- Interpatient differences in the dose-response relationship for cytotoxic drug therapy in ovarian and breast cancer by applying a population PK-PD approach. Breast and ovarian cancer have been chosen as examples of common chemo sensitive yet often incurable tumours.
- Quantitative relationships between interpatient differences in the exposure to anticancer agents and toxicities of the therapy.
- Whether patients should benefit from individualized drug treatment.
- Subpopulations of patients for which anticancer therapy has a low likelihood of tumour response, using a panel of tumour related pharmacodynamic markers (p53, Her-2/neu ER/PR, EGFR, LRP).
- Subpopulations of patients which are particularly at risk; for the development of severe side effects.
Patients with locally advanced or metastatic solid tumours vary widely in their response and tolerance of systemic therapy with anticancer agents. The variability in the dose-response and dose-toxicity relationship is determined by both pharmacokinetic (PK) and pharmacodynamic (PD) (tumour and end-organ related factors respectively). Application of the 'population approach' for characterization of variability in dose-response and dose-toxicity relationships as well as new insights in mechanisms of anticancer drug resistance, form the basis for the current large scale clinical-pharmacologic studies in patients with solid tumours. The studies will be carried out within the framework of the PAMM and ECSG and IDBBC-group of the EORTC. The population approach offers the possibility of gaining integrated information on PK, PD and response from sparse observational data and allows analysis of a variety of unbalanced study designs. Recent in vitro and in vivo studies have revealed that estrogen/progesteron (ER/PR) receptor status and overexpression of lung resistance protein (LRP), epidermal growth factor receptor (EGFR) or (mutant) oncogenes, such as p53 and Her-2/neu may cause resistance to anticancer agents in breast or ovarian cancer. We propose to apply the population approach in phase III/IV studies in ovarian and breast cancer using NONMEM (nonlinear mixed effect models, USF, CA USA). We will implement procedures for crossvalidation of analytical and biologic methods to prevent methodological bias. We define the following covariates for population PK analysis body weight, WHO performance score, age, albumin, renal, liver and bone marrow function, comedication; and add tumour stage, differentiation, TNM classification and p53, Her-2/neu ER/PR, LRP and EGFR tumour status for population PK-PD analysis
Funding SchemeCSC - Cost-sharing contracts
3075 EA Rotterdam
9713 EZ Groningen
92210 Saint Cloud
1081 JC Amsterdam
OX3 9DS Oxford/headington
1066 EC Amsterdam
AB9 2ZD Aberdeen
G12 8QQ Glasgow
NE2 4HH Newcastle Upon Tyne
751 23 Uppsala
1081 HV Amsterdam