vindesine (4-deacetyl-vinblastine 3-carboxyamide).

Vindesine (VDS) pharmacokinetics, including tissue distribution, metabolism and elimination, were investigated in rats using both in vivo and in vitro models. VDS was found to be intensively distributed in tissues after i.v. injection in rat. The most important drug accumulation site was the spleen (615.0 ng/g at 24 h). Liver and kidneys also retained VDS in significant amounts (respectively 170.1 +/- 11.0 ng/g and 145.0 +/- 17.0 ng/g at 24 h). Urine excretion of drug over 7 days was low (10.1 +/- 1.8% of total dose) and consisted mainly of unchanged drug (more than 85%). The major excretion route for VDS was the feces (69.6 +/- 2.5% of total dose) via the bile (50% of total dose excreted in 72 h). High performance liquid chromatography analysis (HPLC) of collected bile samples revealed the excretion of three VDS biotransformation products. These results were confirmed in vitro using freshly isolated rat hepatocytes in suspension. Rapid and high VDS uptake by liver cells, probably through a passive diffusion mechanism followed by a tight cellular binding, was demonstrated. Moreover, VDS was intensively converted, in vitro, into four metabolites which were rapidly excreted into the extracellular medium. In contrast, the intracellular medium contained almost exclusively unchanged drug, presumably fixed to tubulin proteins. Two anti-VDS monoclonal antibodies with different specificities were used to test metabolite immunoreactivities. The results suggested that some structural modifications occurred in the catharantine moiety of the molecule but that the VDS dimeric structure seemed well conserved after biotransformation.

[Pharmacokinetics of cisplatin and vindesine in a patient with chronic renal failure undergoing hemodialysis].

Plasma total platinum and vindesine levels were monitored in a patient with chronic renal failure undergoing hemodialysis. Plasma levels of cisplatin were determined as platinum by atomic absorption spectrophotometry, and plasma vindesine levels were measured by radioimmunoassay. Fifty mg. of cisplatin in combination with 3 mg. of vindesine were infused for 60 minutes before dialysis. During dialysis, plasma total platinum levels decreased rapidly in a biphasic fashion and 1.76 at 30 hours after infusion. Plasma vindesine levels declined with higher concentration. In conclusion, it is considered that cisplatin and vindesine can be given to anuric patients undergoing hemodialysis. However, it is suggested that smaller doses should be given to prevent side effects.

[Clinical pharmacokinetics of vinca alkaloids]. / Pharmacocinétique clinique des vinca-alcaloïdes.

Vinca alkaloids (VA) represent a family of closely related molecules, which includes vincristine (VCR), vinblastine (VLB), vindesine (VDS) and navelbine (NVB), a new synthetic VA presently in phase II clinical trial. Development of sensitive and specific analytical tools (polyclonal and monoclonal antibodies) enabled us to investigate the kinetic behavior of VDS and NVB after IV bolus or long term administration. Following IV bolus injection, the mean pharmacokinetic parameters are: total plasma clearance: 0.53 l/h-1kg-1, 0.72 l/h-1kg-1 and apparent elimination half-life: 23.2 h, 39.5 h for VDS and NVB, respectively. Chronic treatment reveals time- and dose-dependence relationships and detailed observations of individual kinetics demonstrate an important interindividual variability for both drugs. Renal excretion of VDS and NVB is low (from 5 to 12% of the total dose), suggesting the important role of the liver in their rapid elimination.