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Meng S, Zhu N, Han D, Li B, Zhang X, Zhang J, Liu T. Synthesis and Biological Evaluation of Methoxypolyethylene-Glycol-Substituted Abiraterone Derivatives as Potential Antiprostate Cancer Agents. Mol Pharm 2024. [PMID: 38815167 DOI: 10.1021/acs.molpharmaceut.3c01188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Globally, prostate cancer is the most commonly diagnosed tumor and a cause of death in older men. Abiraterone, an orally administered irreversible CYP17 inhibitor, is employed to treat prostate cancer. However, abiraterone has several clinical limitations, such as poor water solubility, low dissolution rate, low bioavailability, and toxic side effects in the liver and kidney. Therefore, there is a need to identify high-efficiency and low-toxicity water-soluble abiraterone derivatives. In this work, we aimed to design and synthesize a series of abiraterone derivatives by methoxypoly(ethylene glycol) (mPEG) modification. Their antitumor activities and toxicology were analyzed in vitro and in vivo. The most potent compound, 2e, retained the principle of action on the CYP17 enzyme target and significantly improved the abiraterone water solubility, cell permeability, and blood safety. No significant abnormalities were observed in toxicology. mPEG-modification significantly improved abiraterone's antitumor activity and efficiency while reducing the associated toxic effects. The finding will provide a theoretical basis for future clinical application of mPEG-modified abiraterone.
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Affiliation(s)
- Shuai Meng
- Department of Pharmacy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300192, People's Republic of China
| | - Na Zhu
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300192, People's Republic of China
- Institute of Traditional Chinese Medicine, Tianjin Key Laboratory of Chinese Medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, People's Republic of China
| | - Di Han
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300192, People's Republic of China
- Institute of Traditional Chinese Medicine, Tianjin Key Laboratory of Chinese Medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, People's Republic of China
| | - Bole Li
- Department of Pharmacy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Xiaolong Zhang
- Department of Pharmacy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Jie Zhang
- Department of Pharmacy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Tianjun Liu
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300192, People's Republic of China
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Gasperoni L, Giunta EF, Montanari D, Masini C, De Giorgi U. New-generation androgen receptor signaling inhibitors (ARSIs) in metastatic hormone-sensitive prostate cancer (mHSPC): pharmacokinetics, drug-drug interactions (DDIs), and clinical impact. Expert Opin Drug Metab Toxicol 2024:1-12. [PMID: 38778707 DOI: 10.1080/17425255.2024.2353749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The therapeutic scenario of metastatic hormone-sensitive prostate cancer (mHSPC) has dramatically changed in recent years, with the approval of new-generation Androgen Receptor Signaling Inhibitors (ARSIs), in combination with the androgen deprivation therapy (ADT), which was the previous standard of care. Despite showing a similar clinical efficacy, ARSIs, all of which are administered orally, are different in terms of pharmacokinetic and drug-drug interactions (DDIs). AREAS COVERED This review covers the main pharmacokinetic characteristics of ARSIs that have been approved for the first-line therapy of mHSPC patients, underlying the differences among these molecules and focusing on the known or possible interactions with other drugs. Full-text articles and abstracts were searched in PubMed. EXPERT OPINION Since prostate cancer occurs mainly in older age, comorbidities and the consequent polypharmacy increase the DDI risk in mHSPC patients who are candidates for ARSI. Waiting for new therapeutic options, in the absence of direct comparisons, pharmacokinetic knowledge is essential to guide clinicians in prescribing ARSI in this setting.
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Affiliation(s)
- Lorenzo Gasperoni
- Oncological Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola (FC), Italy
| | - Emilio Francesco Giunta
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola (FC), Italy
| | - Daniela Montanari
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola (FC), Italy
| | - Carla Masini
- Oncological Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola (FC), Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola (FC), Italy
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Yu A, Hazra A, Jiao JJ, Hellemans P, Mitselos A, Tian H, Ruixo JJP, Haddish-Berhane N, Ouellet D, Russu A. Demonstrating Bioequivalence for Two Dose Strengths of Niraparib and Abiraterone Acetate Dual-Action Tablets Versus Single Agents: Utility of Clinical Study Data Supplemented with Modeling and Simulation. Clin Pharmacokinet 2024; 63:511-527. [PMID: 38436924 PMCID: PMC11052869 DOI: 10.1007/s40262-023-01340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE The combination of niraparib and abiraterone acetate (AA) plus prednisone is under investigation for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) and metastatic castration-sensitive prostate cancer (mCSPC). Regular-strength (RS) and lower-strength (LS) dual-action tablets (DATs), comprising niraparib 100 mg/AA 500 mg and niraparib 50 mg/AA 500 mg, respectively, were developed to reduce pill burden and improve patient experience. A bioequivalence (BE)/bioavailability (BA) study was conducted under modified fasting conditions in patients with mCRPC to support approval of the DATs. METHODS This open-label randomized BA/BE study (NCT04577833) was conducted at 14 sites in the USA and Europe. The study had a sequential design, including a 21-day screening phase, a pharmacokinetic (PK) assessment phase comprising three periods [namely (1) single-dose with up to 1-week run-in, (2) daily dose on days 1-11, and (3) daily dose on days 12-22], an extension where both niraparib and AA as single-agent combination (SAC; reference) or AA alone was continued from day 23 until discontinuation, and a 30-day follow-up phase. Patients were randomly assigned in a parallel-group design (four-sequence randomization) to receive a single oral dose of niraparib 100 mg/AA 1000 mg as a LS-DAT or SAC in period 1, and patients continued as randomized into a two-way crossover design during periods 2 and 3 where they received niraparib 200 mg/AA 1000 mg once daily as a RS-DAT or SAC. The design was powered on the basis of crossover assessment of RS-DAT versus SAC. During repeated dosing (periods 2 and 3, and extension phase), all patients also received prednisone/prednisolone 5 mg twice daily. Plasma samples were collected for measurement of niraparib and abiraterone plasma concentrations. Statistical assessment of the RS-DAT and LS-DAT versus SAC was performed on log-transformed pharmacokinetic parameters data from periods 2 and 3 (crossover) and from period 1 (parallel), respectively. Additional paired analyses and model-based bioequivalence assessments were conducted to evaluate the similarity between the LS-DAT and SAC. RESULTS For the RS-DAT versus SAC, the 90% confidence intervals (CI) of geometric mean ratios (GMR) for maximum concentration at a steady state (Cmax,ss) and area under the plasma concentration-time curve from 0-24 h at a steady state (AUC 0-24h,ss) were respectively 99.18-106.12% and 97.91-104.31% for niraparib and 87.59-106.69 and 86.91-100.23% for abiraterone. For the LS-DAT vs SAC, the 90% CI of GMR for AUC0-72h of niraparib was 80.31-101.12% in primary analysis, the 90% CI of GMR for Cmax,ss and AUC 0-24h,ss of abiraterone was 85.41-118.34% and 86.51-121.64% respectively, and 96.4% of simulated LS-DAT versus SAC BE trials met the BE criteria for both niraparib and abiraterone. CONCLUSIONS The RS-DAT met BE criteria (range 80%-125%) versus SAC based on 90% CI of GMR for Cmax,ss and AUC 0-24h,ss. The LS-DAT was considered BE to SAC on the basis of the niraparib component meeting the BE criteria in the primary analysis for AUC 0-72h; abiraterone meeting the BE criteria in additional paired analyses based on Cmax,ss and AUC 0-24h,ss; and the percentage of simulated LS-DAT versus SAC BE trials meeting the BE criteria for both. CLINICALTRIALS GOV IDENTIFIER NCT04577833.
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Affiliation(s)
- Alex Yu
- Janssen Research and Development, LLC, 1400 McKean Rd, Springhouse, PA, USA.
| | - Anasuya Hazra
- Janssen Research and Development, LLC, 1400 McKean Rd, Springhouse, PA, USA
- Regeneron, Tarrytown, NY, USA
| | - James Juhui Jiao
- Janssen Research and Development, LLC, 920 US Highway 202, Raritan, NJ, USA
| | - Peter Hellemans
- Janssen Pharmaceutica NV, Research and Development BE, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Anna Mitselos
- Janssen Pharmaceutica NV, Research and Development BE, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Hui Tian
- Janssen Research and Development, LLC, 1400 McKean Rd, Springhouse, PA, USA
| | | | | | - Daniele Ouellet
- Janssen Research and Development, LLC, 1400 McKean Rd, Springhouse, PA, USA
| | - Alberto Russu
- Janssen-Cilag SpA, Via Michelangelo Buonarroti 23, 20093, Cologno Monzese, Italy
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Lin L, van der Meer EKO, Steeghs N, Beijnen JH, Huitema ADR. Are novel oral oncolytics underdosed in obese patients? Cancer Chemother Pharmacol 2024; 93:129-136. [PMID: 37906253 PMCID: PMC10853358 DOI: 10.1007/s00280-023-04601-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Data on the effects of obesity on drug exposure of oral targeted oncolytics is scarce. Therefore, the aim of this study was to investigate the influence of body weight and body mass index (BMI) on trough levels of oral oncolytics with an exposure-response relationship. The oral oncolytics of interest were abiraterone, alectinib, cabozantinib, crizotinib, imatinib, pazopanib, sunitinib and trametinib. METHODS This retrospective cohort study included patients treated with the selected oral oncolytics at the standard dose, with a measured trough level at steady state and with available body weight. The Spearman's correlation test was used to determine the correlation between body weight and trough levels. The Fisher's exact text was used to compare the frequency of inadequate trough levels between BMI categories. RESULTS 1265 patients were included across the different oral oncolytics. A negative correlation coefficient was observed between weight and trough levels for crizotinib (n = 75), imatinib (n = 201) and trametinib (n = 310), respectively, ρ = - 0.41, ρ = - 0.24 and ρ = - 0.23, all with a p-value < 0.001. For crizotinib, a higher percentage of patients with a body weight > 100 kg had inadequate trough levels. No statistically significant differences were observed in the frequency of inadequate trough levels between BMI categories. CONCLUSION Higher body weight was only correlated with lower plasma trough levels for crizotinib, imatinib, and trametinib. Therefore, patients with a high body weight may require dose escalation to obtain adequate target levels when treated with these oral oncolytics.
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Affiliation(s)
- Lishi Lin
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ellen K O van der Meer
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Hu Y, Wu J, Cheng B, You R, Yin X, Chen G, Yang L, Zhang Y, Si L, Jiang H, Zhang Y, Huang J, Huang J. Effect of food and polymorphisms in SLCO2B1, CYP3A4 and UGT1A4 on pharmacokinetics of abiraterone and its metabolites in Chinese volunteers. Br J Clin Pharmacol 2024; 90:247-263. [PMID: 37574850 DOI: 10.1111/bcp.15883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 07/03/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023] Open
Abstract
AIMS Abiraterone acetate, a prodrug of abiraterone (ABI), provides an efficient therapeutic option for metastatic castration-resistant prostate cancer patients. ABI undergoes extensive metabolism in vivo and is transformed into active metabolites Δ4 -abiraterone and 3-keto-5α-abiraterone as well as inactive metabolites abiraterone sulfate and abiraterone N-oxide sulfate. We aimed to examine the effect of polymorphisms in SLCO2B1, CYP3A4 and UGT1A4 on the pharmacokinetics of ABI and its metabolites. METHODS In this study, 81 healthy Chinese subjects were enrolled and divided into 2 groups for fasted (n = 45) and fed (n = 36) studies. Plasma samples were collected after administering a 250 mg abiraterone acetate tablet followed by liquid chromatography-tandem mass spectrometry analysis. Genotyping was performed on a MassARRAY system. The association between SLCO2B1, CYP3A4, UGT1A4 genotype and pharmacokinetic parameters of ABI and its metabolites was assessed. RESULTS Food effect study demonstrated high fat meal remarkedly increased systemic exposure of ABI and its metabolites. The geometric mean ratio and 90% confidence interval of area under the plasma concentration-time curve from time 0 to the time of the last quantifiable concentration (AUC0-t ) and maximum plasma concentration (Cmax ) of ABI in fed state vs. fasted state were 351.64% (286.86%-431.04%) and 478.45% (390.01%-586.94%), respectively, while the corresponding results were ranging from 145.11% to 269.42% and 150.10% to 478.45% for AUC0-t and Cmax of ABI metabolites in fed state vs. fasted state, respectively. The SLCO2B1 rs1077858 had a significant influence on AUC0-t and Cmax , while 7 other SLCO2B1 variants prolonged half-life of ABI under both fasted and fed conditions. As for ABI metabolites, the systemic exposure of Δ4 -abiraterone, abiraterone sulfate and abiraterone N-oxide sulfate as well as the elimination of 3-keto-5α-abiraterone were significantly affected by SLCO2B1 polymorphisms. Polymorphisms in CYP3A4 and UGT1A4 did not significantly affect pharmacokinetics of ABI and its metabolites. CONCLUSION Polymorphisms in SLCO2B1 were significantly related to the pharmacokinetic variability of ABI and its metabolites under both fasted and fed conditions.
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Affiliation(s)
- Yixin Hu
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianyuan Wu
- Clinical Trial Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bingyu Cheng
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongli You
- Department of Pharmacology, Beijing Zhendong Pharmaceutical Research Institute Co, Ltd, Beijing, China
| | - Xueyan Yin
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Third Affiliated Hospital of School of Medicine, Shihezi University, Shihezi, China
| | - Guiying Chen
- Wuhan Hongren Biopharmaceutical Inc., Wuhan, China
| | - Ling Yang
- Wuhan Hongzhi Biomedical Inc., Wuhan, China
| | - Yang Zhang
- Wuhan Hongren Biopharmaceutical Inc., Wuhan, China
| | - Luqin Si
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongliang Jiang
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongjun Zhang
- The Third Affiliated Hospital of School of Medicine, Shihezi University, Shihezi, China
| | - Jianying Huang
- Clinical Trial Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiangeng Huang
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tannock IF, Bouche G, Goldstein DA, Goto Y, Lichter AS, Prabhash K, Ranganathan P, Saltz LB, Sonke GS, Strohbehn GW, von Moos R, Ratain MJ. Patient-centred, self-funding dose optimisation trials as a route to reduce toxicity, lower cost and improve access to cancer therapy. Ann Oncol 2023:S0923-7534(23)00687-7. [PMID: 37230253 DOI: 10.1016/j.annonc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Ian F Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada; Optimal Cancer Care Alliance, Ann Arbor, MI, USA.
| | - Gauthier Bouche
- Anticancer Fund, Meise, Belgium; Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Daniel A Goldstein
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | | | - Kumar Prabhash
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Leonard B Saltz
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA; Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gabe S Sonke
- Department of Medical Oncology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, & University of Amsterdam, Amsterdam, The Netherlands
| | - Garth W Strohbehn
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan; Section of Hematology Oncology, Veterans Affairs Ann Arbor Healthcare System; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Roger von Moos
- Department of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland & SAKK Competence Center, Bern
| | - Mark J Ratain
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA; Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
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Tamizhmathy M, Gupta U, Shettiwar A, Kumar GS, Daravath S, Aalhate M, Mahajan S, Maji I, Sriram A, Modak C, Rajalakshmi A, Dikundwar AG, Doijad N, Guru SK, Singh PK. Formulation of inclusion complex of Abiraterone acetate with 2-Hydroxypropyl-Beta-Cyclodextrin: physiochemical characterization, molecular docking and bioavailability evaluation. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2023.104321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Overbeek JK, Ter Heine R, Verheul HMW, Chatelut E, Rudek MA, Gurney H, Plummer R, Gilbert DC, Buclin T, Burger DM, Bloemendal HJ, van Erp NP. Off-label, but on target: the evidence needed to implement alternative dosing regimens of anticancer drugs. ESMO Open 2023; 8:100749. [PMID: 36603522 PMCID: PMC9813708 DOI: 10.1016/j.esmoop.2022.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- J K Overbeek
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - R Ter Heine
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - H M W Verheul
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Medical Oncology, Erasmus University MC Cancer Institute, Rotterdam, Netherlands
| | - E Chatelut
- Institut Claudius-Regaud, IUCT-Oncopole, and CRCT, Université de Toulouse, Inserm, 1, Toulouse, France; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore
| | - M A Rudek
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, USA; Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore; Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - H Gurney
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, Australia
| | - R Plummer
- Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | - D C Gilbert
- MRC Clinical Trials Unit, University College London (UCL), Institute of Clinical Trials and Methodology, London, UK; Optimal Cancer Care Alliance, Ann Arbor, USA
| | - T Buclin
- Division of Clinical Pharmacology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - D M Burger
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - H J Bloemendal
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen
| | - N P van Erp
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
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Mathew A, Benny SJ, Boby JM, Sirohi B. Value-Based Care in Systemic Therapy: The Way Forward. Curr Oncol 2022; 29:5792-5799. [PMID: 36005194 PMCID: PMC9406978 DOI: 10.3390/curroncol29080456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
The rising cost of cancer care has shed light on an important aspect of healthcare delivery. Financial toxicity of therapy must be considered in clinical practice and policy-making. One way to mitigate the impact of financial toxicity of cancer care is by focusing on an approach of healthcare delivery that aims to deliver value to the patient. Should value of therapy be one of the most important determinants of cancer care? If so, how do we measure it? How can we implement it in routine clinical practice? In this viewpoint, we discuss value-based care in systemic therapy in oncology. Strategies to improve the quality of care by incorporating value-based approaches are discussed: use of composite tools to assess the value of drugs, alternative dosing strategies, and the use of Health Technology Assessment in regulatory procedures. We propose that there must be a greater emphasis on value of therapy in determining its use and its cost.
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Affiliation(s)
- Aju Mathew
- Department of Oncology, MOSC Medical College, Ernakulam 682311, Kerala, India
- Correspondence:
| | | | | | - Bhawna Sirohi
- Department of Oncology, Balco Medical Center, Raipur 493661, Chattisgarh, India
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Schlichtig K, Cuba L, Dürr P, Bellut L, Meidenbauer N, Kunath F, Goebell PJ, Mackensen A, Dörje F, Fromm MF, Wullich B. New Oral Antitumor Drugs and Medication Safety in Uro-Oncology: Implications for Clinical Practice Based on a Subgroup Analysis of the AMBORA Trial. J Clin Med 2022; 11:jcm11154558. [PMID: 35956173 PMCID: PMC9369799 DOI: 10.3390/jcm11154558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
Oral antitumor therapeutics (OAT) bear a high risk for medication errors, e.g., due to drug–drug or drug–food interactions or incorrect drug intake. Advanced age, organ insufficiencies, and polymedication are putting uro-oncological patients at an even larger risk. This analysis sets out to (1) investigate the frequency and relevance of medication errors in patients with prostate cancer or renal cell carcinoma treated with OAT and (2) compile recommendations for clinical practice. This post-hoc subgroup analysis used data collected in the randomized AMBORA trial (2017–2020; DRKS00013271). Clinical pharmacologists/pharmacists conducted advanced medication reviews over 12 weeks after initiation of a new oral regimen and assessed the complete medication process for drug–related problems. Medication errors related to either the OAT, prescribed or prescription-free concomitant medication, or food were classified regarding cause and severity. We identified 67 medication errors in 38 patients within the complete medication within 12 weeks. Thereof, 55% were detected at therapy initiation, 27% were caused by the patients, and 25% were drug–drug or drug–food interactions. Problem-prone issues are summarized in a ‘medication safety table’ to provide recommendations for clinical practice in uro-oncology. Tailored strategies including intensified care by clinical pharmacologists/pharmacists should be implemented in clinical practice to improve medication safety.
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Affiliation(s)
- Katja Schlichtig
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Lisa Cuba
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Pharmacy Department, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Pauline Dürr
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Pharmacy Department, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Laura Bellut
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Urology and Pediatric Urology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Norbert Meidenbauer
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Internal Medicine 5, Hematology and Oncology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Frank Kunath
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Urology and Pediatric Urology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Peter J. Goebell
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Urology and Pediatric Urology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Andreas Mackensen
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Internal Medicine 5, Hematology and Oncology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Frank Dörje
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Pharmacy Department, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Martin F. Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Bernd Wullich
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Urology and Pediatric Urology, Erlangen University Hospital, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-822-3178
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11
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Danielak D, Krejčí T, Beránek J. Increasing the efficacy of abiraterone - from pharmacokinetics, through therapeutic drug monitoring to overcoming food effects with innovative pharmaceutical products. Eur J Pharm Sci 2022; 176:106254. [DOI: 10.1016/j.ejps.2022.106254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/02/2022] [Accepted: 07/02/2022] [Indexed: 11/03/2022]
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12
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Liu Y, Li Y, Xu P, Shen Y, Tang B, Wang Q. Development of Abiraterone Acetate Nanocrystal Tablets to Enhance Oral Bioavailability: Formulation Optimization, Characterization, In Vitro Dissolution and Pharmacokinetic Evaluation. Pharmaceutics 2022; 14:pharmaceutics14061134. [PMID: 35745707 PMCID: PMC9228621 DOI: 10.3390/pharmaceutics14061134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Abiraterone acetate is a prodrug of abiraterone used in combination with prednisone as a standard therapeutic strategy for hormone-resistant prostate cancer (mCRPC). Due to the poor solubility and permeability, the release and absorption of abiraterone acetate are low and reduce its bioavailability. In this project, abiraterone acetate tablets prepared using nanocrystal technology were developed to overcome the drawbacks of normal tablets by enhancing in vitro dissolution rate and oral bioavailability. The abiraterone acetate nanocrystal suspensions were prepared by top-down wet milling method using a planetary ball mill with the mixture of Poloxamer 407 and Poloxamer 188 as the optimized stabilizer at a ratio of 7:1. The optimized nanocrystals were freeze-dried and characterized using DLS, TEM, DSC, and XRD. The abiraterone acetate nanocrystal tablets significantly improve the in vitro dissolution rate of abiraterone acetate compared to raw materials. Although exhibiting a similar dissolution rate compared to the Zytiga® tablets, the nanocrystal tablets significantly improve the oral bioavailability with Cmax and AUC0–t being 3.51-fold and 2.80-fold higher, respectively, in the pharmacokinetic study. The present data indicate that nanocrystal is a promising strategy for improving the dissolution and bioavailability of abiraterone acetate.
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Affiliation(s)
- Yuanfen Liu
- Department of Clinical Medicine, Jiangsu Health Vocational College, Nanjing 211800, China;
| | - Yuqi Li
- Department of Pharmaceutics, College of Pharmacy, China Pharmaceutical University, Nanjing 211198, China; (Y.L.); (Y.S.)
| | - Pengcheng Xu
- Department of Pharmaceutical Engineering, College of Pharmacy, Inner Mongolia Medical University, Hohhot 010110, China;
| | - Yan Shen
- Department of Pharmaceutics, College of Pharmacy, China Pharmaceutical University, Nanjing 211198, China; (Y.L.); (Y.S.)
| | - Baoqiang Tang
- Department of Pharmaceutics, College of Pharmacy, China Pharmaceutical University, Nanjing 211198, China; (Y.L.); (Y.S.)
- Shenzhen Aoqi Biological Medicine Co., Ltd., Shenzhen 010110, China
- Correspondence: (B.T.); (Q.W.)
| | - Qiyue Wang
- School of Pharmaceutical Science, Nanjing Tech University, Nanjing 211816, China
- Correspondence: (B.T.); (Q.W.)
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13
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Beg S, Malik AK, Ansari MJ, Malik AA, Ali AMA, Theyab A, Algahtani M, Almalki WH, Alharbi KS, Alenezi SK, Barkat MA, Rahman M, Choudhry H. Systematic Development of Solid Lipid Nanoparticles of Abiraterone Acetate with Improved Oral Bioavailability and Anticancer Activity for Prostate Carcinoma Treatment. ACS OMEGA 2022; 7:16968-16979. [PMID: 35647451 PMCID: PMC9134222 DOI: 10.1021/acsomega.1c07254] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/03/2022] [Indexed: 06/15/2023]
Abstract
In the present work, an attempt was undertaken to improve the oral bioavailability and anticancer activity of abiraterone acetate. Solid lipid nanoparticles (SLNs) were developed using the quality by design (QbD) principles and evaluated through in vitro, ex vivo, and in vivo studies. Solid lipid suitability was evaluated by equilibrium solubility study, while surfactant and cosurfactant were screened based on the ability to form microemulsion with the selected lipid. SLNs were prepared by emulsion/solvent evaporation method using glyceryl monostearate, Tween 80, and Poloxamer 407 as the solid lipid, surfactant, and cosurfactant, respectively. Box-Behnken design was applied for optimization of material attributes and evaluating their impact on particle size, polydispersity index, zeta potential, and entrapment efficiency of the SLNs. In vitro drug release study was evaluated in simulated gastric and intestinal fluids. Cell culture studies on PC-3 cells were performed to evaluate the cytotoxicity of the drug-loaded SLNs in comparison to the free drug suspension. Qualitative uptake was evaluated for Rhodamine B-loaded SLNs and compared with free dye solution. Ex vivo permeability was evaluated on Wistar rat intestine and in vivo pharmacokinetic evaluation on Wistar rats for SLNs and free drug suspension. Concisely, the SLNs showed potential for significant improvement in the biopharmaceutical performance of the selected drug candidate over the existing formulations of abiraterone acetate.
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Affiliation(s)
- Sarwar Beg
- Department
of Pharmaceutics, School of Pharmaceutical Education and Research,
Nanomedicine Research Lab, Jamia Hamdard, New Delhi 110062, India
| | - Ankit K. Malik
- Department
of Pharmaceutics, School of Pharmaceutical Education and Research,
Nanomedicine Research Lab, Jamia Hamdard, New Delhi 110062, India
| | - Mohammad Javed Ansari
- Department
of Pharmaceutics, College of Pharmacy, Prince
Sattam Bin Abdulaziz University, Al-kharj 16278, Saudi Arabia
| | - Asrar A. Malik
- School
of Basic Sciences and Research, Department of Life Sciences, Sharda University, Greater Noida, Uttar Pradesh 201306, India
| | - Ahmed Mahmoud Abdelhaleem Ali
- Department
of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Abdulrahman Theyab
- Department
of Laboratory Medicine, Security Forces
Hospital, Mecca 21955, Saudi Arabia
| | - Mohammad Algahtani
- Department
of Laboratory Medicine, Security Forces
Hospital, Mecca 21955, Saudi Arabia
| | - Waleed H. Almalki
- Department
of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Al-Abidiyah 21955, Saudi Arabia
| | - Khalid S. Alharbi
- Department
of Pharmacology, College of Pharmacy, Jouf
University, Sakakah 72388, Saudi Arabia
| | - Sattam K. Alenezi
- Department
of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Qassim 52222, Saudi Arabia
| | - Md. Abul Barkat
- Department
of Pharmaceutics, College of Pharmacy, University
of Hafr, Al Batin 39524, Saudi Arabia
| | - Mahfoozur Rahman
- Department
of Pharmaceutical Sciences, Shalom Institute of Health and Allied
Sciences, Sam Higginbottom University of
Agriculture, Technology and Sciences, Allahabad 211007, India
| | - Hani Choudhry
- Department
of Biochemistry, Cancer Metabolism and Epigenetic Unit, Faculty of
Science, King Fahd Center for Medical Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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14
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Dey T, Goyal S, Periasamy K, Madan R. Is Low-Dose Abiraterone for Prostate Cancer An Attractive Strategy for Limited Resource Settings? Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractAbiraterone acetate in combination with prednisone is approved for locally advanced as well as metastatic (hormone-sensitive and castrate-resistant) prostate cancer, with overall or disease-free survival gains in suitable patients. Long-term use poses a significant financial strain on the self-paying patients as well as the national health insurance schemes. Abiraterone is known to be a drug with a high “food effect” with increased bioavailability following high fat diet. Some retrospective series and phase 1 and 2 clinical studies have explored the use of low-dose abiraterone (at 25% of standard dose) with high fat meal with similar bioavailability and biochemical response to the standard drug dose. We review and report the available literature for this approach and discuss the financial and scientific implications of the same.
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Affiliation(s)
- Treshita Dey
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kannan Periasamy
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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15
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Yang Z, Yang Y, Xia M, Dai W, Zhu B, Mei X. Improving the dissolution behaviors and bioavailability of abiraterone acetate via multicomponent crystal forms. Int J Pharm 2022; 614:121460. [PMID: 35026315 DOI: 10.1016/j.ijpharm.2022.121460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
Abiraterone acetate (ABA), the first-line drug for the treatment of metastatic castration resistant prostate cancer (mCRPC), is administered at a high daily dosage of 1000 mg due to its poor solubility, and its fasted absolute oral bioavailability is estimated to be less than 10%. In this work we have focused on developing multicomponent forms with improved dissolution behaviors and bioavailability. Two salts of ABA with malonic acid (ABA-MA) and saccharin (ABA-SAC), and five cocrystals with trans-aconitic acid (ABA-TAA), 1-hydroxy-2-naphthoic acid (ABA-1HNA), pyrocatechol (ABA-PCA), resorcinol (ABA-RES) and hydroquinone (ABA-HDE) were successfully obtained. Their crystal structures were elucidated by single crystal X-ray diffraction, and these multicomponent forms were fully characterized by powder X-ray diffraction, thermal analysis and Fourier Transform Infrared spectra. Among them, ABA-TAA cocrystal shows substantial enhancements both in the solubility and intrinsic dissolution rates in different buffer solutions. In the meantime, we unexpectedly found the gelation of ABA-MA salt and ABA-SAC salt in pH 2.0 buffer solution. The gel-like materials generated on the surface of drug will suppress the release of ABA. Moreover, in vivo pharmacokinetic study on beagle dogs was conducted for ABA-TAA cocrystal preparation and ABA commercial product, and ABA-TAA cocrystal preparation shows enhanced absorption. These advantages in dissolution behaviors and bioavailability demonstrate the potential of ABA-TAA cocrystal to be a better candidate for the treatment of mCRPC compared with ABA.
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Affiliation(s)
- Zeen Yang
- Pharmaceutical Analytical & Solid-State Chemistry Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing 100049, China
| | - Yinghong Yang
- Pharmaceutical Analytical & Solid-State Chemistry Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing 100049, China
| | - Mengyuan Xia
- Pharmaceutical Analytical & Solid-State Chemistry Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing 100049, China
| | - Wenjuan Dai
- Pharmaceutical Analytical & Solid-State Chemistry Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China
| | - Bingqing Zhu
- Pharmaceutical Analytical & Solid-State Chemistry Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China.
| | - Xuefeng Mei
- Pharmaceutical Analytical & Solid-State Chemistry Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Shanghai 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing 100049, China.
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16
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Owens K, Argon S, Yu J, Yang X, Wu F, Lee SC, Sun WJ, Ramamoorthy A, Zhang L, Ragueneau-Majlessi I. Exploring the Relationship of Drug BCS Classification, Food Effect, and Gastric pH-Dependent Drug Interactions. AAPS J 2021; 24:16. [PMID: 34961909 DOI: 10.1208/s12248-021-00667-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/16/2021] [Indexed: 01/16/2023] Open
Abstract
Food effect (FE) and gastric pH-dependent drug-drug interactions (DDIs) are both absorption-related. Here, we evaluated if Biopharmaceutics Classification System (BCS) classes may be correlated with FE or pH-dependent DDIs. Trends in FE data were investigated for 170 drugs with clinical FE studies from the literature and new drugs approved from 2013 to 2019 by US Food and Drug Administration. A subset of 38 drugs was also evaluated to determine whether FE results can inform the need for a gastric pH-dependent DDI study. The results of FE studies were defined as no effect (AUC ratio 0.80-1.25), increased exposure (AUC ratio ≥1.25), or decreased exposure (AUC ratio ≤0.8). Drugs with significantly increased exposure FE (AUC ratio ≥2.0; N=14) were BCS Class 2 or 4, while drugs with significantly decreased exposure FE (AUC ratio ≤0.5; N=2) were BCS Class 1/3 or 3. The lack of FE was aligned with the lack of a pH-dependent DDI for all 7 BCS Class 1 or 3 drugs as expected. For the 13 BCS Class 2 or 4 weak base drugs with an increased exposure FE, 6 had a pH-dependent DDI (AUC ratio ≤0.8). Among the 16 BCS Class 2 or 4 weak base drugs with no FE, 6 had a pH-dependent DDI (AUC ratio ≤0.8). FE appears to have limited correlation with BCS classes except for BCS Class 1 drugs, confirming that multiple physiological mechanisms can impact FE. Lack of FE does not indicate absence of pH-dependent DDI for BCS Class 2 or 4 drugs. Graphical Abstract.
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Affiliation(s)
- Katie Owens
- Department of Pharmaceutics, University of Washington, H-272 Health Sciences Building, Box 357610, Seattle, Washington, 98195, USA.
| | - Sophie Argon
- Department of Pharmaceutics, University of Washington, H-272 Health Sciences Building, Box 357610, Seattle, Washington, 98195, USA
| | - Jingjing Yu
- Department of Pharmaceutics, University of Washington, H-272 Health Sciences Building, Box 357610, Seattle, Washington, 98195, USA
| | - Xinning Yang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Fang Wu
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sue-Chih Lee
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Wei-Jhe Sun
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Anuradha Ramamoorthy
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lei Zhang
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Isabelle Ragueneau-Majlessi
- Department of Pharmaceutics, University of Washington, H-272 Health Sciences Building, Box 357610, Seattle, Washington, 98195, USA
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17
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Jordán T, Basa-Dénes O, Angi R, Orosz J, Ötvös Z, Ujhelyi A, Filipcsei G, Molnár L, Solymosi T, Glavinas H, Capone D, Whitfield N, McDermott J, McKenzie L, Shurety L, Duus EM. Dose Finding and Food Effect Studies of a Novel Abiraterone Acetate Formulation for Oral Suspension in Comparison to a Reference Formulation in Healthy Male Subjects. Pharmaceutics 2021; 13:pharmaceutics13122171. [PMID: 34959452 PMCID: PMC8705659 DOI: 10.3390/pharmaceutics13122171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022] Open
Abstract
Currently approved formulations of the androgen synthesis inhibitor abiraterone acetate (AA) consist of multiple tablets administered daily in a fasted state. Removing the food effect and switching to a suspension formulation is expected to improve the pharmacokinetic profile and facilitate drug administration for patients with late-stage prostate cancer. Two four-sequence, four-period randomized crossover investigations were undertaken to establish the pharmacokinetic profiles of single doses of commercially available Zytiga®, as the reference AA (R-AA), and a novel tablet for oral suspension (TOS). Four single doses of TOS (from 62.5 to 250 mg) were compared in study C01, and two single doses each of TOS (250 mg) and R-AA (1000 mg) were compared under fasted and fed (modified fasted for R-AA) conditions in C02. Plasma concentrations of abiraterone over time were measured, and pharmacokinetic parameters were calculated. Each doubling of the dose of TOS was associated with a greater than 3-fold increase in exposure. A single dose of TOS (250 mg) exhibited similar exposure over 24 h, whether given fasted (625 ng × h/mL) or fed (485 ng × h/mL). A single dose of TOS (250 mg) was associated with higher (fasted, p = 0.028) or equivalent exposure (fed) compared to 1000 mg R-AA fasted (532 ng × h/mL). Substantially higher exposures were seen with 1000 mg R-AA under modified fasted conditions compared to TOS, irrespective of prandial status (p < 0.001). TOS was generally safe and well tolerated in the study. A 250 mg dose of a novel AA formulation for oral suspension demonstrated bioequivalence to 1000 mg R-AA under fasted conditions. This novel TOS formulation also addresses some of the limitations of current AA treatment, including low bioavailability, high variability in systemic exposure and a large food effect. It may offer an alternative for patients with dysphagia or discomfort with swallowing large pills.
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Affiliation(s)
- Tamás Jordán
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - Orsolya Basa-Dénes
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - Réka Angi
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - János Orosz
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - Zsolt Ötvös
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - Andrea Ujhelyi
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - Genovéva Filipcsei
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - László Molnár
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - Tamás Solymosi
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - Hristos Glavinas
- Tavanta Therapeutics Hungary Inc., Madarász Viktor utca 47-49, 1138 Budapest, Hungary; (T.J.); (O.B.-D.); (R.A.); (J.O.); (Z.Ö.); (A.U.); (G.F.); (L.M.); (T.S.); (H.G.)
| | - Dominic Capone
- Tavanta Therapeutics Inc., 201 King of Prussia Rd., Suite 650, Radnor, PA 19087, USA; (D.C.); (N.W.)
| | - Nicola Whitfield
- Tavanta Therapeutics Inc., 201 King of Prussia Rd., Suite 650, Radnor, PA 19087, USA; (D.C.); (N.W.)
| | - John McDermott
- Quotient Sciences Ltd., Mere Way, Ruddington, Nottingham NG11 6JS, UK; (J.M.); (L.M.); (L.S.)
| | - Litza McKenzie
- Quotient Sciences Ltd., Mere Way, Ruddington, Nottingham NG11 6JS, UK; (J.M.); (L.M.); (L.S.)
| | - Lauren Shurety
- Quotient Sciences Ltd., Mere Way, Ruddington, Nottingham NG11 6JS, UK; (J.M.); (L.M.); (L.S.)
| | - Elizabeth Manning Duus
- Tavanta Therapeutics Inc., 201 King of Prussia Rd., Suite 650, Radnor, PA 19087, USA; (D.C.); (N.W.)
- Correspondence: ; Tel.: +1-833-776-8963
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18
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Sakai Y, Fukami T, Nagaoka M, Hirosawa K, Ichida H, Sato R, Suzuki K, Nakano M, Nakajima M. Arylacetamide deacetylase as a determinant of the hydrolysis and activation of abiraterone acetate in mice and humans. Life Sci 2021; 284:119896. [PMID: 34450168 DOI: 10.1016/j.lfs.2021.119896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/30/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022]
Abstract
AIM Abiraterone acetate for metastatic castration-resistant prostate cancer is an acetylated prodrug to be hydrolyzed to abiraterone. Abiraterone acetate is known to be hydrolyzed by pancreatic cholesterol esterase secreted into the intestinal lumen. This study aimed to investigate the possibility that arylacetamide deacetylase (AADAC) expressed in enterocytes contributes to the hydrolysis of abiraterone acetate based on its substrate preference. MATERIALS AND METHODS Abiraterone acetate hydrolase activity was measured using human intestinal (HIM) and liver microsomes (HLM) as well as recombinant AADAC. Correlation analysis between activity and AADAC expression was performed in 14 individual HIMs. The in vivo pharmacokinetics of abiraterone acetate was examined using wild-type and Aadac knockout mice administered abiraterone acetate with or without orlistat, a pancreatic cholesterol esterase inhibitor. KEY FINDINGS Recombinant AADAC showed abiraterone acetate hydrolase activity with similar Km value to HIM and HLM. The positive correlation between activity and AADAC levels in individual HIMs supported the responsibility of AADAC for abiraterone acetate hydrolysis. The area under the plasma concentration-time curve (AUC) of abiraterone after oral administration of abiraterone acetate in Aadac knockout mice was 38% lower than that in wild-type mice. The involvement of pancreatic cholesterol esterase in abiraterone formation was revealed by the decreased AUC of abiraterone by coadministration of orlistat. Orlistat potently inhibited AADAC, implying its potential as a perpetrator of drug-drug interactions. SIGNIFICANCE AADAC is responsible for the hydrolysis of abiraterone acetate in the intestine and liver, suggesting that concomitant use of abiraterone acetate and drugs potently inhibiting AADAC should be avoided.
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Affiliation(s)
- Yoshiyuki Sakai
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Tatsuki Fukami
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan; WPI Nano Life Science Institute, Kakuma-machi, Kanazawa 920-1192, Japan.
| | - Mai Nagaoka
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Keiya Hirosawa
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Hiroyuki Ichida
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Rei Sato
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Kohei Suzuki
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Masataka Nakano
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan; WPI Nano Life Science Institute, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Miki Nakajima
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan; WPI Nano Life Science Institute, Kakuma-machi, Kanazawa 920-1192, Japan
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19
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García-Perdomo HA, Gómez-Ospina JC, Chaves-Medina MJ, Sierra JM, Gómez AMA, Rivas JG. Impact of lifestyle in prostate cancer patients. What should we do? Int Braz J Urol 2021; 48:244-262. [PMID: 34472770 PMCID: PMC8932020 DOI: 10.1590/s1677-5538.ibju.2021.0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: This review aimed to analyze interventions raised within primary and tertiary prevention concerning the disease's incidence, progression, and recurrence of Prostate Cancer (PCa). Priority was given to the multidisciplinary approach of PCa patients with an emphasis on modifiable risk factors. Materials and Methods: We conducted a comprehensive literature review in the following databases: Embase, Central, and Medline. We included the most recent evidence assessing cohort studies, case-control studies, clinical trials, and systematic reviews published in the last five years. We only included studies in adults and in vitro or cell culture studies. The review was limited to English and Spanish articles. Results: Preventive interventions at all levels are the cornerstone of adherence to disease treatment and progression avoidance. The relationship in terms of healthy lifestyles is related to greater survival. The risk of developing cancer is associated to different eating habits, determined by geographic variations, possibly related to different genetic susceptibilities. Discussion: PCa is the second most common cancer in men, representing a leading cause of death among men in Latin America. Prevention strategies and healthy lifestyles are associated with higher survival rates in PCa patients. Also, screening for anxiety and the presence of symptoms related to mood disorders is essential in the patient's follow-up concerning their perception of the condition.
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Affiliation(s)
- Herney Andrés García-Perdomo
- Division of Urology/Uroooncology, Department of Surgery, School of Medicine, Universidad Del Valle, Cali, Colombia.,UROGIV Research Group, School of Medicine, Universidad Del Valle, Cali, Colombia
| | | | | | | | | | - Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
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20
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Affiliation(s)
- Ian F. Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Amol Patel
- Department of Medicine, Oncology Centre, Indian Naval Hospital Ship, Asvini, Colaba, Mumbai, Maharashtra, India
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21
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Ryšánek P, Grus T, Lukáč P, Kozlík P, Křížek T, Pozniak J, Roušarová J, Královičová J, Kutinová Canová N, Boleslavská T, Bosák J, Štěpánek F, Šíma M, Slanař O. Validity of cycloheximide chylomicron flow blocking method for the evaluation of lymphatic transport of drugs. Br J Pharmacol 2021; 178:4663-4674. [PMID: 34365639 DOI: 10.1111/bph.15644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/14/2021] [Accepted: 07/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Lymphatic transport of drugs after oral administration is an important mechanism for absorption of highly lipophilic compounds. Direct measurement in lymph duct cannulated animals is the gold standard method, but non-invasive cycloheximide chylomicron flow blocking method has gained popularity recently. However, concerns about its reliability have been raised. The aim of this work was to investigate the validity of cycloheximide chylomicron flow blocking method for the evaluation of lymphatic transport using model compounds with high to very high lipophilicity, that is, abiraterone and cinacalcet. EXPERIMENTAL APPROACH Series of pharmacokinetic studies were conducted with abiraterone acetate and cinacalcet hydrochloride after enteral/intravenous administration to intact, lymph duct cannulated and/or cycloheximide pre-treated rats. KEY RESULTS Mean total absolute oral bioavailability of abiraterone and cinacalcet was 7.0% and 28.7%, respectively. There was a large and significant overestimation of the lymphatic transport extent by the cycloheximide method. Mean relative lymphatic bioavailability of abiraterone and cinacalcet in cycloheximide method was 28-fold and 3-fold higher than in cannulation method, respectively. CONCLUSION AND IMPLICATIONS Cycloheximide chylomicron flow blocking method did not provide reliable results on lymphatic absorption and substantially overestimated lymphatic transport for both molecules, that is, abiraterone and cinacalcet. This non-invasive method should not be used for the assessment of lymphatic transport and previously obtained data should be critically revised.
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Affiliation(s)
- Pavel Ryšánek
- Institute of Pharmacology, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Tomáš Grus
- Department of Cardiovascular Surgery, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Peter Lukáč
- Department of Cardiovascular Surgery, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Petr Kozlík
- Department of Analytical Chemistry, Faculty of Science, Charles University, Prague, Czech Republic
| | - Tomáš Křížek
- Department of Analytical Chemistry, Faculty of Science, Charles University, Prague, Czech Republic
| | - Jiří Pozniak
- Third Department of Surgery, First Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Jaroslava Roušarová
- Institute of Pharmacology, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Jana Královičová
- Institute of Pharmacology, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Nikolina Kutinová Canová
- Institute of Pharmacology, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Tereza Boleslavská
- Preformulation and Biopharmacy Department/Clinical Development Department, Zentiva, k.s, Prague, Czech Republic.,Department of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Jan Bosák
- Preformulation and Biopharmacy Department/Clinical Development Department, Zentiva, k.s, Prague, Czech Republic
| | - František Štěpánek
- Department of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Martin Šíma
- Institute of Pharmacology, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Ondřej Slanař
- Institute of Pharmacology, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
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22
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Patel A, Tannock IF, Srivastava P, Biswas B, Gupta VG, Batra A, Bhethanabhotla S, Pramanik R, Mahindru S, Tilak T, Das CK, Mehta P. Low-Dose Abiraterone in Metastatic Prostate Cancer: Is It Practice Changing? Facts and Facets. JCO Glob Oncol 2021; 6:382-386. [PMID: 32125899 PMCID: PMC7113122 DOI: 10.1200/jgo.19.00341] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE It is projected that approximately 50,000 new cases of prostate cancer will be diagnosed in 2020 in India. Survival has improved because of the development of effective drugs such as abiraterone acetate, but universal accessibility to treatment is not always possible because of cost constraints in lower- and middle-income countries. Recently, the National Comprehensive Cancer Network (NCCN) has included low-dose abiraterone (250 mg/day) with food as an alternative treatment option to full-dose abiraterone (1,000 mg/day) fasting. METHODS The Science and Cost Cancer Consortium conducted a survey to evaluate the use of abiraterone in India and the opinions of medical oncologists about using low-dose treatment. Modeling was used to estimate potential financial benefits to individual patients and to estimate overall costs of health care in India if low-dose abiraterone is prescribed. RESULTS Of 251 Indian medical oncologists who were invited to participate in the survey, 125 provided their e-mail address and received the survey; 118 responded (47% of the total). Of these, 25% were not aware of the recent NCCN recommendation, 55% were already prescribing low-dose abiraterone when resources were limited, 7% had already changed their practice, and 29% agreed to switch to a universal practice of using low-dose abiraterone with food; 9% of practitioners would not use low-dose abiraterone. Estimated mean per patient savings was US$3,640, with annual savings of US$182 million in India. CONCLUSION Use of lower-dose abiraterone would increase access to treatment in India and globally and lead to large cost savings.
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Affiliation(s)
- Amol Patel
- Malignant Diseases Treatment Centre, Army Hospital Research & Referral, New Delhi, India
| | - Ian F Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Priyanka Srivastava
- M.S. Patel Cancer Center, Shreekrishna Hospital and Research Center, Karamsad, Gujarat, India
| | | | - Vineet Govinda Gupta
- Department of Medical Oncology and Hemato-Oncology, Artemis Hospital, Gurugram, Haryana, India
| | - Atul Batra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Raja Pramanik
- All India Institute of Medical Sciences, New Delhi, India
| | - Shubh Mahindru
- Department of Surgical Oncology, Ivy Hospital, Sahibzada Ajit Singh Nagar, Punjab, India
| | - Tvsvgk Tilak
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Chandan Krishna Das
- Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Mehta
- Department of Medical Oncology/Hematology/Bone Marrow Transplantation, Asian Institute of Medical Sciences, Faridabad, Haryana, India
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23
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Gala UH, Miller DA, Su Y, Spangenberg A, Williams ROB. The effect of drug loading on the properties of abiraterone-hydroxypropyl beta cyclodextrin solid dispersions processed by solvent free KinetiSol® technology. Eur J Pharm Biopharm 2021; 165:52-65. [PMID: 33979662 DOI: 10.1016/j.ejpb.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Abiraterone is a poorly water-soluble drug used in the treatment of prostate cancer. In our previous study, we reported that KinetiSol® processed solid dispersions (KSDs) based on hydroxypropyl β-cyclodextrin (HPBCD) showed improved dissolution and pharmacokinetics of abiraterone. However, the nature of abiraterone-HPBCD interaction within the KSDs or the effect of drug loading on the physicochemical properties and in vivo performance of HPBCD-based KSDs remain largely unknown. We hypothesize that KinetiSol technology can prepare abiraterone-HPBCD complexes within KSDs and that increasing the drug loading beyond an optimal point reduces the in vitro and in vivo performance of these KSDs. To confirm our hypothesis, we developed KSDs with 10-50% w/w drug loading and analyzed them using X-ray diffractometry and modulated differential scanning calorimetry. We found that KSDs containing 10-30% drug were amorphous. Interestingly, two-dimensional solid-state nuclear magnetic resonance and Raman spectroscopy indicated that the abiraterone-HPBCD complexes were formed. At elevated temperatures, the 10% and 20% drug-loaded KSDs were physically stable, while the 30% drug-loaded KSD showed recrystallization of abiraterone. In vitro dissolution and in vivo pharmacokinetic performances improved as the drug loading decreased; we attribute this to increased noncovalent interactions between abiraterone and HPBCD at lower drug loadings. Overall, the 10% drug loaded KSD showed a dissolution enhancement of 15.7-fold compared to crystalline abiraterone, and bioavailability enhancement of 3.9-fold compared to the commercial abiraterone acetate tablet Zytiga®. This study is first to confirm that KinetiSol, a high-energy, solvent-free technology, is capable of forming abiraterone-HPBCD complexes. Furthermore, in terms of in vitro and in vivo performance, a 10% drug load is optimal.
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Affiliation(s)
- Urvi H Gala
- DisperSol Technologies LLC, 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, United States.
| | - Dave A Miller
- DisperSol Technologies LLC, 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, United States.
| | - Yongchao Su
- Merck & Co. Inc., 90 E Scott Ave, Rahway, NJ 07065, United States.
| | - Angela Spangenberg
- DisperSol Technologies LLC, 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, United States.
| | - Robert O Bill Williams
- The University of Texas at Austin, College of Pharmacy, 2409 West University Avenue, PHR 4.214, Austin, TX 78712, United States.
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24
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Shpilsky J, Stevens J, Bubley G. An up-to-date evaluation of abiraterone for the treatment of prostate cancer. Expert Opin Pharmacother 2021; 22:1227-1234. [PMID: 33856289 DOI: 10.1080/14656566.2021.1915287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Abiraterone acetate, an oral 17-alpha-hydroxylase inhibitor, effectively prevents the synthesis of androgens from steroid precursors. Abiraterone has become a standard of care in patients with metastatic prostate cancer due to its efficacy in both castrate-sensitive and castrate-resistant disease when given in combination with androgen deprivation therapy (ADT). Abiraterone may have a role in additional aspects of prostate cancer treatment in the future.Areas covered: The present article focuses on the development and establishment of abiraterone among the available treatment options for prostate cancer. A literature search was performed in PubMed/Medline for prior studies and reviews of the drug. Current clinical trials were examined in the Clinicaltrials.gov database.Expert opinion: Abiraterone has shown efficacy in castrate-resistant metastatic prostate cancer, providing an additional degree of hormonal sensitivity for tumors resistant to ADT. Impressively, abiraterone in conjunction with ADT as a first-line treatment for castrate-sensitive prostate cancer also confers a significant overall survival benefit compared to ADT alone. With minimal additional toxicity, abiraterone has established itself as a well-tolerated, convenient, and effective treatment option. Ongoing studies are expected to broaden the drug's indications as well as its preference among other prostate cancer therapies.
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Affiliation(s)
- Jason Shpilsky
- Clinical Fellow in Hematology/Oncology, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julia Stevens
- Clinical Pharmacy Specialist, Ambulatory Oncology, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Glenn Bubley
- Director of Genitourinary Oncology, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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25
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Maluf FC, Pereira FMT, Silva AG, Dettino ALA, Cardoso APG, Sasse AS, Soares A, Kann AG, Herchenhorn D, Jardim DLF, Cortés DEL, Kater FR, Morbeck IAP, Reolon JFN, Rinck JA, Zarbá JJ, Sade JP, da Trindade KM, Costa LAGA, Dos Santos LV, Maia MC, Siqueira MB, Gillessen S. Consensus on the Treatment and Follow-Up for Metastatic Castration-Resistant Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries (PCCCDC). JCO Glob Oncol 2021; 7:559-571. [PMID: 33856891 PMCID: PMC8162971 DOI: 10.1200/go.20.00511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To present a summary of the recommendations for the treatment and follow-up for metastatic castration-resistant prostate cancer (mCRPC) as acquired through a questionnaire administered to 99 physicians working in the field of prostate cancer in developing countries who attended the Prostate Cancer Consensus Conference for Developing Countries. METHODS A total of 106 questions out of more than 300 questions addressed the use of imaging in staging mCRPC, treatment recommendations across availability and response to prior drug treatments, appropriate drug treatments, and follow-up, and those same scenarios when limited resources needed to be considered. Responses were compiled and the percentages were presented by clinicians to support each response. Most questions had five to seven relevant options for response including abstain and/or unqualified to answer, or in the case of yes or no questions, the option to abstain was offered. RESULTS Most of the recommendations from this panel were in line with prior consensus, including the preference of a new antiandrogen for first-line therapy of mCRPC. Important aspects highlighted in the scenario of limited resources included the option of docetaxel as treatment preference as first-line treatment in several scenarios, docetaxel retreatment, consideration for reduced doses of abiraterone, and alternative schedules of an osteoclast-targeted therapy. CONCLUSION There was wide-ranging consensus in the treatment for men with mCRPC in both optimal and limited resource settings.
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Affiliation(s)
- Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
| | | | - Adriano Gonçalves Silva
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Oncologia Clínica ICTr, Curitiba, Brazil
| | | | - Ana Paula Garcia Cardoso
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
| | - André Seeke Sasse
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Grupo Sonhe, Campinas, Brazil
| | - Andrey Soares
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Centro Paulista de Oncologia, Oncoclínicas, São Paulo, Brazil
| | - Ariel Galapo Kann
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Daniel Herchenhorn
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Grupo de oncologia D'Or, Rio de Janeiro, Brazil.,Instituto D'Or de ensino e pesquisa, Rio de Janeiro, Brazil
| | | | | | - Fábio Roberto Kater
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
| | - Igor A Protzner Morbeck
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Hospital Sírio Libanês, Brasília, Brazil.,Universidade Católica de Brasília, Brasília, Brazil
| | - João Francisco Navarro Reolon
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
| | - José Augusto Rinck
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Hospital AC Camargo, São Paulo, Brazil
| | - Juan Jose Zarbá
- Hospital Zenon Santillán, Nacional University of Tucumán, Tucumán, Argentina
| | - Juan Pablo Sade
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Instituto Alexander Fleming y de la Universidad Austral, Buenos Aires, Argentina
| | - Karine Martins da Trindade
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,IEP-Instituto de Ensino e Pesquisa Oncocentro, Fortaleza, Brazil
| | - Leonardo Atem G A Costa
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Grupo de oncologia D'Or, Rio de Janeiro, Brazil
| | | | - Manuel Caitano Maia
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Centro de Oncologia do Paraná, Curitiba, Brazil
| | - Mariana Bruno Siqueira
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Grupo de oncologia D'Or, Rio de Janeiro, Brazil
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona and Università della Svizzera Italiana, Lugano, Switzerland.,Manchester Cancer Research Centre, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
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26
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Tannock IF, Ratain MJ, Goldstein DA, Lichter AS, Rosner GL, Saltz LB. Near-Equivalence: Generating Evidence to Support Alternative Cost-Effective Treatments. J Clin Oncol 2021; 39:950-955. [DOI: 10.1200/jco.20.02768] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Ten Ham RMT, van Nuland M, Vreman RA, de Graaf LG, Rosing H, Bergman AM, Huitema ADR, Beijnen JH, Hövels AM. Cost-Effectiveness Assessment of Monitoring Abiraterone Levels in Metastatic Castration-Resistant Prostate Cancer Patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:121-128. [PMID: 33431146 DOI: 10.1016/j.jval.2020.04.1838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/28/2020] [Accepted: 04/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Abiraterone acetate is registered for the treatment of metastatic castration-sensitive and resistant prostate cancer (mCRPC). Treatment outcome is associated with plasma trough concentrations (Cmin) of abiraterone. Patients with a plasma Cmin below the target of 8.4 ng/mL may benefit from treatment optimization by dose increase or concomitant intake with food. This study aims to investigate the cost-effectiveness of monitoring abiraterone Cmin in patients with mCRPC. METHODS A Markov model was built with health states progression-free survival, progressed disease, and death. The benefits of monitoring abiraterone Cmin followed by a dose increase or food intervention were modeled via a difference in the percentage of patients achieving adequate Cmin taking a healthcare payer perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainties and their impac to the incremental cost-effectiveness ratio (ICER). RESULTS Monitoring abiraterone followed by a dose increase resulted in 0.149 incremental quality-adjusted life-years (QALYs) with €22 145 incremental costs and an ICER of €177 821/QALY. The food intervention assumed equal effects and estimated incremental costs of €7599, resulting in an ICER of €61 019/QALY. The likelihoods of therapeutic drug monitoring (TDM) with a dose increase or food intervention being cost-effective were 8.04%and 81.9%, respectively. CONCLUSIONS Monitoring abiraterone followed by a dose increase is not cost-effective in patients with mCRPC from a healthcare payer perspective. Monitoring in combination with a food intervention is likely to be cost-effective. This cost-effectiveness assessment may assist decision making in future integration of abiraterone TDM followed by a food intervention into standard abiraterone acetate treatment practices of mCRPC patients.
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Affiliation(s)
- Renske M T Ten Ham
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Merel van Nuland
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Laurens G de Graaf
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - André M Bergman
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jos H Beijnen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anke M Hövels
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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28
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Premnath N, Sedhom R, Gupta A. Potential Cost Savings With Low-Dose Abiraterone in the United States. JCO Glob Oncol 2020; 6:743-744. [PMID: 32437265 PMCID: PMC7268904 DOI: 10.1200/go.20.00140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Naveen Premnath
- Naveen Premnath, MD, University of Texas Southwestern Medical Center, Dallas, TX; and Ramy Sedhom, MD and Arjun Gupta, MD, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Ramy Sedhom
- Naveen Premnath, MD, University of Texas Southwestern Medical Center, Dallas, TX; and Ramy Sedhom, MD and Arjun Gupta, MD, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Arjun Gupta
- Naveen Premnath, MD, University of Texas Southwestern Medical Center, Dallas, TX; and Ramy Sedhom, MD and Arjun Gupta, MD, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
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29
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Rauh S, Mavroeidis L, Ntellas P, Gazouli I, Gkoura S, Papadaki A, Mauri D, Metaxas Y, Douillard JY, Pentheroudakis G. Old drug, new clinical use, no man's land for the indication: an awareness call from European experts. ESMO Open 2020; 5:e000615. [PMID: 33551069 PMCID: PMC7046389 DOI: 10.1136/esmoopen-2019-000615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/17/2019] [Accepted: 02/06/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Stefan Rauh
- Department of Hemato Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg.
| | - Leonidas Mavroeidis
- Department of Medical Oncology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Panagiotis Ntellas
- Department of Medical Oncology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Ioanna Gazouli
- Department of Medical Oncology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Stefania Gkoura
- Department of Medical Oncology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Alexandra Papadaki
- Society of Study of Clonal Heterogeneity of Neoplasia EMEKEN, Ioannina, Greece
| | - Davide Mauri
- Department of Medical Oncology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Yannis Metaxas
- Oncology/Hematology, Kantonsspital Graubunden, Chur, Graubünden, Switzerland
| | | | - George Pentheroudakis
- Department of Medical Oncology, University of Ioannina School of Medicine, Ioannina, Greece
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30
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Boleslavská T, Rychecký O, Krov M, Žvátora P, Dammer O, Beránek J, Kozlík P, Křížek T, Hořínková J, Ryšánek P, Roušarová J, Canová NK, Šíma M, Slanař O, Štěpánek F. Bioavailability Enhancement and Food Effect Elimination of Abiraterone Acetate by Encapsulation in Surfactant-Enriched Oil Marbles. AAPS JOURNAL 2020; 22:122. [DOI: 10.1208/s12248-020-00505-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/27/2020] [Indexed: 02/08/2023]
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Kuang Y, Song HL, Yang GP, Pei Q, Yang XY, Ye L, Yang S, Wu ST, Guo C, He QN, Huang J. Effect of high-fat diet on the pharmacokinetics and safety of flumatinib in healthy Chinese subjects. Cancer Chemother Pharmacol 2020; 86:339-346. [PMID: 32757049 PMCID: PMC7479006 DOI: 10.1007/s00280-020-04117-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/19/2020] [Indexed: 11/30/2022]
Abstract
Purpose To evaluate the effect of a high-fat diet on the pharmacokinetics and safety of flumatinib mesylate tablets in healthy Chinese subjects. Methods This study was a randomized, open-label, single-dose, two-period crossover trial in which subjects were randomly assigned to take 400 mg of flumatinib mesylate after a high-fat diet or a fasted state. After a 14-day washout period, the two groups were administered flumatinib mesylate under opposite conditions. Blood samples were collected at baseline 0 and 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 10, 12, 24, 48, 72, and 96 h, respectively. Plasma concentrations of flumatinib and its metabolites (M1 and M3) were analyzed using liquid chromatography-mass spectrometry. Pharmacokinetic parameters were calculated using the non-compartmental module of the Phoenix WinNonlin Version 7.0 software. BE module of WinNonLin was used for statistical analysis of AUC0–t, AUC0–∞ and Cmax in plasma. Results Twelve healthy subjects, half male and half female, were enrolled. One subject withdrew due to a treatment-emergent adverse event. Eleven subjects were administered drugs on fasting and 12 were administered drugs after a high-fat diet. On high-fat diet/fasting, the least square geometric mean (LSGM) ratios of flumatinib, M1, M3, and their 90% confidence interval (CI) were as follows: for flumatinib, Cmax, AUC0–t and AUC0–∞ were 281.65% (225.80–351.31%), 167.43% (143.92–194.79%), and 166.87% (143.47–194.09%); for M1, Cmax, AUC0–t, and AUC0–∞ were 188.59% (145.29–244.79), 163.94% (149.11–180.24%), and 164.48% (150.36–179.94%); for M3, Cmax, AUC0–t, and AUC0–∞ were 63.47% (54.02–74.57%), 85.23% (74.72–97.22%), and 96.73% (86.63–108.02%). Conclusion Among the subjects, oral administration of 400 mg of flumatinib was safe and well tolerated. High-fat diet significantly increases the exposure to flumatinib, therefore, fasting may be recommended. Clinical trial registration The study was registered at chictr.org Identifier: ChiCTR-IIR-17013179.
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Affiliation(s)
- Yun Kuang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui-Ling Song
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guo-Ping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Center for Drug Clinical Evaluation, Central South University, Changsha, Hunan, China.,XiangYa School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, China
| | - Qi Pei
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao-Yan Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Ye
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuang Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shu-Ting Wu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Can Guo
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing-Nan He
- Research Center for Drug Clinical Evaluation of Central, Central South University, Changsha, Hunan, China. .,Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Jie Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Schultz HB, Wignall AD, Thomas N, Prestidge CA. Enhancement of abiraterone acetate oral bioavailability by supersaturated-silica lipid hybrids. Int J Pharm 2020; 582:119264. [PMID: 32278053 DOI: 10.1016/j.ijpharm.2020.119264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/05/2020] [Accepted: 03/23/2020] [Indexed: 12/28/2022]
Abstract
Abiraterone acetate (AbA) has an oral bioavailability of <10% due to its poor water solubility. Here we investigate the performance of silica-lipid hybrids (SLH) and supersaturated SLH (super-SLH) in improving oral bioavailability of AbA. Specifically, we investigate the influence of lipid type and AbA saturation level of the equilibrium solubility in the lipid (Seq), and explore in vitro-in vivo correlation (IVIVC). An oral pharmacokinetic study was conducted in fasted Sprague-Dawley rats. Suspensions of the formulations were administered via oral gavage at an AbA dose of 25 mg/kg. Plasma samples were collected and analyzed for drug content. SLH with a saturation level of 90% Seq enhanced the oral bioavailability of unformulated AbA by 31-fold, and super-SLH with saturation levels of 150, 200 and 250% Seq, enhanced the bioavailability by 11, 10 and 7-fold, respectively. In comparison with the commercial product Zytiga, SLH (90% Seq) increased the oral bioavailability 1.43-fold whereas super-SLH showed no improvement. A reasonable IVIVC existed between the performance of unformulated AbA, SLH and super-SLH, in the in vitro lipolysis and in vivo oral pharmacokinetic studies. SLH and super-SLH significantly enhanced the oral bioavailability of AbA. Additionally, supersaturation of SLH improved drug loading but did not correlate with enhanced AbA bioavailability.
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Affiliation(s)
- Hayley B Schultz
- University of South Australia Cancer Research Institute, Adelaide, South Australia 5000, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia, Mawson Lakes Campus, Mawson Lakes 5095, Australia
| | - Anthony D Wignall
- University of South Australia Cancer Research Institute, Adelaide, South Australia 5000, Australia
| | - Nicky Thomas
- University of South Australia Cancer Research Institute, Adelaide, South Australia 5000, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia, Mawson Lakes Campus, Mawson Lakes 5095, Australia
| | - Clive A Prestidge
- University of South Australia Cancer Research Institute, Adelaide, South Australia 5000, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia, Mawson Lakes Campus, Mawson Lakes 5095, Australia.
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Groenland SL, van Nuland M, Verheijen RB, Schellens JHM, Beijnen JH, Huitema ADR, Steeghs N. Therapeutic Drug Monitoring of Oral Anti-Hormonal Drugs in Oncology. Clin Pharmacokinet 2020; 58:299-308. [PMID: 29862467 DOI: 10.1007/s40262-018-0683-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Oral anti-hormonal drugs are essential in the treatment of breast and prostate cancer. It is well known that the interpatient variability in pharmacokinetic exposure is high for these agents and exposure-response relationships exist for many oral anti-hormonal drugs. Yet, they are still administered at fixed doses. This could lead to underdosing and thus suboptimal efficacy in some patients, while other patients could be overdosed resulting in unnecessary side effects. Therapeutic drug monitoring (TDM), individualized dosing based on measured blood concentrations of the drug, could therefore be a valid option to further optimize treatment. In this review, we provide an overview of relevant clinical pharmacokinetic and pharmacodynamic characteristics of oral anti-hormonal drugs in oncology and translate these into practical guidelines for TDM. For some agents, TDM targets are not well established yet and as a reference the median pharmacokinetic exposure could be targeted (exemestane: minimum plasma concentration (Cmin) 4.1 ng/mL and enzalutamide: Cmin 11.4 mg/L). However, for most drugs, exposure-efficacy analyses could be translated into specific targets (abiraterone: Cmin 8.4 ng/mL, anastrozole: Cmin 34.2 ng/mL, and letrozole: Cmin 85.6 ng/mL). Moreover, prospective clinical trials have shown TDM to be feasible for tamoxifen, for which the exposure-efficacy threshold of its active metabolite endoxifen is 5.97 ng/mL. Based on the available data, we therefore conclude that individualized dosing based on drug concentrations is feasible and promising for oral anti-hormonal drugs and should be developed further and implemented into clinical practice.
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Affiliation(s)
- Stefanie L Groenland
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Merel van Nuland
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek and MC Slotervaart, Amsterdam, The Netherlands
| | - Remy B Verheijen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek and MC Slotervaart, Amsterdam, The Netherlands
| | - Jan H M Schellens
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek and MC Slotervaart, Amsterdam, The Netherlands.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek and MC Slotervaart, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Neeltje Steeghs
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Groenland SL, van Nuland M, Bergman AM, de Feijter JM, Dezentje VO, Rosing H, Beijnen JH, Huitema AD, Steeghs N. Concomitant intake of abiraterone acetate and food to increase pharmacokinetic exposure: real life data from a therapeutic drug monitoring programme. Eur J Cancer 2020; 130:32-38. [DOI: 10.1016/j.ejca.2020.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/16/2020] [Accepted: 02/02/2020] [Indexed: 11/30/2022]
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Gala U, Miller D, Williams RO. Improved Dissolution and Pharmacokinetics of Abiraterone through KinetiSol ® Enabled Amorphous Solid Dispersions. Pharmaceutics 2020; 12:pharmaceutics12040357. [PMID: 32295245 PMCID: PMC7238130 DOI: 10.3390/pharmaceutics12040357] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 01/11/2023] Open
Abstract
Abiraterone is a poorly water-soluble drug. It has a high melting point and limited solubility in organic solvents, making it difficult to formulate as an amorphous solid dispersion (ASD) with conventional technologies. KinetiSol® is a high-energy, fusion-based, solvent-free technology that can produce ASDs. The aim of this study was to evaluate the application of KinetiSol to make abiraterone ASDs. We developed binary KinetiSol ASDs (KSDs) using both polymers and oligomers. For the first time, we reported that KinetiSol can process hydroxypropyl-β-cyclodextrin (HPBCD), a low molecular-weight oligomer. Upon X-ray diffractometry and modulated differential scanning calorimetry analysis, we found the KSDs to be amorphous. In vitro dissolution analysis revealed that maximum abiraterone dissolution enhancement was achieved using a HPBCD binary KSD. However, the KSD showed significant abiraterone precipitation in fasted state simulated intestinal fluid (FaSSIF) media. Hence, hypromellose acetate succinate (HPMCAS126G) was selected as an abiraterone precipitation inhibitor and an optimized ternary KSD was developed. A pharmacokinetic study revealed that HPBCD based binary and ternary KSDs enhanced abiraterone bioavailability by 12.4-fold and 13.8-fold, respectively, compared to a generic abiraterone acetate tablet. Thus, this study is the first to demonstrate the successful production of an abiraterone ASD that exhibited enhanced dissolution and bioavailability.
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Affiliation(s)
- Urvi Gala
- Molecular Pharmaceutics and Drug Delivery Division, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Austin, TX 78712, USA;
- DisperSol Technologies LLC., 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, USA;
| | - Dave Miller
- DisperSol Technologies LLC., 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, USA;
| | - Robert O. Williams
- Molecular Pharmaceutics and Drug Delivery Division, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Austin, TX 78712, USA;
- Correspondence:
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Joulia ML, Carton E, Jouinot A, Allard M, Huillard O, Khoudour N, Peyromaure M, Zerbib M, Schoemann AT, Vidal M, Goldwasser F, Alexandre J, Blanchet B. Pharmacokinetic/Pharmacodynamic Relationship of Enzalutamide and Its Active Metabolite N-Desmethyl Enzalutamide in Metastatic Castration-Resistant Prostate Cancer Patients. Clin Genitourin Cancer 2020; 18:155-160. [DOI: 10.1016/j.clgc.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/25/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
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Supersaturated-Silica Lipid Hybrids Improve in Vitro Solubilization of Abiraterone Acetate. Pharm Res 2020; 37:77. [PMID: 32236761 DOI: 10.1007/s11095-020-02795-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Abiraterone acetate (AbA) is a poorly water-soluble drug with an oral bioavailability of <10% and a significant pharmaceutical food effect. We aimed to develop a more efficient oral solid-state lipid-based formulation for AbA using a supersaturated silica-lipid hybrid (super-SLH) approach to achieve high drug loading, improve in vitro solubilization and mitigate the food effect, while gaining a mechanistic insight into how super-SLH are digested and release drug. METHODS The influence of super-SLH saturation level and lipid type on the physicochemical properties and in vitro solubilization during lipolysis of the formulations was investigated and compared to the commercial product, Zytiga. RESULTS Super-SLH achieved significantly greater levels of AbA solubilization compared to Zytiga. Solubilization was influenced by the AbA saturation level, which determined the solid state of AbA and the relative amount of lipid, and the lipid utilized, which determined its degree of digestion and the affinity of the lipid and digestion products to the silica. A fine balance existed between achieving high drug loads using supersaturation and improving performance using the lipid-based formulation approach. The non-supersaturated SLH prepared with Capmul PG8 mitigated the 3-fold in vitro food effect. CONCLUSION SLH and super-SLH improve in vitro solubilization of AbA, remove the food effect and demonstrate potential to improve oral bioavailability in vivo. Graphical Abstract Abiraterone acetate was formulated as silica-lipid hybrids and demonstrated enhanced in vitro solubilization in comparison to pure abiraterone acetate and commercial product, Zytiga.
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Schultz HB, Meola TR, Thomas N, Prestidge CA. Oral formulation strategies to improve the bioavailability and mitigate the food effect of abiraterone acetate. Int J Pharm 2020; 577:119069. [PMID: 31981706 DOI: 10.1016/j.ijpharm.2020.119069] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023]
Abstract
Abiraterone acetate, marketed as Zytiga®, is an antiandrogen medication used in the treatment of prostate cancer. Abiraterone acetate is a BCS Class IV compound associated with several oral delivery challenges. Its low solubility and high lipophilicity lead to poor oral bioavailability (<10%) and a dramatic positive food effect (5-10-fold). Hence, a large dose of abiraterone acetate (1000 mg per day) is prescribed to patients who must fast for at least 1 h before and 2 h after administration. The recent expiry of Zytiga®s' patent has led to the emergence of publications describing improved oral formulation strategies for abiraterone acetate. This review aims to discuss the characteristics of abiraterone acetate that lead to its unfavorable oral delivery, examine the oral formulation strategies that have been applied, and to describe potential alternative oral formulation strategies that have been used for other BCS Class IV drugs, to determine the most valuable strategies to develop novel and improved alternatives to the current commercial product. Specific emphasis of this review is placed on enabling oral formulation strategies that can improve solubilization and bioavailability, reduce the clinical dose and remove the pharmaceutical food effect to ultimately provide prostate cancer patients with a more efficient formulation with greater patient compliance.
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Affiliation(s)
- Hayley B Schultz
- University of South Australia Cancer Research Institute, Adelaide, South Australia 5000, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia, Mawson Lakes Campus, Mawson Lakes, South Australia 5095, Australia.
| | - Tahlia R Meola
- University of South Australia Cancer Research Institute, Adelaide, South Australia 5000, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia, Mawson Lakes Campus, Mawson Lakes, South Australia 5095, Australia.
| | - Nicky Thomas
- University of South Australia Cancer Research Institute, Adelaide, South Australia 5000, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia, Mawson Lakes Campus, Mawson Lakes, South Australia 5095, Australia.
| | - Clive A Prestidge
- University of South Australia Cancer Research Institute, Adelaide, South Australia 5000, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia, Mawson Lakes Campus, Mawson Lakes, South Australia 5095, Australia.
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Verheijen RB, van der Biessen DAJ, Hotte SJ, Siu LL, Spreafico A, de Jonge MJA, Pronk LC, De Vos FYFL, Schnell D, Hirte HW, Steeghs N, Lolkema MP. Randomized, Open-Label, Crossover Studies Evaluating the Effect of Food and Liquid Formulation on the Pharmacokinetics of the Novel Focal Adhesion Kinase (FAK) Inhibitor BI 853520. Target Oncol 2020; 14:67-74. [PMID: 30742245 PMCID: PMC6407750 DOI: 10.1007/s11523-018-00618-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background BI 853520 is a potent inhibitor of focal adhesion kinase and is currently under clinical development for the treatment of non-hematological malignancies. Objective The objective of this study was to evaluate the effect of food and liquid dispersion on the pharmacokinetics of BI 853520 in two open-label, crossover substudies. Patients and Methods Sixteen patients with advanced solid tumors were enrolled in each substudy. The order of administration was randomized, and pharmacokinetic samples were collected for 48 h after administration of a 200 mg dose of BI 853520. Lack of effect would be demonstrated if the 90% confidence interval (CI) of the ratio of the adjusted geometric mean (GMR) of the area under the plasma curve (area under the plasma concentration–time curve from time zero to the last quantifiable concentration at tz [\documentclass[12pt]{minimal}
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\begin{document}$${\text{AUC}}_{{0{-}t_{\text{z}} }}$$\end{document}AUC0-tz] and observed area under the plasma concentration–time curve extrapolated from time zero to infinity [AUC0–∞,obs]) and maximum plasma concentration (Cmax) did not cross the 80–125% (bioequivalence) boundaries. Results Adjusted GMRs (90% CIs) for the fed versus fasted state were 92.46% (74.24–115.16), 98.17% (78.53–122.74), and 87.34% (71.04–107.38) for \documentclass[12pt]{minimal}
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\begin{document}$${\text{AUC}}_{{0{-}t_{\text{z}} }}$$\end{document}AUC0-tz, AUC0–∞,obs, and Cmax, respectively. Although the 90% CIs were not within bioequivalence limits for the food-effect study, the limited reductions in these pharmacokinetic parameters after administration with a high-fat meal are unlikely to be clinically relevant. Compared with a tablet, administration of BI 853520 as a liquid dispersion did not strongly affect \documentclass[12pt]{minimal}
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\begin{document}$${\text{AUC}}_{{0{-}t_{\text{z}} }}$$\end{document}AUC0-tz, AUC0–∞,obs, or Cmax, resulting in adjusted GMRs (90% CIs) of 1.00 (0.92–1.09), 0.98 (0.90–1.07), and 0.93 (0.86–1.01), respectively. Conclusions These studies demonstrate that BI 853520 can be given with no food restrictions, and as a liquid dispersion, without strongly impacting pharmacokinetics. These pharmacokinetic properties may help make BI 853520 dosing more convenient and flexible, improving treatment compliance. Clinical trials registration ClinicalTrials.gov identifier: NCT01335269. Electronic supplementary material The online version of this article (10.1007/s11523-018-00618-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Remy B Verheijen
- Department of Medical Oncology and Clinical Pharmacology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Diane A J van der Biessen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - Sebastien J Hotte
- Division of Medical Oncology, Juravinski Cancer Centre, 699 Concession Street, Hamilton, ON, L8V 5C2, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, 700 University Avenue, 7th Floor, Toronto, ON, M5G 1Z5, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, 700 University Avenue, 7th Floor, Toronto, ON, M5G 1Z5, Canada
| | - Maja J A de Jonge
- Department of Internal Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - Linda C Pronk
- Clinical Development Oncology, Boehringer Ingelheim España S.A., Parque Empresarial Alvento, Via de los Poblados, 1 planta baja-Edif. B ofic. A y C, 28033, Madrid, Spain
| | - Filip Y F L De Vos
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - David Schnell
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH and Co. KG, Birkendorfer Str. 65, 88397, Biberach, Germany
| | - Hal W Hirte
- Division of Medical Oncology, Juravinski Cancer Centre, 699 Concession Street, Hamilton, ON, L8V 5C2, Canada
| | - Neeltje Steeghs
- Department of Medical Oncology and Clinical Pharmacology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands. .,Department of Internal Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
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40
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Exposure–response analyses of abiraterone and its metabolites in real-world patients with metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2019; 23:244-251. [DOI: 10.1038/s41391-019-0179-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/08/2022]
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Lubberman FJE, Benoist GE, Gerritsen W, Burger DM, Mehra N, Hamberg P, van Oort I, van Erp NP. A prospective phase I multicentre randomized cross-over pharmacokinetic study to determine the effect of food on abiraterone pharmacokinetics. Cancer Chemother Pharmacol 2019; 84:1179-1185. [PMID: 31515667 PMCID: PMC6820614 DOI: 10.1007/s00280-019-03952-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/30/2019] [Indexed: 01/03/2023]
Abstract
Purpose Abiraterone acetate is used at a fixed oral dose of 1000 mg once daily (OD) taken fasted. By administering abiraterone acetate with food, a reduced dose can potentially be given while maintaining equivalent abiraterone exposure. Moreover, administering abiraterone acetate with a breakfast is considered more patient friendly. The aim of this study was to establish the bio-equivalent lower dose of abiraterone when taken with a continental breakfast (CB) compared to the standard intake of 1000 mg OD fasted. Methods In this phase I, randomized cross-over, multi-center study, abiraterone pharmacokinetics (PK) were evaluated in patients with metastatic castration-resistant prostate cancer who were treated for 14 days with 1000 mg abiraterone acetate taken fasted, followed by 14 days of treatment with 500 mg taken with a CB. Results 14 patients were enrolled into the study, of whom 12 were eligible for PK analysis. The geometric mean ratio (GMR) (fed/fasted) was 0.88 (90% CI 0.73–1.07) for area-under-the-curve (AUC0–24h), 1.03 (90% CI 0.79–1.34) for Cmax and 0.81 (90% CI 0.60–1.10) for Ctrough, respectively. High inter-patient variability (> 50%) was found for all PK parameters under both intake conditions. Patients seemed to be slightly more satisfied about the intake of 500 mg abiraterone acetate when taken with a CB compared to 1000 mg fasted. Conclusion In conclusion, a bioequivalent lower dose of abiraterone taken with food could not be established in our study. Although based on the absence of a exposure–toxicity relationship, the strict bioequivalence margins as defined by the FDA guidelines could be applied more flexible for abiraterone. Information on the effect of food on abiraterone pharmacokinetics as presented in our study can be used for patients with difficulties taken their medication fasted. Electronic supplementary material The online version of this article (10.1007/s00280-019-03952-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Floor J E Lubberman
- Department of Pharmacy (864), Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Guillemette E Benoist
- Department of Pharmacy (864), Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Winald Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy (864), Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Paul Hamberg
- Department of Medical Oncology, Franciscus Gasthuis and Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Inge van Oort
- Department of Urology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Nielka P van Erp
- Department of Pharmacy (864), Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Arasaratnam M, Crumbaker M, Bhatnagar A, McKay MJ, Molloy MP, Gurney H. Inter- and intra-patient variability in pharmacokinetics of abiraterone acetate in metastatic prostate cancer. Cancer Chemother Pharmacol 2019; 84:139-146. [PMID: 31081533 DOI: 10.1007/s00280-019-03862-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/02/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE This study examined the inter- and intra-patient variability in pharmacokinetics of AA and its metabolites abiraterone and Δ(4)-abiraterone (D4A), and potential contributing factors. METHODS AA administered daily for ≥4 weeks concurrently with androgen deprivation therapy (ADT) for mCRPC were included. Pharmacokinetic evaluation was performed at two consecutive visits at least 4 weeks apart. Plasma samples were collected 24 h after last dose of AA to obtain drug trough level (DTL) of two active metabolites, abiraterone and D4A. RESULTS 39 plasma samples were obtained from 22 patients, with 17 patients had repeat DTL measurement. Considerable inter-patient variability in DTL was seen, with initial DTL for abiraterone ranging between 1.5 and 25.4 ng/ml (CV 61%) and for D4A between 0.2 and 2.5 ng/ml (CV 61%). Intra-patient variability in DTL for abiraterone varied between 0.85 and 336% and for D4A between 1.14 and 199%. There was no increase in AA exposure with use of dexamethasone (n = 5; DTL 13.9) compared with prednisone (n = 17; DTL 11.0 p = 0.5), dosing in fasted state (n = 13, DTL 12.1) compared to dosing in fed state (n = 9; DTL 11.1, p = 0.8), or chemotherapy-exposed (n = 10; DTL 8.9) compared to chemotherapy naïve (n = 12; DTL 14.0, p = 0.1). CONCLUSIONS Our cohort demonstrated high inter- and intra-patient variability in both abiraterone and D4A with fixed dosing of AA, with no effect from choice of corticosteroids, prior use of chemotherapy, or dosing in fasting state. Monitoring DTL of AA may be necessary to minimise risk of patients being under-dosed and earlier development of resistance.
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Affiliation(s)
- Malmaruha Arasaratnam
- Department of Medical Oncology, Gosford Hospital, Sydney, Australia.
- Kolling Institute, The University of Sydney, Royal North Shore Hospital, Sydney, Australia.
- Gosford Hospital, Holden St, Gosford, NSW, 2250, Australia.
| | - Megan Crumbaker
- Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, Australia
| | - Atul Bhatnagar
- Department of Molecular Sciences, Macquarie University, Sydney, Australia
| | - Matthew J McKay
- Department of Molecular Sciences, Macquarie University, Sydney, Australia
| | - Mark P Molloy
- Kolling Institute, The University of Sydney, Royal North Shore Hospital, Sydney, Australia
- Department of Molecular Sciences, Macquarie University, Sydney, Australia
| | - Howard Gurney
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
- Macquarie University Clinic, Macquarie University Hospital, Sydney, Australia
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Abstract
Oral abiraterone acetate (Zytiga®) is a selective inhibitor of CYP17 and thereby inhibits androgen biosynthesis, with androgen signalling crucial in the progression from primary to metastatic prostate cancer (PC) and subsequently, in the development of metastatic castration-resistant PC (mCRPC). In large phase 3 trials and in the clinical practice setting, oral abiraterone acetate in combination with prednisone was an effective treatment and had an acceptable, manageable tolerability and safety profile in chemotherapy-naive and docetaxel-experienced men with mCRPC. In the pivotal global phase 3 trials, relative to placebo (+prednisone), abiraterone acetate (+prednisone) prolonged overall survival (OS) at data maturity (final analysis) and radiographic progression-free survival (rPFS) at all assessed timepoints. Given its efficacy in prolonging OS and its convenient once-daily oral regimen, in combination with prednisone, abiraterone acetate is an important first-line option for the treatment of mCRPC.
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Affiliation(s)
- Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Investigations of the mechanism behind the rapid absorption of nano-amorphous abiraterone acetate. Eur J Pharm Sci 2019; 129:79-86. [DOI: 10.1016/j.ejps.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/27/2018] [Accepted: 01/01/2019] [Indexed: 11/18/2022]
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Wang C, Hu C, Gao D, Zhao Z, Chen X, Hu X, Gong S, Li L, Zhang L. Pharmacokinetics and bioequivalence of generic and branded abiraterone acetate tablet: a single-dose, open-label, and replicate designed study in healthy Chinese male volunteers. Cancer Chemother Pharmacol 2018; 83:509-517. [DOI: 10.1007/s00280-018-3754-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 12/04/2018] [Indexed: 12/29/2022]
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Farha M, Masson E, Tomkinson H, Mugundu G. Food Effect Study Design With Oral Drugs: Lessons Learned From Recently Approved Drugs in Oncology. J Clin Pharmacol 2018; 59:463-471. [PMID: 30536979 DOI: 10.1002/jcph.1351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/09/2018] [Indexed: 12/24/2022]
Abstract
Evaluation of the effect of food on the pharmacokinetics of oral oncology drugs is critical to drug development, as food can mitigate or exacerbate toxicities and alter systemic exposure. Our aim is to expand on current US Food and Drug Administration (FDA) guidance and provide data-driven food-effect study design recommendations specific to the oncology therapeutic area. Data for recently approved small-molecule oncology drugs was extracted from the clinical pharmacology review in the sponsor's FDA submission package. Information on subject selection, meal types, timing of the study relative to the pivotal trial, and study outcomes was analyzed. The number of subjects enrolled ranged from 12 to 60, and the majority of studies (19 of 29) were conducted in healthy volunteers. Using AstraZeneca cost data, healthy volunteer studies were estimated to cost 10-fold less than cancer patient studies. Nine of 29 (31%) studies included meals with multiple levels of fat content. Analysis of a subset of 16 drugs revealed that final results for the food-effect study were available before the start of the pivotal trial for only 2 drugs. Conducting small food-effect studies powered to estimate effect, rather than confirm no effect, with only a standardized high-fat meal according to FDA guidance may eliminate unnecessary studies, reduce cost, and improve efficiency in oncology drug development. Starting food-effect studies as early as possible is key to inform dosing in pivotal trials.
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Affiliation(s)
- Mark Farha
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Waltham, MA, USA
| | - Eric Masson
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Waltham, MA, USA
| | - Helen Tomkinson
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Ganesh Mugundu
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Waltham, MA, USA
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Karakunnel JJ, Bui N, Palaniappan L, Schmidt KT, Mahaffey KW, Morrison B, Figg WD, Kummar S. Reviewing the role of healthy volunteer studies in drug development. J Transl Med 2018; 16:336. [PMID: 30509294 PMCID: PMC6278009 DOI: 10.1186/s12967-018-1710-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND With the exception of genotoxic oncology drugs, first-in-human, Phase 1 clinical studies of investigational drugs have traditionally been conducted in healthy volunteers (HVs). The primary goal of these studies is to investigate the pharmacokinetics and pharmacodynamics of a novel drug candidate, determine appropriate dosing, and document safety and tolerability. MAIN BODY When tailored to specific study objectives, HV studies are beneficial to manufacturers and patients alike and can be applied to both non-oncology and oncology drug development. Enrollment of HVs not only increases study accrual rates for dose-escalation studies but also alleviates the ethical concern of enrolling patients with disease in a short-term study at subtherapeutic doses when other studies (e.g. Phase 2 or Phase 3 studies) may be more appropriate for the patient. The use of HVs in non-oncology Phase 1 clinical trials is relatively safe but nonetheless poses ethical challenges because of the potential risks to which HVs are exposed. In general, most adverse events associated with non-oncology drugs are mild in severity, and serious adverse events are rare, but examples of severe toxicity have been reported. The use of HVs in the clinical development of oncology drugs is more limited but is nonetheless useful for evaluating clinical pharmacology and establishing an appropriate starting dose for studies in cancer patients. During the development of oncology drugs, clinical pharmacology studies in HVs have been used to assess pharmacokinetics, drug metabolism, food effects, potential drug-drug interactions, effects of hepatic and renal impairment, and other pharmacologic parameters vital for clinical decision-making in oncology. Studies in HVs are also being used to evaluate biosimilars versus established anticancer biologic agents. CONCLUSION A thorough assessment of toxicity and pharmacology throughout the drug development process is critical to ensure the safety of HVs. With the appropriate safeguards, HVs will continue to play an important role in future drug development.
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Affiliation(s)
| | - Nam Bui
- Stanford Cancer Institute, 875 Blake Wilbur Drive, Stanford, CA 94305 USA
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, 900 Blake Wilbur Drive, Room W200, 2nd Floor MC 5358, Stanford, CA 94304 USA
| | - Keith T. Schmidt
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892 USA
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research (SCCR), Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Grant S-102, Stanford, CA 94305 USA
| | | | - William D. Figg
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892 USA
| | - Shivaani Kummar
- Stanford Cancer Institute, 875 Blake Wilbur Drive, Stanford, CA 94305 USA
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Kolesar JM, Liu G. Reply to I.F. Tannock, P. Isaacsson Velho et al, R.Z. Szmulewitz et al, M. Tiako Meyo et al, and F.J.S.H. Woei-A-Jin et al. J Clin Oncol 2018; 36:3065-3066. [PMID: 30188791 DOI: 10.1200/jco.2018.79.3208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jill M Kolesar
- Jill M. Kolesar, University of Kentucky, Lexington, KY; and Glenn Liu, University of Wisconsin-Madison, Madison, WI
| | - Glenn Liu
- Jill M. Kolesar, University of Kentucky, Lexington, KY; and Glenn Liu, University of Wisconsin-Madison, Madison, WI
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Szmulewitz RZ, Peer CJ, Ibraheem A, Martinez E, Kozloff MF, Carthon B, Harvey RD, Fishkin P, Yong WP, Chiong E, Nabhan C, Karrison T, Figg WD, Stadler WM, Ratain MJ. Prospective International Randomized Phase II Study of Low-Dose Abiraterone With Food Versus Standard Dose Abiraterone In Castration-Resistant Prostate Cancer. J Clin Oncol 2018; 36:1389-1395. [PMID: 29590007 PMCID: PMC5941614 DOI: 10.1200/jco.2017.76.4381] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Abiraterone acetate (AA) is a standard of care for metastatic castration-resistant prostate cancer (CRPC). Despite a large food effect, AA was administered under fasting conditions in its pivotal trials. We sought to test the hypothesis that low-dose AA (LOW; 250 mg with a low-fat meal) would have comparable activity to standard AA (STD; 1,000 mg fasting) in patients with CRPC. Patients and Methods Patients (n = 72) with progressive CRPC from seven institutions in the United States and Singapore were randomly assigned to STD or LOW. Both arms received prednisone 5 mg twice daily. Prostate-specific antigen (PSA) was assessed monthly, and testosterone/dehydroepiandrosterone sulfate were assessed every 12 weeks with disease burden radiographic assessments. Plasma was collected for drug concentrations. Log change in PSA, as a pharmacodynamic biomarker for efficacy, was the primary end point, using a noninferiority design. Progression-free survival (PFS), PSA response (≥ 50% reduction), change in androgen levels, and pharmacokinetics were secondary end points. Results Thirty-six patients were accrued to both arms. At 12 weeks, there was a greater effect on PSA in the LOW arm (mean log change, -1.59) compared with STD (-1.19), and noninferiority of LOW was established according to predefined criteria. The PSA response rate was 58% in LOW and 50% in STD, and the median PFS was approximately 9 months in both groups. Androgen levels decreased similarly in both arms. Although there was no difference in PSA response or PFS, abiraterone concentrations were higher in STD. Conclusion Low-dose AA (with low-fat breakfast) is noninferior to standard dosing with respect to PSA metrics. Given the pharmacoeconomic implications, these data warrant consideration by prescribers, payers, and patients. Additional studies are indicated to assess the long-term efficacy of this approach.
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Affiliation(s)
- Russell Z. Szmulewitz
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Cody J. Peer
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Abiola Ibraheem
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Elia Martinez
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Mark F. Kozloff
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Bradley Carthon
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - R. Donald Harvey
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Paul Fishkin
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Wei Peng Yong
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Edmund Chiong
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Chadi Nabhan
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Theodore Karrison
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - William D. Figg
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Walter M. Stadler
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
| | - Mark J. Ratain
- Russell Z. Szmulewitz, Abiola Ibraheem, Elia Martinez, Mark F. Kozloff, Chadi Nabhan, Theodore Karrison, Walter M. Stadler, and Mark J. Ratain, The University of Chicago, Chicago; Mark F. Kozloff, Ingalls Hospital, Harvey; Paul Fishkin, Illinois Cancer Care, Peoria, IL; Cody J. Peer and William D. Figg, National Cancer Institute, Rockville, MD; Bradley Carthon and R. Donald Harvey, Winship Cancer Institute of Emory University, Atlanta, GA; and Wei Peng Yong and Edmund Chiong, National University Cancer Institute, Singapore, Singapore
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Thakur A, Roy A, Ghosh A, Chhabra M, Banerjee S. Abiraterone acetate in the treatment of prostate cancer. Biomed Pharmacother 2018; 101:211-218. [DOI: 10.1016/j.biopha.2018.02.067] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 12/29/2022] Open
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