1
|
Pai SM, Yamada H, Murata H. Evaluation of Drug-Drug Interaction Potential of Enarodustat (JTZ-951) Using a Cytochrome P450 Probe Cocktail. Clin Pharmacol Drug Dev 2023; 12:667-682. [PMID: 37269147 DOI: 10.1002/cpdd.1263] [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: 05/24/2022] [Accepted: 03/26/2023] [Indexed: 06/04/2023]
Abstract
The drug interaction potential of enarodustat (doses: 25, 50 mg) on the activity of cytochrome P450 (CYP) 1A2, 2C9, 2C19, 2D6, and 3A4 was evaluated after once-daily administration for 15 days in a phase 1 multiple-ascending-dose study in healthy subjects. Probe substrates specific for the enzymes, i.e., caffeine (CYP1A2), tolbutamide (CYP2C9), omeprazole (CYP2C19), dextromethorphan (CYP2D6), and midazolam (CYP3A4), were administered orally as a cocktail with (day 15) and without (day -3) enarodustat. Drug interaction was based on geometric mean maximum plasma concentration (Cmax ) and area under the plasma concentration-time curve from the time of dosing to infinity (AUCinf ) ratios (day 15/day -3) for CYP1A2, 2C9, 2C19, 2D6, 3A4, and urinary excretion of dextromethorphan metabolite dextrorphan for CYP2D6. At the 2 enarodustat doses, for caffeine, the geometric mean ratios (range) for Cmax and AUCinf were 0.99-1.06 and 1.61-1.63, respectively. The ratios for peak concentrations and total exposures were 0.98-1.07 and 0.71-1.78 for tolbutamide and omeprazole, respectively. For dextrorphan the Cmax and AUCinf ratios were 0.83-0.90 and 1.02-1.04, respectively. The mean dextrorphan cumulative amount excreted into the urine from the time of dosing to 24 hours values on day -3 and day 15 were 8.25 mg and 8.20 mg at the lower dose, and 9.40 mg and 9.51 mg at the higher dose. The ratios for midazolam Cmax and AUCinf were 1.42-1.63. Overall, there was a lack of enarodustat dose dependency regarding the geometric mean ratios and 90% confidence intervals and urinary excretion of dextrorphan. There were some cases where the 90% confidence intervals at the 2 enarodustat doses were outside the 0.80-1.25 range, but changes in the geometric mean ratios were all <2-fold.
Collapse
Affiliation(s)
- Sudhakar M Pai
- Clinical Pharmacology, Akros Pharma, Inc., Princeton, New Jersey, USA
| | - Hiroyuki Yamada
- Clinical Pharmacology, Pharmaceutical Division, Japan Tobacco Inc., Tokyo, Japan
| | - Hiroyuki Murata
- Drug Metabolism and Pharmacokinetics Research Laboratories, Pharmaceutical Division, Japan Tobacco Inc., Osaka, Japan
| |
Collapse
|
4
|
de Graan AJM, Teunissen SF, de Vos FY, Loos WJ, van Schaik RH, de Jongh FE, de Vos AI, van Alphen RJ, van der Holt B, Verweij J, Seynaeve C, Beijnen JH, Mathijssen RH. Dextromethorphan As a Phenotyping Test to Predict Endoxifen Exposure in Patients on Tamoxifen Treatment. J Clin Oncol 2011; 29:3240-6. [DOI: 10.1200/jco.2010.32.9839] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Tamoxifen, a widely used agent for the prevention and treatment of breast cancer, is mainly metabolized by CYP2D6 and CYP3A to form its most abundant active metabolite, endoxifen. Interpatient variability in toxicity and efficacy of tamoxifen is substantial. Contradictory results on the value of CYP2D6 genotyping to reduce the variable efficacy have been reported. In this pharmacokinetic study, we investigated the value of dextromethorphan, a known probe drug for both CYP2D6 and CYP3A enzymatic activity, as a potential phenotyping probe for tamoxifen pharmacokinetics. Methods In this prospective study, 40 women using tamoxifen for invasive breast cancer received a single dose of dextromethorphan 2 hours after tamoxifen intake. Dextromethorphan, tamoxifen, and their respective metabolites were quantified. Exposure parameters of all compounds were estimated, log transformed, and subsequently correlated. Results A strong and highly significant correlation (r = −0.72; P < .001) was found between the exposures of dextromethorphan (0 to 6 hours) and endoxifen (0 to 24 hours). Also, the area under the plasma concentration–time curve of dextromethorphan (0 to 6 hours) and daily trough endoxifen concentration was strongly correlated (r = −0.70; P < .001). In a single patient using the potent CYP2D6 inhibitor paroxetine, the low endoxifen concentration was accurately predicted by dextromethorphan exposure. Conclusion Dextromethorphan exposure after a single administration adequately predicted endoxifen exposure in individual patients with breast cancer taking tamoxifen. This test could contribute to the personalization and optimization of tamoxifen treatment, but it needs additional validation and simplification before being applicable in future dosing strategies.
Collapse
Affiliation(s)
- Anne-Joy M. de Graan
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Sebastiaan F. Teunissen
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Filip Y.F.L. de Vos
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Walter J. Loos
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Ron H.N. van Schaik
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Felix E. de Jongh
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Aad I. de Vos
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Robbert J. van Alphen
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Bronno van der Holt
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Jaap Verweij
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Caroline Seynaeve
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Jos H. Beijnen
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| | - Ron H.J. Mathijssen
- Anne-Joy M. de Graan, Filip Y.F.L. de Vos, Walter J. Loos, Bronno van der Holt, Jaap Verweij, Caroline Seynaeve, Ron H.J. Mathijssen, Erasmus Medical Center–Daniel den Hood Cancer Center, University Medical Center; Ron H.N. van Schaik, Erasmus Medical Center; Felix E. de Jongh, Ikazia Hospital, Rotterdam; Sebastiaan F. Teunissen, Jos H. Beijnen, Slotervaart Hospital, Amsterdam; Aad I. de Vos, Admiraal De Ruyter Hospital, Goes; and Robbert J. van Alphen, Medical Spectrum Twente, Enschede, the Netherlands
| |
Collapse
|