1
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Agema BC, Buck SAJ, Viskil M, Isebia KT, de Neijs MJ, Sassen SDT, Koch BCP, Joerger M, de Wit R, Koolen SLW, Mathijssen RHJ. Early Identification of Patients at Risk of Cabazitaxel-induced Severe Neutropenia. Eur Urol Oncol 2024; 7:786-793. [PMID: 37925350 DOI: 10.1016/j.euo.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/14/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Cabazitaxel frequently causes severe neutropenia. A higher cabazitaxel systemic exposure is related to a lower nadir absolute neutrophil count (ANC). OBJECTIVE To describe the effect of cabazitaxel systemic exposure on ANC by a population pharmacokinetic/pharmacodynamic (POP-PK/PD) model, and to identify patients at risk of severe neutropenia early in their treatment course using a PK threshold. DESIGN, SETTING, AND PARTICIPANTS Data from five clinical studies were pooled to develop a POP-PK/PD model using NONMEM, linking both patient characteristics and cabazitaxel systemic exposure directly to ANC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A PK threshold, predictive of severe neutropenia (grade ≥3), was determined using a receiver operating characteristic curve. RESULTS AND LIMITATIONS Ninety-six patients were included with a total of 1726 PK samples and 1081 ANCs. The POP-PK/PD model described both cabazitaxel PK and ANC accurately. A cabazitaxel plasma concentration of >4.96 ng/ml at 6 h after the start of infusion was found to be predictive of severe neutropenia, with a sensitivity of 76% and a specificity of 65%. CONCLUSIONS Early cabazitaxel plasma levels are predictive of severe neutropenia. Implementation of the proposed PK threshold results in early identification of almost 76% of all severe neutropenias. If prospectively validated, patients at risk could benefit from prophylactic administration of granulocyte colony stimulating factors, preventing severe neutropenia in an early phase of treatment. Implementation of this threshold permits a less restricted use of the 25 mg/m2 dose, potentially increasing the therapeutic benefit. PATIENT SUMMARY Treatment with cabazitaxel chemotherapy often causes neutropenia, leading to susceptibility to infections, which might be life threatening. We found that a systemic cabazitaxel concentration above 4.96 ng/ml 6 h after the start of infusion is predictive of the occurrence of severe neutropenia. Measurement of systemic cabazitaxel levels provides clinicians with the opportunity to prophylactically stimulate neutrophil growth.
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Affiliation(s)
- Bram C Agema
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands; Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Stefan A J Buck
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Mano Viskil
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Khrystany T Isebia
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Micha J de Neijs
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Sebastiaan D T Sassen
- Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Clinical Pharmacometrics Group, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Clinical Pharmacometrics Group, Rotterdam, The Netherlands
| | - Markus Joerger
- Department of Medical Oncology and Hematology, Cantonal Hospital, St. Gallen, Switzerland
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Stijn L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands; Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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2
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Laganà M, Grisanti S, Ambrosini R, Cosentini D, Abate A, Zamparini M, Ferrari VD, Gianoncelli A, Turla A, Canu L, Terzolo M, Tiberio GAM, Sigala S, Berruti A. Phase II study of cabazitaxel as second-third line treatment in patients with metastatic adrenocortical carcinoma. ESMO Open 2022; 7:100422. [PMID: 35272132 PMCID: PMC9058897 DOI: 10.1016/j.esmoop.2022.100422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 12/11/2022] Open
Abstract
Background Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with a poor prognosis. No efficacious treatment options are currently available for patients with advanced metastatic disease with disease progression to standard etoposide, doxorubicin, cisplatin and mitotane (EDP-M) therapy. We assessed the activity and tolerability of cabazitaxel as a second/third-line approach in metastatic ACC. Patients and methods Patients included in this single-center, phase II study (ClinicalTrials.gov identifier NCT03257891) had disease progression to a cisplatin-containing regimen (such as EDP) plus mitotane, plus/minus a further chemotherapy line. Cabazitaxel was administered intravenously at 25 mg/m2 on day 1 of a 21-day cycle, for a maximum of six cycles. The primary endpoint was a disease control rate after 4 months. Results From March 2018 to September 2019, 25 eligible patients were enrolled. A disease control rate after 4 months was obtained in six patients (24%). No patients attained a disease response according to RECIST 1.1, 9 patients (36%) had stable disease and 16 patients (64%) progressive disease. Median progression-free survival and overall survival were 1.5 months (range 0.3-7 months) and 6 months (range 1-22.2 months), respectively. Cabazitaxel therapy was well tolerated and only three (12%) patients developed grade 3 toxicity which were nausea in one patient (4%) and anemia in two patients (8%). Conclusions Cabazitaxel has a manageable toxicity profile but is poorly active as second/third-line treatment in advanced ACC patients. These results do not support further evaluation of cabazitaxel in this setting. Cabazitaxel is well tolerated but poorly active as second/third-line treatment in patients with advanced ACC. Combining RECIST and Choi criteria could be of value in the assessment of disease response to chemotherapy in ACC patients. Older age, elevated cortisol and LDH blood level correlate with a greater risk of death in multivariate analysis.
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Affiliation(s)
- M Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - S Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - R Ambrosini
- Radiology Unit, ASST Spedali Civili, Brescia, Italy
| | - D Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - A Abate
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - M Zamparini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - V D Ferrari
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - A Gianoncelli
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - A Turla
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - L Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - M Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - G A M Tiberio
- Surgical Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - S Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - A Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy.
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3
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Park SE, El-Sayed NS, Shamloo K, Lohan S, Kumar S, Sajid MI, Tiwari RK. Targeted Delivery of Cabazitaxel Using Cyclic Cell-Penetrating Peptide and Biomarkers of Extracellular Matrix for Prostate and Breast Cancer Therapy. Bioconjug Chem 2021; 32:1898-1914. [PMID: 34309357 DOI: 10.1021/acs.bioconjchem.1c00319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Targeted drug delivery for cancer therapy is an emerging area of research. Cancer cells overexpress certain biomarkers that can be exploited for their targeted therapy. Cyclic cell-penetrating peptides (cCPP) are increasingly assessed for intracellular cargo delivery in cancer cells. In this study, we have conjugated cabazitaxel (CBT) to the cCPP via an ester bond to assist CBT release in the tumor's acidic environment. Integrin targeting (RGDC, TP1) and extra domain B of fibronectin (EDB-Fn) targeting (CTVRTSAD, TP2) peptides were linked to the peptide-drug conjugate (cCPP-CBT) via a disulfide bond to provide targeting ability to the conjugates until they reach the tumor site. Conjugate 11 (TP1-cCPP-CBT) and conjugate 16 (TP2-cCPP-CBT) showed approximately 3-4-fold less antiproliferative activity on integrin and EDB-FN overexpressing cancer cell lines as compared to the CBT analogue used for comparison (CBT-GA, 5). Conjugates (11 and 16) were less toxic (31-34-fold less antiproliferative activity) to the normal human embryonic kidney (HEK-293) cells as compared to CBT. The flow cytometry and quantitative confocal microscopy data further confirm the selective efficacy of conjugates (TP1-cCPP-FAM (10) and TP1-cCPP-FAM (15)) toward biomarker overexpressing cancer cells. Furthermore, the stability and release studies of conjugate 11 revealed its therapeutic potential under different conditions, such as human plasma, different pHs, and redox conditions. This conjugation strategy was proven to enhance chemotherapeutics agents' efficacy and targeting and can be applied to other chemotherapeutic agents.
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Affiliation(s)
- Shang Eun Park
- Center for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, California 92618, United States
| | - Naglaa Salem El-Sayed
- Center for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, California 92618, United States.,Cellulose and Paper Department, National Research Center, Dokki 12622, Cairo, Egypt
| | - Kiumars Shamloo
- Center for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, California 92618, United States
| | - Sandeep Lohan
- Center for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, California 92618, United States
| | - Sumit Kumar
- Department of Chemistry, Deenbandhu Chhotu Ram University of Science and Technology, Murthal, Haryana 131039, India
| | - Muhammad Imran Sajid
- Center for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, California 92618, United States.,Faculty of Pharmacy, University of Central Punjab, Lahore 54000, Pakistan
| | - Rakesh Kumar Tiwari
- Center for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, California 92618, United States
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4
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Muth M, Ojara FW, Kloft C, Joerger M. Role of TDM-based dose adjustments for taxane anticancer drugs. Br J Clin Pharmacol 2020; 87:306-316. [PMID: 33247980 DOI: 10.1111/bcp.14678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/10/2020] [Accepted: 11/03/2020] [Indexed: 01/14/2023] Open
Abstract
The classical taxanes (paclitaxel, docetaxel), the newer taxane cabazitaxel and the nanoparticle-bound nab-paclitaxel are among the most widely used anticancer drugs. Still, the optimal use and the value of pharmacological personalization of the taxanes is still controversial. We give an overview on the pharmacological properties of the taxanes, including metabolism, pharmacokinetics-pharmacodynamic relations and aspects in the clinical use of taxanes. The latter includes the ongoing debate on the most effective and safe regimen, the recommended initial dose, and pharmacological dosing individualization. The taxanes are among the most widely used anticancer drugs in patients with solid malignancies. Despite their longtime use in clinical routine, the optimal dosing strategy (weekly versus 3-weekly) or optimal average dose (cabazitaxel, nab-paclitaxel) has not been fully resolved, as it may differ according to tumour entity and line of treatment. The value of pharmacological individualization of the taxanes (TDM, TCI) has been partly explored for 3-weekly paclitaxel and docetaxel, but remains mostly unexplored for cabazitaxel and nab-paclitaxel at present.
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Affiliation(s)
- Marsilla Muth
- Department of Oncology & Hematology, Cantonal Hospital, St. Gallen, Switzerland
| | - Francis Williams Ojara
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Germany.,Graduate Research Training Program PharMetrX, Germany
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Germany
| | - Markus Joerger
- Department of Oncology & Hematology, Cantonal Hospital, St. Gallen, Switzerland
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5
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Saltalamacchia G, Frascaroli M, Bernardo A, Quaquarini E. Renal and Cardiovascular Toxicities by New Systemic Treatments for Prostate Cancer. Cancers (Basel) 2020; 12:cancers12071750. [PMID: 32630204 PMCID: PMC7407336 DOI: 10.3390/cancers12071750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer (PC) is the most common male cancer in Western Countries. In recent years, the treatment of relapsed or metastatic disease had benefited by the introduction of a variety of new different drugs. In consideration of the relative long survival of PC patients, side effects of these drugs must be considered and monitored. In this review, we analyzed the newly developed therapies for PC treatment, describing the mechanism of action, the metabolism and latest clinical trials that led to the approval of these drugs in clinical practice. We then evaluated the cardiovascular and renal side effects from pivotal phase III and II studies and meta-analyses. Cardiovascular side effects are the most frequent, in particular hypertension, while renal toxicity is rarer and not well described in literature. Therefore, there is a need to better define the effects of these therapies, in order to personalize patient treatment on the basis of their comorbidities and preferences, in addition to their symptoms and disease load.
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Affiliation(s)
- Giuseppe Saltalamacchia
- Operative Unit of Medical Oncology, IRCCS Istituti Clinici Scientifici Maugeri, 27100 Pavia, Italy; (G.S.); (A.B.)
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Mara Frascaroli
- Operative Unit of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, 27100 Pavia, Italy;
| | - Antonio Bernardo
- Operative Unit of Medical Oncology, IRCCS Istituti Clinici Scientifici Maugeri, 27100 Pavia, Italy; (G.S.); (A.B.)
| | - Erica Quaquarini
- Operative Unit of Medical Oncology, IRCCS Istituti Clinici Scientifici Maugeri, 27100 Pavia, Italy; (G.S.); (A.B.)
- Experimental Medicine School, University of Pavia, 27100 Pavia, Italy
- Correspondence: ; +39-0382-592671
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6
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Belderbos BPS, de With M, Singh RK, Agema BC, El Bouazzaoui S, Oomen-de Hoop E, de Wit R, van Schaik RHN, Mathijssen RHJ, Bins S. The influence of single-nucleotide polymorphisms on overall survival and toxicity in cabazitaxel-treated patients with metastatic castration-resistant prostate cancer. Cancer Chemother Pharmacol 2020; 85:547-553. [PMID: 31893292 DOI: 10.1007/s00280-019-04011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/07/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Cabazitaxel, used in patients with metastatic castration-resistant prostate cancer (mCRPC), is associated with adverse events which may require dose reductions or discontinuation of treatment. We investigated the potential association of single-nucleotide polymorphisms (SNPs) in genes encoding drug transporters and drug-metabolizing enzymes with cabazitaxel toxicity, overall survival (OS) and pharmacokinetics (PK). METHODS A total of 128 cabazitaxel-treated mCRPC patients, of whom prospectively collected data on toxicity and OS were available and 24 mCRPC patients with available cabazitaxel PK measurements, were genotyped using genomic DNA obtained from EDTA blood. The SLCO1B1 (388A > G; *1B; rs2306283 and 521 T > C; *5; rs4149056 and haplotype SLCO1B1*15), SLCO1B3 (334 T > G; rs4149117), CYP3A4 (*22; rs35599367), CYP3A5 (*3; rs776746), ABCB1 (3435C > T; rs1045642), and TUBB1 (57 + 87A > C; rs463312) SNPs were tested for their association with clinical and PK parameters by univariate/multivariate logistic regression, log-rank test, or Kruskal-Wallis test. RESULTS The SLCO1B1*15 haplotype was significantly associated with a lower incidence of leukopenia and neutropenia (p = 0.020 and p = 0.028, respectively). Patients harboring a homozygous variant for SLCO1B1*1B experienced higher rate ≥ grade 3 (p = 0.042). None of the SNPs were associated with pharmacokinetics or OS. CONCLUSIONS In this study, SLCO1B1 (SLCO1B1*15 and SLCO1B1*1B) was associated with cabazitaxel-induced adverse events in mCRPC patients. As the associations were opposite to previous studies in other drugs and contradicted an underlying pharmacokinetic rationale, these findings are likely to be false-positive and would ideally be validated with even larger (pharmacokinetic) cohorts.
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Affiliation(s)
- Bodine P S Belderbos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Mirjam de With
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rajbir K Singh
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Bram C Agema
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Samira El Bouazzaoui
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Sander Bins
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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7
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Shimizu Y, Tamada S, Kato M, Hirayama Y, Takeyama Y, Iguchi T, Sadar MD, Nakatani T. Androgen Receptor Splice Variant 7 Drives the Growth of Castration Resistant Prostate Cancer without Being Involved in the Efficacy of Taxane Chemotherapy. J Clin Med 2018; 7:jcm7110444. [PMID: 30453546 PMCID: PMC6262607 DOI: 10.3390/jcm7110444] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 12/15/2022] Open
Abstract
Expression of androgen receptor (AR) splice variant 7 (AR-V7) has been identified as the mechanism associated with the development of castration-resistant prostate cancer (CRPC). However, a potential link between AR-V7 expression and resistance to taxanes, such as docetaxel or cabazitaxel, has not been unequivocally demonstrated. To address this, we used LNCaP95-DR cells, which express AR-V7 and exhibit resistance to enzalutamide and docetaxel. Interestingly, LNCaP95-DR cells showed cross-resistance to cabazitaxel. Furthermore, these cells had increased levels of P-glycoprotein (P-gp) and their sensitivity to both docetaxel and cabazitaxel was restored through treatment with tariquidar, a P-gp antagonist. Results generated demonstrated that P-gp mediated cross-resistance between docetaxel and cabazitaxel. Although the LNCaP95-DR cells had increased expression of AR-V7 and its target genes (UBE2C, CDC20), the knockdown of AR-V7 did not restore sensitivity to docetaxel or cabazitaxel. However, despite resistance to docetaxel and carbazitaxel, EPI-002, an antagonist of the AR amino-terminal domain (NTD), had an inhibitory effect on the proliferation of LNCaP95-DR cells, which was similar to that achieved with the parental LNCaP95 cells. On the other hand, enzalutamide had no effect on the proliferation of either cell line. In conclusion, our results suggested that EPI-002 may be an option for the treatment of AR-V7-driven CRPC, which is resistant to taxanes.
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Affiliation(s)
- Yasuomi Shimizu
- Department of Urology, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan.
| | - Satoshi Tamada
- Department of Urology, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan.
| | - Minoru Kato
- Department of Urology, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan.
| | | | - Yuji Takeyama
- Department of Urology, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan.
| | - Taro Iguchi
- Department of Urology, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan.
| | - Marianne D Sadar
- Genome Sciences Centre, BC Cancer, Vancouver, BC V5Z 1L3, Canada.
| | - Tatsuya Nakatani
- Department of Urology, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan.
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8
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Manley PE, Trippett T, Smith AA, Macy ME, Leary SES, Boklan J, Cohen KJ, Goldman S, Kilburn LB, Dhall G, Devin J, Herzog CE, Partap S, Fauchet F, Badreddine E, Bernard JP, Chi SN. A phase 1/2 dose-finding, safety, and activity study of cabazitaxel in pediatric patients with refractory solid tumors including tumors of the central nervous system. Pediatr Blood Cancer 2018; 65:e27217. [PMID: 29750396 DOI: 10.1002/pbc.27217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND This phase 1/2 study (NCT01751308) evaluated cabazitaxel in pediatric patients. Phase 1 determined the maximum tolerated dose (MTD) in patients with recurrent/refractory solid tumors, including central nervous system (CNS) tumors. Phase 2 evaluated activity in pediatric recurrent high-grade glioma (HGG) or diffuse intrinsic pontine glioma (DIPG). PROCEDURE In phase 1, a 3 + 3 dose-escalation study design was followed. Cabazitaxel was administered at a starting dose of 20 mg/m2 . Dose-limiting toxicities (DLTs) during cycle 1 were assessed to determine the MTD. Tumor response and cabazitaxel pharmacokinetics were also assessed. In phase 2, patients received cabazitaxel at the MTD determined in phase 1. Tumor responses were assessed every 9 weeks (modified Response Assessment in Neuro-oncology criteria). Progression-free survival and cabazitaxel pharmacokinetics were evaluated, and overall survival was estimated. RESULTS In phase 1, 23 patients were treated, including 19 with CNS tumors. One patient had a partial response; five had stable disease for >3 cycles. Common adverse events included fatigue, diarrhea, nausea and vomiting, febrile neutropenia, and hypersensitivity reactions. Two of three DLTs (febrile neutropenia) occurred with a dose of 35 mg/m2 ; the MTD was 30 mg/m2 . Slightly higher cabazitaxel clearance was observed compared with adult trials. In phase 2, 16 patients (eight HGG and eight DIPG) were enrolled; 11 were evaluable for response and five withdrew (three due to anaphylaxis). All 11 patients progressed within four cycles. No responses were observed; the study was stopped due to futility. CONCLUSIONS The safety profile of cabazitaxel was consistent with previous studies. The MTD (30 mg/m2 ) was higher than the adult MTD. Cabazitaxel did not demonstrate activity in recurrent/refractory HGG or DIPG.
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Affiliation(s)
- Peter E Manley
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tanya Trippett
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Amy A Smith
- Department of Pediatric Hematology-Oncology, Arnold Palmer Hospital, Orlando, Florida
| | - Margaret E Macy
- Department of Pediatric Hematology, Oncology & Bone Marrow Transplantation, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah E S Leary
- Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Jessica Boklan
- Department of Hematology/Oncology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Kenneth J Cohen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Stewart Goldman
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lindsay B Kilburn
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, District of Columbia
| | - Girish Dhall
- Department of Pediatric Neuro-Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | | | - Cynthia E Herzog
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sonia Partap
- Department of Pediatric Neurology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California
| | | | | | | | - Susan N Chi
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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9
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Nimmervoll BV, Boulos N, Bianski B, Dapper J, DeCuypere M, Shelat A, Terranova S, Terhune HE, Gajjar A, Patel YT, Freeman BB, Onar-Thomas A, Stewart CF, Roussel MF, Guy RK, Merchant TE, Calabrese C, Wright KD, Gilbertson RJ. Establishing a Preclinical Multidisciplinary Board for Brain Tumors. Clin Cancer Res 2018; 24:1654-1666. [PMID: 29301833 PMCID: PMC5884708 DOI: 10.1158/1078-0432.ccr-17-2168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/21/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022]
Abstract
Purpose: Curing all children with brain tumors will require an understanding of how each subtype responds to conventional treatments and how best to combine existing and novel therapies. It is extremely challenging to acquire this knowledge in the clinic alone, especially among patients with rare tumors. Therefore, we developed a preclinical brain tumor platform to test combinations of conventional and novel therapies in a manner that closely recapitulates clinic trials.Experimental Design: A multidisciplinary team was established to design and conduct neurosurgical, fractionated radiotherapy and chemotherapy studies, alone or in combination, in accurate mouse models of supratentorial ependymoma (SEP) subtypes and choroid plexus carcinoma (CPC). Extensive drug repurposing screens, pharmacokinetic, pharmacodynamic, and efficacy studies were used to triage active compounds for combination preclinical trials with "standard-of-care" surgery and radiotherapy.Results: Mouse models displayed distinct patterns of response to surgery, irradiation, and chemotherapy that varied with tumor subtype. Repurposing screens identified 3-hour infusions of gemcitabine as a relatively nontoxic and efficacious treatment of SEP and CPC. Combination neurosurgery, fractionated irradiation, and gemcitabine proved significantly more effective than surgery and irradiation alone, curing one half of all animals with aggressive forms of SEP.Conclusions: We report a comprehensive preclinical trial platform to assess the therapeutic activity of conventional and novel treatments among rare brain tumor subtypes. It also enables the development of complex, combination treatment regimens that should deliver optimal trial designs for clinical testing. Postirradiation gemcitabine infusion should be tested as new treatments of SEP and CPC. Clin Cancer Res; 24(7); 1654-66. ©2018 AACR.
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Affiliation(s)
- Birgit V Nimmervoll
- Cancer Research UK Cambridge Institute and Department of Oncology, University of Cambridge, Cambridge, England, United Kingdom
| | - Nidal Boulos
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brandon Bianski
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jason Dapper
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael DeCuypere
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Anang Shelat
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sabrina Terranova
- Cancer Research UK Cambridge Institute and Department of Oncology, University of Cambridge, Cambridge, England, United Kingdom
| | - Hope E Terhune
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yogesh T Patel
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Burgess B Freeman
- Preclinical Pharmacokinetics Core, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Clinton F Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Martine F Roussel
- Department of Tumor Cell Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - R Kipling Guy
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Thomas E Merchant
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Karen D Wright
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Richard J Gilbertson
- Cancer Research UK Cambridge Institute and Department of Oncology, University of Cambridge, Cambridge, England, United Kingdom.
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10
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Belderbos BPS, Bins S, van Leeuwen RWF, Oomen-de Hoop E, van der Meer N, de Bruijn P, Hamberg P, Overkleeft ENM, van der Deure WM, Lolkema MP, de Wit R, Mathijssen RHJ. Influence of Enzalutamide on Cabazitaxel Pharmacokinetics: a Drug-Drug Interaction Study in Metastatic Castration-resistant Prostate Cancer (mCRPC) Patients. Clin Cancer Res 2017; 24:541-546. [PMID: 29150561 DOI: 10.1158/1078-0432.ccr-17-2336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/20/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022]
Abstract
Purpose: In ongoing clinical research on metastatic castration-resistant prostate cancer (mCRPC) treatment, the potential enhanced efficacy of the combination of taxanes with AR-targeted agents, that is, enzalutamide and abiraterone, is currently being explored. Because enzalutamide induces the CYP3A4 enzyme and taxanes are metabolized by this enzyme, a potential drug-drug interaction needs to be investigated.Experimental Design: Therefore, we performed a pharmacokinetic cross-over study in mCRPC patients who were scheduled for treatment with cabazitaxel Q3W (25 mg/m2). Patients were studied for three consecutive cabazitaxel cycles. Enzalutamide (160 mg once daily) was administered concomitantly after the first cabazitaxel cycle, during 6 weeks. Primary endpoint was the difference in mean area under the curve (AUC) between the first (cabazitaxel monotherapy) and third cabazitaxel cycle, when enzalutamide was added.Results: A potential clinically relevant 22% (95% CI, 9%-34%; P = 0.005) reduction in cabazitaxel exposure was found with concomitant enzalutamide use. The geometric mean AUC0-24h of cabazitaxel was 181 ng*h/mL (95% CI, 150-219 ng*h/mL) in cycle 3 and 234 ng*h/mL (95% CI, 209-261 ng*h/mL) in cycle 1. This combination did not result in excessive toxicity, whereas PSA response was promising.Conclusions: We found a significant decrease in cabazitaxel exposure when combined with enzalutamide. In an era of clinical trials on combination strategies for mCRPC, it is important to be aware of clinically relevant drug-drug interactions. Because recent study results support the use of a lower standard cabazitaxel dose of 20 mg/m2, the clinical relevance of this interaction may be substantial, because the addition of enzalutamide may result in subtherapeutic cabazitaxel exposure. Clin Cancer Res; 24(3); 541-6. ©2017 AACR.
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Affiliation(s)
- Bodine P S Belderbos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Sander Bins
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Roelof W F van Leeuwen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Nelly van der Meer
- Clinical Trial Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Peter de Bruijn
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Paul Hamberg
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | | | | | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
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11
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Abstract
Despite a growing number of treatment options, metastatic castrate resistant prostate cancer remains almost universally fatal. Dose individualization ensures patients receive the maximal benefit from each line of treatment potentially leading to improved outcomes, a reduction in quality of life impairment and minimization of premature cessation for avoidable toxicity. Herein, we review drug-specific issues that may be associated with unexpected or unrecognized variations in drug systemic exposure despite the use of protocol doses. In particular, we discuss the potential for under-exposure of docetaxel and cabazitaxel; over-exposure of enzalutamide; and varied absorption of abiraterone acetate.
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Affiliation(s)
- Megan Crumbaker
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, New South Wales, Australia
- Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, New South Wales, Australia
- Macquarie University, New South Wales, Australia
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12
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Oudard S, Fizazi K, Sengeløv L, Daugaard G, Saad F, Hansen S, Hjälm-Eriksson M, Jassem J, Thiery-Vuillemin A, Caffo O, Castellano D, Mainwaring PN, Bernard J, Shen L, Chadjaa M, Sartor O. Cabazitaxel Versus Docetaxel As First-Line Therapy for Patients With Metastatic Castration-Resistant Prostate Cancer: A Randomized Phase III Trial-FIRSTANA. J Clin Oncol 2017; 35:3189-3197. [PMID: 28753384 DOI: 10.1200/jco.2016.72.1068] [Citation(s) in RCA: 217] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose In patients with metastatic castration-resistant prostate cancer (mCRPC), overall survival (OS) is significantly improved with cabazitaxel versus mitoxantrone after prior docetaxel treatment. FIRSTANA ( ClinicalTrials.gov identifier: NCT01308567) assessed whether cabazitaxel 20 mg/m2 (C20) or 25 mg/m2 (C25) is superior to docetaxel 75 mg/m2 (D75) in terms of OS in patients with chemotherapy-naïve mCRPC. Patients and Methods Patients with mCRPC and Eastern Cooperative Oncology Group performance status of 0 to 2 were randomly assigned 1:1:1 to receive C20, C25, or D75 intravenously every 3 weeks plus daily prednisone. The primary end point was OS. Secondary end points included safety; progression-free survival (PFS); tumor, prostate-specific antigen, and pain response; pharmacokinetics; and health-related quality of life. Results Between May 2011 and April 2013, 1,168 patients were randomly assigned. Baseline characteristics were similar across cohorts. Median OS was 24.5 months with C20, 25.2 months with C25, and 24.3 months with D75. Hazard ratio for C20 versus D75 was 1.01 (95% CI, 0.85 to 1.20; P = .997), and hazard ratio for C25 versus D75 was 0.97 (95% CI, 0.82 to 1.16; P = .757). Median PFS was 4.4 months with C20, 5.1 months with C25, and 5.3 months with D75, with no significant differences between treatment arms. Radiographic tumor responses were numerically higher for C25 (41.6%) versus D75 (30.9%; nominal P = .037, without multiplicity test adjustment). Rates of grade 3 or 4 treatment-emergent adverse events were 41.2%, 60.1%, and 46.0% for C20, C25, and D75, respectively. Febrile neutropenia, diarrhea, and hematuria were more frequent with C25; peripheral neuropathy, peripheral edema, alopecia, and nail disorders were more frequent with D75. Conclusion C20 and C25 did not demonstrate superiority for OS versus D75 in patients with chemotherapy-naïve mCRPC. Tumor response was numerically higher with C25 versus D75; pain PFS was numerically improved with D75 versus C25. Cabazitaxel and docetaxel demonstrated different toxicity profiles, with overall less toxicity with C20.
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Affiliation(s)
- Stéphane Oudard
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Karim Fizazi
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Lisa Sengeløv
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Gedske Daugaard
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Fred Saad
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Steinbjørn Hansen
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Marie Hjälm-Eriksson
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Jacek Jassem
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Antoine Thiery-Vuillemin
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Orazio Caffo
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Daniel Castellano
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Paul N Mainwaring
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - John Bernard
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Liji Shen
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Mustapha Chadjaa
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
| | - Oliver Sartor
- Stéphane Oudard, Georges Pompidou European Hospital, Rene Descartes University; Mustapha Chadjaa; Sanofi, Paris; Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif; Antoine Thiery-Vuillemin, Centre Hospitalier Universitaire Minjoz Besançon, Besançon, France; Lisa Sengeløv, Herlev Hospital, Herlev; Gedske Daugaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Steinbjørn Hansen, Odense University Hospital, Odense, Denmark; Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Marie Hjälm-Eriksson, Karolinska University Hospital, Stockholm, Sweden; Jacek Jassem, Medical University of Gdansk, Gdansk, Poland; Orazio Caffo, Santa Chiara Hospital, Trento, Italy; Daniel Castellano, University Hospital 12 de Octubre, Madrid, Spain; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; John Bernard, Sanofi, Cambridge, MA; Liji Shen, Sanofi, Bridgewater, NJ; and Oliver Sartor, Tulane Cancer Center, New Orleans, LA
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13
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Massard C, Mateo J, Loriot Y, Pezaro C, Albiges L, Mehra N, Varga A, Bianchini D, Ryan CJ, Petrylak DP, Attard G, Shen L, Fizazi K, de Bono J. Phase I/II trial of cabazitaxel plus abiraterone in patients with metastatic castration-resistant prostate cancer (mCRPC) progressing after docetaxel and abiraterone. Ann Oncol 2017; 28:90-95. [PMID: 28039155 PMCID: PMC5378222 DOI: 10.1093/annonc/mdw441] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Abiraterone and cabazitaxel improve survival in patients with metastatic castration-resistant prostate cancer (mCRPC). We conducted an open-label phase I/II trial of cabazitaxel plus abiraterone to assess the antitumor activity and tolerability in patients with progressive mCRPC after docetaxel (phase I), and after docetaxel and abiraterone (phase II) (NCT01511536). Patients and methods The primary objectives were to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of cabazitaxel plus abiraterone (phase I), and the prostate-specific antigen (PSA) response defined as a ≥ 50% decrease confirmed ≥3 weeks later with this combination (phase II). Results Ten patients were enrolled in the phase I component; nine were evaluable. No DLTs were identified. The MTD was established as the approved doses for both drugs (cabazitaxel 25 mg/m2 every 3 weeks and abiraterone 1000 mg once daily). Daily abiraterone treatment did not impact on cabazitaxel clearance. Twenty-seven patients received cabazitaxel plus abiraterone plus prednisone (5 mg twice daily) in phase II. The median number of cycles administered (cabazitaxel) was seven (range: 1-28). Grade 3-4 treatment-emergent adverse events included asthenia (in 5 patients; 14%), neutropenia (in 5 patients; 14%) and diarrhea (in 3 patients; 8%). Nine patients (24%) required dose reductions of cabazitaxel. Of 26 evaluable patients, 12 achieved a PSA response [46%; 95% confidence interval (CI): 26.6-66.6%]. Median PSA-progression-free survival was 6.9 months (95% CI: 4.1-10.3 months). Of 14 patients with measurable disease at baseline, 3 (21%) achieved a partial response per response evaluation criteria in solid tumors. Conclusions The combination of cabazitaxel and abiraterone has a manageable safety profile and shows antitumor activity in patients previously treated with docetaxel and abiraterone.
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Affiliation(s)
- C Massard
- Department of Drug Development, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France.,Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - J Mateo
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Y Loriot
- Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - C Pezaro
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - L Albiges
- Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - N Mehra
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A Varga
- Department of Drug Development, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - D Bianchini
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - C J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - D P Petrylak
- Comprehensive Cancer Center Yale School of Medicine, New Haven
| | - G Attard
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - L Shen
- Sanofi Genzyme, Cambridge, USA
| | - K Fizazi
- Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - J de Bono
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
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14
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Janssen A, Verkleij CPM, van der Vlist A, Mathijssen RHJ, Bloemendal HJ, Ter Heine R. Towards better dose individualisation: metabolic phenotyping to predict cabazitaxel pharmacokinetics in men with prostate cancer. Br J Cancer 2017; 116:1312-1317. [PMID: 28399110 PMCID: PMC5482735 DOI: 10.1038/bjc.2017.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cabazitaxel is approved for treatment of castration-resistant metastatic prostate cancer. The current dosing strategy of cabazitaxel is based on body surface area (BSA). Body surface area is known as a poor predictor for total systemic exposure to drugs, since it does not take into account variability in activity of metabolising enzymes, necessary for clearance of drugs. As exposure to cabazitaxel is related to treatment response, it is essential to develop a better individualised dosing strategy. METHODS Ten patients with metastatic castration-resistant prostate cancer, who received cabazitaxel dosed on BSA as a part of routine palliative care, were enrolled in this study. Midazolam was administered as phenotyping probe for cytochrome P450 isoenzyme 3A (CYP3A). The relationship between midazolam and cabazitaxel clearance was investigated using non-linear mixed effects modelling. RESULTS The clearance of Midazolam highly correlated with cabazitaxel clearance (R=0.74). Midazolam clearance significantly (P<0.004) explained the majority (∼60%) of the inter-individual variability in cabazitaxel clearance in the studied population. CONCLUSIONS Metabolic phenotyping of CYP3A using midazolam is a promising strategy to individualise cabazitaxel dosing. Before clinical application, a randomised study is warranted.
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Affiliation(s)
- A Janssen
- Laboratory of Translational Immunology, University Medical Center, Utrecht 3584 CX, The Netherlands
| | - C P M Verkleij
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein 3435 CM, The Netherlands
| | - A van der Vlist
- Department of Pulmonology, Jeroen Bosch Hospital, Den Bosch 5223 GZ, The Netherlands
| | - R H J Mathijssen
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam 3075 EA, The Netherlands
| | - H J Bloemendal
- Department of Internal Medicine, Meander Medical Center, Amersfoort 3813 TZ, The Netherlands.,Department of Medical Oncology, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands
| | - R Ter Heine
- Department of Pharmacy, Radboud UMC, Nijmegen 6525 GA, The Netherlands
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15
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Armstrong AJ, Humeniuk MS, Healy P, Szmulewitz R, Winters C, Kephart J, Harrison MR, Martinez E, Mundy K, Halabi S, George D. Phase Ib Trial of Cabazitaxel and Tasquinimod in Men With Heavily Pretreated Metastatic Castration Resistant Prostate Cancer (mCRPC): The CATCH Trial. Prostate 2017; 77:385-395. [PMID: 27862097 PMCID: PMC6309626 DOI: 10.1002/pros.23277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tasquinimod is an immunomodulating and anti-antiangiogenic oral agent with anti-prostate cancer activity in preclinical studies and in clinical trials of men with metastatic castration resistant prostate cancer (mCRPC), including single agent activity and in combination with taxanes. We sought to identify the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of tasquinimod in combination with cabazitaxel and prednisone in men with chemorefractory mCRPC. METHODS Men with mCRPC who had failed prior docetaxel chemotherapy received cabazitaxel 25 mg/m2 every 3 weeks with oral tasquinimod at 1 of 3 escalating dose levels (0.25, 0.5, and 1.0 mg once daily) with prednisone and PEG-filgastrim support, using a 3 + 3 dose escalation design. Treatment continued until progressive disease or unacceptable toxicity. RESULTS We enrolled 25 men with chemorefractory mCRPC. The RP2D was 0.5 mg tasquinimod based on excess DLTs (two of three men) observed at dose level 3 (1.0 mg) including grade 3 sensory neuropathy and grade 3 atrial fibrillation. Dose level 2 was expanded to 14 men, where 3 DLTs were observed: grade 3 fatigue, grade 4 febrile neutropenia, and grade 3 liver function abnormalities. The proportion of men with a ≥30% PSA decline was 63% and the median composite progression-free survival (PFS) was 8.5 months (95% CI 4.2-16.4 months) based on 12 PFS events. The median number of cycles of cabazitaxel was 6 (range 1-13), with six men receiving >10 cycles. Best overall RECIST responses (CR + PR) were observed in three men (12%), with stable disease in 12 (48%). No pharmacokinetic interactions were observed. CONCLUSIONS We determined the RP2D of tasquinimod combined with cabazitaxel to be 0.5 mg daily following a 3 week lead-in of tasquinimod 0.25 mg with growth factor support. No unexpected toxicities occurred. Prostate 77: 385-395, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew J. Armstrong
- Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery, Duke Cancer Institute, Durham, North Carolina
- Correspondence to: Andrew J. Armstrong, MD, ScM, FACP, Associate Professor of Medicine and Surgery, Associate Director for Clinical Research in Genitourinary Oncology, Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery, Duke Cancer Institute, DUMC Box 103861, Duke University, Durham, NC 27710.
| | - Michael S. Humeniuk
- Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Patrick Healy
- Department of Biostatistics, Duke University, Durham, North Carolina
| | | | - Carolyn Winters
- Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Julie Kephart
- Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Michael R. Harrison
- Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Elia Martinez
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Kelly Mundy
- Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Susan Halabi
- Department of Biostatistics, Duke University, Durham, North Carolina
| | - Daniel George
- Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery, Duke Cancer Institute, Durham, North Carolina
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16
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Sarantopoulos J, Mita AC, He A, Wade JL, Hsueh CT, Morris JC, Lockhart AC, Quinn DI, Hwang J, Mier J, Zhang W, Wack C, Yin J, Clot PF, Rixe O. Safety and pharmacokinetics of cabazitaxel in patients with hepatic impairment: a phase I dose-escalation study. Cancer Chemother Pharmacol 2017; 79:339-351. [PMID: 28058445 PMCID: PMC5306058 DOI: 10.1007/s00280-016-3210-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/29/2016] [Indexed: 11/30/2022]
Abstract
Purpose Cabazitaxel has not been studied in patients with hepatic impairment (HI). This phase I study assessed cabazitaxel safety and pharmacokinetics in patients with HI. Methods Patients with advanced, non-hematologic cancer, and normal hepatic function (Cohort 1: C-1), or mild (C-2), moderate (C-3), severe (C-4) HI received cabazitaxel starting doses of 25, 20, 10, and 10 mg/m2, respectively. Doses were escalated in patients with HI based on Cycle 1 dose-limiting toxicities (DLTs). Adverse events and the cabazitaxel pharmacokinetic profile were assessed. Results In C-2, three patients receiving cabazitaxel 25 mg/m2 experienced DLTs; maximum tolerated dose (MTD) was 20 mg/m2. In C-3, two patients receiving 20 mg/m2 experienced DLTs; MTD was 15 mg/m2. C-4 was discontinued early due to DLTs. The most frequent cabazitaxel-related, grade 3–4 toxicity was neutropenia (42%). Cabazitaxel clearance normalized to body surface area (CL/BSA) was lower in C-1 (geometric mean [GM] 13.4 L/h/m2) than expected (26.4 L/h/m2), but similar in C-2 (23.5 L/h/m2) and C-3 (27.9 L/h/m2). CL/BSA in C-4 was 18.1 L/h/m2. Compared with C-2, CL/BSA increased 19% in C-3 (GM ratio 1.19; 90% CI 0.74–1.91), but decreased 23% in C-4 (0.77; 0.39–1.53). Cabazitaxel free fraction was unaltered. No significant correlation was found between grade 3–4 toxicities and pharmacokinetic parameters. Conclusions Mild–moderate HI did not cause substantial decline in cabazitaxel clearance. Cabazitaxel dose reductions in patients with mild–moderate HI, and a contraindication in patients with severe HI, are justified based on safety data.
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Affiliation(s)
- John Sarantopoulos
- Institute for Drug Development, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aiwu He
- Department of Medicine and Oncology and Innovation Center for Biomedical Informatics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - James L Wade
- Division of Medical Oncology/Hematology, Cancer Care Center of Decatur, Decatur, IL, USA
| | - Chung-Tsen Hsueh
- Division of Medical Oncology/Hematology, Loma Linda University, Loma Linda, CA, USA
| | - John C Morris
- Division of Hematology-Oncology, Department of Medicine, University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | - A Craig Lockhart
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - David I Quinn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jimmy Hwang
- Department of Medicine and Oncology and Innovation Center for Biomedical Informatics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - James Mier
- Department of Medicine, Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Olivier Rixe
- Division of Hematology/Oncology, Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA.
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17
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Azaro A, Rodón J, Machiels JP, Rottey S, Damian S, Baird R, Garcia-Corbacho J, Mathijssen RHJ, Clot PF, Wack C, Shen L, de Jonge MJA. A phase I pharmacokinetic and safety study of cabazitaxel in adult cancer patients with normal and impaired renal function. Cancer Chemother Pharmacol 2016; 78:1185-1197. [PMID: 27796539 PMCID: PMC5114328 DOI: 10.1007/s00280-016-3175-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/12/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE Limited data are available on cabazitaxel pharmacokinetics in patients with renal impairment. This open-label, multicenter study assessed cabazitaxel in patients with advanced solid tumors and normal or impaired renal function. METHODS Cohorts A (normal renal function: creatinine clearance [CrCL] >80 mL/min/1.73 m2), B (moderate renal impairment: CrCL 30 to <50 mL/min/1.73 m2) and C (severe impairment: CrCL <30 mL/min/1.73 m2) received cabazitaxel 25 mg/m2 (A, B) or 20 mg/m2 (C, could be escalated to 25 mg/m2), once every 3 weeks. Pharmacokinetic parameters and cabazitaxel unbound fraction (F U) were assessed using linear regression and mixed models. Geometric mean (GM) and GM ratios (GMRs) were determined using mean CrCL intervals (moderate and severe renal impairment: 40 and 15 mL/min/1.73 m2) versus a control (90 mL/min/1.73 m2). RESULTS Overall, 25 patients received cabazitaxel (median cycles: 3 [range 1-20]; Cohort A: 5 [2-13]; Cohort B: 3 [1-15]; and Cohort C: 5 [1-20]), of which 24 were eligible for pharmacokinetic analysis (eight in each cohort). For moderate and severe renal impairment versus normal renal function, GMR estimates were: clearance normalized to body surface area (CL/BSA) 0.95 (90% CI 0.80-1.13) and 0.89 (0.61-1.32); area under the curve normalized to dose (AUC/dose) 1.06 (0.88-1.27) and 1.14 (0.76-1.71); and F U 0.99 (0.94-1.04) and 0.97 (0.87-1.09), respectively. Estimated slopes of linear regression of log parameters versus log CrCL (renal impairment) were: CL/BSA 0.06 (-0.15 to 0.28); AUC/dose -0.07 (-0.30 to 0.16); and F U 0.02 (-0.05 to 0.08). Cabazitaxel safety profile was consistent with previous reports. CONCLUSIONS Renal impairment had no clinically meaningful effect on cabazitaxel pharmacokinetics.
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Affiliation(s)
- Analía Azaro
- Molecular Therapeutics Research Unit, Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain. .,Pharmacology Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Jordi Rodón
- Molecular Therapeutics Research Unit, Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jean-Pascal Machiels
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université Catholique de Louvain, Brussels, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, University Hospital of Ghent and Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Richard Baird
- Early Phase Clinical Trials Team, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Javier Garcia-Corbacho
- Early Phase Clinical Trials Team, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ron H J Mathijssen
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Maja J A de Jonge
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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18
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Treatment regimens of classical and newer taxanes. Cancer Chemother Pharmacol 2015; 77:221-33. [PMID: 26589792 DOI: 10.1007/s00280-015-2893-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
The classical taxanes (paclitaxel, docetaxel), the newer taxane cabazitaxel and the nanoparticle-bound nab-paclitaxel are among the most widely used anticancer drugs. The taxanes share the characteristics of extensive hepatic metabolism and biliary excretion, the need for dose adaptation in patients with liver dysfunction, and a substantial pharmacokinetic variability even after taking into account known covariates. Data from clinical studies suggest that optimal scheduling of the taxanes is dependent not only on the specific taxane compound, but also on the tumor type and line of treatment. Still, the optimal dosing regimen (weekly vs 3 weekly) and optimal dose of the taxanes are controversial, as is the value of pharmacological personalization of taxane dosing. In this article, an overview is given on the pharmacological properties of the taxanes, including metabolism, pharmacokinetics-pharmacodynamics and aspects in the clinical use of taxanes. The latter includes the ongoing debate on the most active and safe regimen, the recommended initial dose and the issue of therapeutic drug dosing.
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19
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Phase I dose-escalation study of cabazitaxel administered in combination with gemcitabine in patients with metastatic or unresectable advanced solid malignancies. Anticancer Drugs 2015; 26:785-92. [PMID: 26020806 PMCID: PMC4484664 DOI: 10.1097/cad.0000000000000250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Taxane–gemcitabine combinations have demonstrated antitumor activity. This phase I study (NCT01001221) aimed to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of cabazitaxel plus gemcitabine and to assess the preliminary efficacy of this combination. The patients included had metastatic or unresectable solid tumors and had exhausted standard treatment. Cohorts of three to six patients received cabazitaxel (15–20 mg/m2) before (part 1a) or after (part 1b) gemcitabine (700–1000 mg/m2) on Day 1 and gemcitabine alone on Day 8. Prophylactic growth factors were not allowed in cycle 1. In part 1a (n=12), five patients received 20 mg/m2 cabazitaxel plus 1000 mg/m2 gemcitabine (20/1000), five received 15/900, two received 15/700. In part 1b, all six patients received the lowest dose (700/15). At all doses, two or more patients experienced a DLT, regardless of administration sequence, including febrile neutropenia (n=4), grade 4 neutropenia (n=2), grade 4 thrombocytopenia (n=2), and grade 3 aspartate transaminase increase (n=1). The MTD was not established as all cohorts exceeded the MTD by definition. All patients experienced an adverse event; the most frequent all-grade nonhematologic events were fatigue (66.7%), decreased appetite (50.0%), and diarrhea (44.4%). The most frequent grade 3–4 hematologic abnormalities were neutropenia (83.3%), leukopenia (77.8%), and lymphopenia (72.2%). Toxicity was sequence-independent but appeared worse with gemcitabine followed by cabazitaxel. Durable partial responses were observed in three patients (prostate cancer, appendiceal cancer, and melanoma). The unacceptable DLTs with cabazitaxel plus gemcitabine, at doses reduced more than 25% from single-agent doses, preclude further investigation.
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20
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A phase I open-label study investigating the disposition of [14C]-cabazitaxel in patients with advanced solid tumors. Anticancer Drugs 2015; 26:350-8. [PMID: 25462133 DOI: 10.1097/cad.0000000000000185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cabazitaxel is a semisynthetic taxane approved for the treatment of patients with hormone-refractory metastatic prostate cancer (now known as metastatic castration-resistant prostate cancer) treated previously with a docetaxel-containing treatment regimen. The human plasma pharmacokinetics of cabazitaxel have been described previously, but detailed analyses of the metabolism and excretion pathways of cabazitaxel have not yet been published. Metabolite profiling, quantification, and identification as well as excretion analyses were carried out on samples from patients with advanced solid tumors who received an intravenous infusion of 25 mg/m [C]-cabazitaxel (50 μCi, 1.85 MBq) over 1 h. In plasma, cabazitaxel was the main circulating compound. Seven metabolites were detected, but with each accounting for 5% or less of the parent drug exposure, none were considered relevant metabolites. In excreta, 76.0% of the administered dose was recovered in feces within 2 weeks and 3.7% of the dose was excreted in urine within 1 week. Approximately 20 metabolites were detected in excreta; the main metabolites corresponded to combined mono-O-demethyl or di-O-demethyl derivatives on the taxane ring, with hydroxyl or cyclized derivatives on the lateral chain. Docetaxel (di-O-demethyl-cabazitaxel) was only detected at trace levels in excreta. These results suggest an extensive hepatic metabolism and biliary excretion of cabazitaxel in humans.
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21
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Waddell JA, Solimando DA. Cabazitaxel and Prednisone Regimen for Prostate Cancer. Hosp Pharm 2015; 50:460-3. [PMID: 26405336 PMCID: PMC4568105 DOI: 10.1310/hpj5006-460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net.
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22
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Parente P, Gurney H, Ng S, Bahre M. Clinical perspectives: practical insights from clinical experience with cabazitaxel in Australia. Asia Pac J Clin Oncol 2015; 11:199-207. [PMID: 25856659 DOI: 10.1111/ajco.12343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/29/2022]
Abstract
Prostate cancer, and in particular the management options for patients with metastatic castration-resistant prostate cancer (mCRPC), remains an important health issue. The approval of cabazitaxel provides a new treatment option for patients who have progressed despite docetaxel therapy. Clinical use of cabazitaxel in mCRPC is based on the results of the TROPIC study, which demonstrated an approximately 30% reduction in the risk of death compared with mitoxantrone. In this paper, we draw on accumulating clinical experience with cabazitaxel in Australia to discuss important questions such as how to select the right patient for treatment and how to proactively prevent and manage toxicities associated with this therapy. Recognizing the need for a multidisciplinary approach to patient care, opinion and insight has been sought from medical oncologists, nurses and pharmacists. While lack of trial data means that a number of questions remain unanswered, local clinical experience has helped to guide treatment decisions and refine management protocols. Appropriate patient selection, careful ongoing monitoring and proactive management of adverse events will ensure optimal treatment of patients. Nurses in particular play an important role in educating patients and identifying patients at increased risk of developing adverse events with cabazitaxel. The oncology team must work together to educate patients; taking a proactive approach to issues such as adverse events will help maximize the clinical outcome of cabazitaxel treatment and impact positively on the patient's quality of life.
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Affiliation(s)
- Phillip Parente
- Medical Oncology, Box Hill Hospital, Box Hill, Australia.,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Howard Gurney
- Clinical Research, Medical Oncology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Siobhan Ng
- Clinical Oncology, St John of God Private Hospital, Bendat Family Comprehensive Cancer Centre, Subiaco, Western Australia, Australia
| | - Martina Bahre
- Clinical Oncology, St John of God Private Hospital, Bendat Family Comprehensive Cancer Centre, Subiaco, Western Australia, Australia
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Quantification of taxanes in biological matrices: a review of bioanalytical assays and recommendations for development of new assays. Bioanalysis 2014; 6:993-1010. [PMID: 24806907 DOI: 10.4155/bio.14.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Since the isolation of paclitaxel and its approval for the treatment of breast cancer, various taxanes and taxane formulations have been developed. To date, almost 100 bioanalytical assays have been published with the method development and optimization often extensively discussed by the authors. This Review presents an overview of assays published between January 1970 and September 2013 that described method development and validation of assays used to quantify taxanes in biological matrices such as plasma, urine, feces and tissue samples. For liquid chromatography assays, sample pretreatment, chromatographic separation and assay performance are compared. Since this Review discusses the limitations of previously developed liquid chromatography assays and gives recommendations for future assay development, it can be used as a reference for future development of liquid chromatography assays for the quantification of taxanes in various biological matrices to support preclinical and clinical studies.
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Abstract
INTRODUCTION The classical taxanes (paclitaxel, docetaxel), the newer taxane cabazitaxel and the nanoparticle-bound nab-paclitaxel are among the most widely used anticancer drugs. Despite years of research, the optimal dosing regimen (weekly vs 3-weekly) and optimal dose is still controversial, as is the value of pharmacological personalization of taxane dosing. AREAS COVERED This review provides an overview of the pharmacological properties of the taxanes, including metabolism, pharmacokinetics-pharmacodynamics and aspects in the clinical use of taxanes. The latter includes the ongoing debate on the most active and safe regimen (paclitaxel, docetaxel, nab-paclitaxel), the recommended initial dose (cabazitaxel) and pharmacological dosing individualization. EXPERT OPINION Taxanes share the characteristics of extensive hepatic metabolism and biliary excretion, the need for dose adaptation in patients with liver dysfunction, and substantial pharmacokinetic variability even after taking into account known covariates. Data from clinical studies suggest that optimal scheduling of the taxanes is dependent not only on the specific taxane compound, but also on the tumor type and line of treatment. Finally, treating oncologists should be aware of the substantial risk for drug-drug interactions that is a direct consequence of the complex hepatic metabolism of the taxanes.
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Affiliation(s)
- Markus Joerger
- Cantonal Hospital, Medical Oncology and Clinical Pharmacology , Rorschacherstr. 95, 9007 St. Gallen , Switzerland +41 71 4941111 ; +41 71 4942563 ;
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Vrignaud P, Semiond D, Benning V, Beys E, Bouchard H, Gupta S. Preclinical profile of cabazitaxel. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:1851-67. [PMID: 25378905 PMCID: PMC4207555 DOI: 10.2147/dddt.s64940] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
First-generation taxanes have changed the treatment paradigm for a wide variety of cancers, but innate or acquired resistance frequently limits their use. Cabazitaxel is a novel second-generation taxane developed to overcome such resistance. In vitro, cabazitaxel showed similar antiproliferative activity to docetaxel in taxane-sensitive cell lines and markedly greater activity in cell lines resistant to taxanes. In vivo, cabazitaxel demonstrated excellent antitumor activity in a broad spectrum of docetaxel-sensitive tumor xenografts, including a castration-resistant prostate tumor xenograft, HID28, where cabazitaxel exhibited greater efficacy than docetaxel. Importantly, cabazitaxel was also active against tumors with innate or acquired resistance to docetaxel, suggesting therapeutic potential for patients progressing following taxane treatment and those with docetaxel-refractory tumors. In patients with tumors of the central nervous system (CNS), and in patients with pediatric tumors, therapeutic success with first-generation taxanes has been limited. Cabazitaxel demonstrated greater antitumor activity than docetaxel in xenograft models of CNS disease and pediatric tumors, suggesting potential clinical utility in these special patient populations. Based on therapeutic synergism observed in an in vivo tumor model, cabazitaxel is also being investigated clinically in combination with cisplatin. Nonclinical evaluation of the safety of cabazitaxel in a range of animal species showed largely reversible changes in the bone marrow, lymphoid system, gastrointestinal tract, and male reproductive system. Preclinical safety signals of cabazitaxel were consistent with the previously reported safety profiles of paclitaxel and docetaxel. Clinical observations with cabazitaxel were consistent with preclinical results, and cabazitaxel is indicated, in combination with prednisone, for the treatment of patients with hormone-refractory metastatic prostate cancer previously treated with docetaxel. In conclusion, the demonstrated activity of cabazitaxel in tumors with innate or acquired resistance to docetaxel, CNS tumors, and pediatric tumors made this agent a candidate for further clinical evaluation in a broader range of patient populations compared with first-generation taxanes.
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Phase I study of cabazitaxel plus cisplatin in patients with advanced solid tumors: study to evaluate the impact of cytochrome P450 3A inhibitors (aprepitant, ketoconazole) or inducers (rifampin) on the pharmacokinetics of cabazitaxel. Cancer Chemother Pharmacol 2014; 74:1113-24. [PMID: 25307552 DOI: 10.1007/s00280-014-2572-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Cabazitaxel is primarily metabolized by CYP3A. This study evaluated the impact of moderate/strong CYP3A inhibitors [aprepitant (Study Part 2); ketoconazole (Study Part 3)] or strong CYP3A inducers [rifampin (Study Part 4)] on the pharmacokinetics of cabazitaxel. METHODS Adult patients received IV cabazitaxel/cisplatin 15/75 mg/m(2) on Day 1 of 3-week cycles (5/75 mg/m(2) in Cycles 1 and 2 of Part 3 to allow a safety margin to the cabazitaxel MTD). Patients received repeated oral doses of aprepitant, ketoconazole or rifampin before/during Cycle 2. Cabazitaxel clearance was the primary endpoint; clearance and area under the plasma concentration-time curve (AUC) were normalized to body surface area and dose, respectively. RESULTS The PK population included 13 (Part 2), 23 (Part 3) and 21 patients (Part 4). Repeated aprepitant administration did not affect cabazitaxel clearance [geometric mean ratio (GMR) 0.98; 90 % confidence interval (CI) 0.80-1.19]. Repeated ketoconazole administration resulted in 20 % decrease in cabazitaxel clearance (GMR 0.80; 90 % CI 0.55-1.15), associated with 25 % increase in AUC (GMR 1.25; 90 % CI 0.86-1.81). Repeated rifampin administration resulted in 21 % increase in cabazitaxel clearance (GMR 1.21; 90 % CI 0.95-1.53), associated with 17 % decrease in AUC (GMR 0.83; 90 % CI 0.65-1.05). The GMR of AUC0-24 with rifampin administration was 1.09 (90 % CI 0.9-1.33), suggesting that rifampin had a low impact during the initial phases of cabazitaxel elimination. Safety findings were consistent with previous results. CONCLUSIONS Cabazitaxel pharmacokinetics are modified by drugs strongly affecting CYP3A. Co-administration of cabazitaxel with strong CYP3A inhibitors or inducers should be avoided.
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Phase I dose-escalation study of cabazitaxel administered in combination with cisplatin in patients with advanced solid tumors. Invest New Drugs 2014; 32:1236-45. [DOI: 10.1007/s10637-014-0145-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/25/2014] [Indexed: 11/27/2022]
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Maison-Blanche P, Dakhil S, Baron A, Rottey S, Millard F, Daugaard G, Machiels JP, Conkright W, Sharma S, Soetekouw PMMB, Yachnin J, Sengeløv L, Van Veldhuizen P, Agarwala SS, Sémiond D, Chadjaa M, Shen L, Wade JL. An open-label study to investigate the cardiac safety profile of cabazitaxel in patients with advanced solid tumors. Cancer Chemother Pharmacol 2014; 73:1241-52. [PMID: 24718982 DOI: 10.1007/s00280-014-2460-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/21/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE This study assessed the cardiovascular safety of cabazitaxel, based on thorough evaluation of QT and non-QT variables, and the relationship between pharmacokinetic and pharmacodynamic electrocardiographic (ECG) profiles and the occurrence of Grade ≥3 cardiovascular adverse events. METHODS Patients with advanced solid tumors were treated with cabazitaxel 25 mg/m(2) every 3 weeks. Digital ECG recordings were obtained during Cycle 1 over 24 h after dosing. The primary end point was effect of cabazitaxel on QT interval corrected by the Fridericia formula (QTcF). Secondary end points were additional ECG parameters (QT, PR and QRS intervals, and heart rate), plasma pharmacokinetics of cabazitaxel and overall clinical safety. RESULTS The pharmacodynamic (ECG) population included 94 patients. In 63 patients with a full 24-h ECG evaluation, the maximum upper bound of 90 % confidence interval (CI) for mean QTcF change from baseline was 7.46 ms (mean 4.8 ms), occurring at 1 h 30 min post-infusion. The slope of QTcF change from baseline versus cabazitaxel concentration was slightly negative (-0.012 [95 % CI -0.017; -0.008], equivalent to a 1.2 ms decrease per 100 ng/mL increase in cabazitaxel concentration). For non-QT variables, no effect was noted. No Grade ≥3 cardiac adverse events were observed; Grade ≥3 hypotension and lymphocele occurred in two patients and one patient, respectively. CONCLUSION These results suggest that cabazitaxel has no clinically significant cardiovascular adverse effects in patients with advanced solid tumors.
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Affiliation(s)
- Pierre Maison-Blanche
- Cardiology Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Bichat, Paris, France,
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Mukai H, Takahashi S, Nozawa M, Onozawa Y, Miyazaki J, Ohno K, Suzuki K. Phase I dose-escalation and pharmacokinetic study (TED 11576) of cabazitaxel in Japanese patients with castration-resistant prostate cancer. Cancer Chemother Pharmacol 2014; 73:703-10. [PMID: 24488323 DOI: 10.1007/s00280-014-2394-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study is to analyze the pharmacokinetic (PK) profile of cabazitaxel and evaluate its safety and tolerability as a 1-h IV infusion every 3 weeks in Japanese patients with castration-resistant prostate cancer (CRPC). METHODS Seventeen patients were treated with cabazitaxel at doses of 20 and 25 mg/m(2) for PK analyses. Dose escalation was performed only in the absence of dose-limiting toxicity (DLT). The maximum tolerated dose (MTD) was the highest dose at which less than 33 % of the patients developed DLT. RESULTS Cabazitaxel exhibited a triphasic elimination profile with a long terminal half-life of 116 ± 29.0 or 113 ± 28.0 h after IV infusion of 20 or 25 mg/m(2) cabazitaxel, respectively. The major differences in the PK parameters of cabazitaxel and docetaxel were cabazitaxel's fairly high clearance rate, representing approximately half the hepatic flow, and its large volume of distribution at steady-state conditions. No DLT was observed during Cycle 1. Mild-to-moderate hematological adverse events (AEs), including neutropenia, and other AEs typically associated with taxanes were observed; all AEs were manageable. Cabazitaxel at 25 mg/m(2) every 3 weeks was selected as the MTD in Japanese patients. CONCLUSIONS The PK parameters of cabazitaxel in Japanese CRPC patients were comparable with those previously determined in Caucasian subjects. The safety and tolerability of cabazitaxel were also comparable in both ethnic populations.
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Affiliation(s)
- Hirofumi Mukai
- National Cancer Center Hospital East, 6-5-1 Kashiwanoha Kashiwa-Shi, Chiba, 277-8577, Japan,
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Abstract
INTRODUCTION Microtubules play an important role in several cellular processes, particularly in the formation of the mitotic spindle during the process of mitosis. These highly dynamic mitotic-spindle microtubules have become a successful target of cancer therapy. Microtubule-targeting agents, such as vinca alkaloids and taxanes, were used in clinic over 50 years. In past decades, development of new antimicrotubule agents that possess different structure and binding sites of tubulin has shown potent activity against the proliferation of various cancer cells, as well as in multidrug-resistant cancers. Interestingly, many of these agents represent an attractive ability that targeting the tumor blood vessels results in tumor vascular disruption. Therefore, exploring new agents and strategies may provide more effective therapeutic options in the related treatment of cancer. AREAS COVERED In past few years, there are many chemical compounds that successfully interferes the microtubules and display antitumor effect. In these, published compounds supply the fresh minds in modification of present drugs and new insights into the development of tubulin inhibitors. EXPERT OPINION This article arranges the microtubule-targeting agents that have published in patent in recent years. It may help in the investigation of new tubulin binding site and development of novel drug candidate in the future.
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Affiliation(s)
- Yi-Min Liu
- Taipei Medical University, School of Pharmacy, College of Pharmacy , 250 Wuxing Street, Taipei 11031, Taiwan , Republic of China +886 2 2736 1661, ext 6130 ;
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Fumoleau P, Trigo JM, Isambert N, Sémiond D, Gupta S, Campone M. Phase I dose-finding study of cabazitaxel administered weekly in patients with advanced solid tumours. BMC Cancer 2013; 13:460. [PMID: 24099585 PMCID: PMC3854123 DOI: 10.1186/1471-2407-13-460] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cabazitaxel is approved in patients with metastatic hormone-refractory prostate cancer previously treated with a docetaxel-containing regimen. This study evaluated a weekly cabazitaxel dosing regimen. Primary objectives were to report dose-limiting toxicities (DLTs) and to determine the maximum tolerated dose (MTD). Efficacy, safety and pharmacokinetics were secondary objectives. METHODS Cabazitaxel was administered weekly (1-hour intravenous infusion at 1.5-12 mg/m² doses) for the first 4 weeks of a 5-week cycle in patients with solid tumours. Monitoring of DLTs was used to determine the MTD and the recommended weekly dose. RESULTS Thirty-one patients were enrolled. Two of six patients experienced DLTs at 12 mg/m², which was declared the MTD. Gastrointestinal disorders were the most common adverse event. Eight patients developed neutropenia (three ≥ Grade 3); one occurrence of febrile neutropenia was reported. There were two partial responses (in breast cancer) and 13 patients had stable disease (median duration of 3.3 months). Increases in C(max) and AUC(0-t) were dose proportional for the 6-12 mg/m² doses. CONCLUSION The MTD of weekly cabazitaxel was 12 mg/m² and the recommended weekly dose was 10 mg/m². The observed safety profile and antitumour activity of cabazitaxel were consistent with those observed with other taxanes in similar dosing regimens. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov as NCT01755390.
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Affiliation(s)
- Pierre Fumoleau
- Centre Georges-François Leclerc, 1 rue Professeur Marion, 21079 Dijon Cedex France.
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Kunos CA, Stefan T, Jacobberger JW. Cabazitaxel-induced stabilization of microtubules enhances radiosensitivity in ovarian cancer cells. Front Oncol 2013; 3:226. [PMID: 24066277 PMCID: PMC3776429 DOI: 10.3389/fonc.2013.00226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/16/2013] [Indexed: 12/21/2022] Open
Abstract
Background: Up to 40% of women with ovarian cancer have short disease-free intervals due to molecular mechanisms of chemotherapy resistance. New therapeutic strategies are sought. Ovarian cancers are sensitive to radiochemotherapy. The taxane cabazitaxel (XRP6258, Jevtana) promotes tubulin assembly and stabilizes microtubules against depolymerization in cells, acting similarly in mechanism to paclitaxel. Here, sequences of cabazitaxel-radiation co-administration are tested for drug-alone cytotoxicity and optimal radiosensitization. Materials and Methods: SKOV3, OVCAR3, and TOV-112D ovarian cancer cells were administered cabazitaxel 24 h before (first), 18 h before (second), together (third), or 24 h after (fourth) a single radiation dose, and then, investigated by clonogenic assay and flow cytometric assays. Radiation dose-cell survival data were fitted by two-stage multivariate analyses of variance. High-content flow cytometry partitioned cabazitaxel effects into G2-phase versus M-phase events by DNA content, cyclin A2, and phospho-S10-histone H3 (PHH3). Paclitaxel served as a comparator. Findings: Cabazitaxel cytotoxicity and radiosensitization were dose dependent. Cabazitaxel added 24 h before radiation was the most lethal schedule. DNA content measurements by flow cytometry showed that cabazitaxel-treated cells accumulated in the radiosensitive G2/M 4C DNA complement compartment. Cytometry also showed that surviving cabazitaxel-induced cell cycle arrested cells resolve the arrest by entering 4C or by 8C DNA complement cell cycles. Interpretation: The radiosensitizing effect of cabazitaxel was schedule dependent, due to cell cycle redistribution, and best when cabazitaxel was given 24 h before radiation. Clinical trials of administering both cabazitaxel and radiation should be explored in women with chemoresistant ovarian cancer.
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Affiliation(s)
- Charles A Kunos
- Department of Radiation Oncology, Case Western Reserve School of Medicine, Cleveland , OH , USA
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