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Ferrer F, Tetu P, Dousset L, Lebbe C, Ciccolini J, Combarel D, Meyer N, Paci A, Bouchet S. Tyrosine kinase inhibitors in cancers: Treatment optimization - Part II. Crit Rev Oncol Hematol 2024; 200:104385. [PMID: 38810843 DOI: 10.1016/j.critrevonc.2024.104385] [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: 01/24/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024] Open
Abstract
Real-life populations are more heterogeneous than those included in prospective clinical studies. In cancer patients, comorbidities and co-medications favor the appearance of severe adverse effects which can significantly impact quality of life and treatment effectiveness. Most of tyrosine kinase inhibitors (TKI) have been developed with flat oral dosing exposing patients to the risk of poor adherence due to side effects. Additionally, genetic or physiological factors, differences in diet, and drug-drug interactions can lead to inter-individual variability affecting treatment outcomes and increasing the risk of adverse events. Knowledge of the different factors of variability allows individualized patient management. This review examines the effects of adherence, food intake, and pharmaceutical form on the pharmacokinetics of oral TKI, as well as evaluating pharmacokinetics considerations improving TKI management. Concentration-effectiveness and concentration-toxicity data are presented for the selected TKI, and a simple therapeutic drug monitoring schema is outlined to help individualize dosing of oral TKI.
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Affiliation(s)
- Florent Ferrer
- Department of Pharmacology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; SMARTc Unit, CRCM Inserm U1068, Aix Marseille Univ and APHM, Marseille, France; Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France
| | - Pauline Tetu
- Department of Dermatology, APHP Dermatology, Paris 7 Diderot University, INSERM U976, Hôpital Saint-Louis, Paris, France; Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France
| | - Léa Dousset
- Dermatology Department, Bordeaux University Hospital, Bordeaux, France; Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France
| | - Céleste Lebbe
- Department of Dermatology, APHP Dermatology, Paris 7 Diderot University, INSERM U976, Hôpital Saint-Louis, Paris, France; Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France
| | - Joseph Ciccolini
- SMARTc Unit, CRCM Inserm U1068, Aix Marseille Univ and APHM, Marseille, France; Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France
| | - David Combarel
- Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France; Service de Pharmacocinétique, Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, Châtenay-Malabry 92 296, France
| | - Nicolas Meyer
- Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France; Université Paul Sabatier-Toulouse III, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche, Toulouse 1037-CRCT, France
| | - Angelo Paci
- Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France; Service de Pharmacocinétique, Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, Châtenay-Malabry 92 296, France
| | - Stéphane Bouchet
- Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France; Département de Pharmacologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
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Gao D, Wang G, Wu H, Ren J. Physiologically-based pharmacokinetic modeling for optimal dosage prediction of olaparib when co-administered with CYP3A4 modulators and in patients with hepatic/renal impairment. Sci Rep 2023; 13:16027. [PMID: 37749178 PMCID: PMC10519932 DOI: 10.1038/s41598-023-43258-9] [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: 06/03/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023] Open
Abstract
This study aimed to develop a physiologically-based pharmacokinetic (PBPK) model to predict the maximum plasma concentration (Cmax) and trough concentration (Ctrough) at steady-state of olaparib (OLA) in Caucasian, Japanese and Chinese. Furthermore, the PBPK model was combined with mean and 95% confidence interval to predict optimal dosing regimens of OLA when co-administered with CYP3A4 modulators and administered to patients with hepatic/renal impairment. The dosing regimens were determined based on safety and efficacy PK threshold Cmax (< 12,500 ng/mL) and Ctrough (772-2500 ng/mL). The population PBPK model for OLA was successfully developed and validated, demonstrating good consistency with clinically observed data. The ratios of predicted to observed values for Cmax and Ctrough fell within the range of 0.5 to 2.0. When OLA was co-administered with a strong or moderate CYP3A4 inhibitor, the recommended dosing regimens should be reduced to 100 mg BID and 150 mg BID, respectively. Additionally, the PBPK model also suggested that OLA could be not recommended with a strong or moderate CYP3A4 inducer. For patients with moderate hepatic and renal impairment, the dosing regimens of OLA were recommended to be reduced to 200 mg BID and 150 mg BID, respectively. In cases of severe hepatic and renal impairment, the PBPK model suggested a dosing regimen of 100 mg BID for OLA. Overall, this present PBPK model can determine the optimal dosing regimens for various clinical scenarios involving OLA.
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Affiliation(s)
- Dongmei Gao
- Department of Medical Oncology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Guopeng Wang
- Zhongcai Health (Beijing) Biological Technology Development Co., Ltd., Beijing, 101500, China
| | - Honghai Wu
- Department of Clinical Pharmacy, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Jiawei Ren
- North China Electric Power University, No.2, Beinong Road, Huilongguan, Changping District, Beijing, 102206, China.
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Wang LG, Montaño AR, Combs JR, McMahon NP, Solanki A, Gomes MM, Tao K, Bisson WH, Szafran DA, Samkoe KS, Tichauer KM, Gibbs SL. OregonFluor enables quantitative intracellular paired agent imaging to assess drug target availability in live cells and tissues. Nat Chem 2023; 15:729-739. [PMID: 36997700 DOI: 10.1038/s41557-023-01173-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/27/2023] [Indexed: 04/30/2023]
Abstract
Non-destructive fluorophore diffusion across cell membranes to provide an unbiased fluorescence intensity readout is critical for quantitative imaging applications in live cells and tissues. Commercially available small-molecule fluorophores have been engineered for biological compatibility, imparting high water solubility by modifying rhodamine and cyanine dye scaffolds with multiple sulfonate groups. The resulting net negative charge, however, often renders these fluorophores cell-membrane-impermeant. Here we report the design and development of our biologically compatible, water-soluble and cell-membrane-permeable fluorophores, termed OregonFluor (ORFluor). By adapting previously established ratiometric imaging methodology using bio-affinity agents, it is now possible to use small-molecule ORFluor-labelled therapeutic inhibitors to quantitatively visualize their intracellular distribution and protein target-specific binding, providing a chemical toolkit for quantifying drug target availability in live cells and tissues.
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Affiliation(s)
- Lei G Wang
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, USA
| | - Antonio R Montaño
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, USA
| | - Jason R Combs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, USA
| | - Nathan P McMahon
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, USA
| | - Allison Solanki
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, USA
| | - Michelle M Gomes
- Cancer Early Detection Advanced Research Center (CEDAR), Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Kai Tao
- Cancer Early Detection Advanced Research Center (CEDAR), Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - William H Bisson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Dani A Szafran
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Department of Surgery, Dartmouth Health, Lebanon, NH, USA
| | - Kenneth M Tichauer
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, USA.
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
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Lin B, Ziebro J, Smithberger E, Skinner KR, Zhao E, Cloughesy TF, Binder ZA, O’Rourke DM, Nathanson DA, Furnari FB, Miller CR. EGFR, the Lazarus target for precision oncology in glioblastoma. Neuro Oncol 2022; 24:2035-2062. [PMID: 36125064 PMCID: PMC9713527 DOI: 10.1093/neuonc/noac204] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The Lazarus effect is a rare condition that happens when someone seemingly dead shows signs of life. The epidermal growth factor receptor (EGFR) represents a target in the fatal neoplasm glioblastoma (GBM) that through a series of negative clinical trials has prompted a vocal subset of the neuro-oncology community to declare this target dead. However, an argument can be made that the core tenets of precision oncology were overlooked in the initial clinical enthusiasm over EGFR as a therapeutic target in GBM. Namely, the wrong drugs were tested on the wrong patients at the wrong time. Furthermore, new insights into the biology of EGFR in GBM vis-à-vis other EGFR-driven neoplasms, such as non-small cell lung cancer, and development of novel GBM-specific EGFR therapeutics resurrects this target for future studies. Here, we will examine the distinct EGFR biology in GBM, how it exacerbates the challenge of treating a CNS neoplasm, how these unique challenges have influenced past and present EGFR-targeted therapeutic design and clinical trials, and what adjustments are needed to therapeutically exploit EGFR in this devastating disease.
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Affiliation(s)
- Benjamin Lin
- Department of Pathology, Division of Neuropathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julia Ziebro
- Department of Pathology, Division of Neuropathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin Smithberger
- Department of Pathology, Division of Neuropathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pathobiology and Translational Sciences Program, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kasey R Skinner
- Department of Pathology, Division of Neuropathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Neurosciences Curriculum, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eva Zhao
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Timothy F Cloughesy
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Zev A Binder
- Department of Neurosurgery and Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Donald M O’Rourke
- Department of Neurosurgery and Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Nathanson
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Frank B Furnari
- Department of Medicine, Division of Regenerative Medicine, University of California, San Diego, San Diego, California, USA
- Ludwig Cancer Research, San Diego, California, USA
| | - C Ryan Miller
- Department of Pathology, Division of Neuropathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
Background and Objective Dacomitinib is a kinase inhibitor indicated for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR)-activating mutations. To evaluate the effect of hepatic impairment on the pharmacokinetics of dacomitinib, two dedicated studies were conducted to inform optimal dosing. Methods Study 1 (NCT01571388) evaluated the effect of mild and moderate hepatic impairment on the plasma pharmacokinetics, safety, and tolerability after a single oral dose of dacomitinib 30 mg, and Study 2 (NCT03865446) evaluated the same endpoints in a severe hepatic impairment population. Both studies were phase I, open-label, parallel-group studies. A one-way analysis of variance (ANOVA) with unequal variance assumption and hepatic impairment group as a fixed effect was used to compare the natural log of area under the plasma concentration-time curve extrapolated to infinite time (AUCinf), AUC from time zero to the last quantifiable concentration (AUClast), and maximum plasma concentration (Cmax) for each hepatic impairment group to the respective normal hepatic function group. Since dacomitinib is a cytochrome P450 (CYP) 2D6 substrate, only participants with extensive or intermediate CYP2D6 phenotypes were included in the primary analysis. Results The AUCinf for participants with mild, moderate, or severe hepatic impairment decreased by 6%, decreased by 23%, and increased by 4%, respectively, compared with normal hepatic function, while the Cmax for participants with mild, moderate, or severe hepatic impairment increased by 3%, decreased by 20%, and increased by 31%, respectively, compared with normal hepatic function. A single oral dose of dacomitinib 30 mg was well tolerated in all participants. Conclusion Based on these pharmacokinetic results, dacomitinib pharmacokinetics of participants with mild, moderate, or severe hepatic impairment were not statistically different relative to participants with normal hepatic function based on the ANOVA analysis. No dacomitinib dose adjustments for patients with hepatic impairment are recommended. Clinical Trial Registration ClinicalTrials.gov NCT01571388, registered 5 April 2012; ClinicalTrials.gov NCT03865446, registered 6 March 2019. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-022-01125-x.
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Mano Y, Mizuo H. Minimal impact of hepatic and renal impairment on plasma protein binding of lenvatinib, and identification of its major plasma binding protein. Biopharm Drug Dispos 2019; 40:307-311. [DOI: 10.1002/bdd.2204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/31/2019] [Accepted: 08/12/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Yuji Mano
- Drug Metabolism and PharmacokineticsEisai Co., Ltd Tokodai 5‐1‐3 Tsukuba‐shi Ibaraki 300‐2635 Japan
| | - Hitoshi Mizuo
- Drug Metabolism and PharmacokineticsEisai Co., Ltd Tokodai 5‐1‐3 Tsukuba‐shi Ibaraki 300‐2635 Japan
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Zaibet S, Vauchier C, Khoudour N, Roulleaux Dugage M, Korb-Savoldelli V, Alexandre J, Blanchet B, Goldwasser F, Thomas-Schoemann A, Bellesoeur A. Enjeux et écueils des thérapies ciblées orales en pratique clinique quotidienne : 5e journée de pharmacologie des anti-tumoraux. Bull Cancer 2018; 105:1102-1109. [DOI: 10.1016/j.bulcan.2018.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
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Li GF, Yu G, Li Y, Zheng Y, Zheng QS, Derendorf H. Quantitative Estimation of Plasma Free Drug Fraction in Patients With Varying Degrees of Hepatic Impairment: A Methodological Evaluation. J Pharm Sci 2018. [DOI: 10.1016/j.xphs.2018.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Monitoring of erlotinib in pancreatic cancer patients during long-time administration and comparison to a physiologically based pharmacokinetic model. Cancer Chemother Pharmacol 2018; 81:763-771. [PMID: 29453635 PMCID: PMC5854746 DOI: 10.1007/s00280-018-3545-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
Purpose In this study, a therapeutic drug monitoring (TDM) of erlotinib in pancreatic cancer patients was performed over 50 weeks to reveal possible alterations in erlotinib plasma concentrations. Additionally, a physiologically based pharmacokinetic (PBPK) model was created to assess such variations in silico. Methods Patients with advanced pancreatic cancer received a chemotherapeutic combination of 100 mg erlotinib q.d., 500–900 mg capecitabine b.d. and 5 mg/kg bevacizumab q.2wks. Samples were analyzed by HPLC and the results were compared to a PBPK model, built with the software GastroPlus™ and based on calculated and literature data. Results The erlotinib plasma concentrations did not show any accumulation, but displayed a high inter-patient variability over the whole investigated period. Trough plasma concentrations ranged from 0.04 to 1.22 µg/ml after day 1 and from 0.01 to 2.4 µg/ml in the long-term assessment. 7% of the patients showed concentrations below the necessary activity threshold of 0.5 µg/ml during the first week. The impact of some co-variates on the pharmacokinetic parameters Cmax and AUC0–24 were shown in a PBPK model, including food effects, changes in body weight, protein binding or liver function and the concomitant intake of gastric acid reducing agents (ARAs). Conclusion This study presents the approach of combining TDM and PBPK modeling for erlotinib, a drug with a high interaction potential. TDM is an important method to monitor drugs with increased inter-patient variability, additionally, the PBPK model contributed valuable insights to the interaction mechanisms involved, resulting in an effective combination from a PK perspective to ensure a safe treatment.
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Lichtman SM, Harvey RD, Damiette Smit MA, Rahman A, Thompson MA, Roach N, Schenkel C, Bruinooge SS, Cortazar P, Walker D, Fehrenbacher L. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology–Friends of Cancer Research Organ Dysfunction, Prior or Concurrent Malignancy, and Comorbidities Working Group. J Clin Oncol 2017; 35:3753-3759. [DOI: 10.1200/jco.2017.74.4102] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with organ dysfunction, prior or concurrent malignancies, and comorbidities are often excluded from clinical trials. Excluding patients on the basis of these factors results in clinical trial participants who are healthier and younger than the overall population of patients with cancer. Methods ASCO and Friends of Cancer Research established a multidisciplinary working group that included experts in trial design and conduct to examine how eligibility criteria could be more inclusive. The group analyzed current eligibility criteria; conducted original data analysis; considered safety concerns, potential benefits, research, and potential hurdles of this approach through discussion; and reached consensus on recommendations regarding updated eligibility criteria that prioritize inclusiveness without compromising patient safety. Results If renal toxicity and clearance are not of direct treatment-related concern, then patients with lower creatinine clearance values of > 30 mL/min should be included in trials. Inclusion of patients with mild to moderate hepatic dysfunction may be possible when the totality of the available nonclinical and clinical data indicates that inclusion is safe. Ejection fraction values should be used with investigator assessment of a patient’s risk for heart failure to determine eligibility. Patients with laboratory parameters out of normal range as a result of hematologic disease should be included in trials. Measures of patient functional status should be included in trials to better assess fit versus frail patients. Conclusion Expanding inclusion of these patients will increase the number and diversity of patients in clinical trials and result in a more appropriate population of patients.
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Affiliation(s)
- Stuart M. Lichtman
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - R. Donald Harvey
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Marie-Anne Damiette Smit
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Atiqur Rahman
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Michael A. Thompson
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Nancy Roach
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Caroline Schenkel
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Suanna S. Bruinooge
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Patricia Cortazar
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Dana Walker
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Louis Fehrenbacher
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
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Pinter M, Trauner M, Peck-Radosavljevic M, Sieghart W. Cancer and liver cirrhosis: implications on prognosis and management. ESMO Open 2016; 1:e000042. [PMID: 27843598 PMCID: PMC5070280 DOI: 10.1136/esmoopen-2016-000042] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 12/11/2022] Open
Abstract
Liver cirrhosis, the end-stage of every chronic liver disease, is not only the major risk factor for the development of hepatocellular carcinoma but also a limiting factor for anticancer therapy of liver and non-hepatic malignancies. Liver cirrhosis may limit surgical and interventional approaches to cancer treatment, influence pharmacokinetics of anticancer drugs, increase side effects of chemotherapy, render patients susceptible for hepatotoxicity, and ultimately result in a competitive risk for morbidity and mortality. In this review, we provide a concise overview about the impact of liver cirrhosis on the management and prognosis of patients with primary liver cancer or non-hepatic malignancies.
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Affiliation(s)
- Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School & Massachusetts General Hospital, Boston, USA
| | - Michael Trauner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III , Medical University of Vienna , Vienna , Austria
| | - Markus Peck-Radosavljevic
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Wolfgang Sieghart
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Austrian Society of Gastroenterology & Hepatology, Working Group GI-Oncology
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Impact of epidermal growth factor receptor (EGFR) activating mutations and their targeted treatment in the prognosis of stage IV non-small cell lung cancer (NSCLC) patients harboring liver metastasis. J Transl Med 2015; 13:257. [PMID: 26248464 PMCID: PMC4528698 DOI: 10.1186/s12967-015-0622-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Liver metastases appear in 20-30% of patients diagnosed with non-small cell lung cancer (NSCLC) and represent a poor prognosis feature of NSCLC and a possibly more treatment-resistant condition. Potential clinical outcome differences in NSCLC patients with liver metastases harboring molecular alterations in EGFR, KRAS and EML4-ALK genes are still to be determined. This study aims to evaluate the incidence of liver metastasis in a single population and look for potential correlations between EGFR mutations, liver infiltration and clinical outcomes. METHODS A total of 236 consecutive stage IV NSCLC patients treated at the Clínica Universidad de Navarra were analyzed. RESULTS At onset, liver metastases were present in 16.9% of patients conferring them a shorter overall survival (OS) compared to those with different metastatic locations excluding liver infiltration (10 vs. 21 months; p = 0.001). Patients with EGFR wild-type tumors receiving standard chemotherapy and showing no liver involvement presented a superior median OS compared to those with liver metastases (23 vs. 13 months; p = 0.001). Conversely, patients with EGFR-mutated tumors treated with EGFR tyrosin-kinase inhibitors (TKI's) presented no significant differences in OS regardless of liver involvement (median OS not reached vs. 25 months; p = 0.81). CONCLUSION Overall, liver metastases at onset negatively impact OS of NSCLC patients. EGFR TKIs however, may reverse the effects of an initial negative prognosis of liver metastasis in first-line treatment of EGFR mutated NSCLC patients.
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Giri N, Masters JC, Plotka A, Liang Y, Boutros T, Pardo P, O'Connell J, Bello C. Investigation of the impact of hepatic impairment on the pharmacokinetics of dacomitinib. Invest New Drugs 2015; 33:931-41. [PMID: 26048096 DOI: 10.1007/s10637-015-0256-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/25/2015] [Indexed: 12/21/2022]
Abstract
Dacomitinib (PF-00299804) is a small-molecule inhibitor of the tyrosine kinases human epidermal growth factor receptor-1 (HER1; epidermal growth factor receptor, EGFR), HER2, and HER4 currently being developed for the treatment of lung cancer with sensitizing mutations in EGFR or refractory to EGFR-directed treatment. Dacomitinib is largely metabolized by the liver through oxidative and conjugative metabolism; therefore, determination of the impact of varying degrees of hepatic impairment on the pharmacokinetics (PK) of dacomitinib was warranted to ensure patient safety. In this phase I, open-label, parallel-group study, a single dose of dacomitinib was administered to healthy volunteers and to subjects with mild or moderate liver dysfunction, as determined by Child-Pugh classification. The primary goal of this study was to evaluate the effects of mild and moderate hepatic impairment on the single-dose PK profile of dacomitinib, as well as to assess the safety and tolerability in these subjects. Plasma protein binding and impact of hepatic function on the PK of the active metabolite PF-05199265 was also investigated. Twenty-five male subjects received dacomitinib 30 mg, with 8 subjects in the healthy- and mild-impairment cohorts and 9 subjects in the moderate-impairment cohort. Compared with healthy volunteers, there was no significant change in dacomitinib exposure in subjects with mild or moderate liver dysfunction and no observed alteration in plasma protein binding. No serious treatment-related adverse events were reported in any group, and dacomitinib was well tolerated. A dose adjustment does not appear necessary when administering dacomitinib to patients with mild or moderate hepatic impairment.
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Affiliation(s)
- Nagdeep Giri
- Pfizer Inc, 10646 Science Center Drive, La Jolla, CA, 92121, USA,
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Individualized dosing of tyrosine kinase inhibitors: are we there yet? Drug Discov Today 2015; 20:18-36. [DOI: 10.1016/j.drudis.2014.09.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/25/2014] [Accepted: 09/12/2014] [Indexed: 12/11/2022]
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Oral epidermal growth factor receptor tyrosine kinase inhibitors for the treatment of non-small cell lung cancer: Comparative pharmacokinetics and drug–drug interactions. Cancer Treat Rev 2014; 40:917-26. [DOI: 10.1016/j.ctrv.2014.06.010] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/17/2014] [Accepted: 06/21/2014] [Indexed: 12/23/2022]
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Grigorian A, O'Brien CB. Hepatotoxicity Secondary to Chemotherapy. J Clin Transl Hepatol 2014; 2:95-102. [PMID: 26357620 PMCID: PMC4521265 DOI: 10.14218/jcth.2014.00011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/06/2014] [Accepted: 05/22/2014] [Indexed: 12/20/2022] Open
Abstract
The difficult problem faced by multiple generation of practicing physicians is determining the cause of abnormal liver function tests in cancer patients on chemotherapy. Hepatotoxicity from chemotherapy occurs frequently from an unpredictable or idiosyncratic reaction. Despite remarkable advances in our understanding of the mechanisms of action, pharmacodynamics, and interrelationships between the liver and chemotherapy, the underlying etiology of hepatic toxicity for various agents remains unexplained. Here, we present a concise review of the broad differential diagnosis for abnormal liver function tests (LFTs) in oncology patients.
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Affiliation(s)
- Alla Grigorian
- Divisions of Liver and GI Transplantation, University of Miami School of Medicine, Miami, FL, USA
| | - Christopher B O'Brien
- Divisions of Liver and GI Transplantation, University of Miami School of Medicine, Miami, FL, USA
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A phase Ib trial of LY2584702 tosylate, a p70 S6 inhibitor, in combination with erlotinib or everolimus in patients with solid tumours. Eur J Cancer 2014; 50:876-84. [DOI: 10.1016/j.ejca.2013.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 11/24/2022]
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Abstract
The treatment of advanced non-small cell lung cancer has been with systemic chemotherapy and usually consists of a platinum doublet chemotherapy. The identification of somatic driver mutations has resulted in new drugs that target these mutations. This report discusses the two most important new targeted therapy drugs for the treatment of advanced non-small cell lung cancer that have these driver mutations.
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