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Shigaki R, Yoshida R, Yagita A, Nagasue K, Naraoka T, Nitanai K, Yanada H, Tenma T, Kida R, Umekage Y, Mori C, Minami Y, Sato H, Iwayama K, Hashino Y, Fukudo M, Sasaki T. Case Report: Case series: association between blood concentration and side effects of sotorasib. Front Oncol 2023; 13:1269991. [PMID: 38044989 PMCID: PMC10690615 DOI: 10.3389/fonc.2023.1269991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Sotorasib is a crucial therapeutic agent for patients with non-small cell lung cancer (NSCLC) harboring the KRAS p.G12C mutation. Despite its efficacy, the relationship between blood sotorasib concentrations and side effects remains largely unexplored. Methods This study enrolled five patients with KRAS p.G12C-positive NSCLC treated with sotorasib (LUMAKRAS® Tablets, Amgen, Japan) between July 2022 and February 2023 at Asahikawa Medical University Hospital. Blood sotorasib levels were monitored, and their association with adverse events was examined, with no adjustments made to drug dosages based on these levels. Results Variable blood sotorasib levels were observed among the participants. Notably, one patient developed interstitial pneumonitis, although a definitive attribution to sotorasib was uncertain due to prior pembrolizumab treatment. The study revealed no consistent association between blood sotorasib levels and adverse events or therapeutic outcomes, with some patients experiencing severe side effects at higher concentrations, while others did not. Conclusion Preliminary findings suggested that monitoring blood sotorasib levels may aid in anticipating adverse events in this small cohort. However, future studies with larger sample sizes and extended follow-up periods are required to validate these initial observations. Such studies could potentially offer insights into personalized dosing strategies, thereby mitigating adverse effects and enhance patient care for individuals with KRAS p.G12C-positive NSCLC.
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Affiliation(s)
- Ryota Shigaki
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Ryohei Yoshida
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
- Department of Respiratory Medicine, Yoshida Hospital, Hokkaido, Japan
| | - Akari Yagita
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Kazunori Nagasue
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Taeka Naraoka
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Kiichi Nitanai
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Hiraku Yanada
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Toshiyuki Tenma
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Ryotaro Kida
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Yasuhiro Umekage
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Chie Mori
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Yoshinori Minami
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
| | - Hideki Sato
- Department of Pharmacotherapy, Hokkaido University of Science, Hokkaido, Japan
| | - Kuninori Iwayama
- Department of Pharmacotherapy, Hokkaido University of Science, Hokkaido, Japan
| | - Yasuhisa Hashino
- Department of Pharmacotherapy, Hokkaido University of Science, Hokkaido, Japan
| | - Masahide Fukudo
- Department of Pharmacy, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Takaaki Sasaki
- Respiratory Center, Asahikawa Medical University, Hokkaido, Japan
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Yokota H, Sato K, Sakamoto S, Okuda Y, Asano M, Takeda M, Nakayama K, Miura M. Effects of polymorphisms in pregnane X receptor and ABC transporters on afatinib in Japanese patients with non-small cell lung cancer: pharmacogenomic-pharmacokinetic and exposure-response analysis. Cancer Chemother Pharmacol 2023; 92:315-324. [PMID: 37500985 DOI: 10.1007/s00280-023-04569-w] [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: 03/10/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Because of the large interindividual variability of afatinib pharmacokinetics and adverse events, we evaluated the effects of polymorphisms in pregnane X receptor (NR1I2) and ABC transporters (ABCB1, ABCG2, and ABCC2) on the pharmacokinetics of afatinib. METHODS The steady-state area under the concentration-time curve (AUC)0-24 of afatinib was analyzed using blood sampling just prior to and at 1, 2, 4, 6, 8, 12, and 24 h on day 15 after administration. RESULTS The median oral clearance (CL/F) of afatinib in patients with the NR1I2 7635A allele was significantly lower than those in patients with the 7635G/G genotype (42.0 and 60.0 L/h, respectively, P = 0.025). There were no significant differences in afatinib CL/F between genotypes for NR1I2 8055C > T, -25385C > T, ABCB1, ABCG2, and ABCC2 polymorphisms. Based on the area under the receiver-operating characteristic curve, the threshold afatinib AUC0-24 value for prediction of dose reduction or withdrawal was 689 ng·h/mL at the best sensitivity (81.0%) and specificity (72.7%). In multivariate logistic regression analysis, an afatinib AUC0-24 above 689 ng·h/mL was independently associated with increased risk of dose reduction or withdrawal (OR: 11.66, P = 0.012). CONCLUSIONS The NR1I2 7635A allele was related to a lower afatinib CL/F. Based on the AUC of 689 ng h/mL and CL/F, the optimal doses for patients with the NR1I2 7635G/G genotype and 7635A allele were recommended to be set at 40 and 30 mg/day, respectively, and subsequent adjustment of the maintenance dose based on the plasma concentrations of afatinib may be necessary to avoid afatinib-related adverse events.
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Affiliation(s)
- Hayato Yokota
- Department of Pharmacy, Akita University Hospital, Akita, Japan
| | - Kazuhiro Sato
- Division of Respiratory Medicine, Department of Internal Medicine, Akita University School of Medicine, Akita, Japan
| | - Sho Sakamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Akita University School of Medicine, Akita, Japan
| | - Yuji Okuda
- Division of Respiratory Medicine, Department of Internal Medicine, Akita University School of Medicine, Akita, Japan
| | - Mariko Asano
- Division of Respiratory Medicine, Department of Internal Medicine, Akita University School of Medicine, Akita, Japan
| | - Masahide Takeda
- Division of Respiratory Medicine, Department of Internal Medicine, Akita University School of Medicine, Akita, Japan
| | - Katsutoshi Nakayama
- Division of Respiratory Medicine, Department of Internal Medicine, Akita University School of Medicine, Akita, Japan
| | - Masatomo Miura
- Department of Pharmacy, Akita University Hospital, Akita, Japan.
- Department of Pharmacokinetics, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
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Relationship between Plasma Concentrations of Afatinib and the Onset of Diarrhea in Patients with Non-Small Cell Lung Cancer. BIOLOGY 2021; 10:biology10101054. [PMID: 34681153 PMCID: PMC8533256 DOI: 10.3390/biology10101054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 12/26/2022]
Abstract
Simple Summary Higher afatinib plasma concentrations have been reported to be associated with the severity of diarrhea; however, the specific target plasma concentration of afatinib required to avoid severe diarrhea onset is unclear. We found that an afatinib AUC0–24 of greater than or equal to 823.5 ng·h/mL and C0 of greater than or equal to 28.5 ng/mL may be used as cut-off values for the incidence of afatinib-induced grade 2 diarrhea. A significant correlation between the AUC0–24 and C0 of afatinib was observed (r2 = 0.761; p < 0.001). Therefore, we could use C0 as a marker of therapeutic drug monitoring. In the current study, the median time to the incidence of grade 2 diarrhea in patients with a C0 of more than 28.5 ng/mL was 16 days. Therefore, we recommend monitoring the C0 of afatinib on day 8 after the beginning of afatinib therapy. Abstract We evaluated the area under the plasma concentration–time curve (AUC) of afatinib required to avoid the onset of grade 2 or higher diarrhea. The C0 and AUC0–24 of afatinib were significant higher in patients with grade 2 diarrhea than in those with grade 0–1 diarrhea. The areas under the receiver operator curves were 0.795 with the highest sensitivity (89%) and specificity (74%) at an AUC0–24 threshold of 823.5 ng·h/mL, and 0.754 with the highest sensitivity (89%) and specificity (74%) at a C0 threshold of 28.5 ng/mL. In Kaplan–Meier analysis based on these cut-off AUC0–24 and C0 values, the median time to the incidence of grade 2 diarrhea was 16 days. The predicted AUC0–24 of afatinib from the single point of C6 showed the highest correlation with the measured AUC0–24 (r2 = 0.840); however, a significant correlation between the AUC0–24 and C0 was also observed (r2 = 0.761). C0 could be used as a marker of therapeutic drug monitoring because afatinib C0 was related to AUC0–24. Therefore, afatinib C0 should be monitored on day 8 after beginning therapy, and the daily dose of afatinib should be adjusted as an index with a cut-off value of 28.5 ng/mL.
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High-Trough Plasma Concentration of Afatinib Is Associated with Dose Reduction. Cancers (Basel) 2021; 13:cancers13143425. [PMID: 34298637 PMCID: PMC8305619 DOI: 10.3390/cancers13143425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022] Open
Abstract
Afatinib is used to treat non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation as a second-generation EGFR-tyrosine kinase inhibitor (TKI). Early prediction of adverse effects based on the pharmacokinetics of afatinib enables support for quality of life (QOL) in patients with no change in efficacy. We examined the pharmacokinetic relationship between trough plasma concentration and adverse effects and evaluated the utility of measuring the trough plasma concentration of afatinib as the first EGFR-TKI treatment for NSCLC in a prospective multicenter study. Twenty-four patients treated with afatinib were enrolled in this study. All blood samples were collected at the trough point, and plasma concentrations were measured using high-performance liquid chromatography-tandem mass spectrometry. Logistic regression analysis for the dose reduction of afatinib was performed, and the receiver operating characteristic (ROC) curve was plotted. Although all patients started afatinib at 40 mg/day, plasma concentrations were variable, and mean and median trough plasma concentrations were 32.9 ng/mL and 32.5 ng/mL in this study, respectively. Minimum and maximum trough plasma concentrations were 10.4 ng/mL and 72.7 ng/mL, respectively. This variability was speculated to involve personal parameters such as laboratory data. However, no patient characteristics or laboratory data examined correlated with the trough plasma concentration of afatinib, except albumin. Albumin showed a weak correlation with plasma concentration (r = 0.60, p = 0.009). The trough plasma concentration of afatinib was significantly associated with the dose reduction of afatinib (p = 0.047). The area under the ROC curve (AUC) for the trough plasma concentration of afatinib was 0.81. The cut-off value was 21.4 ng/mL. The sensitivity and specificity of the cut-off as a risk factor were 0.80 and 0.75. In summary, the trough plasma concentration of afatinib was associated with continued or reduced dosage because of the onset of several adverse effects, and a threshold was seen. Adverse effects not only lower QOL but also hinder continued treatment. Measuring plasma concentrations of afatinib appears valuable to predict adverse effects and continue effective therapy.
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