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Wang D, Hung N, Hung T, Eden K, Chan WK, Kwan R, Qin A, Chang C, Duffull S, Glue P, Jackson C. Oral docetaxel plus encequidar - a phase 1 clinical trial. Cancer Chemother Pharmacol 2024:10.1007/s00280-024-04674-4. [PMID: 38814342 DOI: 10.1007/s00280-024-04674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To determine the bioavailability, safety, and tolerability of a single dose of oral docetaxel plus encequidar (oDox + E) and compare its pharmacokinetic exposure with current standard of care IV docetaxel. INTRODUCTION Docetaxel is a taxane widely used as an anti-neoplastic agent. Due to low oral bioavailability secondary to gut P-glycoprotein (P-gp) efflux, its current use is limited to intravenous administration. Oral docetaxel may provide a less resource intensive, more convenient, and tolerable alternative. Encequidar is a first in class, minimally absorbed, oral gut-specific P-gp inhibitor. We tested whether oDox + E can achieve comparable pharmacokinetic exposure to IV docetaxel. METHODS A multicentre, phase I open-label, pharmacokinetic trial was undertaken to determine the bioavailability, safety, and tolerability of a single dose of oDox + E (at 75 mg/m2 + 15 mg, 150 mg/m2 + 15 mg, and 300 mg/m2 + 15 mg) in metastatic prostate cancer (mPC) patients compared to standard of care IV docetaxel as prescribed by their oncologists. The 15 mg of Encequidar at each dose level was given one hour prior to oral docetaxel. RESULTS 11 patients were enrolled; 9 patients completed the study. Oral docetaxel exposure increased with dose, achieving the highest at 300 mg/m2 oDox + E (with AUC0 - infinity of 1343.3 ± 443.0 ng.h/mL compared to the IV docetaxel AUC0 - infinity of 2000 ± 325 ng.h/mL) and became non-linear at 300 mg/m2. The mean absolute bioavailability of oDox + E across all 3 dose levels was 16.14% (range: 8.19-25.09%). No patient deaths, dose limiting toxicity, treatment-related serious adverse event or grade 4 toxicity were observed. Maximal tolerated dose was not reached. CONCLUSION oDox + E has a safe and tolerable adverse event profile in patients with metastatic prostate cancer. The increase in oral bioavailability of oDox + E suggests a multi-dose oDox + E regimen could theoretically achieve exposures comparable with standard of care IV docetaxel. Further development to examine the optimal multiple dose regimen of oDox + E is warranted. TRIAL REGISTRATION NUMBER U1111-1173-5473.
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Affiliation(s)
- David Wang
- Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.
| | - Noelyn Hung
- Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Tak Hung
- Zenith Technology Limited, Otago, New Zealand
| | | | - Wing-Kai Chan
- Athenex Limited, USA (Former association), Athens, USA
| | - Rudolf Kwan
- Athenex Limited, USA (Former association), Athens, USA
| | - Albert Qin
- PharmaEssentia Corporation, Taipei, Taiwan
| | | | | | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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Wang D, Hughes-Medlicott N, Klingler L, Wang Y, Hung N, Duffull S, Hung T, Glue P, Qin A, Kwan R, Chan WK, Jackson C. A Sensitive Assay for Unbound Docetaxel Using Ultrafiltration plus HPLC-MS and Its Application to a Clinical Study. Pharmaceutics 2024; 16:602. [PMID: 38794263 PMCID: PMC11124465 DOI: 10.3390/pharmaceutics16050602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Docetaxel, a taxane used in the treatment of solid tumours, exerts pharmacological activity when in its unbound form. We report a sensitive assay to quantify unbound docetaxel after oral administration of docetaxel plus encequidar (oDox+E). Unbound drug quantification is important due to its direct correlation with drug-related toxicity and therapeutic efficacy. We improve on the sensitivity of current assay methods and demonstrate the utility of the assay on a novel formulation of oral docetaxel. METHODS Ultrafiltration followed by high-performance liquid chromatography and tandem mass spectrometry (HPLC-MS/MS) was utilized. Long-term stability, precision, accuracy, and recovery experiments were conducted to validate the assay. Additionally, patient samples from a Phase I dose-escalation pharmacokinetic study were analyzed using the developed assay. RESULTS The assay method exhibited long-term stability with an observed change between 0.8 and 6.9% after 131 days of storage at -60 °C. Precision and accuracy quality controls met the FDA acceptance criteria. An average recovery of 88% was obtained. Patient sample analysis demonstrated successful implementation of the assay. CONCLUSION A validated sensitive assay was developed with an LLOQ of 0.084 ng/mL using 485 µL of human plasma. The sensitivity of the assay allowed quantification of unbound docetaxel concentrations in an early-phase oDox+E clinical study to compare it against IV docetaxel using pharmacokinetic modelling. Successful development of oDox+E represents an opportunity to replace the current IV docetaxel regimen with an oral regimen with lower cost, decreased side effects, and improve patient quality of life and experience.
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Affiliation(s)
- David Wang
- Department of Anaesthesia, Waikato Hospital, Hamilton 3204, New Zealand
| | | | | | - Yi Wang
- Zenith Technology Limited, Dunedin 9016, New Zealand
| | - Noelyn Hung
- Zenith Technology Limited, Dunedin 9016, New Zealand
- Department of Pathology, University of Otago, Dunedin 9016, New Zealand
| | - Stephen Duffull
- School of Pharmacy, University of Otago, Dunedin 9016, New Zealand
- Certara, Radnor, PA 19087, USA
| | - Tak Hung
- Zenith Technology Limited, Dunedin 9016, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin 9016, New Zealand
| | - Albert Qin
- PharmaEssentia Corporation, Taipei 115, Taiwan
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Monteith BE, Venner CP, Cheung MC, Pater J, Shepherd L, Richardson H, Reece D, Gul E, Lalancette M, Castonguay V, Kukreti V, Tiedemann R, Phua C, Bhella S, Dudebout J, Sherry M, Yen H, Chen BE, Hay AE. A descriptive cost-analysis of MYX.1/MCRN003, a phase 2 clinical trial evaluating high-dose weekly carfilzomib, cyclophosphamide, and dexamethasone in relapsed and refractory multiple myeloma. Eur J Haematol 2021; 107:333-342. [PMID: 34053112 DOI: 10.1111/ejh.13671] [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: 03/23/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalence of multiple myeloma is increasing and there is a need to evaluate escalating therapy costs (Canadian Cancer Statistics A, 2020). The MYX.1 phase II trial showed that high-dose weekly carfilzomib, cyclophosphamide, and dexamethasone (wKCD) is efficacious in relapsed and refractory disease. We conducted a descriptive cost analysis, from the perspective of the Canadian public healthcare system, using trial data. METHODS The primary outcome was the mean total cost per patient. Resource utilization data were collected from all 75 trial patients over a trial time horizon. Costs are presented in Canadian dollars (2020). RESULTS The cost of treatment was calculated from the time of patient (pt) enrollment until the second data lock. The mean total cost was $203 336.08/pt (range $17 891.27-$505 583.55) Canadian dollars (CAD, where 1 CAD = 0.67 Euro (EUR)) and $14 081.45/pt per cycle. The median number of cycles was 15. The predominant cost driver was the cost of chemotherapy accounting for an average of $179 332.78/pt or $12 419.17/pt per cycle. Carfilzomib acquisition accounted for the majority of chemotherapy costs - $162 471.65/pt or $11 251.50/pt per cycle. Fifty-six percent (56%) of patients had at least one hospitalization during the trial period with an average cost of $12 657.86 per hospitalization. Three patients developed thrombotic microangiopathy (TMA) with an average cost of $18 863.32/pt including the cost of hospitalizations and therapeutic plasma exchange. CONCLUSIONS High-dose wKCD is an active triplet regimen for relapsed and refractory multiple myeloma (RRMM) associated with reduced total cost compared with twice-weekly carfilzomib-based regimens.
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Affiliation(s)
- Bethany E Monteith
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada.,Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | | | - Matthew C Cheung
- Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Joe Pater
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | | | - Donna Reece
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Engin Gul
- Canadian Myeloma Research Group (formerly the Myeloma Canada Research Network), Vaughan, ON, Canada
| | - Marc Lalancette
- CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Quebec City, QC, Canada
| | - Vincent Castonguay
- CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Quebec City, QC, Canada
| | - Vishal Kukreti
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Rodger Tiedemann
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Chai Phua
- Victoria Hospital, Western University, London, ON, Canada
| | - Sita Bhella
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Jill Dudebout
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Max Sherry
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Hope Yen
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Annette E Hay
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada.,Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
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