Population Pharmacokinetic Study and Individual Dose Adjustments of High-Dose Methotrexate in Chinese Pediatric Patients With Acute Lymphoblastic Leukemia or Osteosarcoma. 2019

Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.

High-dose methotrexate (>0.5 g/m2 ) is among the first-line chemotherapeutic agents used in treating acute lymphoblastic leukemia (ALL) and osteosarcoma in children. Despite rapid hydration, leucovorin rescue, and routine therapeutic drug monitoring, severe toxicity is not uncommon. This study aimed at developing population pharmacokinetic (popPK) models of high-dose methotrexate for ALL and osteosarcoma and demonstrating the possibility and convenience of popPK model-based individual dose optimization using R and shiny, which is more accessible, efficient, and clinician-friendly than NONMEM. The final data set consists of 36 ALL (354 observations) and 16 osteosarcoma (585 observations) patients. Covariate model building and parameter estimations were done using NONMEM and Perl-speaks-NONMEM. Diagnostic Plots and bootstrapping validated the models' performance and stability. The dose optimizer developed based on the validated models can obtain identical individual parameter estimates as NONMEM. Compared to calling a NONMEM execution and reading its output, estimating individual parameters within R reduces the execution time from 8.7-12.8 seconds to 0.4-1.0 second. For each subject, the dose optimizer can recommend (1) an individualized optimal dose and (2) an individualized range of doses. For osteosarcoma, recommended optimal doses by the optimizer resemble the final doses at which the subjects were eventually stabilized. The dose optimizers developed demonstrated the potential to inform dose adjustments using a model-based, convenient, and efficient tool for high-dose methotrexate. Although the dose optimizer is not meant to replace clinical judgment, it provides the clinician with the individual pharmacokinetics perspective by recommending the (range of) optimal dose.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008297 Male Males
D008727 Methotrexate An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of TETRAHYDROFOLATE DEHYDROGENASE and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. Amethopterin,Methotrexate Hydrate,Methotrexate Sodium,Methotrexate, (D)-Isomer,Methotrexate, (DL)-Isomer,Methotrexate, Dicesium Salt,Methotrexate, Disodium Salt,Methotrexate, Sodium Salt,Mexate,Dicesium Salt Methotrexate,Hydrate, Methotrexate,Sodium, Methotrexate
D001859 Bone Neoplasms Tumors or cancer located in bone tissue or specific BONES. Bone Cancer,Cancer of Bone,Cancer of the Bone,Neoplasms, Bone,Bone Neoplasm,Neoplasm, Bone
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D004305 Dose-Response Relationship, Drug The relationship between the dose of an administered drug and the response of the organism to the drug. Dose Response Relationship, Drug,Dose-Response Relationships, Drug,Drug Dose-Response Relationship,Drug Dose-Response Relationships,Relationship, Drug Dose-Response,Relationships, Drug Dose-Response
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths

Related Publications

Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
January 2021, Frontiers in pharmacology,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
July 2023, Pharmaceutical research,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
January 2010, International journal of clinical pharmacology and therapeutics,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
June 2021, Journal of clinical pharmacology,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
August 2019, International journal of clinical pharmacology and therapeutics,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
January 2020, Cancer chemotherapy and pharmacology,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
January 2018, Journal of the advanced practitioner in oncology,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
January 1994, Cancer chemotherapy and pharmacology,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
April 2023, Cancer,
Ka Ho Hui, and Ho Man Chu, and Pui Shan Fong, and Wai Tsoi Frankie Cheng, and Tai Ning Lam
February 2008, Zhongguo shi yan xue ye xue za zhi,
Copied contents to your clipboard!