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Boerrigter E, Benoist GE, Overbeek JK, Donders R, Mehra N, van Oort IM, Ter Heine R, van Erp NP. The effect of chemotherapy on the exposure-response relation of abiraterone in metastatic castration-resistant prostate cancer. Br J Clin Pharmacol 2021; 88:1170-1178. [PMID: 34436788 PMCID: PMC9293353 DOI: 10.1111/bcp.15057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022] Open
Abstract
Aims To assess whether the exposure–response relation for abiraterone is different in pre‐chemotherapy patients compared to post‐chemotherapy patients with metastatic castration‐resistant prostate cancer (mCRPC). Methods Data were collected from three clinical studies in mCRPC patients treated with abiraterone acetate. Cox regression analysis was used to determine the relation between abiraterone exposure and survival (progression‐free survival [PFS] and overall survival [OS]). An interaction term was used to test whether chemotherapy pretreatment was an effect modifier. To investigate the effect of the previously defined exposure threshold of 8.4 ng/mL on survival, Kaplan–Meier analysis was used. Results In total, 98 mCRPC patients were included, of which 78 were pre‐chemotherapy and 20 were post‐chemotherapy patients. Chemotherapy pretreatment in mCRPC setting appears to be an effect modifier. In pre‐chemotherapy patients, no significant association between abiraterone exposure and survival was observed (HR 0.68 [95% CI 0.42–1.10], P = .12 and HR 0.85 [95% CI 0.46–1.60], P = .61, PFS and OS, respectively) and no longer survival was seen for patients with an abiraterone exposure above the predefined threshold. In contrast, a significant association was seen in post‐chemotherapy patients (HR 0.30 [95% CI 0.12–0.74], P = .01 and HR 0.38 [95% CI 0.18–0.82] P = .01, PFS and OS, respectively), with an increased survival when exposed above this threshold. Conclusion Chemotherapy pretreatment in mCRPC setting modifies the abiraterone exposure–response relation. No relation between abiraterone exposure and survival was seen for pre‐chemotherapy patients. Therefore, potentially lower doses can be used in this setting to prevent overtreatment and reduce financial toxicity.
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Affiliation(s)
- Emmy Boerrigter
- Department of Pharmacy, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Guillemette E Benoist
- Department of Pharmacy, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joanneke K Overbeek
- Department of Pharmacy, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Rogier Donders
- Department for Heath Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud university medical center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Rob Ter Heine
- Department of Pharmacy, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Nielka P van Erp
- Department of Pharmacy, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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2
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Boerrigter E, Benoist GE, van Oort IM, Verhaegh GW, van Hooij O, Groen L, Smit F, Oving IM, de Mol P, Smilde TJ, Somford DM, Mehra N, Schalken JA, van Erp NP. Liquid biopsy reveals KLK3 mRNA as a prognostic marker for progression free survival in patients with metastatic castration-resistant prostate cancer undergoing first-line abiraterone acetate and prednisone treatment. Mol Oncol 2021; 15:2453-2465. [PMID: 33650292 PMCID: PMC8410566 DOI: 10.1002/1878-0261.12933] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022] Open
Abstract
Circulating RNAs extracted from liquid biopsies represent a promising source of cancer‐ and therapy‐related biomarkers. We screened whole blood from patients with metastatic castration‐resistant prostate cancer (mCRPC) following their first‐line treatment with abiraterone acetate and prednisone (AA‐P) to identify circulating RNAs that may correlate with progression‐free survival (PFS). In a prospective multicenter observational study, 53 patients with mCRPC were included after they started first‐line AA‐P treatment. Blood was drawn at baseline, 1, 3, and 6 months after treatment initiation. The levels of predefined circulating RNAs earlier identified as being upregulated in patients with mCRPC (e.g., microRNAs, long noncoding RNAs, and mRNAs), were analyzed. Uni‐ and multivariable Cox regression and Kaplan–Meier analyses were used to analyze the prognostic value of the various circulating RNAs for PFS along treatment. Detectable levels of kallikrein‐related peptidase 3 (KLK3) mRNA at baseline were demonstrated to be an independent prognostic marker for PFS (201 vs 501 days, P = 0.00054). Three months after AA‐P treatment initiation, KLK3 could not be detected in the blood of responding patients, but was still detectable in 56% of the patients with early progression. Our study confirmed that KLK3 mRNA detection in whole blood is an independent prognostic marker in mCRPC patients receiving AA‐P treatment. Furthermore, the levels of circulating KLK3 mRNA in patients receiving AA‐P treatment might reflect treatment response or early signs of progression.
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Affiliation(s)
- Emmy Boerrigter
- Department of PharmacyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Guillemette E. Benoist
- Department of PharmacyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Inge M. van Oort
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | - Gerald W. Verhaegh
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | - Onno van Hooij
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | - Levi Groen
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | | | - Irma M. Oving
- Department of Medical OncologyZiekenhuisgroep TwenteAlmelothe Netherlands
| | - Pieter de Mol
- Department of Medical OncologyGelderse Vallei HospitalEdethe Netherlands
| | - Tineke J. Smilde
- Department of Medical OncologyJeroen Bosch Hospital‘s Hertogenboschthe Netherlands
| | | | - Niven Mehra
- Deparment of Medical OncologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Jack A. Schalken
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | - Nielka P. van Erp
- Department of PharmacyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
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3
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Gala UH, Miller DA, Su Y, Spangenberg A, Williams ROB. The effect of drug loading on the properties of abiraterone-hydroxypropyl beta cyclodextrin solid dispersions processed by solvent free KinetiSol® technology. Eur J Pharm Biopharm 2021; 165:52-65. [PMID: 33979662 DOI: 10.1016/j.ejpb.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Abiraterone is a poorly water-soluble drug used in the treatment of prostate cancer. In our previous study, we reported that KinetiSol® processed solid dispersions (KSDs) based on hydroxypropyl β-cyclodextrin (HPBCD) showed improved dissolution and pharmacokinetics of abiraterone. However, the nature of abiraterone-HPBCD interaction within the KSDs or the effect of drug loading on the physicochemical properties and in vivo performance of HPBCD-based KSDs remain largely unknown. We hypothesize that KinetiSol technology can prepare abiraterone-HPBCD complexes within KSDs and that increasing the drug loading beyond an optimal point reduces the in vitro and in vivo performance of these KSDs. To confirm our hypothesis, we developed KSDs with 10-50% w/w drug loading and analyzed them using X-ray diffractometry and modulated differential scanning calorimetry. We found that KSDs containing 10-30% drug were amorphous. Interestingly, two-dimensional solid-state nuclear magnetic resonance and Raman spectroscopy indicated that the abiraterone-HPBCD complexes were formed. At elevated temperatures, the 10% and 20% drug-loaded KSDs were physically stable, while the 30% drug-loaded KSD showed recrystallization of abiraterone. In vitro dissolution and in vivo pharmacokinetic performances improved as the drug loading decreased; we attribute this to increased noncovalent interactions between abiraterone and HPBCD at lower drug loadings. Overall, the 10% drug loaded KSD showed a dissolution enhancement of 15.7-fold compared to crystalline abiraterone, and bioavailability enhancement of 3.9-fold compared to the commercial abiraterone acetate tablet Zytiga®. This study is first to confirm that KinetiSol, a high-energy, solvent-free technology, is capable of forming abiraterone-HPBCD complexes. Furthermore, in terms of in vitro and in vivo performance, a 10% drug load is optimal.
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Affiliation(s)
- Urvi H Gala
- DisperSol Technologies LLC, 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, United States.
| | - Dave A Miller
- DisperSol Technologies LLC, 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, United States.
| | - Yongchao Su
- Merck & Co. Inc., 90 E Scott Ave, Rahway, NJ 07065, United States.
| | - Angela Spangenberg
- DisperSol Technologies LLC, 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, United States.
| | - Robert O Bill Williams
- The University of Texas at Austin, College of Pharmacy, 2409 West University Avenue, PHR 4.214, Austin, TX 78712, United States.
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Groenland SL, van Nuland M, Verheijen RB, Schellens JHM, Beijnen JH, Huitema ADR, Steeghs N. Therapeutic Drug Monitoring of Oral Anti-Hormonal Drugs in Oncology. Clin Pharmacokinet 2020; 58:299-308. [PMID: 29862467 DOI: 10.1007/s40262-018-0683-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Oral anti-hormonal drugs are essential in the treatment of breast and prostate cancer. It is well known that the interpatient variability in pharmacokinetic exposure is high for these agents and exposure-response relationships exist for many oral anti-hormonal drugs. Yet, they are still administered at fixed doses. This could lead to underdosing and thus suboptimal efficacy in some patients, while other patients could be overdosed resulting in unnecessary side effects. Therapeutic drug monitoring (TDM), individualized dosing based on measured blood concentrations of the drug, could therefore be a valid option to further optimize treatment. In this review, we provide an overview of relevant clinical pharmacokinetic and pharmacodynamic characteristics of oral anti-hormonal drugs in oncology and translate these into practical guidelines for TDM. For some agents, TDM targets are not well established yet and as a reference the median pharmacokinetic exposure could be targeted (exemestane: minimum plasma concentration (Cmin) 4.1 ng/mL and enzalutamide: Cmin 11.4 mg/L). However, for most drugs, exposure-efficacy analyses could be translated into specific targets (abiraterone: Cmin 8.4 ng/mL, anastrozole: Cmin 34.2 ng/mL, and letrozole: Cmin 85.6 ng/mL). Moreover, prospective clinical trials have shown TDM to be feasible for tamoxifen, for which the exposure-efficacy threshold of its active metabolite endoxifen is 5.97 ng/mL. Based on the available data, we therefore conclude that individualized dosing based on drug concentrations is feasible and promising for oral anti-hormonal drugs and should be developed further and implemented into clinical practice.
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Affiliation(s)
- Stefanie L Groenland
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Merel van Nuland
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek and MC Slotervaart, Amsterdam, The Netherlands
| | - Remy B Verheijen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek and MC Slotervaart, Amsterdam, The Netherlands
| | - Jan H M Schellens
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek and MC Slotervaart, Amsterdam, The Netherlands.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek and MC Slotervaart, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Neeltje Steeghs
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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5
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Groenland SL, van Nuland M, Bergman AM, de Feijter JM, Dezentje VO, Rosing H, Beijnen JH, Huitema AD, Steeghs N. Concomitant intake of abiraterone acetate and food to increase pharmacokinetic exposure: real life data from a therapeutic drug monitoring programme. Eur J Cancer 2020; 130:32-38. [DOI: 10.1016/j.ejca.2020.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/16/2020] [Accepted: 02/02/2020] [Indexed: 11/30/2022]
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6
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Gala U, Miller D, Williams RO. Improved Dissolution and Pharmacokinetics of Abiraterone through KinetiSol ® Enabled Amorphous Solid Dispersions. Pharmaceutics 2020; 12:pharmaceutics12040357. [PMID: 32295245 PMCID: PMC7238130 DOI: 10.3390/pharmaceutics12040357] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 01/11/2023] Open
Abstract
Abiraterone is a poorly water-soluble drug. It has a high melting point and limited solubility in organic solvents, making it difficult to formulate as an amorphous solid dispersion (ASD) with conventional technologies. KinetiSol® is a high-energy, fusion-based, solvent-free technology that can produce ASDs. The aim of this study was to evaluate the application of KinetiSol to make abiraterone ASDs. We developed binary KinetiSol ASDs (KSDs) using both polymers and oligomers. For the first time, we reported that KinetiSol can process hydroxypropyl-β-cyclodextrin (HPBCD), a low molecular-weight oligomer. Upon X-ray diffractometry and modulated differential scanning calorimetry analysis, we found the KSDs to be amorphous. In vitro dissolution analysis revealed that maximum abiraterone dissolution enhancement was achieved using a HPBCD binary KSD. However, the KSD showed significant abiraterone precipitation in fasted state simulated intestinal fluid (FaSSIF) media. Hence, hypromellose acetate succinate (HPMCAS126G) was selected as an abiraterone precipitation inhibitor and an optimized ternary KSD was developed. A pharmacokinetic study revealed that HPBCD based binary and ternary KSDs enhanced abiraterone bioavailability by 12.4-fold and 13.8-fold, respectively, compared to a generic abiraterone acetate tablet. Thus, this study is the first to demonstrate the successful production of an abiraterone ASD that exhibited enhanced dissolution and bioavailability.
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Affiliation(s)
- Urvi Gala
- Molecular Pharmaceutics and Drug Delivery Division, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Austin, TX 78712, USA;
- DisperSol Technologies LLC., 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, USA;
| | - Dave Miller
- DisperSol Technologies LLC., 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, TX 78626, USA;
| | - Robert O. Williams
- Molecular Pharmaceutics and Drug Delivery Division, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Austin, TX 78712, USA;
- Correspondence:
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7
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Harnessing the therapeutic potential of anticancer drugs through amorphous solid dispersions. Biochim Biophys Acta Rev Cancer 2019; 1873:188319. [PMID: 31678141 DOI: 10.1016/j.bbcan.2019.188319] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
Abstract
The treatment of cancer is still a major challenge. But tremendous progress in anticancer drug discovery and development has occurred in the last few decades. However, this progress has resulted in few effective oncology products due to challenges associated with anticancer drug delivery. Oral administration is the most preferred route for anticancer drug delivery, but the majority of anticancer drugs currently in product pipelines and the majority of those that have been commercially approved have inherently poor water solubility, and this cannot be mitigated without compromising their potency and stability. The poor water solubility of anticancer drugs, in conjunction with other factors, leads to suboptimal pharmacokinetic performance. Thus, these drugs have limited efficacy and safety when administered orally. The amorphous solid dispersion (ASD) is a promising formulation technology that primarily enhances the aqueous solubility of poorly water-soluble drugs. In this review, we discuss the challenges associated with the oral administration of anticancer drugs and the use of ASD technology in alleviating these challenges. We emphasize the ability of ASDs to improve not only the pharmacokinetics of poorly water-soluble anticancer drugs, but also their efficacy and safety. The goal of this paper is to rationalize the application of ASD technology in the formulation of anticancer drugs, thereby creating superior oncology products that lead to improved therapeutic outcomes.
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8
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Lubberman FJE, Benoist GE, Gerritsen W, Burger DM, Mehra N, Hamberg P, van Oort I, van Erp NP. A prospective phase I multicentre randomized cross-over pharmacokinetic study to determine the effect of food on abiraterone pharmacokinetics. Cancer Chemother Pharmacol 2019; 84:1179-1185. [PMID: 31515667 PMCID: PMC6820614 DOI: 10.1007/s00280-019-03952-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/30/2019] [Indexed: 01/03/2023]
Abstract
Purpose Abiraterone acetate is used at a fixed oral dose of 1000 mg once daily (OD) taken fasted. By administering abiraterone acetate with food, a reduced dose can potentially be given while maintaining equivalent abiraterone exposure. Moreover, administering abiraterone acetate with a breakfast is considered more patient friendly. The aim of this study was to establish the bio-equivalent lower dose of abiraterone when taken with a continental breakfast (CB) compared to the standard intake of 1000 mg OD fasted. Methods In this phase I, randomized cross-over, multi-center study, abiraterone pharmacokinetics (PK) were evaluated in patients with metastatic castration-resistant prostate cancer who were treated for 14 days with 1000 mg abiraterone acetate taken fasted, followed by 14 days of treatment with 500 mg taken with a CB. Results 14 patients were enrolled into the study, of whom 12 were eligible for PK analysis. The geometric mean ratio (GMR) (fed/fasted) was 0.88 (90% CI 0.73–1.07) for area-under-the-curve (AUC0–24h), 1.03 (90% CI 0.79–1.34) for Cmax and 0.81 (90% CI 0.60–1.10) for Ctrough, respectively. High inter-patient variability (> 50%) was found for all PK parameters under both intake conditions. Patients seemed to be slightly more satisfied about the intake of 500 mg abiraterone acetate when taken with a CB compared to 1000 mg fasted. Conclusion In conclusion, a bioequivalent lower dose of abiraterone taken with food could not be established in our study. Although based on the absence of a exposure–toxicity relationship, the strict bioequivalence margins as defined by the FDA guidelines could be applied more flexible for abiraterone. Information on the effect of food on abiraterone pharmacokinetics as presented in our study can be used for patients with difficulties taken their medication fasted. Electronic supplementary material The online version of this article (10.1007/s00280-019-03952-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Floor J E Lubberman
- Department of Pharmacy (864), Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Guillemette E Benoist
- Department of Pharmacy (864), Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Winald Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy (864), Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Paul Hamberg
- Department of Medical Oncology, Franciscus Gasthuis and Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Inge van Oort
- Department of Urology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Nielka P van Erp
- Department of Pharmacy (864), Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Woei-A-Jin FJSH, Van Nieuwenhuyse T, van Erp NP, Beuselinck B, Stroobants S, Moes DJAR, Osanto S, Spriet I. Dose Reduction May Jeopardize Efficacy of Abiraterone Acetate. J Clin Oncol 2018; 36:3062-3064. [PMID: 30188790 DOI: 10.1200/jco.2018.79.3182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F J Sherida H Woei-A-Jin
- F.J. Sherida H. Woei-A-Jin, University Hospitals Leuven, Leuven, Belgium; and Leiden University Medical Center, Leiden, the Netherlands; Tine Van Nieuwenhuyse, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium; Nielka P. van Erp, Radboud University Medical Center, Nijmegen, the Netherlands; Benoit Beuselinck and Stephanie Stroobants, University Hospitals Leuven, Leuven, Belgium; Dirk Jan A.R. Moes and Susanne Osanto, Leiden University Medical Center, Leiden, the Netherlands; and Isabel Spriet, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Tine Van Nieuwenhuyse
- F.J. Sherida H. Woei-A-Jin, University Hospitals Leuven, Leuven, Belgium; and Leiden University Medical Center, Leiden, the Netherlands; Tine Van Nieuwenhuyse, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium; Nielka P. van Erp, Radboud University Medical Center, Nijmegen, the Netherlands; Benoit Beuselinck and Stephanie Stroobants, University Hospitals Leuven, Leuven, Belgium; Dirk Jan A.R. Moes and Susanne Osanto, Leiden University Medical Center, Leiden, the Netherlands; and Isabel Spriet, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nielka P van Erp
- F.J. Sherida H. Woei-A-Jin, University Hospitals Leuven, Leuven, Belgium; and Leiden University Medical Center, Leiden, the Netherlands; Tine Van Nieuwenhuyse, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium; Nielka P. van Erp, Radboud University Medical Center, Nijmegen, the Netherlands; Benoit Beuselinck and Stephanie Stroobants, University Hospitals Leuven, Leuven, Belgium; Dirk Jan A.R. Moes and Susanne Osanto, Leiden University Medical Center, Leiden, the Netherlands; and Isabel Spriet, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Benoit Beuselinck
- F.J. Sherida H. Woei-A-Jin, University Hospitals Leuven, Leuven, Belgium; and Leiden University Medical Center, Leiden, the Netherlands; Tine Van Nieuwenhuyse, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium; Nielka P. van Erp, Radboud University Medical Center, Nijmegen, the Netherlands; Benoit Beuselinck and Stephanie Stroobants, University Hospitals Leuven, Leuven, Belgium; Dirk Jan A.R. Moes and Susanne Osanto, Leiden University Medical Center, Leiden, the Netherlands; and Isabel Spriet, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stephanie Stroobants
- F.J. Sherida H. Woei-A-Jin, University Hospitals Leuven, Leuven, Belgium; and Leiden University Medical Center, Leiden, the Netherlands; Tine Van Nieuwenhuyse, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium; Nielka P. van Erp, Radboud University Medical Center, Nijmegen, the Netherlands; Benoit Beuselinck and Stephanie Stroobants, University Hospitals Leuven, Leuven, Belgium; Dirk Jan A.R. Moes and Susanne Osanto, Leiden University Medical Center, Leiden, the Netherlands; and Isabel Spriet, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dirk Jan A R Moes
- F.J. Sherida H. Woei-A-Jin, University Hospitals Leuven, Leuven, Belgium; and Leiden University Medical Center, Leiden, the Netherlands; Tine Van Nieuwenhuyse, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium; Nielka P. van Erp, Radboud University Medical Center, Nijmegen, the Netherlands; Benoit Beuselinck and Stephanie Stroobants, University Hospitals Leuven, Leuven, Belgium; Dirk Jan A.R. Moes and Susanne Osanto, Leiden University Medical Center, Leiden, the Netherlands; and Isabel Spriet, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Susanne Osanto
- F.J. Sherida H. Woei-A-Jin, University Hospitals Leuven, Leuven, Belgium; and Leiden University Medical Center, Leiden, the Netherlands; Tine Van Nieuwenhuyse, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium; Nielka P. van Erp, Radboud University Medical Center, Nijmegen, the Netherlands; Benoit Beuselinck and Stephanie Stroobants, University Hospitals Leuven, Leuven, Belgium; Dirk Jan A.R. Moes and Susanne Osanto, Leiden University Medical Center, Leiden, the Netherlands; and Isabel Spriet, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Isabel Spriet
- F.J. Sherida H. Woei-A-Jin, University Hospitals Leuven, Leuven, Belgium; and Leiden University Medical Center, Leiden, the Netherlands; Tine Van Nieuwenhuyse, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium; Nielka P. van Erp, Radboud University Medical Center, Nijmegen, the Netherlands; Benoit Beuselinck and Stephanie Stroobants, University Hospitals Leuven, Leuven, Belgium; Dirk Jan A.R. Moes and Susanne Osanto, Leiden University Medical Center, Leiden, the Netherlands; and Isabel Spriet, University Hospitals Leuven; and Katholieke Universiteit Leuven, Leuven, Belgium
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10
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Thakur A, Roy A, Ghosh A, Chhabra M, Banerjee S. Abiraterone acetate in the treatment of prostate cancer. Biomed Pharmacother 2018; 101:211-218. [DOI: 10.1016/j.biopha.2018.02.067] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 12/29/2022] Open
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Benoist GE, van der Doelen MJ, Ter Heine R, van Erp NP, Mehra N. A clinically relevant decrease in abiraterone exposure associated with carbamazepine use in a patient with castration-resistant metastatic prostate cancer. Br J Clin Pharmacol 2018; 84:1064-1067. [PMID: 29384591 DOI: 10.1111/bcp.13532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/19/2018] [Accepted: 01/19/2018] [Indexed: 12/13/2022] Open
Abstract
ADVERSE EVENT Decreased abiraterone exposure after introducing carbamazepine. DRUGS IMPLICATED Abiraterone acetate and carbamazepine. THE PATIENT A 65-year-old man with metastatic castration resistant prostate cancer, was treated with abiraterone acetate and prednisolone, and received concomitant carbamazepine for treatment of facial neuropathy. EVIDENCE THAT LINKS THE DRUG TO THE EVENT The interaction was confirmed by a decrease in abiraterone exposure >2-fold (area-under-the-curve and trough levels). After discontinuation of carbamazepine therapy, the abiraterone exposure normalized. No alternative causes were found that explain the decrease in abiraterone exposure. MECHANISM Induction of CYP3A and potentially phase I metabolism (SULT2A1) by carbamazepine. IMPLICATIONS FOR THERAPY Clinicians and pharmacists should be aware of this clinically relevant interaction. The national drug-drug interaction checker does not warn for this interaction, whereas both the Lexicomp® and Micromedex® advice to avoid if possible or to increase the abiraterone dose frequency to twice daily. Carbamazepine should not be combined with abiraterone to avoid underexposure and suboptimal therapy. Therapeutic drug monitoring of abiraterone is useful to guide therapy when drug-drug interactions cannot be avoided.
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Affiliation(s)
- Guillemette E Benoist
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten J van der Doelen
- Department of Urology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob Ter Heine
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nielka P van Erp
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Benoist GE, van der Meulen E, Lubberman FJE, Gerritsen WR, Smilde TJ, Schalken JA, Beumer JH, Burger DM, van Erp NP. Analytical challenges in quantifying abiraterone with LC-MS/MS in human plasma. Biomed Chromatogr 2017; 31:10.1002/bmc.3986. [PMID: 28370076 PMCID: PMC6114173 DOI: 10.1002/bmc.3986] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 11/09/2022]
Abstract
A method was developed and validated to quantify abiraterone in human plasma. During assay development, several analytical challenges were encountered: limited stability in patient samples, adsorption to glass, coelution with metabolites and carry-over issues. Limited stability (2 h) was found for abiraterone in fresh plasma as well as whole blood at ambient temperature. When kept at 2-8°C, abiraterone in plasma was stable for 24 h and in whole blood for 8 h. Adsorption of abiraterone to glass materials was addressed by using polypropylene throughout the method. Carry-over was reduced to acceptable limits by incorporating a third mobile phase into the gradient. The chromatographic separation of abiraterone with its multiple metabolites was addressed by using a longer analytical column and adjusting the gradient. Abiraterone was extracted by protein precipitation, separated on a C18 column with gradient elution and analyzed with tandem quadrupole mass spectrometry in positive ion mode. A stable deuterated isotope was used as the internal standard. The assay ranges from 1 to 500 ng/mL. Within- and-between-day precisions and accuracies were below 13.4% and within 95-102%. This bioanalytical method was successfully validated and applied to determine plasma concentrations of abiraterone in clinical studies and in regular patient care for patients with metastatic castration-resistant prostate cancer.
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Affiliation(s)
| | - Eric van der Meulen
- Department of Pharmacy, Radboud university medical center, Nijmegen, Netherlands
| | | | - Winald R. Gerritsen
- Department of Medical Oncology, Radboud university medical center, Nijmegen, Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Jack A. Schalken
- Department of Urology, Radboud university medical center, Nijmegen, Netherlands
| | - Jan H. Beumer
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, United States of America
| | - David M. Burger
- Department of Pharmacy, Radboud university medical center, Nijmegen, Netherlands
| | - Nielka P. van Erp
- Department of Pharmacy, Radboud university medical center, Nijmegen, Netherlands
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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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Abstract
Recent reports suggest a potentially beneficial increase in abiraterone exposure when abiraterone acetate plus prednisone is administered with food. We evaluated the basis for current dosing recommendations under modified fasted conditions for patients with metastatic castration-resistant prostate cancer with a PubMed search of studies assessing the impact of food on abiraterone pharmacokinetics. Studies show that abiraterone exposure increases with administration in a fed versus fasted state and with high-fat versus low-fat meals. Food effect is substantially attenuated in metastatic castration-resistant prostate cancer patients compared with healthy subjects. The potential variability in absorption, unproven clinical benefits and increased toxicity with abiraterone acetate plus prednisone administration in the fed state underscore the importance of adhering to current dosing recommendations.
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Xu S, De Porre P. Author's Reply to Srinivas: "Modeling the Relationship Between Exposure to Abiraterone and Prostate-Specific Antigen Dynamics in Patients with Metastatic Castration-Resistant Prostate Cancer". Clin Pharmacokinet 2016; 56:213-214. [PMID: 27815867 DOI: 10.1007/s40262-016-0469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Steven Xu
- Janssen Research & Development, 920 Route 202, Raritan, NJ, 08869, USA.
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Srinivas NR. Comment on: "Modeling the Relationship between Exposure to Abiraterone and Prostate-Specific Antigen Dynamics in Patients with Metastatic Castration-Resistant Prostate Cancer". Clin Pharmacokinet 2016; 56:211-212. [PMID: 27815866 DOI: 10.1007/s40262-016-0468-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nuggehally R Srinivas
- Zydus Research Center, Sarkhej-Bavla NH 8A, Moraiya, Ahmedabad, 382 210, Gujarat, India.
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