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Hulin A, Gelé T, Fenioux C, Kempf E, Sahali D, Tournigand C, Ollero M. Pharmacology of Tyrosine Kinase Inhibitors: Implications for Patients with Kidney Diseases. Clin J Am Soc Nephrol 2024; 19:927-938. [PMID: 38079278 PMCID: PMC11254026 DOI: 10.2215/cjn.0000000000000395] [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] [Indexed: 01/03/2024]
Abstract
Tyrosine kinase inhibitors (TKI) have introduced a significant advancement in cancer management. These compounds are administered orally, and their absorption holds a pivotal role in determining their variable efficacy. They exhibit extensive distribution within the body, binding strongly to both plasma and tissue proteins. Often reliant on efflux and influx transporters, TKI undergo primary metabolism by intestinal and hepatic cytochrome P450 enzymes, with nonkidney clearance being predominant. Owing to their limited therapeutic window, many TKI display considerable intraindividual and interindividual variability. This review offers a comprehensive analysis of the clinical pharmacokinetics of TKI, detailing their interactions with drug transporters and metabolic enzymes, while discussing potential clinical implications. The prevalence of kidney conditions, such as AKI and CKD, among patients with cancer is explored in their effect on TKI pharmacokinetics. Finally, the potential nephrotoxicity associated with TKI is also examined.
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Affiliation(s)
- Anne Hulin
- Pharmacology Laboratory, University Medicine Department of Biology-Pathology, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Thibaut Gelé
- Pharmacology Laboratory, University Medicine Department of Biology-Pathology, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Charlotte Fenioux
- Oncology Unit, University Medicine Department of Cancer, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
| | - Emmanuelle Kempf
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Oncology Unit, University Medicine Department of Cancer, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
| | - Dil Sahali
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Nephrology Unit, University Medicine Department of Medicine, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
| | - Christophe Tournigand
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Oncology Unit, University Medicine Department of Cancer, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
| | - Mario Ollero
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
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Matte P, Bihan K, Isnard-Bagnis C, Zahr N, Thiery-Vuillemin A, Gougis P, Campedel L. Management of cancer treatments in hemodialysis patients. Bull Cancer 2024; 111:701-719. [PMID: 36931910 DOI: 10.1016/j.bulcan.2023.01.018] [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: 10/27/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION The number of cancer patients receiving long-term hemodialysis (HD) is increasing, and HD could jeopardize treatments' safety and efficacy. Therefore, managing anticancer drugs is critical in this frail population. In addition, evidence of HD safety or risk is regularly released both for cytotoxic chemotherapy (CT) or hormone therapy (HT) as well as new therapies with molecularly targeted therapies (MTT), immune checkpoint inhibitors (ICI), and a summary of current knowledge is needed. METHODS We aimed to synthesize available data on cancer treatments in HD patients using PubMed database, FDA labels, summary of product characteristics (SmPC), FDA and EMA approval documents, guidelines and finally case reports for which relevant pharmacokinetic (PK) data is available. RESULTS For CT, recently proposed guidelines were balanced by the publication of particular toxic reports following them. SmPC was helpful in some cases, but no data was found for most CTs. MTT, both oral and monoclonal antibodies, were rarely modified by HD. However, HD patients have particular frailty that could require dose adaptation despite no substantial PK modification. Similarly, exposure to ICIs is unlikely to be modified by HD since immunoglobulins are not dialyzable. For HT, PK characteristics and HD impact were more heterogeneous and were reviewed molecule by molecule. CONCLUSIONS We summarized current knowledge on HD and cancer treatments. Data remains scarce, and the latest guidelines rely on few clinical data. There is a need to collect both retrospective and prospective data to better characterize the safety and relevant dose and schedule adaptations whenever needed in this situation to reinforce future guidelines.
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Affiliation(s)
- Paul Matte
- Groupement hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, service d'oncologie médicale, Paris, France; Groupe de recherche interdisciplinaire francophone en onco-néphrologie (GRIFON), Paris, France
| | - Kevin Bihan
- Groupement hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, service de pharmacologie, Paris, France
| | - Corinne Isnard-Bagnis
- Groupe de recherche interdisciplinaire francophone en onco-néphrologie (GRIFON), Paris, France; Groupement hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Service de néphrologie, Paris, France
| | - Noël Zahr
- Groupement hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, service de pharmacologie, Paris, France
| | | | - Paul Gougis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Inserm, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005 Paris, France
| | - Luca Campedel
- Groupe de recherche interdisciplinaire francophone en onco-néphrologie (GRIFON), Paris, France; Centre hospitalier universitaire Gabriel-Montpied, service d'oncologie médicale, Clermont-Ferrand, France.
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Hirasawa T, Kikuchi M, Takasaki S, Kumondai M, Sato Y, Sato T, Imoto E, Hayakawa Y, Maekawa M, Mano N. High throughput LC/ESI-MS/MS method for simultaneous analysis of 20 oral molecular-targeted anticancer drugs and the active metabolite of sunitinib in human plasma. Heliyon 2023; 9:e16926. [PMID: 37484337 PMCID: PMC10360929 DOI: 10.1016/j.heliyon.2023.e16926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/20/2023] [Accepted: 06/01/2023] [Indexed: 07/25/2023] Open
Abstract
Many types of oral molecular-targeted anticancer drugs are clinically used in cancer genomic medicine. Combinations of multiple molecular-targeted anticancer drugs are also being investigated, expecting to prolong the survival of patients with cancer. Therapeutic drug monitoring of oral molecular-targeted drugs is important to ensure efficacy and safety. A liquid chromatography/electrospray ionization-tandem mass spectrometry (LC/ESI-MS/MS) has been used for simultaneous determination of these drugs in human plasma. However, the sensitivity of mass spectrometers and differences in the therapeutic range of drugs have rendered the development of simultaneous LC/ESI-MS/MS methods difficult. In this study, a simultaneous quantitative method for 20 oral molecular-targeted anticancer drugs and the active metabolite of sunitinib was developed based on the results of linear range shifts of the calibration curves using four ion abundance adjustment techniques (collision energy defects, in-source collision-induced dissociation, secondary product ion selected reaction monitoring, and isotopologue selected reaction monitoring). The saturation of the detector for the seven analytes was resolved by incorporating optimal ion abundance adjustment techniques. Furthermore, the reproducibility of this method was confirmed in validation tests, and plasma from patients was measured by this method to demonstrate its usefulness in actual clinical practice. This analytical method is expected to make a substantial contribution to the promotion of personalized medicine in the future.
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Affiliation(s)
- Tensei Hirasawa
- Faculty of Pharmaceutical Sciences, Tohoku University, 6-3 Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan
| | - Masafumi Kikuchi
- Faculty of Pharmaceutical Sciences, Tohoku University, 6-3 Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Shinya Takasaki
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Masaki Kumondai
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yu Sato
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Toshihiro Sato
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Eishi Imoto
- Shimadzu Corporation, 1 Nishinokyo Kuwabara-cho, Nakagyo-ku, Kyoto 604-8511, Japan
| | - Yoshihiro Hayakawa
- Shimadzu Corporation, 1 Nishinokyo Kuwabara-cho, Nakagyo-ku, Kyoto 604-8511, Japan
| | - Masamitsu Maekawa
- Faculty of Pharmaceutical Sciences, Tohoku University, 6-3 Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Nariyasu Mano
- Faculty of Pharmaceutical Sciences, Tohoku University, 6-3 Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Gupta A, Nadaf A, Ahmad S, Hasan N, Imran M, Sahebkar A, Jain GK, Kesharwani P, Ahmad FJ. Dasatinib: a potential tyrosine kinase inhibitor to fight against multiple cancer malignancies. Med Oncol 2023; 40:173. [PMID: 37165283 DOI: 10.1007/s12032-023-02018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/29/2023] [Indexed: 05/12/2023]
Abstract
Dasatinib is the 2nd generation TKI (Tyrosine Kinase Inhibitor) having the potential to treat numerous forms of leukemic and cancer patients and it is 300 times more potent than imatinib. Cancer is the major cause of death globally and need to enumerate novel strategies to coping with it. Various novel therapeutics introduced into the market for ease in treating various forms of cancer. We reviewed and evaluated all the related aspects of dasatinib, which can enhance the knowledge about dasatinib therapeutics methodology, pharmacodynamic and pharmacokinetics, side effects, advantages, disadvantages, various kinds of interactions and its novel formulations as well.
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Affiliation(s)
- Akash Gupta
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Arif Nadaf
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Shadaan Ahmad
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Nazeer Hasan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Mohammad Imran
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Amirhossein Sahebkar
- Applied Biomedical Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gaurav Kumar Jain
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
- Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Chennai, India.
| | - Farhan J Ahmad
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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Cortes J. How to manage CML patients with comorbidities. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:237-242. [PMID: 33275749 PMCID: PMC7727590 DOI: 10.1182/hematology.2020006911] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Patients with chronic myeloid leukemia (CML) often have comorbidities, at an incidence that might be higher than in the general population. Because of the favorable outcome of most patients with CML treated with tyrosine kinase inhibitors (TKIs), a greater number of comorbidities might be the most significant adverse feature for long-term survival. The presence of comorbidities may also affect the risk of developing adverse events with TKIs. This effect is perhaps best exemplified by the risk of developing arterio-occlusive events, which is greatest for patients who have other risk factors for such events, with the risk increasing with higher numbers of comorbidities. The coexistence of comorbidities in patients with CML not only may affect TKI selection but also demands close monitoring of the overall health condition of the patient to optimize safety and provide the opportunity for an optimal outcome to such patients. With optimal, holistic management of leukemia and all other conditions afflicting them, patients with CML and comorbidities may aim for a near-normal life expectancy, just as the more select patients enrolled in clinical trials now enjoy.
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Cortes J. How to manage CML patients with comorbidities. Blood 2020; 136:2507-2512. [PMID: 33236757 DOI: 10.1182/blood.2020006911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/19/2020] [Indexed: 11/20/2022] Open
Abstract
Patients with chronic myeloid leukemia (CML) often have comorbidities, at an incidence that might be higher than in the general population. Because of the favorable outcome of most patients with CML treated with tyrosine kinase inhibitors (TKIs), a greater number of comorbidities might be the most significant adverse feature for long-term survival. The presence of comorbidities may also affect the risk of developing adverse events with TKIs. This effect is perhaps best exemplified by the risk of developing arterio-occlusive events, which is greatest for patients who have other risk factors for such events, with the risk increasing with higher numbers of comorbidities. The coexistence of comorbidities in patients with CML not only may affect TKI selection but also demands close monitoring of the overall health condition of the patient to optimize safety and provide the opportunity for an optimal outcome to such patients. With optimal, holistic management of leukemia and all other conditions afflicting them, patients with CML and comorbidities may aim for a near-normal life expectancy, just as the more select patients enrolled in clinical trials now enjoy.
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Taniguchi Y, Takahashi N, Miura M, Hirase C, Sueda S, Espinoza JL, Rai S, Nakayama S, Serizawa K, Kumode T, Watatani Y, Morita Y, Tanaka H, Matsumura I. The Impact of Hemodialysis and Liver Cirrhosis on the Plasma Concentrations of Tyrosine Kinase Inhibitors in a Patient with Chronic Myeloid Leukemia. Intern Med 2020; 59:2745-2749. [PMID: 32641651 PMCID: PMC7691019 DOI: 10.2169/internalmedicine.4871-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We recently treated a chronic myeloid leukemia (CML) patient with liver and renal dysfunction, who was undergoing hemodialysis (HD). He was treated with 50 mg dasatinib (DAS) once daily just before HD. The maximum plasma concentration of DAS was 227 ng/mL on a non-HD day and 46.9 ng/mL on a HD day. He was subsequently treated with 200 mg bosutinib (BOS) once daily. The plasma concentration of BOS changed from 74.5 ng/mL before HD to 58.8 ng/mL after HD. Our results indicate that close monitoring of the plasma tyrosine kinase inhibitor concentrations should be considered in CML patients with organ impairment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Aniline Compounds/blood
- Aniline Compounds/therapeutic use
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Dasatinib/blood
- Dasatinib/therapeutic use
- Female
- Humans
- Japan
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Liver Cirrhosis/physiopathology
- Liver Cirrhosis/therapy
- Male
- Middle Aged
- Nitriles/blood
- Nitriles/therapeutic use
- Protein Kinase Inhibitors/blood
- Quinolines/blood
- Quinolines/therapeutic use
- Renal Dialysis
- Renal Insufficiency/physiopathology
- Renal Insufficiency/therapy
- Treatment Outcome
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Affiliation(s)
- Yasuhiro Taniguchi
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Naoto Takahashi
- Departments of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Masatomo Miura
- Department of Pharmacy, Akita University Hospital, Japan
| | - Chikara Hirase
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Sanae Sueda
- Department of Hematology, PL General Hospital, Japan
| | - Jorge Luis Espinoza
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
- Faculty of Medicine, UNIDES University, Nicaragua
| | - Shinya Rai
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Shoko Nakayama
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Kentaro Serizawa
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Takahiro Kumode
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Yosaku Watatani
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Yasuyoshi Morita
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Hirokazu Tanaka
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Itaru Matsumura
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
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Vascular events may predict the prognosis of patients with chronic myeloid leukemia. Int J Hematol 2020; 112:263. [PMID: 32533516 DOI: 10.1007/s12185-020-02889-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
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