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Fan B, Mellinghoff IK, Wen PY, Lowery MA, Goyal L, Tap WD, Pandya SS, Manyak E, Jiang L, Liu G, Nimkar T, Gliser C, Prahl Judge M, Agresta S, Yang H, Dai D. Clinical pharmacokinetics and pharmacodynamics of ivosidenib, an oral, targeted inhibitor of mutant IDH1, in patients with advanced solid tumors. Invest New Drugs 2019; 38:433-444. [PMID: 31028664 PMCID: PMC7066280 DOI: 10.1007/s10637-019-00771-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 02/13/2019] [Accepted: 03/28/2019] [Indexed: 01/25/2023]
Abstract
Background Mutant isocitrate dehydrogenase 1 and 2 (IDH1/IDH2) enzymes produce the oncometabolite D-2-hydroxyglutarate (2-HG). Ivosidenib (AG-120) is a targeted mutant IDH1 inhibitor under evaluation in a phase 1 dose escalation and expansion study of IDH1-mutant advanced solid tumors including cholangiocarcinoma, chondrosarcoma, and glioma. We explored the pharmacokinetic (PK) and pharmacodynamic (PD) profiles of ivosidenib in these populations. Methods Ivosidenib was administered orally once (QD) or twice (BID) daily in continuous 28-day cycles; 168 patients received ≥1 dose within the range 100 mg BID to 1200 mg QD. PK and PD were assessed using validated liquid chromatography-tandem mass spectrometry assays. Results Ivosidenib demonstrated good oral exposure after single and multiple doses, was rapidly absorbed, and had a long terminal half-life (mean 40–102 h after single dose). Exposure increased less than dose proportionally. Steady state was reached by day 15, with moderate accumulation across all tumors (1.5- to 1.7-fold for area-under-the-curve at 500 mg QD). None of the intrinsic and extrinsic factors assessed affected ivosidenib exposure, including patient/disease characteristics and concomitant administration of weak CYP3A4 inhibitors/inducers. After multiple doses in patients with cholangiocarcinoma or chondrosarcoma, plasma 2-HG was reduced by up to 98%, to levels seen in healthy subjects. Exposure-response relationships for safety and efficacy outcomes were flat across the doses tested. Conclusions Ivosidenib demonstrated good oral exposure and a long half-life. Robust, persistent plasma 2-HG inhibition was observed in IDH1-mutant cholangiocarcinoma and chondrosarcoma. Ivosidenib 500 mg QD is an appropriate dose irrespective of various intrinsic and extrinsic factors. Trial RegistrationClinicalTrials.gov (NCT02073994).
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Affiliation(s)
- Bin Fan
- DMPK, Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139, USA.
| | - Ingo K Mellinghoff
- Departments of Neurology and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Maeve A Lowery
- Trinity St James Cancer Institute, Trinity College, Dublin, Ireland
| | - Lipika Goyal
- Department of Internal Medicine, Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Shuchi S Pandya
- Clinical Development, Agios Pharmaceuticals, Inc., Cambridge, MA, USA
| | - Erika Manyak
- DMPK, Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139, USA
| | - Liewen Jiang
- Biostatistics - Clinical Development, Agios Pharmaceuticals, Inc., Cambridge, MA, USA
| | - Guowen Liu
- DMPK, Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139, USA
| | - Tara Nimkar
- Clinical Operations - Clinical Development, Agios Pharmaceuticals, Inc., Cambridge, MA, USA
| | - Camelia Gliser
- Clinical Development, Agios Pharmaceuticals, Inc., Cambridge, MA, USA
| | - Molly Prahl Judge
- Clinical Development, Agios Pharmaceuticals, Inc., Cambridge, MA, USA
| | - Sam Agresta
- Clinical Development, Agios Pharmaceuticals, Inc., Cambridge, MA, USA
| | - Hua Yang
- DMPK, Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139, USA
| | - David Dai
- DMPK, Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139, USA
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Fan B, Mellinghoff IK, Wen PY, Pandya SS, Jiang L, Liu G, Nimkar T, Yang H, Dai D. Pharmacokinetics/pharmacodynamics (PK/PD) of ivosidenib in patients with IDH1-mutant advanced solid tumors from a phase 1 study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Bin Fan
- Agios Pharmaceuticals, Inc., Cambridge, MA
| | | | - Patrick Y. Wen
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA
| | | | | | - Guowen Liu
- Agios Pharmaceuticals, Inc., Cambridge, MA
| | | | - Hua Yang
- Agios Pharmaceuticals, Inc., Cambridge, MA
| | - David Dai
- Agios Pharmaceuticals, Inc., Cambridge, MA
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