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Liao MZ, Lu D, Lu T, Gibiansky L, Deng R, Samineni D, Dere R, Lin A, Hirata J, Shen BQ, Zhang D, Li D, Li C, Miles D. Clinical pharmacology strategies to accelerate the development of polatuzumab vedotin and summary of key findings. Adv Drug Deliv Rev 2024; 207:115193. [PMID: 38311111 DOI: 10.1016/j.addr.2024.115193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/12/2023] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
The favorable benefit-risk profile of polatuzumab vedotin, as demonstrated in a pivotal Phase Ib/II randomized study (GO29365; NCT02257567), coupled with the need for effective therapies in relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL), prompted the need to accelerate polatuzumab vedotin development. An integrated, fit-for-purpose clinical pharmacology package was designed to support regulatory approval. To address key clinical pharmacology questions without dedicated clinical pharmacology studies, we leveraged non-clinical and clinical data for polatuzumab vedotin, published clinical data for brentuximab vedotin, a similar antibody-drug conjugate, and physiologically based pharmacokinetic and population pharmacokinetic modeling approaches. We review strategies and model-informed outcomes that contributed to regulatory approval of polatuzumab vedotin plus bendamustine and rituximab in R/R DLBCL. These strategies made polatuzumab vedotin available to patients earlier than previously possible; depending on the strength of available data and the regulatory/competitive environment, they may also prove useful in accelerating the development of other agents.
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Affiliation(s)
| | - Dan Lu
- Genentech, Inc. South San Francisco, CA, United States
| | - Tong Lu
- Genentech, Inc. South San Francisco, CA, United States
| | | | - Rong Deng
- Genentech, Inc. South San Francisco, CA, United States
| | | | - Randall Dere
- Genentech, Inc. South San Francisco, CA, United States
| | - Andy Lin
- Genentech, Inc. South San Francisco, CA, United States
| | - Jamie Hirata
- Genentech, Inc. South San Francisco, CA, United States
| | - Ben-Quan Shen
- Genentech, Inc. South San Francisco, CA, United States
| | - Donglu Zhang
- Genentech, Inc. South San Francisco, CA, United States
| | - Dongwei Li
- Genentech, Inc. South San Francisco, CA, United States
| | - Chunze Li
- Genentech, Inc. South San Francisco, CA, United States
| | - Dale Miles
- Genentech, Inc. South San Francisco, CA, United States.
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Badawi M, Chen X, Marroum P, Suleiman AA, Mensing S, Koenigsdorfer A, Schiele JT, Palenski T, Samineni D, Hoffman D, Menon R, Salem AH. Bioavailability Evaluation of Venetoclax Lower-Strength Tablets and Oral Powder Formulations to Establish Interchangeability with the 100 mg Tablet. Clin Drug Investig 2022; 42:657-668. [PMID: 35829925 PMCID: PMC9338003 DOI: 10.1007/s40261-022-01172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Venetoclax is an approved BCL-2 inhibitor, currently under evaluation in different hematological malignancies in adult and pediatric populations. Venetoclax is available as 10, 50, and 100 mg tablets. To provide an alternative to patients who find taking the commonly prescribed 100 mg tablet a challenge, the interchangeability of lower-strength tablets with the 100 mg tablet was investigated. Additionally, newly developed oral suspension powder formulations to facilitate dosing in pediatrics were evaluated. Methods Pharmacokinetic data from 80 healthy female participants from three phase I studies were utilized to evaluate the bioavailability of (1) 10 and 50 mg tablets relative to a 100 mg tablet; (2) 0.72 and 7.2% (drug to total weight) oral powder formulations relative to the 100 mg tablet; and (3) oral powder formulations administered using different vehicles (apple juice, apple sauce, and yogurt) relative to water under fed conditions. Results Bioavailability assessments at a 100 mg dose of venetoclax demonstrated bioequivalence across the 10, 50, and 100 mg tablet strengths. Oral powder formulations met the bioequivalence criteria (0.80–1.25) with respect to area under the concentration–time curve to time of the last measurable concentration (AUCt) and to infinite time (AUC∞) but exhibited a slightly lower maximum plasma concentration (Cmax). Exposure–response analyses were utilized to demonstrate that the lower Cmax observed with the powder formulations is not clinically meaningful. The delivery vehicles tested did not affect the bioavailability of venetoclax oral powder formulations. Conclusions The smaller-sized tablets (10 and 50 mg) and the newly developed oral powder formulations of venetoclax can be used interchangeably with the 100 mg tablets to improve the patients’ experience, while maintaining adequate exposure. Clinical Trials Identifiers NCT01682616, 11 September 2012; NCT02005471, 9 December 2013; NCT02242942, 17 September 2014; NCT02203773, 30 July 2014; NCT02287233, 10 November 2014; NCT02993523, 15 December 2016; NCT03069352, 3 March 2017. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-022-01172-4.
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Affiliation(s)
- Mohamed Badawi
- Clinical Pharmacology and Pharmacometrics (R4PK/AP31), AbbVie Inc, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA
| | - Xin Chen
- Data and Statistical Sciences, AbbVie Inc, North Chicago, IL, USA
| | - Patrick Marroum
- Clinical Pharmacology and Pharmacometrics (R4PK/AP31), AbbVie Inc, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA
| | - Ahmed A Suleiman
- Clinical Pharmacology and Pharmacometrics, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Sven Mensing
- Clinical Pharmacology and Pharmacometrics, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Anette Koenigsdorfer
- Drug Product Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Julia Teresa Schiele
- Drug Product Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Tammy Palenski
- Clinical Development, AbbVie Inc, North Chicago, IL, USA
| | - Divya Samineni
- Clinical Pharmacology, Genentech, Inc, South San Francisco, CA, USA
| | - David Hoffman
- Data and Statistical Sciences, AbbVie Inc, North Chicago, IL, USA
| | - Rajeev Menon
- Clinical Pharmacology and Pharmacometrics (R4PK/AP31), AbbVie Inc, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA
| | - Ahmed Hamed Salem
- Clinical Pharmacology and Pharmacometrics (R4PK/AP31), AbbVie Inc, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA. .,Clinical Pharmacy, Ain Shams University, Cairo, Egypt.
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Samineni D, Gibiansky L, Wang B, Vadhavkar S, Rajwanshi R, Tandon M, Sinha A, Al-Sawaf O, Fischer K, Hallek M, Salem AH, Li C, Miles D. Pharmacokinetics and Exposure-Response Analysis of Venetoclax + Obinutuzumab in Chronic Lymphocytic Leukemia: Phase 1b Study and Phase 3 CLL14 Trial. Adv Ther 2022; 39:3635-3653. [PMID: 35708885 PMCID: PMC9309146 DOI: 10.1007/s12325-022-02170-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study aims to investigate pharmacokinetics (PK) and exposure-response parameters of the 400 mg once-daily venetoclax dose regimen in combination with obinutuzumab, which was approved for the first-line (1L) treatment of chronic lymphocytic leukemia (CLL) based on data from the phase 3 CLL14 study and the phase 1b dose-finding GP28331 study. METHODS Parameter estimates and uncertainty, which were estimated by a previously developed population PK (popPK) model, were used as informative priors for this analysis. They were re-estimated, and then used to evaluate additional covariate effects, describe venetoclax PK when administered with obinutuzumab, and provide empirical Bayes estimates of PK parameters and exposure. Exposure-progression-free survival (PFS) and exposure-safety relationships were assessed using data from CLL14, with steady-state nominal venetoclax exposure (CmeanSS,nominal) as the predictor variable. Exposure-safety analyses were conducted using logistic regression for selected treatment-emergent grade ≥ 3 adverse events (AEs) and serious AEs (SAEs). Dose intensities were summarized by tertiles of CmeanSS,nominal. RESULTS PK data from 274 patients (CLL14, n = 194; GP28331, n = 80) were included. The final model provided good fit of the observed data. Obinutuzumab co-administration, history of prior treatments, and disease severity at baseline had no appreciable influence on venetoclax steady-state exposure. No significant correlations were observed between venetoclax exposure and PFS, or between venetoclax exposure and the probability of treatment-emergent grade ≥ 3 neutropenia, grade ≥ 3 thrombocytopenia, grade ≥ 3 infections, and SAEs. Median dose intensities for venetoclax and obinutuzumab remained similar across venetoclax exposure tertiles. CONCLUSION PopPK and exposure-efficacy, exposure-safety, and exposure-tolerability analyses support the 400 mg once-daily venetoclax dose plus obinutuzumab for 1L treatment in patients with CLL. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers NCT02242942 and NCT02339181.
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Affiliation(s)
- Divya Samineni
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA.
| | | | - Bei Wang
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | | | | | | | | | - Othman Al-Sawaf
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, Cologne, Germany
| | - Kirsten Fischer
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, Cologne, Germany
| | - Ahmed Hamed Salem
- AbbVie Inc., North Chicago, IL, USA.,Department of Clinical Pharmacy, Ain Shams University, Cairo, Egypt
| | - Chunze Li
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | - Dale Miles
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
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Delimpasi S, Quach H, Cavo M, Ho PJ, Lee C, Santoro A, Schots R, Vlummens P, Yoon DH, Yoon SS, Dos Santos C, Samineni D, Huang J, Wehrman K, Patil U, Sheikh S, Dimopoulos MA. CAMMA 3: A multicenter phase Ib trial evaluating the safety, pharmacokinetics, and activity of subcutaneous cevostamab monotherapy in patients with relapsed or refractory multiple myeloma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps8070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8070 Background: Multiple myeloma (MM) remains an incurable disease. Although new treatment paradigms have increased survival, most patients relapse and treatment in later lines remains a challenge. Prognosis for patients refractory to immunomodulatory drugs, proteasome inhibitors and anti-CD38 antibodies is extremely poor, with an estimated survival of < 1 year (Gandhi et al. 2019). Therefore, patients with relapsed/refractory (R/R) disease represent a high unmet need, and new targets and treatment modalities are needed. Cevostamab is an IgG1-based T-cell-dependent bispecific antibody engineered to target the most membrane-proximal domain of fragment crystallizable receptor-like 5 (FcRH5) on myeloma cells, and cluster of differentiation 3 (CD3) on T cells. This dual binding results in efficient immunological synapse formation and T-cell-mediated killing of myeloma cells. In the ongoing first-in-human Phase I GO39775 study, intravenous (IV) administration of cevostamab monotherapy continues to show clinically meaningful activity and durable responses in patients with heavily pre-treated R/R MM (Trudel et al. ASH 2021), and uses Cycle (C) 1 step-up dosing for the mitigation of cytokine release syndrome (CRS). Subcutaneous (SC) delivery of antibody therapies has been shown to be effective and well tolerated and offers several advantages over IV administration in regards to improved healthcare utilization, including ease of administration, reduced treatment burden and reduced hospitalization. The slower absorption rate observed with SC versus IV antibody therapies may also support the potential for SC cevostamab to provide a further improved CRS profile (Bartlett et al. ASH 2021). CAMMA 3 (GO43227; ISRCTN26168155) is an open-label, multicenter, Phase Ib dose-escalation and dose-expansion trial evaluating the safety, tolerability, pharmacokinetics (PK) and preliminary activity of SC cevostamab monotherapy in patients with R/R MM. Methods: For inclusion, patients must be aged ≥18 years and must have R/R MM for which no established therapies are available or appropriate. Cevostamab is administered by SC injection in 28-day cycles, with step-up dosing in C1, q2w dosing in C2–6, and q4w dosing in C7–13. Patients may receive up to 13 cycles unless there is disease progression or unacceptable toxicity. Patients who respond to cevostamab but develop recurrent or progressive disease after 13 cycles may be eligible for cevostamab re-treatment. Primary objectives are to evaluate the safety and tolerability (including the maximum tolerated dose and dose-limiting toxicities) of SC cevostamab and to identify a recommended Phase II dose. Secondary objectives include assessment of PK, activity, and immunogenicity, and identification of biomarkers associated with response and resistance. Clinical trial information: 26168155.
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Affiliation(s)
- Sosana Delimpasi
- Department of Hematology and Lymphoma, Evangelismos Hospital, Athens, Greece
| | - Hang Quach
- Faculty of Medicine, University of Melbourne, Department of Haematology, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Michele Cavo
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - P. Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital & University of Sydney, Camperdown, NSW, Australia
| | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Rik Schots
- University Hospital Brussels, Brussels, Belgium
| | - Philip Vlummens
- Department of Clinical Hematology, Ghent University Hospital, Ghent, Belgium
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Soo Yoon
- Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | - Upen Patil
- Genentech, Inc., South San Francisco, CA
| | | | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Vij R, Schade H, Trudel S, Chang AC, Huang J, Samineni D, Sumiyoshi T, Tsai J, Wong T, Harrison SJ. CAMMA 1: A multicenter phase Ib trial evaluating the safety, pharmacokinetics, and activity of cevostamab-containing regimens in patients with relapsed or refractory multiple myeloma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps8069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8069 Background: Treatment of relapsed/refractory (R/R) multiple myeloma (MM) is challenging, especially in later lines where drug resistance reduces therapeutic options and remission duration. Prognosis is poor (estimated survival: < 1 year) for patients with MM who have received > 3 prior lines of therapy and are triple refractory to immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs) and anti-CD38 agents (Gandhi et al. 2019). Thus R/R MM constitutes a significant unmet medical need. Fragment crystallizable receptor-like 5 (FcRH5) is expressed on myeloma cells with near 100% prevalence (Li et al. 2017), constituting a novel therapeutic target. Cevostamab is an IgG1-based T-cell-engaging bispecific antibody engineered to target the most membrane-proximal domain of FcRH5 on myeloma cells and cluster of differentiation 3 (CD3) on T-cells, resulting in T-cell killing of myeloma cells. Clinical data from the first-in-human Phase I study (GO39775) suggest that cevostamab monotherapy is highly active in heavily pretreated patients with R/R MM, with an overall response rate of 56.7% at the 132–198mg dose level (Trudel et al. ASH 2021 Oral presentation). Thus, cevostamab’s activity and safety profile support further development. Due to their stimulatory effects on T-cell activity, combination of cevostamab with anti-myeloma agents (pomalidomide [P] or daratumumab [D]) may be synergistic, offering the potential to further improve efficacy. CAMMA 1 (NCT04910568) is an open-label, multicenter Phase Ib trial evaluating the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics of cevostamab-containing combination regimens (Arm B: cevostamab plus P and dexamethasone [d] [Pd]; Arm C: cevostamab plus Dd) in patients with R/R MM. A modified weekly schedule for cevostamab is also under investigation (Arm A: cevostamab monotherapy). Methods: Patients must be aged ≥18 years, have an ECOG performance status of 0 or 1 and a life expectancy of > 12 weeks. Patients in all arms have R/R MM; Arms B and C include patients with prior IMiD and PI exposure. Patients with prior CAR-T therapy may enroll with a washout period of 12 weeks post-CAR-T infusion. Cevostamab is administered by intravenous infusion q1w (C1–2)/q2w (C3–6)/q4w (C7–13) in Arm A, q2w (C1–6)/q4w (C7+) in Arm B, and q3w (C1–8)/q4w (C9+) in Arm C. Each arm consists of a safety run-in and an expansion cohort. Enrolment for Arm A is ongoing, with patients receiving up to 13 treatment cycles. Arms B and C are planned; patients will receive treatment until disease progression or unacceptable toxicity. The primary objective is to evaluate the safety and tolerability of cevostamab plus Pd, cevostamab plus Dd and cevostamab monotherapy. Secondary objectives include assessment of activity, PK, immunogenicity, and pharmacodynamic biomarkers. Clinical trial information: NCT04910568.
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Affiliation(s)
- Ravi Vij
- Washington University, St. Louis, MO
| | | | - Suzanne Trudel
- Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | - Simon J. Harrison
- Peter MacCallum Cancer Center and Royal Melbourne Hospital, and Sir Peter MacCallum Department of Oncology, Melbourne, VIC, Australia
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Herrera AF, Patel MR, Burke JM, Advani R, Cheson BD, Sharman JP, Penuel E, Polson AG, Liao CD, Li C, Schuth E, Vaze A, Samineni D, Elstrom R, Cooper J, Diefenbach C. Anti-CD79B Antibody-Drug Conjugate DCDS0780A in Patients with B-Cell Non-Hodgkin Lymphoma: Phase 1 Dose-Escalation Study. Clin Cancer Res 2022; 28:1294-1301. [PMID: 34980599 PMCID: PMC9365381 DOI: 10.1158/1078-0432.ccr-21-3261] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/11/2021] [Accepted: 12/30/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Targeting CD79B using antibody-drug conjugates (ADC) is an effective therapeutic strategy in B-cell non-Hodgkin lymphoma (B-NHL). We investigated DCDS0780A, an anti-CD79B ADC with THIOMAB technology (TDC) that consistently conjugates two anti-neoplastic molecules per antibody, in contrast with ADCs with heterogeneous loads. PATIENTS AND METHODS This phase 1 study enrolled 60 patients with histologically confirmed B-NHL that had relapsed/failed to respond following ≥1 prior treatment regimens; 41 (68%) had diffuse large B-cell lymphoma (DLBCL). Fifty-one patients received DCDS0780A monotherapy once every 3 weeks (0.3-4.8 mg/kg); 9 received combination therapy (3.6-4.8 mg/kg) with rituximab. RESULTS Fifty-four (90%) patients experienced adverse events related to study drug, the most common of which were blurred vision, fatigue, corneal deposits, neutropenia, nausea, and peripheral neuropathy. 4.8 mg/kg was the highest dose tested and the recommended phase II dose. The pharmacokinetic profile was linear at doses ≥1.2 mg/kg. Response rate in all-treated patients (N = 60) was 47% (n = 28), including 17 complete responses (28%) and 11 partial responses (18%). The median duration of response (15.2 months) was the same for all responders (n = 28) and patients with DLBCL (n = 20). CONCLUSIONS DCDS0780A as the TDC format for CD79B was tested at higher doses than its ADC counterpart investigated earlier, leading to deep responses. However, dose intensity was limited by ocular toxicities seen at the higher doses indicating that the TDC format was unable, in the current study, to expand the therapeutic index for the CD79B target. The encouraging antitumor activity advocates continuation of investigations into novel ADC technologies.
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Affiliation(s)
- Alex F. Herrera
- City of Hope Medical Center, Duarte, California.,Corresponding Author: Alex F. Herrera, City of Hope Medical Center, 1500 East Duarte Road, Duarte, CA 91010. Phone: 626-256-4673; E-mail:
| | - Manish R. Patel
- Sarah Cannon Research Institute and Florida Cancer Specialists, Sarasota, Florida
| | - John M. Burke
- US Oncology and Rocky Mountain Cancer Centers, Aurora, Colorado
| | | | | | - Jeff P. Sharman
- US Oncology and Willamette Valley Cancer Institute, Springfield, Oregon
| | | | | | - Chen Di Liao
- Hoffmann-La Roche Limited, Mississauga, Ontario, Canada
| | - Chunze Li
- Genentech, Inc., South San Francisco, California
| | - Eva Schuth
- Genentech, Inc., South San Francisco, California
| | - Anjali Vaze
- Genentech, Inc., South San Francisco, California
| | | | | | - James Cooper
- Genentech, Inc., South San Francisco, California
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Samineni D, Huang W, Gibiansky L, Ding H, Zhang R, Li C, Sinha A, Rajwanshi R, Humphrey K, Bazeos A, Salem AH, Miles D. Population Pharmacokinetics and Exposure-Response Analyses for Venetoclax in Combination with R-CHOP in Relapsed/Refractory and Previously Untreated Patients with Diffuse Large B Cell Lymphoma. Adv Ther 2022; 39:598-618. [PMID: 34822104 PMCID: PMC8799559 DOI: 10.1007/s12325-021-01919-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/07/2021] [Indexed: 12/16/2022]
Abstract
Introduction Outcomes remain poor in patients with diffuse large B cell lymphoma (DLBCL) who overexpress BCL-2 protein. We present population pharmacokinetics (PopPK) and exposure–response (ER) analyses for venetoclax (a selective BCL-2 inhibitor) administered with rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with relapsed/refractory (R/R) and previously untreated (1L) non-Hodgkin lymphoma (NHL) from the phase 1b/2 CAVALLI study, to confirm dose selection for future studies. Methods Analyses included 216 patients with R/R or 1L NHL treated for eight 21-day cycles with 400–800 mg venetoclax (cycle 1: days 4–10; cycles 2–8: days 1–10) in combination with R for eight cycles and CHOP for 6–8 cycles. A legacy PopPK model for venetoclax was used to describe the observed data and provide post hoc PK parameters. Venetoclax steady-state exposure (AUCss) was used to predict clinical efficacy, safety, or tolerability. To isolate the effect of venetoclax, ER analyses referenced data from the R-CHOP arm of a historical control study, GOYA, in 1L DLBCL. Results There was no significant association between venetoclax AUCss and progression-free survival or complete response either for all-comers or the BCL-2-immunohistochemistry-positive subpopulation. No statistically significant trends were observed with venetoclax AUCss and the key grade ≥ 3 adverse events and serious adverse events. Similar dose intensities were observed for venetoclax and R-CHOP components across venetoclax exposures, suggesting venetoclax did not impact delivery of the R-CHOP backbone. Conclusions The PopPK and ER analyses, in addition to the positive benefit–risk observed in the clinical data, support the selection of 800 mg venetoclax given with R-CHOP for future studies in BCL-2-immunohistochemistry-positive patients with 1L DLBCL. Trial Registration ClinicalTrials.gov Identifier NCT02055820. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01919-z.
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Affiliation(s)
- Divya Samineni
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA.
| | - Weize Huang
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | | | - Hao Ding
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | - Rong Zhang
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | - Chunze Li
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | | | | | | | | | - Ahmed Hamed Salem
- AbbVie Inc., North Chicago, IL, USA
- Ain Shams University, Cairo, Egypt
| | - Dale Miles
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
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Li C, Chen SC, Chen Y, Girish S, Kaagedal M, Lu D, Lu T, Samineni D, Jin JY. Impact of Physiologically Based Pharmacokinetics, Population Pharmacokinetics and Pharmacokinetics/Pharmacodynamics in the Development of Antibody-Drug Conjugates. J Clin Pharmacol 2021; 60 Suppl 1:S105-S119. [PMID: 33205423 PMCID: PMC7756373 DOI: 10.1002/jcph.1720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/26/2020] [Indexed: 12/14/2022]
Abstract
Antibody‐drug conjugates are important molecular entities in the treatment of cancer, with 8 antibody‐drug conjugates approved by the US Food and Drug Administration since 2000 and many more in early‐ and late‐stage clinical development. These conjugates combine the target specificity of monoclonal antibodies with the potent anticancer activity of small‐molecule therapeutics. The complex structure of antibody‐drug conjugates poses unique challenges to pharmacokinetic (PK) and pharmacodynamic (PD) characterization because it requires a quantitative understanding of the PK and PD properties of multiple different molecular species (eg, conjugate, total antibody, and unconjugated payload) in different tissues. Quantitative clinical pharmacology using mathematical modeling and simulation provides an excellent approach to overcome these challenges, as it can simultaneously integrate the disposition, PK, and PD of antibody‐drug conjugates and their components in a quantitative manner. In this review, we highlight diverse quantitative clinical pharmacology approaches, ranging from system models (eg, physiologically based pharmacokinetic [PBPK] modeling) to mechanistic and empirical models (eg, population PK/PD modeling for single or multiple analytes, exposure‐response modeling, platform modeling by pooling data across multiple antibody‐drug conjugates). The impact of these PBPK and PK/PD models to provide insights into clinical dosing justification and inform drug development decisions is also highlighted.
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Affiliation(s)
- Chunze Li
- Genentech Inc., South San Francisco, California, USA
| | | | - Yuan Chen
- Genentech Inc., South San Francisco, California, USA
| | | | | | - Dan Lu
- Genentech Inc., South San Francisco, California, USA
| | - Tong Lu
- Genentech Inc., South San Francisco, California, USA
| | | | - Jin Y Jin
- Genentech Inc., South San Francisco, California, USA
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Badawi M, Tong B, Chen X, Palenski T, Kim SY, Samineni D, Hoffman D, Menon R, Salem AH. Abstract 641: Clinical assessment of the bioavailability of venetoclax tablet and powder formulations. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Venetoclax is a first in class BCL-2 inhibitor that is approved for treatment of CLL and AML. It is currently under evaluation in other indications in adult and pediatric populations. Venetoclax is available as 10 mg, 50 mg, and 100 mg film-coated tablets. While the 100 mg tablet is most commonly used, the smaller size of the lower strength tablets is preferred by patients experiencing difficulty swallowing large tablets. Moreover, two powder formulations for suspension (0.72% and 7.2%) to be mixed with delivery vehicles were developed. In this abstract we present data from clinical studies that evaluated the bioavailability of the different venetoclax formulations relative to the commercially available 100 mg tablet. Three open-label, single-dose, crossover bioavailability studies in healthy female subjects were conducted. The first study evaluated the bioavailability of the commercially available 10 and 50 mg tablets relative to the 100 mg tablet. Forty subjects received a 100 mg dose of venetoclax (1x100 mg tablet, 2x50 mg tablets or 10x10 mg tablets) at the start of each period after a low-fat breakfast. The second study evaluated the bioavailability of the two powder formulations relative to the 100 mg tablet. Sixteen subjects received a 100 mg dose of venetoclax (1x100 mg film-coated tablet; 100 mg 0.72% powder formulation; 100 mg 7.2% powder formulation; and 4x25 mg dispersible tablets for oral suspension used in the Phase 1 study) in each of the 4 periods after a high fat breakfast. The third study evaluated the bioavailability of the two powder formulations when administered with different dosing vehicles relative to water. Twenty-four subjects (12 per cohort) received 100 mg of venetoclax (0.72% powder formulation or the 7.2% powder formulation) with either water, apple juice, apple sauce or yogurt in each of the 4 periods after a moderate fat breakfast. Bioavailability assessment of the commercial tablets demonstrated that ten 10 mg tablets were bioequivalent to one 100 mg tablet, two 50 mg tablets were bioequivalent to one 100 mg tablet, and two 50 mg tablets were bioequivalent to ten 10 mg tablets. The two powder formulations for oral suspension (0.72% and 7.2%) met the bioequivalence criteria (0.80-1.25) to the commercial 100 mg tablet with respect to AUCt and AUC∞, but the lower bound of the 90% CI of the Cmax extended slightly below 0.80. The delivery vehicles (water, apple juice, apple sauce and yogurt) did not affect the bioavailability of venetoclax 0.72% or 7.2% oral suspensions
Citation Format: Mohamed Badawi, Bo Tong, Xin Chen, Tammy Palenski, Su Young Kim, Divya Samineni, David Hoffman, Rajeev Menon, Ahmed Hamed Salem. Clinical assessment of the bioavailability of venetoclax tablet and powder formulations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 641.
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Affiliation(s)
| | - Bo Tong
- 1AbbVie Inc., North Chicago, IL
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10
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Daver N, Salhotra A, Brandwein JM, Podoltsev NA, Pollyea DA, Jurcic JG, Assouline S, Yee K, Li M, Pourmohamad T, Samineni D, Sumiyoshi T, Vaze A, Dere RC, Ma C, Cooper J. A Phase I dose-escalation study of DCLL9718S, an antibody-drug conjugate targeting C-type lectin-like molecule-1 (CLL-1) in patients with acute myeloid leukemia. Am J Hematol 2021; 96:E175-E179. [PMID: 33617672 PMCID: PMC8252033 DOI: 10.1002/ajh.26136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/15/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Naval Daver
- Department of Leukemia MD Anderson Cancer Center Houston Texas
| | | | | | | | - Daniel A. Pollyea
- Division of Hematology, Department of Medicine University of Colorado Aurora Colorado
| | - Joseph G. Jurcic
- Columbia University Irving Medical Center New York Presbyterian Hospital, and Herbert Irving Comprehensive Cancer Center, Columbia University New York New York
| | - Sarit Assouline
- Jewish General Hospital, McGill University Montreal Quebec Canada
| | - Karen Yee
- Department of Medical Oncology Princess Margaret Hospital Toronto Ontario Canada
| | - Mengsong Li
- Genentech, Inc. South San Francisco California
| | | | | | | | - Anjali Vaze
- Genentech, Inc. South San Francisco California
| | | | - Connie Ma
- Genentech, Inc. South San Francisco California
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Liao MZ, Lu D, Kågedal M, Miles D, Samineni D, Liu SN, Li C. Model-Informed Therapeutic Dose Optimization Strategies for Antibody-Drug Conjugates in Oncology: What Can We Learn From US Food and Drug Administration-Approved Antibody-Drug Conjugates? Clin Pharmacol Ther 2021; 110:1216-1230. [PMID: 33899934 PMCID: PMC8596428 DOI: 10.1002/cpt.2278] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
Antibody–drug conjugates (ADCs) combine the specificity of an antibody with the cytotoxicity of a chemical agent. They represent a rapidly evolving area of oncology drug development and hold significant promise. There are currently nine ADCs on the market, more than half of which gained US Food and Drug Administration approval more recently, since 2019. Despite their enormous promise, the therapeutic window for these ADCs remains relatively narrow, especially when compared with other oncology drugs, such as targeted therapies or checkpoint inhibitors. In this review, we provide a detailed overview of the five dosing regimen optimization strategies that have been leveraged to broaden the therapeutic window by mitigating the safety risks while maintaining efficacy. These include body weight cap dosing; treatment duration capping; dose schedule (e.g., dosing frequency and dose fractionation); response‐guided dosing recommendations; and randomized dose‐finding. We then discuss how the lessons learned from these studies can inform ADC development going forward. Informed application of these dosing strategies should allow researchers to maximize the safety and efficacy for next‐generation ADCs.
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Affiliation(s)
| | - Dan Lu
- Genentech Inc., South San Francisco, California, USA
| | - Matts Kågedal
- Genentech Inc., South San Francisco, California, USA
| | - Dale Miles
- Genentech Inc., South San Francisco, California, USA
| | | | | | - Chunze Li
- Genentech Inc., South San Francisco, California, USA
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12
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Morschhauser F, Feugier P, Flinn IW, Gasiorowski R, Greil R, Illés Á, Johnson NA, Larouche JF, Lugtenburg PJ, Patti C, Salles GA, Trněný M, de Vos S, Mir F, Samineni D, Kim SY, Jiang Y, Punnoose E, Sinha A, Clark E, Spielewoy N, Humphrey K, Bazeos A, Zelenetz AD. A phase 2 study of venetoclax plus R-CHOP as first-line treatment for patients with diffuse large B-cell lymphoma. Blood 2021; 137:600-609. [PMID: 33538797 PMCID: PMC7869186 DOI: 10.1182/blood.2020006578] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/24/2020] [Indexed: 12/29/2022] Open
Abstract
The phase 2 CAVALLI (NCT02055820) study assessed efficacy and safety of venetoclax, a selective B-cell lymphoma-2 (Bcl-2) inhibitor, with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in first-line (1L) diffuse large B-cell lymphoma (DLBCL), including patients demonstrating Bcl-2 protein overexpression by immunohistochemistry (Bcl-2 IHC+). Eligible patients were ≥18 years of age and had previously untreated DLBCL, Eastern Cooperative Oncology Group performance status ≤2, and International Prognostic Index 2 to 5. Venetoclax 800 mg (days 4-10, cycle 1; days 1-10, cycles 2-8) was administered with rituximab (8 cycles) and cyclophosphamide, doxorubicin, vincristine, and prednisone (6-8 cycles) in 21-day cycles. Primary end points were safety, tolerability, and research_plete response (CR) at end of treatment (EOT). Secondary end points were progression-free survival (PFS) and overall survival. Comparative analyses used covariate-adjusted R-CHOP controls from the GOYA/BO21005 study, an appropriate contemporary benchmark for safety and efficacy. Safety and efficacy analyses included 206 patients. CR rate at EOT was 69% in the overall population and was maintained across Bcl-2 IHC+ subgroups. With a median follow-up of 32.2 months, trends were observed for improved investigator-assessed PFS for venetoclax plus R-CHOP in the overall population (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.43-0.87) and Bcl-2 IHC+ subgroups (HR, 0.55; 95% CI, 0.34-0.89) vs R-CHOP. Despite a higher incidence of grade 3/4 hematologic adverse events (86%), related mortality was not increased (2%). Chemotherapy dose intensity was similar in CAVALLI vs GOYA. The addition of venetoclax to R-CHOP in 1L DLBCL demonstrates increased, but manageable, myelosuppression and the potential of improved efficacy, particularly in high-risk Bcl-2 IHC+ patient subgroups.
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Affiliation(s)
- Franck Morschhauser
- Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Groupe de Recherche sur les Formes Injectables et les Technologies Associées (ULR 7365-GRITA), Lille, France
| | - Pierre Feugier
- CHU de Nancy, Université de Lorraine, Vandoeuvre lès Nancy, France
| | - Ian W Flinn
- Sarah Cannon Research Institute-Tennessee Oncology, Nashville, TN
| | | | - Richard Greil
- Paracelcus Medical University Salzburg, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Árpád Illés
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Pieternella J Lugtenburg
- HOVON Lunenburg Lymphoma Phase I-II Consortium, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Caterina Patti
- Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Gilles A Salles
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, University of Lyon, Pierre-Bénite, France
| | - Marek Trněný
- First Department of Medicine, Charles University General Hospital, Prague, Czech Republic
| | - Sven de Vos
- David Geffen School of Medicine, University of California (UCLA), Los Angeles, CA
| | - Farheen Mir
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | | | | | | | | | - Arijit Sinha
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Emma Clark
- Roche Products Limited, Welwyn Garden City, United Kingdom
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13
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Li C, Zhang C, Li Z, Samineni D, Lu D, Wang B, Chen SC, Zhang R, Agarwal P, Fine BM, Girish S. Clinical pharmacology of vc-MMAE antibody-drug conjugates in cancer patients: learning from eight first-in-human Phase 1 studies. MAbs 2021; 12:1699768. [PMID: 31852341 PMCID: PMC6927763 DOI: 10.1080/19420862.2019.1699768] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
vc-MMAE antibody–drug conjugates (ADCs) consist of a monoclonal antibody (mAb) covalently bound with a potent anti-mitotic toxin (MMAE) through a protease-labile valine-citrulline (vc) linker. The objective of this study was to characterize the pharmacokinetics (PK) and explore exposure–response relationships of eight vc-MMAE ADCs, against different targets and for diverse tumor indications, using data from eight first-in-human Phase 1 studies. PK parameters of the three analytes, namely antibody-conjugated MMAE (acMMAE), total antibody, and unconjugated MMAE, were estimated using non-compartmental approaches and compared across the eight vc-MMAE ADCs. Relationships between analytes were assessed by linear regression. Exposure–response relationships were explored with key efficacy (objective response rate) and safety (Grade 2+ peripheral neuropathy) endpoints. PK profiles of acMMAE, total antibody and unconjugated MMAE following the first dose of 2.4 mg/kg were comparable across the eight ADCs; the exposure differences between molecules were small relative to the inter-subject variability. acMMAE exposure was strongly correlated with total antibody exposure for all the eight ADCs, but such correlation was less evident between acMMAE and unconjugated MMAE exposure. For multiple ADCs evaluated, efficacy and safety endpoints appeared to correlate well with acMMAE exposure, but not with unconjugated MMAE over the doses tested. PK of vc-MMAE ADCs was well characterized and demonstrated remarkable similarity at 2.4 mg/kg across the eight ADCs. Results from analyte correlation and exposure–response relationship analyses suggest that measurement of acMMAE analyte alone might be adequate for vc-MMAE ADCs to support the clinical pharmacology strategy used during late-stage clinical development.
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Affiliation(s)
- Chunze Li
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Cindy Zhang
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Zao Li
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Divya Samineni
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Dan Lu
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Bei Wang
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Shang-Chiung Chen
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Rong Zhang
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Priya Agarwal
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Bernard M Fine
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
| | - Sandhya Girish
- Genentech Research & Early Development, Genentech, Inc, South San Francisco, CA, USA
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Samineni D, Ding H, Ma F, Shi R, Lu D, Miles D, Mao J, Li C, Jin J, Wright M, Girish S, Chen Y. Physiologically Based Pharmacokinetic Model-Informed Drug Development for Polatuzumab Vedotin: Label for Drug-Drug Interactions Without Dedicated Clinical Trials. J Clin Pharmacol 2020; 60 Suppl 1:S120-S131. [PMID: 33205435 DOI: 10.1002/jcph.1718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/26/2020] [Indexed: 01/13/2023]
Abstract
Model-informed drug development (MIDD) has become an important approach to improving clinical trial efficiency, optimizing drug dosing, and proposing drug labeling in the absence of dedicated clinical trials. For the first time, we developed a physiologically based pharmacokinetic (PBPK) model-based approach to assess CYP3A-mediated drug-drug interaction (DDI) risk for polatuzumab vedotin (Polivy), an anti-CD79b-vc-monomethyl auristatin E (MMAE) antibody-drug conjugate (ADC). The model was developed and verified using data from the existing clinical DDI study for brentuximab vedotin, a similar vc-MMAE ADC. Analogous to the brentuximab vedotin clinical study, polatuzumab vedotin at the proposed labeled dose was predicted to have a limited drug interaction potential with strong CYP3A inhibitor and inducer. Polatuzumab vedotin was also predicted to neither inhibit nor induce CYP3A. The present work demonstrated a high-impact application using a PBPK MIDD approach to predict the CYP3A-mediated DDI to enable drug labeling in the absence of any dedicated clinical DDI study. The key considerations for the PBPK report included in the Biologics License Application/Marketing Authorization Application submission, as well as the strategy and responses to address some of the critical and challenging questions from the health authorities following the submission are also discussed. Our experience and associated perspective using a PBPK approach to ultimately enable a drug interaction label claim for polatuzumab vedotin in lieu of a dedicated clinical DDI study, as well as the interactions with the regulatory agencies, further provides confidence in applying MIDD to accelerate the registration and approval of new drug therapies.
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Affiliation(s)
- Divya Samineni
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Hao Ding
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Fang Ma
- Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California, USA
| | - Rong Shi
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Dan Lu
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Dale Miles
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Jialin Mao
- Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California, USA
| | - Chunze Li
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Jin Jin
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Matthew Wright
- Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California, USA
| | - Sandhya Girish
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Yuan Chen
- Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California, USA
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15
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Gopalakrishnan S, Menon R, Chyla B, Samineni D, Jacobson A, Kim SY, Mensing S, Salem AH. Abstract 3024: Relationship between venetoclax concentrations and undetectable MRD in patients with chronic lymphocytic leukemia. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Minimal residual disease (MRD) is an important clinical endpoint in chronic lymphocytic leukemia (CLL) because it correlates with progression free survival and overall survival. The objective of this work is to investigate the impact of venetoclax (VEN) exposures on undetectable MRD rates in blood and bone marrow (BM) in relapsed/refractory (R/R) CLL patients receiving VEN monotherapy or combination therapy with rituximab (RTX).
Data from a total of 708 patients from four VEN monotherapy studies and one combination Phase 1b study (VEN + 6-9 cycles of RTX) in R/R CLL patients were utilized to perform this analysis. The median number of prior therapies in these studies was 3, 42% of the patients had 17p chromosomal deletion and 28% had prior B-Cell Receptor inhibitor (BCRi) therapy. Blood and BM MRD assessments were available for 70% and 38%, respectively, of patients included in the analysis. Absence of an MRD measurement was assumed as detectable MRD for the purposes of this analysis.
The average concentration (Cavg) of VEN was computed for each patient by fitting a population pharmacokinetic model to the observed VEN concentration data. The model was used to calculate area under the curve and compute Cavg accounting for VEN dose ramp-ups, reductions and interruptions. The relationships between venetoclax Cavg and undetectable MRD rates were assessed by using quartile plots. Logistic regression analyses were also conducted to quantify the exposure-response relationship.
With VEN monotherapy, the undetectable MRD rates in blood and BM increased with the increase in VEN exposures. With VEN + RTX combination treatment, the undetectable MRD rates in blood and BM showed an increase with increasing VEN average concentration, but the benefit saturated with limited increase at exposures beyond 400mg.
Logistic regression analyses indicated statistically significant (p<0.01) relationships between VEN average concentrations and undetectable MRD rates in both blood and BM.
These results demonstrate that higher venetoclax concentrations are associated with higher undetectable MRD rates in both blood and BM. When VEN is combined with RTX, an increase in VEN dose beyond 400mg is unlikely to result in higher undetectable MRD rates.
Citation Format: Sathej Gopalakrishnan, Rajeev Menon, Brenda Chyla, Divya Samineni, Amanda Jacobson, Su Young Kim, Sven Mensing, Ahmed Hamed Salem. Relationship between venetoclax concentrations and undetectable MRD in patients with chronic lymphocytic leukemia [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3024.
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Moore KN, Birrer MJ, Marsters J, Wang Y, Choi Y, Royer-Joo S, Lemahieu V, Armstrong K, Cordova J, Samineni D, Schuth E, Vaze A, Maslyar D, Humke EW, Hamilton EP, Liu JF. Phase 1b study of anti-NaPi2b antibody-drug conjugate lifastuzumab vedotin (DNIB0600A) in patients with platinum-sensitive recurrent ovarian cancer. Gynecol Oncol 2020; 158:631-639. [PMID: 32534811 DOI: 10.1016/j.ygyno.2020.05.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/23/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study investigated the safety and tolerability of lifastuzumab vedotin (DNIB0600A) (LIFA), an antibody-drug conjugate, in patients with recurrent platinum-sensitive ovarian cancer (PSOC). METHODS In this open-label, multicenter phase 1b study, LIFA was administered intravenously once every 3 weeks (Q3W) with starting dose 1.2 mg/kg in a 3 + 3 dose-escalation scheme. All patients received carboplatin at dose AUC 6 mg/mL·min (AUC6) Q3W for up to 6 cycles. Dose expansion cohorts were enrolled ± bevacizumab 15 mg/kg Q3W. RESULTS Patients received LIFA at 1.2, 1.8, and 2.4 mg (n = 4, 5, and 20, respectively) with carboplatin. The maximum tolerated dose was not reached. The recommended phase 2 dose (RP2D) was LIFA 2.4 mg/kg + carboplatin AUC6 (cycles 1-6), with or without bevacizumab 15 mg/kg. Twelve patients received RP2D with bevacizumab. All patients experienced ≥1 adverse event (AE). The most common treatment-related AEs were neutropenia, peripheral neuropathy, thrombocytopenia, nausea, fatigue, anemia, diarrhea, vomiting, hypomagnesaemia, aspartate aminotransferase increased, alanine aminotransferase increased, and alopecia. Thirty-four (83%) patients experienced grade ≥ 3 AEs, the most frequent of which were neutropenia and thrombocytopenia. Nine (22%) patients experienced serious AEs. Pulmonary toxicities (34%), considered a potential risk of LIFA, included one patient who discontinued study treatment due to grade 2 pneumonitis. The median duration of progression-free survival was 10.71 months (95% CI: 8.54, 13.86) with confirmed complete/partial responses in 24 (59%) patients. Pharmacokinetics of mono-therapy LIFA was similar in combination therapy. CONCLUSION LIFA in combination with carboplatin ± bevacizumab demonstrated acceptable safety and encouraging activity in PSOC patients.
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Affiliation(s)
- Kathleen N Moore
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America; Sarah Cannon Research Institute, Nashville, TN, United States of America.
| | | | - Jim Marsters
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Yulei Wang
- Genentech, Inc., South San Francisco, CA, United States of America
| | - YounJeong Choi
- Genentech, Inc., South San Francisco, CA, United States of America
| | | | - Vanessa Lemahieu
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Katy Armstrong
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Julie Cordova
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Divya Samineni
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Eva Schuth
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Anjali Vaze
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Daniel Maslyar
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Eric W Humke
- Genentech, Inc., South San Francisco, CA, United States of America
| | - Erika P Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, United States of America
| | - Joyce F Liu
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
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Gerber DE, Infante JR, Gordon MS, Goldberg SB, Martín M, Felip E, Martinez Garcia M, Schiller JH, Spigel DR, Cordova J, Westcott V, Wang Y, Shames DS, Choi Y, Kahn R, Dere RC, Samineni D, Xu J, Lin K, Wood K, Royer-Joo S, Lemahieu V, Schuth E, Vaze A, Maslyar D, Humke EW, Burris HA. Phase Ia Study of Anti-NaPi2b Antibody–Drug Conjugate Lifastuzumab Vedotin DNIB0600A in Patients with Non–Small Cell Lung Cancer and Platinum-Resistant Ovarian Cancer. Clin Cancer Res 2019; 26:364-372. [DOI: 10.1158/1078-0432.ccr-18-3965] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/02/2019] [Accepted: 09/18/2019] [Indexed: 11/16/2022]
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18
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Kågedal M, Samineni D, Gillespie WR, Lu D, Fine BM, Girish S, Li C, Jin JY. Time-to-Event Modeling of Peripheral Neuropathy: Platform Analysis of Eight Valine-Citrulline-Monomethylauristatin E Antibody-Drug Conjugates. CPT Pharmacometrics Syst Pharmacol 2019; 8:606-615. [PMID: 31207190 PMCID: PMC6709423 DOI: 10.1002/psp4.12442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/01/2019] [Indexed: 12/28/2022] Open
Abstract
Peripheral neuropathy (PN) is a common long-term debilitating toxicity of antimicrotubule agents. PN was the most frequent adverse event resulting in dose modifications and/or discontinuation of treatment for valine-citrulline-monomethylauristatin E antibody-drug conjugates (ADCs) developed at Genentech. A pooled time-to-event analysis across eight ADCs (~700 patients) was performed to evaluate the relationship between the ADC exposure and the risk for developing a clinically significant (grade ≥ 2) PN. In addition, the impact of demographic and pathophysiological risk factors on the risk for PN was explored. The time-to-event analysis suggested that the development of PN risk increased with ADC exposure, treatment duration, body weight, and previously reported PN. This model can be used to inform clinical strategies such as adaptations to dosing regimen and/or treatment duration as well as inform clinical eligibility to reduce the incidence of grade ≥ 2 PN.
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Affiliation(s)
| | | | | | - Dan Lu
- Genentech Inc.South San FranciscoCaliforniaUSA
| | | | | | - Chunze Li
- Genentech Inc.South San FranciscoCaliforniaUSA
| | - Jin Y. Jin
- Genentech Inc.South San FranciscoCaliforniaUSA
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19
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Morschhauser F, Flinn I, Gasiorowski R, Illés Á, Feugier P, Greil R, Johnson N, Larouche J, Lugtenburg P, Patti C, Salles G, Trněný M, de Vos S, Mir F, Kornacker M, Punnoose E, Samineni D, Szafer-Glusman E, Petrich A, Sinha A, Spielewoy N, Humphrey K, Bazeos A, Zelenetz A. IMPROVED OUTCOMES IN PATIENTS (PTS) WITH BCL2-POSITIVE DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) TREATED WITH VENETOCLAX (VEN) PLUS R-CHOP: RESULTS FROM THE PHASE 2 CAVALLI STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.95_2629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- F. Morschhauser
- Institute of Hematology-Transfusion; Université de Lille, Centre Hospitalier Universitaire [CHU] Lille, Groupe de Recherche sur les Formes Injectables et les Technologies Associées; Lille France
| | - I.W. Flinn
- Center for Blood Cancers; Sarah Cannon Research Institute-Tennessee Oncology; Nashville TN United States
| | - R. Gasiorowski
- Department of Haematology; Concord Hospital, University of Sydney; Sydney Australia
| | - Á. Illés
- Faculty of Medicine; Department of Hematology, University of Debrecen; Debrecen Hungary
| | - P. Feugier
- Service d'Hématologie; CHU Régional de Nancy; Vandoeuvre lès Nancy France
| | - R. Greil
- 3rd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute, Cancer Cluster Salzburg; Salzburg Austria
| | - N.A. Johnson
- Department of Medicine, Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
| | - J. Larouche
- Hematology-Oncology, CHU de Québec; Hôpital de l'Enfant-Jésus; Quebec Canada
| | - P.J. Lugtenburg
- HOVON Lunenburg Lymphoma Phase I-II Consortium, Department of Hematology; Erasmus MC Cancer Institute; Rotterdam Netherlands
| | - C. Patti
- Department of Hematology; Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello; Palermo Italy
| | - G. Salles
- Clinical Hematology; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, University of Lyon; Pierre-Benite France
| | - M. Trněný
- 1st Department of Medicine; Charles University General Hospital; Prague Czech Republic
| | - S. de Vos
- Division Hematology/Oncology; David Geffen School of Medicine at UCLA; Los Angeles CA United States
| | - F. Mir
- On assignment to PD Clinical Oncology, Roche Products Ltd; Welwyn Garden City, United Kingdom, and Royal Marsden Hospital; Sutton United Kingdom
| | - M. Kornacker
- Pharma Research and Early Development; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - E.A. Punnoose
- Oncology Biomarker Development; Genentech, Inc.; South San Francisco CA United States
| | - D. Samineni
- Genentech Research and Early Development; Genentech, Inc.; South San Francisco CA United States
| | - E. Szafer-Glusman
- Oncology Biomarker Development; Genentech, Inc.; South San Francisco CA United States
| | - A. Petrich
- Oncology Early Development; AbbVie; North Chicago IL United States
| | - A. Sinha
- Product Development; Roche Products Ltd; Welwyn Garden City United Kingdom
| | - N. Spielewoy
- Pharmaceutical Development Clinical Science Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - K. Humphrey
- Clinical Development Oncology; Roche Products Ltd.; Welwyn Garden City United Kingdom
| | - A. Bazeos
- PD Clinical Science; Oncology, Roche Products Ltd.; Welwyn Garden City United Kingdom
| | - A.D. Zelenetz
- Lymphoma Service; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; New York City NY United States
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20
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Li C, Zhang C, Deng R, Leipold D, Li D, Latifi B, Gao Y, Zhang C, Li Z, Miles D, Chen SC, Samineni D, Wang B, Agarwal P, Lu D, Prabhu S, Girish S, Kamath AV. Prediction of Human Pharmacokinetics of Antibody-Drug Conjugates From Nonclinical Data. Clin Transl Sci 2019; 12:534-544. [PMID: 31115997 PMCID: PMC6742937 DOI: 10.1111/cts.12649] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/26/2019] [Indexed: 12/16/2022] Open
Abstract
Prediction of human pharmacokinetics (PK) based on preclinical information for antibody–drug conjugates (ADCs) provide important insight into first‐in‐human (FIH) study design. This retrospective analysis was conducted to identify an appropriate scaling method to predict human PK for ADCs from animal PK data in the linear range. Different methods for projecting human clearance (CL) from animal PK data for 11 ADCs exhibiting linear PK over the tested dose ranges were examined: multiple species allometric scaling (CL vs. body weight), allometric scaling with correction factors, allometric scaling based on rule of exponent, and scaling from only cynomolgus monkey PK data. Two analytes of interest for ADCs, namely total antibody and conjugate (measured as conjugated drug or conjugated antibody), were assessed. Percentage prediction errors (PEs) and residual sum of squares (RSS) were compared across methods. Human CL was best estimated using cynomolgus monkey PK data alone and an allometric scaling exponent of 1.0 for CL. This was consistently observed for both conjugate and total antibody analytes. Other scaling methods either underestimated or overestimated human CL, or produced larger average absolute PEs and RSS. Human concentration‐time profiles were also reasonably predicted from the cynomolgus monkey data using species‐invariant time method with a fixed exponent of 1.0 for CL and 1.0 for volume of distribution. In conclusion, results from this retrospective analysis of 11 ADCs indicate that allometric scaling of CL with an exponent of 1.0 using cynomolgus monkey PK data alone can successfully project human PK profiles of an ADC within linear range.
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Affiliation(s)
- Chunze Li
- Genentech Inc., South San Francisco, California, USA
| | - Cindy Zhang
- Genentech Inc., South San Francisco, California, USA
| | - Rong Deng
- Genentech Inc., South San Francisco, California, USA
| | | | - Dongwei Li
- Genentech Inc., South San Francisco, California, USA
| | | | - Yuying Gao
- Certara USA, Inc., Menlo Park, California, USA
| | - Crystal Zhang
- Genentech Inc., South San Francisco, California, USA
| | - Zao Li
- Genentech Inc., South San Francisco, California, USA
| | - Dale Miles
- Genentech Inc., South San Francisco, California, USA
| | | | | | - Bei Wang
- Genentech Inc., South San Francisco, California, USA
| | - Priya Agarwal
- Genentech Inc., South San Francisco, California, USA
| | - Dan Lu
- Genentech Inc., South San Francisco, California, USA
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21
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Stewart AK, Krishnan AY, Singhal S, Boccia RV, Patel MR, Niesvizky R, Chanan-Khan AA, Ailawadhi S, Brumm J, Mundt KE, Hong K, McBride J, Shon-Nguyen Q, Xiao Y, Ramakrishnan V, Polson AG, Samineni D, Leipold D, Humke EW, McClellan JS, Berdeja JG. Phase I study of the anti-FcRH5 antibody-drug conjugate DFRF4539A in relapsed or refractory multiple myeloma. Blood Cancer J 2019; 9:17. [PMID: 30718503 PMCID: PMC6362066 DOI: 10.1038/s41408-019-0178-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/06/2018] [Accepted: 08/17/2018] [Indexed: 12/14/2022] Open
Abstract
FcRH5 is a cell surface marker enriched on malignant plasma cells when compared to other hematologic malignancies and normal tissues. DFRF4539A is an anti-FcRH5 antibody-drug conjugated to monomethyl auristatin E (MMAE), a potent anti-mitotic agent. This phase I study assessed safety, tolerability, maximum tolerated dose (MTD), anti-tumor activity, and pharmacokinetics of DFRF4539A in patients with relapsed/refractory multiple myeloma. DFRF4539A was administered at 0.3-2.4 mg/kg every 3 weeks or 0.8-1.1 mg/kg weekly as a single-agent by intravenous infusion to 39 patients. Exposure of total antibody and antibody-conjugate-MMAE analytes was linear across the doses tested. There were 37 (95%) adverse events (AEs), 8 (21%) serious AEs, and 15 (39%) AEs ≥ grade 3. Anemia (n = 10, 26%) was the most common AE considered related to DFRF4539A. Two cases of grade 3 acute renal failure were attributed to DFRF4539A. There were no deaths; the MTD was not reached. DFRF4539A demonstrated limited activity in patients at the doses tested with 2 (5%) partial response, 1 (3%) minimal response, 18 (46%) stable disease, and 16 (41%) progressive disease. FcRH5 was confirmed to be expressed and occupied by antibody post-treatment and thus remains a valid myeloma target. Nevertheless, this MMAE-based antibody-drug-conjugate targeting FcRH5 was unsuccessful for myeloma.
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Affiliation(s)
- A Keith Stewart
- Division of Hematology-Oncology, Mayo Clinic, Phoenix, AZ, USA.
| | - Amrita Y Krishnan
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Medical Center, Duarte, CA, USA
| | - Seema Singhal
- Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Ralph V Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD, USA
| | - Manish R Patel
- Florida Cancer Specialists, Sarasota, FL, USA.,Sarah Cannon Research Institute, Nashville, TN, USA
| | - Ruben Niesvizky
- Multiple Myeloma Center, New York Presbyterian Hospital-Cornell Medical Center, New York, NY, USA
| | | | | | | | | | - Kyu Hong
- Genentech, Inc., South San Francisco, CA, USA
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22
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Samineni D, Girish S, Li C. Impact of Shed/Soluble targets on the PK/PD of approved therapeutic monoclonal antibodies. Expert Rev Clin Pharmacol 2016; 9:1557-1569. [DOI: 10.1080/17512433.2016.1243055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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23
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Sukumaran S, Zhang C, Leipold DD, Saad OM, Xu K, Gadkar K, Samineni D, Wang B, Milojic-Blair M, Carrasco-Triguero M, Rubinfeld B, Fielder P, Lin K, Ramanujan S. Development and Translational Application of an Integrated, Mechanistic Model of Antibody-Drug Conjugate Pharmacokinetics. AAPS J 2016; 19:130-140. [PMID: 27679517 DOI: 10.1208/s12248-016-9993-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/13/2016] [Indexed: 01/07/2023]
Abstract
Antibody drug conjugates (ADC), in which small molecule cytotoxic agents are non-specifically linked to antibodies, can enable targeted delivery of chemotherapeutics to tumor cells. ADCs are often produced and administered as a mixture of conjugated antibodies with different drug to antibody ratios (DAR) resulting in complex and heterogeneous disposition kinetics. We developed a mechanism-based platform model that can describe and predict the complex pharmacokinetic (PK) behavior of ADCs with protease-cleavable valine-citrulline (VC) linker linked to Monomethylmonomethyl auristatin F/E by incorporating known mechanisms of ADC disposition. The model includes explicit representation of all DAR species; DAR-dependent sequential deconjugation of the drug, resulting in the conversion of higher DAR to lower DAR species; and DAR-dependent antibody/ADC clearance. PK profiles of multiple analytes (total antibody, drug-conjugated antibody, and/or antibody-conjugated drug) for different ADC molecules and targets in rodents and cynomolgus monkeys were used for model development. The integrated cross-species model was successful in capturing the multi-analyte PK profiles after administration of purified ADCs with defined DAR species and ADCs with mixtures of DAR. Human PK predictions for DSTP3086S (anti-STEAP1-vc-MMAE) with the platform model agreed well with PK (total antibody and antibody-conjugated drug concentrations) measurements in the dose-ranging phase I clinical study. The integrated model is applicable to various other ADCs with different formats, conjugated drugs, and linkers, and provides a valuable tool for the exploration of mechanisms governing disposition of ADCs and enables translational predictions.
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Affiliation(s)
- Siddharth Sukumaran
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Crystal Zhang
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Douglas D Leipold
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Ola M Saad
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Keyang Xu
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Kapil Gadkar
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Divya Samineni
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Bei Wang
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Marija Milojic-Blair
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | | | - Bonnee Rubinfeld
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Paul Fielder
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Kedan Lin
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA
| | - Saroja Ramanujan
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, California, 94080, USA.
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24
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Harris JM, Cabanski CR, Scheerens H, Samineni D, Bradley MS, Cochran C, Staubach P, Metz M, Sussman G, Maurer M. A randomized trial of quilizumab in adults with refractory chronic spontaneous urticaria. J Allergy Clin Immunol 2016; 138:1730-1732. [PMID: 27567329 DOI: 10.1016/j.jaci.2016.06.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 05/18/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | | | | | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Martin Metz
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gordon Sussman
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
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25
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Harris JM, Maciuca R, Bradley MS, Cabanski CR, Scheerens H, Lim J, Cai F, Kishnani M, Liao XC, Samineni D, Zhu R, Cochran C, Soong W, Diaz JD, Perin P, Tsukayama M, Dimov D, Agache I, Kelsen SG. A randomized trial of the efficacy and safety of quilizumab in adults with inadequately controlled allergic asthma. Respir Res 2016; 17:29. [PMID: 26993628 PMCID: PMC4797126 DOI: 10.1186/s12931-016-0347-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Quilizumab, a humanized IgG1 monoclonal antibody, targets the M1-prime segment of membrane-expressed IgE, leading to depletion of IgE-switched and memory B cells. In patients with mild asthma, quilizumab reduced serum IgE and attenuated the early and late asthmatic reaction following whole lung allergen challenge. This study evaluated the efficacy and safety of quilizumab in adults with allergic asthma, inadequately controlled despite high-dose inhaled corticosteroids (ICS) and a second controller. Methods Five hundred seventy-eight patients were randomized to monthly or quarterly dosing regimens of subcutaneous quilizumab or placebo for 36 weeks, with a 48-week safety follow-up. Quilizumab was evaluated for effects on the rate of asthma exacerbations, lung function, patient symptoms, serum IgE, and pharmacokinetics. Exploratory analyses were conducted on biomarker subgroups (periostin, blood eosinophils, serum IgE, and exhaled nitric oxide). Results Quilizumab was well tolerated and reduced serum total and allergen-specific IgE by 30–40 %, but had no impact on asthma exacerbations, lung function, or patient-reported symptom measures. At Week 36, the 300 mg monthly quilizumab group showed a 19.6 % reduction (p = 0.38) in the asthma exacerbation rate relative to placebo, but this was neither statistically nor clinically significant. Biomarker subgroups did not reveal meaningful efficacy benefits following quilizumab treatment. Conclusions Quilizumab had an acceptable safety profile and reduced serum IgE. However, targeting the IgE pathway via depletion of IgE-switched and memory B cells was not sufficient for a clinically meaningful benefit for adults with allergic asthma uncontrolled by standard therapy. Trial registration ClinicalTrials.gov NCT01582503 Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0347-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey M Harris
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA.
| | - Romeo Maciuca
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - Mary S Bradley
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | | | - Heleen Scheerens
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - Jeremy Lim
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - Fang Cai
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - Mona Kishnani
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - X Charlene Liao
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - Divya Samineni
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - Rui Zhu
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - Colette Cochran
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080-4990, USA
| | - Weily Soong
- Alabama Allergy & Asthma Center, Birmingham, AL, USA
| | - Joseph D Diaz
- Allergy and Asthma Research Center PA, San Antonio, TX, USA
| | | | | | - Dimo Dimov
- Trakia University, Stara Zagora, Bulgaria
| | - Ioana Agache
- Transylvania University, Faculty of Medicine, Brasov, Romania
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26
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Weekes CD, Lamberts LE, Borad MJ, Voortman J, McWilliams RR, Diamond JR, de Vries EGE, Verheul HM, Lieu CH, Kim GP, Wang Y, Scales SJ, Samineni D, Brunstein F, Choi Y, Maslyar DJ, Colon-Otero G. Phase I Study of DMOT4039A, an Antibody-Drug Conjugate Targeting Mesothelin, in Patients with Unresectable Pancreatic or Platinum-Resistant Ovarian Cancer. Mol Cancer Ther 2016; 15:439-47. [PMID: 26823490 DOI: 10.1158/1535-7163.mct-15-0693] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/24/2015] [Indexed: 11/16/2022]
Abstract
DMOT4039A, a humanized anti-mesothelin mAb conjugated to the antimitotic agent monomethyl auristatin E (MMAE), was given to patients with pancreatic and ovarian cancer every 3 weeks (0.2-2.8 mg/kg; q3w) or weekly (0.8-1.2 mg/kg). A 3+3 design was used for dose escalation followed by expansion at the recommended phase II dose (RP2D) to evaluate safety and pharmacokinetics. Antitumor response was evaluated per RECIST 1.1 and serum CA19-9 or CA125 declines. Tumor mesothelin expression was determined by IHC. Seventy-one patients (40 pancreatic cancer; 31 ovarian cancer) were treated with DMOT4039A. For the q3w schedule (n = 54), the MTD and RP2D was 2.4 mg/kg, with dose-limiting toxicities of grade 3 hyperglycemia and grade 3 hypophosphatemia at 2.8 mg/kg. For the weekly schedule (n = 17), the maximum assessed dose was 1.2 mg/kg, with further dose escalations deferred because of toxicities limiting scheduled retreatment in later cycles, and therefore the RP2D level for the weekly regimen was determined to be 1 mg/kg. Across both schedules, the most common toxicities were gastrointestinal and constitutional. Treatment-related serious adverse events occurred in 6 patients; 4 patients continued treatment following dose reductions. Drug exposure as measured by antibody-conjugated MMAE and total antibody was generally dose proportional over all dose levels on both schedules. A total of 6 patients had confirmed partial responses (4 ovarian; 2 pancreatic) with DMOT4039A at 2.4 to 2.8 mg/kg i.v. q3w. DMOT4039A administered at doses up to 2.4 mg/kg q3w and 1.0 mg/kg weekly has a tolerable safety profile and antitumor activity in both pancreatic and ovarian cancer.
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Affiliation(s)
- Colin D Weekes
- Division of Medical Oncology, University of Colorado School of Medicine and Developmental Therapeutics Program, University of Colorado Cancer Center, Aurora, Colorado.
| | - Laetitia E Lamberts
- University Medical Center Groningen, University of Groningen, the Netherlands
| | | | | | | | - Jennifer R Diamond
- Division of Medical Oncology, University of Colorado School of Medicine and Developmental Therapeutics Program, University of Colorado Cancer Center, Aurora, Colorado
| | | | - Henk M Verheul
- VU University Medical Center, Amsterdam, the Netherlands
| | - Christopher H Lieu
- Division of Medical Oncology, University of Colorado School of Medicine and Developmental Therapeutics Program, University of Colorado Cancer Center, Aurora, Colorado
| | | | - Yulei Wang
- Genentech Inc., South San Francisco, California
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27
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Chen Y, Samineni D, Mukadam S, Wong H, Shen BQ, Lu D, Girish S, Hop C, Jin JY, Li C. Physiologically Based Pharmacokinetic Modeling as a Tool to Predict Drug Interactions for Antibody-Drug Conjugates. Clin Pharmacokinet 2014; 54:81-93. [DOI: 10.1007/s40262-014-0182-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Weekes CD, Lamberts LE, Borad MJ, Voortman J, McWilliams RR, Diamond JR, De Vries E, Verheul HM, Lieu CH, Yue H, Wang Y, Scales S, Samineni D, Wood K, Brunstein F, Maslyar DJ, Kim GP. A phase I study of DMOT4039A, an antibody-drug conjugate (ADC) targeting mesothelin (MSLN), in patients (pts) with unresectable pancreatic (PC) or platinum-resistant ovarian cancer (OC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Laetitia E. Lamberts
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | | | | | | | | | | | - Henk M.W. Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam, Netherlands
| | | | | | | | | | | | - Katie Wood
- Genentech, Inc., South San Francisco, CA
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29
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Liu L, Mugundu GM, Kirby BJ, Samineni D, Desai PB, Unadkat JD. Quantification of human hepatocyte cytochrome P450 enzymes and transporters induced by HIV protease inhibitors using newly validated LC-MS/MS cocktail assays and RT-PCR. Biopharm Drug Dispos 2012; 33:207-17. [PMID: 22498895 DOI: 10.1002/bdd.1788] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/10/2012] [Accepted: 04/11/2012] [Indexed: 11/08/2022]
Abstract
Human immunodeficiency virus (HIV) protease inhibitors (PIs) produce profound and unpredictable drug-drug interactions (DDIs) that cannot be explained fully by their inhibition/inactivation of CYP3A enzymes. Delineating and quantifying the CYPs and transporters inducible by PIs are crucial in developing an integrative mechanistic understanding and prediction of PI-based DDIs. To do so, two LC-MS/MS cocktail assays were modified and validated simultaneously to quantify the CYP activity of CYP3A, 2B6, 2C8, 2C9, 2C19, 1A, 2E1, 2A6 and 2D6 enzymes. These new assays were applied to evaluate the induction potential of eight PIs in microsomes isolated from PI-treated human hepatocytes. The mRNA expression of these CYPs and transporters (OATP1B1, OATP1B3, OATP1A2, MDR1, MRP2 and MRP4) was also evaluated using relative RT-PCR. The majority of PIs were net inducers of CYP3As and 2B6 at both the mRNA and activity level (> 2-fold), while ritonavir, saquinavir, nelfinavir or lopinavir did not induce CYP3A activity (< 2-fold), presumably due to CYP3A inactivation. OATP1B1 and MDR1 were the only two hepatic transporters induced (> 2-fold) by the PIs. Amprenavir was the most potent net inducer. In conclusion, our validated cocktail assays can be implemented to comprehensively quantify CYP activities in human liver microsomes and hepatocyte studies. The results also provide the much needed data on the net induction potential of the PIs for hepatic CYPs and transporters. A qualitative agreement was observed between our results and published PI-based DDIs, suggesting that human hepatocytes are a useful platform for more extensive and quantitative in vitro-in vivo prediction of PI-based DDIs.
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Affiliation(s)
- Li Liu
- Department of Pharmaceutics, University of Washington, Seattle, 98195, USA
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30
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Sa Y, Hao J, Samineni D, Clark J, Pyne-Geithman G, Broderick J, Lu A. Brain distribution and elimination of recombinant human TIMP-1 after cerebral ischemia and reperfusion in rats. Neurol Res 2012; 33:433-8. [PMID: 21535944 DOI: 10.1179/1743132810y.0000000012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate recombinant human TIMP-1 ((125)I-rhTIMP-1) half-life in blood and its distribution in rat brain tissue after cerebral ischemia/reperfusion as part of a therapeutic development paradigm. METHOD A suture model of the middle cerebral artery occlusion was used. (125)I-labeled rhTIMP-1 at 60 μg/kg (11.23 μCi/μg) was administered to rats intravenously at the beginning of reperfusion. Blood and brain tissue were collected. The radioactivity was detected with a gamma counter and analyzed by autoradiography. RESULTS The blood half-life T(1/2) of (125)I-rhTIMP-1 was 42.2 hours. Thirty minutes after (125)I-rhTIMP-1 administration, an increased accumulation of (125)I-rhTIMP-1 in the ischemic hemisphere was observed. The maximum brain tissue concentration C(max) was 26.1 ng/g at 1.5 hours in the striatum and 13.9 ng/g at 5 hours in the cortex when the uptake percentage of brain tissue to blood was 6.1±0.4 and 6.7±2.1%, respectively. The cortex and striatum elimination half-lives T(1/2) were 45.3 and 39.2 hours, respectively. Electrophoretic analysis of ischemic samples for (125)I-rhTIMP-1 showed a clear 28 kDa band 1.5 hours after (125)I-rhTIMP-1 administration in the cortex and striatum. The intensity of the 28 kDa band decreased after 3.0 hours of the administration. Some (125)I-rhTIMP-1 maintained its molecular integrity for 8.5 hours in ischemic striatum after reperfusion. DISCUSSION (125)I-labeled rhTIMP-1 was distributed quickly into ischemic brain tissue and had a slow elimination in both blood and brain tissue. These results, along with other studies suggesting therapeutic benefits, will aid in the development of TIMP-1 for protecting ischemic stroke.
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Affiliation(s)
- Yalian Sa
- Department of Neurology, College of Medicine, University of Cincinnati, OH 45267-0532, USA
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Samineni D, Desai PB, Sallans L, Fichtenbaum CJ. Steady-state pharmacokinetic interactions of darunavir/ritonavir with lipid-lowering agent rosuvastatin. J Clin Pharmacol 2011; 52:922-31. [PMID: 21712498 DOI: 10.1177/0091270011407494] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV-1 protease inhibitors often cause dyslipidemia, necessitating the use of lipid-lowering agents such as rosuvastatin. However, when given concomitantly, these therapeutic agents often exhibit adverse drug interactions. In this study (phase I open-label trial, n = 12 HIV-1 seronegative participants), the authors assessed the drug interactions between darunavir/ritonavir given in combination with rosuvastatin. Participants were randomized to receive rosuvastatin (10 mg/day) or darunavir/ritonavir (600/100 mg twice daily) alone for 7 days in a crossover design followed by combination therapy for 7 days with intervening 7-day washout periods. Intensive blood sampling for pharmacokinetics and fasting lipids was performed on days 7, 21, and 35. The geometric mean AUC(0-24 h) of rosuvastatin increased from 109 to 161 ng·h/mL (P < .005) and C(max) increased 6.7 to 16.3 ng/mL (P < .001) when coadministered with darunavir/ritonavir. In the presence of darunavir/ritonavir and rosuvastatin, total cholesterol and triglyceride levels increased by 10% (P = .007) and 56% (P = .011), whereas the high-density lipoprotein cholesterol levels decreased by 13% (P = .006) relative to rosuvastatin administration alone. There were no significant adverse events attributable to the coadministration of these drugs. Rosuvastatin levels increase in the presence of darunavir/ritonavir coadministration, whereas the lipid-lowering benefits are blunted. The clinical significance of these changes requires further investigation.
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Affiliation(s)
- Divya Samineni
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio 45267-0004, USA
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Abstract
IMPORTANCE TO THE FIELD Dyslipidemia is common among HIV-infected patients receiving antiretroviral therapy. A higher risk of coronary heart disease (CHD) is associated with specific antiretroviral medications. The aging of HIV infected people and the intersection of other CHD risk factors have led to the need for developing effective interventions to lower the risk of CHD events. AREAS COVERED IN THIS REVIEW The authors review current literature on the use of fenofibrate and related derivatives in HIV-infected people with dyslipidemia using antiretroviral therapy. WHAT THE READER WILL GAIN Fibrates have been demonstrated to reduce the risk of CHD events in HIV seronegative individuals with mixed results on survival benefits. There are no published studies of CHD outcomes using fibrates in people with HIV infection. Several studies conducted in HIV infected people demonstrate the ability of fenofibrate to lower triglycerides and increase high-density lipoprotein cholesterol levels with few adverse events. The authors review the pharmacology and clinical efficacy/safety of the use of fenofibrate in people with HIV infection. TAKE HOME MESSAGE Fenofibrate is a generally safe and useful agent for the treatment of mixed dyslipidemia and hypertriglyceridemia in people with HIV infection though limited data are available particularly on clinical outcomes.
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