1
|
Kleemiss M, Müller CE, Schneider M, Strotmann R, Orlowski K, Goteti K, Yanik M, Brossart P, Bauernfeind FG. Tepotinib in a Patient With Advanced Non-Small Cell Lung Cancer Harboring MET Exon 14 Skipping Undergoing Concomitant Hemodialysis for Renal Failure: A Case Report. Clin Lung Cancer 2024; 25:577-580. [PMID: 38987049 DOI: 10.1016/j.cllc.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Moritz Kleemiss
- Department of internal Medicine III, University Hospital Bonn, Bonn, Germany.
| | - Christa E Müller
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical & Medicinal Chemistry, University of Bonn
| | - Marion Schneider
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical & Medicinal Chemistry, University of Bonn
| | - Rainer Strotmann
- Qualitative Pharmacology, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Katrin Orlowski
- Merck Healthcare Germany GmbH, Weiterstadt, Germany, an affiliate of Merck KGaA, Darmstadt, Germany
| | | | - Mert Yanik
- Merck Healthcare Germany GmbH, Weiterstadt, Germany, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Peter Brossart
- Department of internal Medicine III, University Hospital Bonn, Bonn, Germany
| | | |
Collapse
|
2
|
Young GC, Spracklin DK, James AD, Hvenegaard MG, Pedersen ML, Wagner DS, Georgi K, Schieferstein H, Bjornsdottir I, Romeo AA, Cassidy KC, Da-Violante G, Blech S, Schulz SI, Cuyckens F, Nguyen MA, Scarfe G. Non-Labeled, Stable Labeled, or Radiolabelled Approaches for Provision of Intravenous Pharmacokinetics in Humans: A Discussion Piece. Clin Pharmacol Ther 2024; 115:931-938. [PMID: 38018358 DOI: 10.1002/cpt.3121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
A review of the use of microdoses and isotopic microtracers for clinical intravenous pharmacokinetic (i.v. PK) data provision is presented. The extent of application of the varied approaches available and the relative merits of each are highlighted with the aim of assisting practitioners in making informed decisions on the most scientifically appropriate design to adopt for any given new drug in development. It is envisaged that significant efficiencies will be realized as i.v. PK data in humans becomes more routinely available for suitable assets in early development, than has been the case prior to the last decade.
Collapse
Affiliation(s)
| | | | | | | | - Mette L Pedersen
- Drug Metabolism and Pharmacokinetics, Early Research and Development, Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Katrin Georgi
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | | | - Andrea A Romeo
- Roche Pharma Research and Early Development, Basel, Switzerland
| | | | | | - Stefan Blech
- Boehringer-Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | | | | | | |
Collapse
|
3
|
Roffel AF, van Hoogdalem EJ. The application of Phase 0 and microtracer approaches in early clinical development: past, present, and future. Front Pharmacol 2024; 15:1369079. [PMID: 38562464 PMCID: PMC10982362 DOI: 10.3389/fphar.2024.1369079] [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: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Phase 0 microdosing studies were introduced to the drug development community approximately 20 years ago. A microdose is defined as less than 1/100th of the dose calculated based on animal data to yield a pharmacological effect in humans, with a maximum of 100 μg, or 30 nmoles for protein products. In our experience, Phase 0 microdose studies have not been fully embraced by the pharmaceutical industry. This notion is based on the number of Phase 0 studies that we have been involved in. Thus, we conducted at least 17 Phase 0 microdose studies in the Zero's (on average, two per year), but in the years beyond this, it was only 15 studies (1.4 per year); in these latter years, we did conduct a total of 23 studies which employed an intravenous (i.v.) microdose for absolute bioavailability (ABA) assessments (two per year on average), which are the most used and potentially informative type of clinical study using a microdose, albeit they are formally not microdose studies. In the current review, we summarize the past use of and experience with Phase 0 microdose designs in early clinical development, including intravenous 14C microdose ABA studies, and assess what is needed to increase the adoption of useful applications of Phase 0/microdose studies in the near future.
Collapse
|
4
|
Yalkinoglu Ö, Becker A, Krebs-Brown A, Vetter C, Lüpfert C, Perrin D, Heuer J, Biedert H, Hirt S, Bytyqi A, Bachmann A, Strotmann R. Assessment of the potential of the MET inhibitor tepotinib to affect the pharmacokinetics of CYP3A4 and P-gp substrates. Invest New Drugs 2023; 41:596-605. [PMID: 37415001 PMCID: PMC10447267 DOI: 10.1007/s10637-023-01378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
Tepotinib is a highly selective, potent, mesenchymal-epithelial transition factor (MET) inhibitor, approved for the treatment of non-small cell lung cancer harboring MET exon 14 skipping alterations. The aims of this work were to investigate the potential for drug-drug interactions via cytochrome P450 (CYP) 3A4/5 or P-glycoprotein (P-gp) inhibition. In vitro studies were conducted in human liver microsomes, human hepatocyte cultures and Caco-2 cell monolayers to investigate whether tepotinib or its major metabolite (MSC2571109A) inhibited or induced CYP3A4/5 or inhibited P-gp. Two clinical studies were conducted to investigate the effect of multiple dose tepotinib (500 mg once daily orally) on the single dose pharmacokinetics of a sensitive CYP3A4 substrate (midazolam 7.5 mg orally) and a P-gp substrate (dabigatran etexilate 75 mg orally) in healthy participants. Tepotinib and MSC2571109A showed little evidence of direct or time-dependent CYP3A4/5 inhibition (IC50 > 15 μM) in vitro, although MSC2571109A did show mechanism-based CYP3A4/5 inhibition. Tepotinib did not induce CYP3A4/5 activity in vitro, although both tepotinib and MSC2571109A increased CYP3A4 mRNA. In clinical studies, tepotinib had no effect on the pharmacokinetics of midazolam or its metabolite 1'-hydroxymidazolam. Tepotinib increased dabigatran maximum concentration and area under the curve extrapolated to infinity by 38% and 51%, respectively. These changes were not considered to be clinically relevant. Tepotinib was considered safe and well tolerated in both studies. The potential of tepotinib to cause clinically relevant DDI with CYP3A4- or P-gp-dependent drugs at the clinical dose is considered low. Study 1 (midazolam): NCT03628339 (registered 14 August 2018). Study 2 (dabigatran): NCT03492437 (registered 10 April 2018).
Collapse
Affiliation(s)
- Özkan Yalkinoglu
- Clinical Pharmacology, Quantitative Pharmacology, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Andreas Becker
- Clinical Pharmacology, Quantitative Pharmacology, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Axel Krebs-Brown
- Global Biostatistics, Epidemiology and Medical Writing, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Claudia Vetter
- Clinical Pharmacology, Quantitative Pharmacology, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Christian Lüpfert
- Clinical Pharmacology, Quantitative Pharmacology, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Dominique Perrin
- NCE DMPK, Discovery and Development Technologies, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Jürgen Heuer
- Clinical Services, Nuvisan GmbH, Neu-Ulm, Germany
| | | | - Stefan Hirt
- LC/MS Bioanalysis, Nuvisan GmbH, Neu-Ulm, Germany
| | - Afrim Bytyqi
- Clinical Pharmacology, Quantitative Pharmacology, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Angelika Bachmann
- Clinical Pharmacology, Quantitative Pharmacology, the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Rainer Strotmann
- Clinical Pharmacology, Quantitative Pharmacology, the healthcare business of Merck KGaA, Darmstadt, Germany.
| |
Collapse
|
5
|
Young GC, Spracklin DK, James AD, Hvenegaard MG, Scarfe G, Wagner DS, Georgi K, Schieferstein H, Bjornsdottir I, van Groen B, Romeo AA, Cassidy KC, Da-Violante G, Bister B, Blech S, Lyer R, Schulz SI, Cuyckens F, Moliner P. Considerations for Human ADME Strategy and Design Paradigm Shift(s) - An Industry White Paper. Clin Pharmacol Ther 2023; 113:775-781. [PMID: 35733280 DOI: 10.1002/cpt.2691] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022]
Abstract
The human absorption, distribution, metabolism, and excretion (hADME) study is the cornerstone of the clinical pharmacology package for small molecule drugs, providing comprehensive information on the rates and routes of disposition and elimination of drug-related material in humans through the use of 14 C-labeled drug. Significant changes have already been made in the design of the hADME study for many companies, but opportunity exists to continue to re-think both the design and timing of the hADME study in light of the potential offered by newer technologies, that enable flexibility in particular to reducing the magnitude of the radioactive dose used. This paper provides considerations on the variety of current strategies that exist across a number of pharmaceutical companies and on some of the ongoing debates around a potential move to the so called "human first/human only" approach, already adopted by at least one company. The paper also provides a framework for continuing the discussion in the application of further shifts in the paradigm.
Collapse
Affiliation(s)
- Graeme C Young
- GlaxoSmithKline Research & Development Ltd., David Jack Centre, Ware, UK
| | | | | | | | - Graeme Scarfe
- AstraZeneca, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Katrin Georgi
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | | | | | - Andrea A Romeo
- Roche Pharma Research and Early Development, Basel, Switzerland
| | | | | | - Bojan Bister
- Boehringer-Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Stefan Blech
- Boehringer-Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | | | | | | |
Collapse
|
6
|
Berges N, Klug JH, Eicher A, Loehr J, Schwarz D, Bomke J, Leuthner B, Perrin D, Schadt O. Differences in Sustained Cellular Effects of MET inhibitors Are Driven by Prolonged Target Engagement and Lysosomal Retention. Mol Pharmacol 2023; 103:77-88. [PMID: 36400432 DOI: 10.1124/molpharm.122.000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Intracellular distribution of drug compounds is dependent on physicochemical characteristics and may have a significant bearing on the extent of target occupancy and, ultimately, drug efficacy. We assessed differences in the physicochemical profiles of MET inhibitors capmatinib, crizotinib, savolitinib, and tepotinib and their effects on cell viability and MET phosphorylation under steady-state and washout conditions (to mimic an open organic system) in a human lung cancer cell line. To examine the differences of the underlying molecular mechanisms at the receptor level, we investigated the residence time at the kinase domain and the cellular target engagement. We found that the ranking of the drugs for cell viability was different under steady-state and washout conditions and that under washout conditions, tepotinib displayed the most potent inhibition of phosphorylated MET. Postwashout effects were correlated with the partitioning of the drug into acidic subcellular compartments such as lysosomes, and the tested MET inhibitors were grouped according to their ability to access lysosomes (crizotinib and tepotinib) or not (capmatinib and savolitinib). Reversible lysosomal retention may represent a valuable intracellular storage mechanism for MET inhibitors, enabling prolonged receptor occupancy in dynamic, open-physiologic systems and may act as a local drug reservoir. The use of washout conditions to simulate open systems and investigate intracellular drug distribution is a useful characterization step that deserves further investigation. SIGNIFICANCE STATEMENT: Generally, determination of potency and receptor occupancy is performed under steady-state conditions. In vivo conditions are more complex due to concentration differences between compartments and equilibrium processes. Experiments under steady state cannot explore effects such as sustained target inhibition. This study has shown that differences between MET inhibitors are observable by applying washout conditions to in vitro assays. This important finding applies to most compound classes and may inspire readers to rethink their assay designs in the future.
Collapse
Affiliation(s)
- Nina Berges
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | - Anna Eicher
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Jennifer Loehr
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Daniel Schwarz
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Joerg Bomke
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | | | - Oliver Schadt
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| |
Collapse
|
7
|
Xiong W, Hietala SF, Nyberg J, Papasouliotis O, Johne A, Berghoff K, Goteti K, Dong J, Girard P, Venkatakrishnan K, Strotmann R. Exposure-response analyses for the MET inhibitor tepotinib including patients in the pivotal VISION trial: support for dosage recommendations. Cancer Chemother Pharmacol 2022; 90:53-69. [PMID: 35771259 PMCID: PMC9300558 DOI: 10.1007/s00280-022-04441-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
Purpose Tepotinib is a highly selective MET inhibitor approved for treatment of non-small cell lung cancer (NSCLC) harboring METex14 skipping alterations. Analyses presented herein evaluated the relationship between tepotinib exposure, and efficacy and safety outcomes. Methods Exposure–efficacy analyses included data from an ongoing phase 2 study (VISION) investigating 500 mg/day tepotinib in NSCLC harboring METex14 skipping alterations. Efficacy endpoints included objective response, duration of response, and progression-free survival. Exposure–safety analyses included data from VISION, plus four completed studies in advanced solid tumors/hepatocellular carcinoma (30–1400 mg). Safety endpoints included edema, serum albumin, creatinine, amylase, lipase, alanine aminotransferase, aspartate aminotransferase, and QT interval corrected using Fridericia’s method (QTcF). Results Tepotinib exhibited flat exposure–efficacy relationships for all endpoints within the exposure range observed with 500 mg/day. Tepotinib also exhibited flat exposure–safety relationships for all endpoints within the exposure range observed with 30–1400 mg doses. Edema is the most frequently reported adverse event and the most frequent cause of tepotinib dose reductions and interruptions; however, the effect plateaued at low exposures. Concentration-QTc analyses using data from 30 to 1400 mg tepotinib resulted in the upper bounds of the 90% confidence interval being less than 10 ms for the mean exposures at the therapeutic (500 mg) and supratherapeutic (1000 mg) doses. Conclusions These analyses provide important quantitative pharmacologic support for benefit/risk assessment of the 500 mg/day dosage of tepotinib as being appropriate for the treatment of NSCLC harboring METex14 skipping alterations. Registration Numbers NCT01014936, NCT01832506, NCT01988493, NCT02115373, NCT02864992. Supplementary Information The online version contains supplementary material available at 10.1007/s00280-022-04441-3.
Collapse
Affiliation(s)
- Wenyuan Xiong
- Merck Institute of Pharmacometrics, Lausanne, Switzerland
| | | | | | | | | | | | - Kosalaram Goteti
- EMD Serono Research and Development Institute Inc., Billerica, MA, USA
| | - Jennifer Dong
- EMD Serono Research and Development Institute Inc., Billerica, MA, USA
| | - Pascal Girard
- Merck Institute of Pharmacometrics, Lausanne, Switzerland
| | | | | |
Collapse
|
8
|
Xiong W, Papasouliotis O, Jonsson EN, Strotmann R, Girard P. Population pharmacokinetic analysis of tepotinib, an oral MET kinase inhibitor, including data from the VISION study. Cancer Chemother Pharmacol 2022; 89:655-669. [PMID: 35385993 PMCID: PMC9054876 DOI: 10.1007/s00280-022-04423-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/14/2022] [Indexed: 01/18/2023]
Abstract
Purpose Tepotinib is a highly selective, potent, mesenchymal–epithelial transition factor (MET) inhibitor, approved for the treatment of non-small cell lung cancer (NSCLC) harboring MET exon 14 skipping. Objectives of this population pharmacokinetic (PK) analysis were to evaluate the dose–exposure relationship of tepotinib and its major circulating metabolite, MSC2571109A, and to identify the intrinsic/extrinsic factors that are predictive of PK variability. Methods Data were included from 12 studies in patients with cancer and in healthy participants. A sequential modeling approach was used to analyze the parent and metabolite data, including covariate analyses. Potential associations between observed covariates and PK parameters were illustrated using bootstrap analysis-based forest plots. Results A two-compartment model with sequential zero- and first-order absorption, and a first-order elimination from the central compartment, best described the plasma PK of tepotinib in humans across the dose range of 30–1400 mg. The bioavailability of tepotinib was shown to be dose dependent, although bioavailability decreased primarily at doses above the therapeutic dose of 500 mg. The intrinsic factors of race, age, sex, body weight, mild/moderate hepatic impairment and mild/moderate renal impairment, along with the extrinsic factors of opioid analgesic and gefitinib intake, had no relevant effect on tepotinib PK. Tepotinib has a long effective half-life of ~ 32 h. Conclusions Tepotinib shows dose proportionality up to at least the therapeutic dose, and time-independent clearance with a profile appropriate for once-daily dosing. None of the covariates identified had a clinically meaningful effect on tepotinib exposure or required dose adjustments. Supplementary Information The online version contains supplementary material available at 10.1007/s00280-022-04423-5.
Collapse
Affiliation(s)
- Wenyuan Xiong
- Merck Institute of Pharmacometrics, Merck KGaA, Lausanne, Switzerland.,UCB, Bulle, Switzerland
| | | | | | - Rainer Strotmann
- Quantitative Pharmacology, Merck Healthcare KGaA, Darmstadt, Germany
| | - Pascal Girard
- Merck Institute of Pharmacometrics, Merck KGaA, Lausanne, Switzerland
| |
Collapse
|
9
|
Fogli S, Tabbò F, Capuano A, Re MD, Passiglia F, Cucchiara F, Scavone C, Gori V, Novello S, Schmidinger M, Danesi R. The expanding family of c-Met inhibitors in solid tumors: a comparative analysis of their pharmacologic and clinical differences. Crit Rev Oncol Hematol 2022; 172:103602. [DOI: 10.1016/j.critrevonc.2022.103602] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 12/16/2022] Open
|
10
|
Vagiannis D, Budagaga Y, Morell A, Zhang Y, Novotná E, Skarka A, Kammerer S, Küpper JH, Hanke I, Rozkoš T, Hofman J. Tepotinib Inhibits Several Drug Efflux Transporters and Biotransformation Enzymes: The Role in Drug-Drug Interactions and Targeting Cytostatic Resistance In Vitro and Ex Vivo. Int J Mol Sci 2021; 22:ijms222111936. [PMID: 34769363 PMCID: PMC8584989 DOI: 10.3390/ijms222111936] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022] Open
Abstract
Tepotinib is a novel tyrosine kinase inhibitor recently approved for the treatment of non-small cell lung cancer (NSCLC). In this study, we evaluated the tepotinib's potential to perpetrate pharmacokinetic drug interactions and modulate multidrug resistance (MDR). Accumulation studies showed that tepotinib potently inhibits ABCB1 and ABCG2 efflux transporters, which was confirmed by molecular docking. In addition, tepotinib inhibited several recombinant cytochrome P450 (CYP) isoforms with varying potency. In subsequent drug combination experiments, tepotinib synergistically reversed daunorubicin and mitoxantrone resistance in cells with ABCB1 and ABCG2 overexpression, respectively. Remarkably, MDR-modulatory properties were confirmed in ex vivo explants derived from NSCLC patients. Furthermore, we demonstrated that anticancer effect of tepotinib is not influenced by the presence of ABC transporters associated with MDR, although monolayer transport assays designated it as ABCB1 substrate. Finally, tested drug was observed to have negligible effect on the expression of clinically relevant drug efflux transporters and CYP enzymes. In conclusion, our findings provide complex overview on the tepotinib's drug interaction profile and suggest a promising novel therapeutic strategy for future clinical investigations.
Collapse
Affiliation(s)
- Dimitrios Vagiannis
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, 500 05 Hradec Králové, Czech Republic; (D.V.); (Y.B.); (Y.Z.)
| | - Youssif Budagaga
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, 500 05 Hradec Králové, Czech Republic; (D.V.); (Y.B.); (Y.Z.)
| | - Anselm Morell
- Department of Biochemical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, 500 05 Hradec Králové, Czech Republic; (A.M.); (E.N.)
| | - Yu Zhang
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, 500 05 Hradec Králové, Czech Republic; (D.V.); (Y.B.); (Y.Z.)
| | - Eva Novotná
- Department of Biochemical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, 500 05 Hradec Králové, Czech Republic; (A.M.); (E.N.)
| | - Adam Skarka
- Department of Chemistry, Faculty of Science, University of Hradec Králové, Hradecká 1285, 500 03 Hradec Králové, Czech Republic;
| | - Sarah Kammerer
- Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Universitätsplatz 1, 01968 Senftenberg, Germany; (S.K.); (J.-H.K.)
| | - Jan-Heiner Küpper
- Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Universitätsplatz 1, 01968 Senftenberg, Germany; (S.K.); (J.-H.K.)
| | - Ivo Hanke
- Department of Cardiac Surgery, Faculty of Medicine, Charles University and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic;
| | - Tomáš Rozkoš
- The Fingerland Department of Pathology, Faculty of Medicine, Charles University and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic;
| | - Jakub Hofman
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, 500 05 Hradec Králové, Czech Republic; (D.V.); (Y.B.); (Y.Z.)
- Correspondence: ; Tel.: +420-495-067-593
| |
Collapse
|
11
|
Xiong W, Friese-Hamim M, Johne A, Stroh C, Klevesath M, Falchook GS, Hong DS, Girard P, El Bawab S. Translational pharmacokinetic-pharmacodynamic modeling of preclinical and clinical data of the oral MET inhibitor tepotinib to determine the recommended phase II dose. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:428-440. [PMID: 33818908 PMCID: PMC8129711 DOI: 10.1002/psp4.12602] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022]
Abstract
Tepotinib is a highly selective and potent MET inhibitor in development for the treatment of patients with solid tumors. Given the favorable tolerability and safety profiles up to the maximum tested dose in the first‐in‐human (FIH) trial, an efficacy‐driven translational modeling approach was proposed to establish the recommended phase II dose (RP2D). To study the in vivo pharmacokinetics (PKs)/target inhibition/tumor growth inhibition relationship, a subcutaneous KP‐4 pancreatic cell‐line xenograft model in mice with sensitivity to MET pathway inhibition was selected as a surrogate tumor model. Further clinical PK and target inhibition data (derived from predose and postdose paired tumor biopsies) from a FIH study were integrated with the longitudinal PKs and target inhibition profiles from the mouse xenograft study to establish a translational PK/pharmacodynamic (PD) model. Preclinical data showed that tumor regression with tepotinib treatment in KP‐4 xenograft tumors corresponded to 95% target inhibition. We therefore concluded that a PD criterion of sustained, near‐to‐complete (>95%) phospho‐MET inhibition in tumors should be targeted for tepotinib to be effective. Simulations of dose‐dependent target inhibition profiles in human tumors that exceeded the PD threshold in more than 90% of patients established an RP2D of tepotinib 500 mg once daily. This translational mathematical modeling approach supports an efficacy‐driven rationale for tepotinib phase II dose selection of 500 mg once daily. Tepotinib at this dose has obtained regulatory approval for the treatment of patients with non‐small cell lung cancer harboring MET exon 14 skipping.
Collapse
Affiliation(s)
- Wenyuan Xiong
- Merck Institute of Pharmacokinetics (an affiliate of Merck KGaA, Darmstadt, Germany), Lausanne, Switzerland
| | | | | | | | | | | | | | - Pascal Girard
- Merck Institute of Pharmacokinetics (an affiliate of Merck KGaA, Darmstadt, Germany), Lausanne, Switzerland
| | | |
Collapse
|
12
|
Pudelko L, Jaehrling F, Reusch C, Vitri S, Stroh C, Linde N, Sanderson MP, Musch D, Lebrun CJ, Keil M, Esdar C, Blaukat A, Rosell R, Schumacher KM, Karachaliou N. SHP2 Inhibition Influences Therapeutic Response to Tepotinib in Tumors with MET Alterations. iScience 2020; 23:101832. [PMID: 33305187 PMCID: PMC7718487 DOI: 10.1016/j.isci.2020.101832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Tepotinib is an oral MET inhibitor approved for metastatic non-small cell lung cancer (NSCLC) harboring MET exon 14 (METex14) skipping mutations. Examining treatment-naive or tepotinib-resistant cells with MET amplification or METex14 skipping mutations identifies other receptor tyrosine kinases (RTKs) that co-exist in cells prior to tepotinib exposure and become more prominent upon tepotinib resistance. In a small cohort of patients with lung cancer with MET genetic alterations treated with tepotinib, gene copy number gains of other RTKs were found at baseline and affected treatment outcome. An Src homology 2 domain-containing phosphatase 2 (SHP2) inhibitor delayed the emergence of tepotinib resistance and synergized with tepotinib in treatment-naive and tepotinib-resistant cells as well as in xenograft models. Alternative signaling pathways potentially diminish the effect of tepotinib monotherapy, and the combination of tepotinib with an SHP2 inhibitor enables the control of tumor growth in cells with MET genetic alterations.
Collapse
Affiliation(s)
- Linda Pudelko
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Frank Jaehrling
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Christof Reusch
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Sanziago Vitri
- Rosell Oncology Institute (IOR), Dexeus University Hospital, QuironSalud Group, 08028 Barcelona, Spain
| | - Christopher Stroh
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Nina Linde
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Michael P. Sanderson
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Doreen Musch
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | | | - Marina Keil
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Christina Esdar
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Andree Blaukat
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
| | - Rafael Rosell
- Rosell Oncology Institute (IOR), Dexeus University Hospital, QuironSalud Group, 08028 Barcelona, Spain
- Germans Trias i Pujol Research Institute and Hospital (IGTP), Molecular and Cellular Oncology Laboratory, Badalona 08916, Spain
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, 08028 Barcelona, Spain
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
| | | | - Niki Karachaliou
- Translational Innovation Platform Oncology, Merck KGaA, Darmstadt 64293, Germany
- Global Clinical Development, Merck KGaA, Darmstadt 64293, Germany
| |
Collapse
|
13
|
|