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Zamboni WC, Charlab R, Burckart GJ, Stewart CF. Effect of Obesity on the Pharmacokinetics and Pharmacodynamics of Anticancer Agents. J Clin Pharmacol 2023; 63 Suppl 2:S85-S102. [PMID: 37942904 DOI: 10.1002/jcph.2326] [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: 05/01/2023] [Accepted: 07/12/2023] [Indexed: 11/10/2023]
Abstract
An objective of the Precision Medicine Initiative, launched in 2015 by the US Food and Drug Administration and National Institutes of Health, is to optimize and individualize dosing of drugs, especially anticancer agents, with high pharmacokinetic and pharmacodynamic variability. The American Society of Clinical Oncology recently reported that 40% of obese patients receive insufficient chemotherapy doses and exposures, which may lead to reduced efficacy, and recommended pharmacokinetic studies to guide appropriate dosing in these patients. These issues will only increase in importance as the incidence of obesity in the population increases. This publication reviews the effects of obesity on (1) tumor biology, development of cancer, and antitumor response; (2) pharmacokinetics and pharmacodynamics of small-molecule anticancer drugs; and (3) pharmacokinetics and pharmacodynamics of complex anticancer drugs, such as carrier-mediated agents and biologics. These topics are not only important from a scientific research perspective but also from a drug development and regulator perspective. Thus, it is important to evaluate the effects of obesity on the pharmacokinetics and pharmacodynamics of anticancer agents in all categories of body habitus and especially in patients who are obese and morbidly obese. As the effects of obesity on the pharmacokinetics and pharmacodynamics of anticancer agents may be highly variable across drug types, the optimal dosing metric and algorithm for difference classes of drugs may be widely different. Thus, studies are needed to evaluate current and novel metrics and methods for measuring body habitus as related to optimizing the dose and reducing pharmacokinetic and pharmacodynamic variability of anticancer agents in patients who are obese and morbidly obese.
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Affiliation(s)
- William C Zamboni
- UNC Eshelman School of Pharmacy, UNC Lineberger Comprehensive Cancer Center, Caroline Institute of Nanomedicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rosane Charlab
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Gilbert J Burckart
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Chen L, Wu F, Chen X, Chen Y, Deng L, Cai Q, Wu L, Guo W, Chen M, Li Y, Zhang W, Jin X, Chen H, Nie Q, Wu X, Lin Y, Wang C, Fu F. Impact of body mass index in therapeutic response for HER2 positive breast cancer treated with neoadjuvant targeted therapy: a multi-center study and meta-analysis. NPJ Breast Cancer 2023; 9:46. [PMID: 37258524 DOI: 10.1038/s41523-023-00552-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
While overweight/obesity has become a major public health issue worldwide, any association between body mass index (BMI) and therapeutic response in neoadjuvant targeted therapy treated HER2 positive breast cancer patients remain unclear. The information from a total of four-hundred and ninety-one neoadjuvant targeted therapy treated HER2 positive breast cancer patients from four institutions were retrospectively collected. Univariate and multivariate logistic analysis was developed to determine the association between BMI and therapeutic response. A meta-analysis of published literature was then conducted to confirm the effect of overweight/obesity on pCR for patients treated with neoadjuvant targeted therapy. Restricted cubic spline (RCS) adjusted for confounding factors demonstrated a decrease pCR with increasing BMI (OR = 0.937, P = 0.045). Patients were then categorized into under/normal weight (n = 299) and overweight/obesity (n = 192). Overweight/obese patients were independently associated with a poor therapeutic response. In the subgroup analysis, a significant negative impact of overweight/obesity on pCR can be observed both in single-targeted (OR = 0.556; P = 0.02) and dual-targeted (OR = 0.392; P = 0.021) populations. Six eligible studies involving 984 neoadjuvant targeted therapy treated HER2 positive breast cancer patients were included in the meta-analysis. The meta-analysis also demonstrated that overweight/obesity was significantly associated with a poor response to neoadjuvant anti-HER2 therapy (OR = 0.68; P = 0.007). Our result show that overweight and obese HER2 positive breast cancer patients are less likely to achieve pCR after neoadjuvant targeted therapy.
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Affiliation(s)
- Lili Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Fan Wu
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Xiaobin Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Yazhen Chen
- Department of Breast Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, 363000, Zhangzhou, Fujian, P.R. China
| | - Lin Deng
- Department of Oncology, No. 900 Hospital of The Joint Logistic Support Force, Fuzhou, China
| | - Qindong Cai
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Long Wu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wenhui Guo
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Minyan Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Yan Li
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Wenzhe Zhang
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Xuan Jin
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Hanxi Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Qian Nie
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Xiong Wu
- Department of Breast Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, 363000, Zhangzhou, Fujian, P.R. China.
| | - Yuxiang Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China.
| | - Chuan Wang
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China.
| | - Fangmeng Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China.
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McCloskey C, Ortega MT, Nair S, Garcia MJ, Manevy F. A Systematic Review of Time and Resource Use Costs of Subcutaneous Versus Intravenous Administration of Oncology Biologics in a Hospital Setting. PHARMACOECONOMICS - OPEN 2023; 7:3-36. [PMID: 35996066 PMCID: PMC9395845 DOI: 10.1007/s41669-022-00361-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND The introduction of human epidermal growth factor receptor 2 (HER2)-targeted treatment options, including dual HER2 blockade, has improved the prognosis for patients with HER2-positive breast cancer (BC) substantially. However, most of these treatments are administered via the intravenous (IV) route, which can present many challenges, such as long infusion and observation times, issues associated with repeated IV access, and increased strain on time and resources of medical centers and healthcare professionals. A fixed-dose combination of pertuzumab and trastuzumab for subcutaneous (SC) injection (pertuzumab, trastuzumab, and hyaluronidase-zzxf (PHESGO®, F. Hoffmann-La Roche Ltd, Basel, Switzerland; PH FDC SC)) has been approved for use alongside chemotherapy for early-stage and metastatic HER2-positive BC. OBJECTIVES This systematic literature review was performed to identify evidence relating to time/resource use and resulting cost differences between SC and IV administration of oncology biologics in a hospital setting, and, ultimately, to inform economic modeling and associated health technology assessment of PH FDC SC. METHODS Electronic databases (Embase, MEDLINE, and EconLit) were searched on 9 April 2020. Additional hand searches were performed to identify publications not captured in the electronic database search. Publication screening and data extraction (study characteristics, participants, interventions, costs, and time/resource use) were carried out per the standard Cochrane review methodology. The quality of economic evidence of cost analyses was assessed using the 36-item checklist of the National Institute for Health and Care Excellence Single Technology Appraisal Specification for submission of evidence (January 2015). RESULTS The database search identified 2,740 records, of which 237 underwent full text screening. Full text screening, prioritization of publications about patients with a cancer diagnosis, and the addition of four citations identified during the hand search resulted in 72 final included publications, relating to 71 unique studies. This included 40 publications that described the time/resource use and/or costs associated with SC versus IV trastuzumab administration for the treatment of HER2-positive BC, and 28 publications that described time/resource use and/or costs associated with rituximab SC versus IV administration for the treatment of non-Hodgkin's lymphoma/follicular lymphoma and diffuse large B-cell lymphoma. The majority of publications showed substantial time savings for preparation and administration of SC versus IV therapy, and cost savings associated with reductions in healthcare professional time and resource use for SC administration. LIMITATIONS There was a lack of consensus between publications regarding time and cost measurements. In addition, the search was limited to publications related to anticancer drugs; the majority of the studies included were performed in European countries. CONCLUSIONS AND IMPLICATIONS This review indicated a substantial body of evidence showing time/resource and cost savings of SC versus IV administration of oncology biologics in a hospital setting, which can be used to inform economic evaluations of PH FDC SC.
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Affiliation(s)
| | | | | | - Maria João Garcia
- Pharmaceuticals Division, Global Access-Evidence Chapter, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Federico Manevy
- Pharmaceuticals Division, Global Access-Evidence Chapter, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
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