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Reizine NM, Danahey K, Truong TM, George D, House LK, Karrison TG, van Wijk XMR, Yeo KTJ, Ratain MJ, O'Donnell PH. Clinically actionable genotypes for anticancer prescribing among >1500 patients with pharmacogenomic testing. Cancer 2022; 128:1649-1657. [PMID: 35090043 PMCID: PMC9153953 DOI: 10.1002/cncr.34104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/06/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND In recent years, there has been increasing evidence supporting the role of germline pharmacogenomic factors predicting toxicity for anticancer therapies. Although somatic genomic data are used frequently in oncology care planning, germline pharmacogenomic testing is not. This study hypothesizes that comprehensive germline pharmacogenomic profiling could have high relevance for cancer care. METHODS Between January 2011 and August 2020, patients at the University of Chicago Medical Center were genotyped across custom germline pharmacogenomic panels for reasons unrelated to cancer care. Actionable anticancer pharmacogenomic gene/drug interactions identified by the FDA were defined including: CYP2C9 (erdafitinib), CYP2D6 (gefitinib), DPYD (5-fluorouracil and capecitabine), TPMT (thioguanine and mercaptopurine), and UGT1A1 (belinostat, irinotecan, nilotinib, pazopanib, and sacituzumab-govitecan hziy). The primary objective was to determine the frequency of individuals with actionable or high-risk genotypes across these 5 key pharmacogenes, thus potentially impacting prescribing for at least 1 of these 11 commonly prescribed anticancer therapies. RESULTS Data from a total of 1586 genotyped individuals were analyzed. The oncology pharmacogene with the highest prevalence of high-risk, actionable genotypes was UGT1A1, impacting 17% of genotyped individuals. Actionable TPMT and DPYD genotypes were found in 9% and 4% of patients, respectively. Overall, nearly one-third of patients genotyped across all 5 genes (161/525, 31%) had at least one actionable genotype. CONCLUSIONS These data suggest that germline pharmacogenomic testing for 5 key pharmacogenes could identify a substantial proportion of patients at risk with standard dosing, an estimated impact similar to that of somatic genomic profiling. LAY SUMMARY Differences in our genes may explain why some drugs work safely in certain individuals but can cause side effects in others. Pharmacogenomics is the study of how genetic variations affect an individual's response to medications. In this study, an evaluation was done for important genetic variations that can affect the tolerability of anticancer therapy. By analyzing the genetic results of >1500 patients, it was found that nearly one-third have genetic variations that could alter recommendations of what drug, or how much of, an anticancer therapy they should be given. Performing pharmacogenomic testing before prescribing could help to guide personalized oncology care.
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Affiliation(s)
- Natalie M Reizine
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois.,Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois
| | - Keith Danahey
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois.,Center for Research Informatics, University of Chicago, Chicago, Illinois
| | - Tien M Truong
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois.,Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois
| | - David George
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois.,Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Larry K House
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois.,Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois
| | - Theodore G Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Xander M R van Wijk
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois.,Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois.,Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois
| | - Kiang-Teck J Yeo
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois.,Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois.,Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois
| | - Mark J Ratain
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois.,Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois.,Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois
| | - Peter H O'Donnell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois.,Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois.,Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois
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Ramirez J, House LK, Ratain MJ. Influence of N-acetyltransferase 2 gene polymorphisms on the in vitro metabolism of the epidermal growth factor receptor inhibitor rociletinib. Br J Clin Pharmacol 2021; 87:4313-4322. [PMID: 33818816 DOI: 10.1111/bcp.14848] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022] Open
Abstract
AIMS Rociletinib showed activity in T790M-positive non-small cell lung cancer patients. It undergoes amide hydrolysis to form M502, followed by N-acetylation to M544 or amide hydrolysis to M460. We identified the enzymes responsible for rociletinib metabolism, and investigated the relationship between M544 formation and N-acetyltransferase 2 (NAT2) polymorphisms. METHODS Rociletinib and metabolites were incubated with carboxylesterase (CES)1b, CES1c, CES2, NAT1, NAT2, arylacetamide deacetylase, inhibitors, pooled human liver microsomes (HLM) and cytosols (HLC). Cytosols (n = 107) were genotyped for NAT2 polymorphisms (rs1041983 and rs1801280) and incubated with M502. Human hepatocytes from intermediate (NAT2*6/*12A) and slow (NAT2*5B/*5B) acetylators were incubated with 10 μM rociletinib and metabolites for 24 hours. Metabolites were measured by high-performance liquid chromatography. RESULTS M502 was formed from rociletinib and M544 by CES2 and HLM; M544 and N-acetyl-M460 were formed by NAT2 and HLC; M460 was not formed by CES or arylacetamide deacetylase. M502 formation by HLM was inhibited by bis-(4-nitrophenyl)phosphate and eserine (10 μM). M544 formation in HLC was inhibited by 100 μM quercetin and was associated with NAT2 genotype (P < .0001). M460 formation in HLM was inhibited by eserine, and M460 was N-acetylated in HLC. Hepatocytes formed M502, M544 and M460. The intermediate acetylator showed higher production (range: 3.4-5.1-fold) of N-acetylated metabolites than the slow acetylator. CONCLUSIONS Results indicate that NAT2 and CES2 are involved in rociletinib metabolism, and polymorphic NAT2 could alter drug exposure in patients. Slow NAT2 acetylators would have higher exposure to M502 and M460 and consequently, be at increased risk of experiencing hyperglycaemia and QTc prolongation.
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Affiliation(s)
| | - Larry K House
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mark J Ratain
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, IL, USA.,Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
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Ramírez J, House LK, Karrison TG, Janisch LA, Turcich M, Salgia R, Ratain MJ, Sharma MR. Prolonged Pharmacokinetic Interaction Between Capecitabine and a CYP2C9 Substrate, Celecoxib. J Clin Pharmacol 2019; 59:1632-1640. [DOI: 10.1002/jcph.1476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/12/2019] [Indexed: 01/06/2023]
Affiliation(s)
| | - Larry K. House
- Department of MedicineUniversity of Chicago Chicago IL USA
| | - Theodore G. Karrison
- Department of Public Health SciencesUniversity of Chicago Chicago IL USA
- Comprehensive Cancer CenterUniversity of Chicago Chicago IL USA
| | | | | | - Ravi Salgia
- Department of MedicineUniversity of Chicago Chicago IL USA
- Comprehensive Cancer CenterUniversity of Chicago Chicago IL USA
| | - Mark J. Ratain
- Department of MedicineUniversity of Chicago Chicago IL USA
- Comprehensive Cancer CenterUniversity of Chicago Chicago IL USA
- Committee on Clinical Pharmacology and PharmacogenomicsUniversity of Chicago Chicago IL USA
| | - Manish R. Sharma
- Department of MedicineUniversity of Chicago Chicago IL USA
- Comprehensive Cancer CenterUniversity of Chicago Chicago IL USA
- Committee on Clinical Pharmacology and PharmacogenomicsUniversity of Chicago Chicago IL USA
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Ramírez J, Mirkov S, House LK, Ratain MJ. Glucuronidation of OTS167 in Humans Is Catalyzed by UDP-Glucuronosyltransferases UGT1A1, UGT1A3, UGT1A8, and UGT1A10. Drug Metab Dispos 2015; 43:928-35. [PMID: 25870101 DOI: 10.1124/dmd.115.063271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/13/2015] [Indexed: 01/18/2023] Open
Abstract
OTS167 is a potent maternal embryonic leucine zipper kinase inhibitor undergoing clinical testing as antineoplastic agent. We aimed to identify the UDP-glucuronosyltransferases (UGTs) involved in OTS167 metabolism, study the relationship between UGT genetic polymorphisms and hepatic OTS167 glucuronidation, and investigate the inhibitory potential of OTS167 on UGTs. Formation of a single OTS167-glucuronide (OTS167-G) was observed in pooled human liver (HLM) (Km = 3.4 ± 0.2 µM), intestinal microsomes (HIM) (Km = 1.7 ± 0.1 µM), and UGTs. UGT1A1 (64 µl/min/mg) and UGT1A8 (72 µl/min/mg) exhibited the highest intrinsic clearances (CLint) for OTS167, followed by UGT1A3 (51 µl/min/mg) and UGT1A10 (47 µl/min/mg); UGT1A9 was a minor contributor. OTS167 glucuronidation in HLM was highly correlated with thyroxine glucuronidation (r = 0.91, P < 0.0001), SN-38 glucuronidation (r = 0.79, P < 0.0001), and UGT1A1 mRNA (r = 0.72, P < 0.0001). Nilotinib (UGT1A1 inhibitor) and emodin (UGT1A8 and UGT1A10 inhibitor) exhibited the highest inhibitory effects on OTS167-G formation in HLM (68%) and HIM (47%). We hypothesize that OTS167-G is an N-glucuronide according to mass spectrometry. A significant association was found between rs6706232 and reduced OTS167-G formation (P = 0.03). No or weak UGT inhibition (range: 0-21%) was observed using clinically relevant OTS167 concentrations (0.4-2 µM). We conclude that UGT1A1 and UGT1A3 are the main UGTs responsible for hepatic formation of OTS167-G. Intestinal UGT1A1, UGT1A8, and UGT1A10 may contribute to first-pass OTS167 metabolism after oral administration.
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Affiliation(s)
| | - Snezana Mirkov
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Larry K House
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mark J Ratain
- Department of Medicine, University of Chicago, Chicago, Illinois
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Innocenti F, Schilsky RL, Ramírez J, Janisch L, Undevia S, House LK, Das S, Wu K, Turcich M, Marsh R, Karrison T, Maitland ML, Salgia R, Ratain MJ. Dose-finding and pharmacokinetic study to optimize the dosing of irinotecan according to the UGT1A1 genotype of patients with cancer. J Clin Oncol 2014; 32:2328-34. [PMID: 24958824 DOI: 10.1200/jco.2014.55.2307] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The risk of severe neutropenia from treatment with irinotecan is related in part to UGT1A1*28, a variant that reduces the elimination of SN-38, the active metabolite of irinotecan. We aimed to identify the maximum-tolerated dose (MTD) and dose-limiting toxicity (DLT) of irinotecan in patients with advanced solid tumors stratified by the *1/*1, *1/*28, and *28/*28 genotypes. PATIENTS AND METHODS Sixty-eight patients received an intravenous flat dose of irinotecan every 3 weeks. Forty-six percent of the patients had the *1/*1 genotype, 41% had the *1/*28 genotype, and 13% had the *28/*28 genotype. The starting dose of irinotecan was 700 mg in patients with the *1/*1 and *1/*28 genotypes and 500 mg in patients with the *28/*28 genotype. Pharmacokinetic evaluation was performed at cycle 1. RESULTS In patients with the *1/*1 genotype, the MTD was 850 mg (four DLTs per 16 patients), and 1,000 mg was not tolerated (two DLTs per six patients). In patients with the *1/*28 genotype, the MTD was 700 mg (five DLTs per 22 patients), and 850 mg was not tolerated (four DLTs per six patients). In patients with the *28/*28 genotype, the MTD was 400 mg (one DLT per six patients), and 500 mg was not tolerated (three DLTs per three patients). The DLTs were mainly myelosuppression and diarrhea. Irinotecan clearance followed linear kinetics. At the MTD for each genotype, dosing by genotype resulted in similar SN-38 areas under the curve (AUCs; r(2) = 0.0003; P = .97), but the irinotecan AUC was correlated with the actual dose (r(2) = 0.39; P < .001). Four of 48 patients with disease known to be responsive to irinotecan achieved partial response. CONCLUSION The UGT1A1*28 genotype can be used to individualize dosing of irinotecan. Additional studies should evaluate the effect of genotype-guided dosing on efficacy in patients receiving irinotecan.
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Affiliation(s)
- Federico Innocenti
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL.
| | - Richard L Schilsky
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Jacqueline Ramírez
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Linda Janisch
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Samir Undevia
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Larry K House
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Soma Das
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Kehua Wu
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Michelle Turcich
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Robert Marsh
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Theodore Karrison
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Michael L Maitland
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Ravi Salgia
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
| | - Mark J Ratain
- Federico Innocenti, Richard L. Schilsky, Jacqueline Ramírez, Linda Janisch, Samir Undevia, Larry K. House, Soma Das, Kehua Wu, Michelle Turcich, Theodore Karrison, Michael L. Maitland, Ravi Salgia, and Mark J. Ratain, University of Chicago, Chicago; and Robert Marsh, NorthShore University Health System, Evanston, IL
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Karovic S, Wen Y, Karrison TG, Bakris GL, Levine MR, House LK, Wu K, Thomeas V, Rudek MA, Wright JJ, Cohen EEW, Fleming GF, Ratain MJ, Maitland ML. Sorafenib dose escalation is not uniformly associated with blood pressure elevations in normotensive patients with advanced malignancies. Clin Pharmacol Ther 2014; 96:27-35. [PMID: 24637941 PMCID: PMC4165641 DOI: 10.1038/clpt.2014.63] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 08/19/2013] [Accepted: 03/10/2014] [Indexed: 12/24/2022]
Abstract
Hypertension with vascular endothelial growth factor (VEGF) receptor inhibitors is associated with superior treatment outcomes for advanced cancer patients. To determine whether increased doses of sorafenib cause incremental increases in blood pressure (BP) we measured 12-hour ambulatory BP in 41 normotensive advanced solid tumor patients in a randomized dose escalation study. After 7 days’ sorafenib (400mg BID) mean diastolic BP (DBP) increased in both study groups. After dose escalation, group A (400mg TID) had marginally significant further increase in 12-hour mean DBP (p=0.053) but group B (600mg BID) did not achieve statistically significant increases (p=0.25). Within groups, individuals varied in BP response to sorafenib dose escalation, but these differences did not correlate with changes in steady state plasma sorafenib concentrations. These findings in normotensive patients suggest BP is a complex pharmacodynamic biomarker of VEGF inhibition. Patients have intrinsic differences in sensitivity to the BP elevating effects of sorafenib.
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Affiliation(s)
- S Karovic
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Y Wen
- Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA
| | - T G Karrison
- 1] Comprehensive Cancer Center, The University of Chicago, Chicago, Illinois, USA [2] Department of Health Studies, The University of Chicago, Chicago, Illinois, USA
| | - G L Bakris
- 1] Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA [2] Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - M R Levine
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - L K House
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - K Wu
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - V Thomeas
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - M A Rudek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - J J Wright
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland, USA
| | - E E W Cohen
- 1] Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA [2] Comprehensive Cancer Center, The University of Chicago, Chicago, Illinois, USA
| | - G F Fleming
- 1] Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA [2] Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA [3] Comprehensive Cancer Center, The University of Chicago, Chicago, Illinois, USA
| | - M J Ratain
- 1] Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA [2] Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA [3] Comprehensive Cancer Center, The University of Chicago, Chicago, Illinois, USA
| | - M L Maitland
- 1] Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA [2] Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA [3] Comprehensive Cancer Center, The University of Chicago, Chicago, Illinois, USA
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Wu K, Cohen EEW, House LK, Ramírez J, Zhang W, Ratain MJ, Bies RR. Nonlinear population pharmacokinetics of sirolimus in patients with advanced cancer. CPT Pharmacometrics Syst Pharmacol 2012; 1:e17. [PMID: 23887441 PMCID: PMC3600722 DOI: 10.1038/psp.2012.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/09/2012] [Indexed: 11/09/2022]
Abstract
Sirolimus, the prototypical inhibitor of the mammalian target of rapamycin, has substantial antitumor activity. In this study, sirolimus showed nonlinear pharmacokinetic characteristics over a wide dose range (from 1 to 60 mg/week). The objective of this study was to develop a population pharmacokinetic (PopPK) model to describe the nonlinearity of sirolimus. Whole blood concentration data, obtained from four phase I clinical trials, were analyzed using a nonlinear mixed-effects modeling (NONMEM) approach. The influence of potential covariates was evaluated. Model robustness was assessed using nonparametric bootstrap and visual predictive check approaches. The data were well described by a two-compartment model incorporating a saturable Michaelis–Menten kinetic absorption process. A covariate analysis identified hematocrit as influencing the oral clearance of sirolimus. The visual predictive check indicated that the final pharmacokinetic model adequately predicted observed concentrations. The pharmacokinetics of sirolimus, based on whole blood concentrations, appears to be nonlinear due to saturable absorption.
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Affiliation(s)
- K Wu
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
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Ramírez J, Wu K, Janisch L, Karrison T, House LK, Innocenti F, Cohen EEW, Ratain MJ. The effect of thalidomide on the pharmacokinetics of irinotecan and metabolites in advanced solid tumor patients. Cancer Chemother Pharmacol 2011; 68:1629-32. [PMID: 21861128 PMCID: PMC3259680 DOI: 10.1007/s00280-011-1727-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/10/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Irinotecan and thalidomide are commonly administered antineoplastic drugs. Combination treatment may potentiate their antitumor effect and protect against irinotecan's intestinal toxicity. We investigated whether thalidomide can modulate the pharmacokinetics of irinotecan and metabolites. METHODS The study employed a crossover design in which advanced solid tumor patients were randomized to two arms and treated with irinotecan 350 mg/m(2) intravenously (IV) every 3 weeks and thalidomide orally (p.o.) 400 mg daily. Pharmacokinetic data when irinotecan was administered as a single agent in each arm were compared to data when the two study agents were co-administered using paired t tests. Eighty percent and 90% confidence intervals for the true difference were also calculated. RESULTS The differences in pharmacokinetic parameters and metabolic markers after thalidomide administration were small and unlikely to be clinically significant. With the exception of APC T (1/2), none of the upper confidence limits exceeds a 50% increase. CONCLUSIONS This study did not find any clinically meaningful effects of thalidomide on the pharmacokinetics of irinotecan or its metabolites.
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Affiliation(s)
- Jacqueline Ramírez
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, 5841 S Maryland Avenue, MC2115, Chicago, IL 60637, USA
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Gangadhar TC, Cohen EEW, Wu K, Janisch L, Geary D, Kocherginsky M, House LK, Ramirez J, Undevia SD, Maitland ML, Fleming GF, Ratain MJ. Two drug interaction studies of sirolimus in combination with sorafenib or sunitinib in patients with advanced malignancies. Clin Cancer Res 2011; 17:1956-63. [PMID: 21447721 PMCID: PMC3077032 DOI: 10.1158/1078-0432.ccr-10-2061] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Sirolimus is the prototypical mTOR inhibitor. Sorafenib and sunitinib are small molecule inhibitors of multiple kinases including VEGF receptor (VEGFR) kinases. These agents have different mechanisms of action, providing a strong rationale for combination. EXPERIMENTAL DESIGN Patients with advanced cancer were assigned to receive either sirolimus or the VEGFR inhibitor alone for a 2-week lead-in period, followed by combination therapy. The primary end point of each trial was to determine whether a drug interaction exists between sirolimus and either sorafenib or sunitinib, as defined by a difference in C(max) for each drug alone compared with its C(max) during combination therapy. RESULTS The sorafenib and sunitinib trials enrolled 34 and 23 patients, respectively. There were no clinically significant differences in C(max) for any of the drugs alone compared with the C(max) during combination therapy. Toxicity profiles were similar to those expected for each drug alone. One patient with adrenal cortical cancer had a partial response to sirolimus and sunitnib. CONCLUSIONS Sirolimus can be safely combined with sorafenib or sunitinib. Our trial design is feasible and informative in screening for potential drug-drug interactions, using a relatively small number of patients and limited pharmacokinetic sampling.
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Affiliation(s)
- Tara C. Gangadhar
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | - Ezra E. W. Cohen
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | - Kehua Wu
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | - Linda Janisch
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | - David Geary
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | | | - Larry K. House
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | - Jackie Ramirez
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | - Samir D. Undevia
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | | | - Gini F. Fleming
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
| | - Mark J. Ratain
- Division of Hematology and Oncology, University of Chicago, Chicago, IL
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10
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House LK, Ramírez J, Ratain MJ. Simultaneous determination of 5-fluorouracil and uracil by high-performance liquid chromatography using four serial columns. J Chromatogr B Biomed Sci Appl 1998; 720:245-50. [PMID: 9892089 DOI: 10.1016/s0378-4347(98)00424-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A sensitive assay was developed for the quantitation of 5-fluorouracil (5-FU) and uracil using liquid-liquid extraction (LLE) and HPLC with UV detection. Analyses were performed with four microBondapak C18 columns connected in series using 20 mM acetic acid with 1% ACN as mobile phase. The calibration curves were linear across the range of 26-1000 ng ml(-1) (0.21-7.8 microM) for 5-FU and 1.0-14.0 microg ml(-1) (0.01-110 microM) for uracil. This assay has been implemented to determine the plasma concentrations for pharmacokinetic studies for 5-FU and uracil in conjunction with clinical trials.
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Affiliation(s)
- L K House
- Department of Medicine, The University of Chicago, IL 60637, USA
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