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Kater AP, Eichhorst BF, Owen CJ, Jaeger U, Chyla B, Lefebure M, Millen R, Jiang Y, Thadani‐Mulero M, Boyer M, Seymour JF. Long-term immune changes in patients with relapsed/refractory chronic lymphocytic leukemia following treatment with venetoclax plus rituximab. Hemasphere 2024; 8:e146. [PMID: 39193190 PMCID: PMC11347997 DOI: 10.1002/hem3.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/22/2024] [Accepted: 06/04/2024] [Indexed: 08/29/2024] Open
Abstract
Immune dysregulation is a hallmark of chronic lymphocytic leukemia (CLL). Anti-CD20 antibodies (e.g., rituximab [R]) can be combined with venetoclax (Ven) to treat CLL. However, anti-CD20 antibodies can increase hypogammaglobulinemia risk, while the effects of Ven on immune dysregulation are still uncertain. We report long-term immune changes in VenR- and bendamustine-R (BR)-treated patients with relapsed/refractory CLL in the MURANO trial (NCT02005471). Patients were randomized to fixed-duration VenR (2 years Ven; VenR for the first 6 months) or BR (6 months). Immune cell levels were evaluated at the end of combination treatment (EOCT), end of treatment (EOT; VenR arm only), and 12 and 24 months post-EOCT. Overall, 130/194 VenR- and 134/195 BR-treated patients completed treatment without progressive disease. In patients who completed VenR combination therapy, median immunoglobulin (Ig)G and IgM levels decreased from baseline to EOT (p ≤ 0.01 and p ≤ 0.0001, respectively); by 24 months, post-EOT IgG had returned to baseline level and IgM had increased from baseline (p ≤ 0.001). Median IgA levels increased from baseline to 12 (p ≤ 0.0001) and 24 months post-EOT (p ≤ 0.0001). In BR-treated patients, changes in IgG, IgA, and IgM levels across the assessed time points were not significant, and by 24 months, post-EOCT IgG, IgA, and IgM were above baseline levels. Grade ≥3 infection rates on treatment were low. Overall, immune recovery was observed with VenR and BR, with stabilization of Ig levels after treatment. Post-treatment infection rates were generally low, making these very tolerable therapies for CLL.
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Affiliation(s)
- Arnon P. Kater
- Department of Hematology, Cancer Center Amsterdam, LYMMCARE, Amsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Barbara F. Eichhorst
- Department of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Carolyn J. Owen
- Departments of Medicine and OncologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Ulrich Jaeger
- Clinical Department of Hematology and HemostaseologyMedical University of ViennaViennaAustria
| | | | | | | | | | | | | | - John F. Seymour
- Peter MacCallum Cancer CentreRoyal Melbourne Hospital and University of MelbourneMelbourneAustralia
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Alaei S, Wang Y, Liu Y, Schiele J, Deng R, Shiller D, Marroum P, Menon R, Salem AH. Venetoclax Clinical Pharmacokinetics After Administration of Crushed, Ground or Whole Tablets. Clin Ther 2024:S0149-2918(24)00080-8. [PMID: 38782609 DOI: 10.1016/j.clinthera.2024.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Venetoclax is a potent, orally bioavailable BCL-2 inhibitor used in the treatment of some hematological malignancies. Crushing tablets may be necessary to help with the administration of venetoclax to patients with swallowing difficulties or patients requiring nasogastric tube feeding. The study was conducted to assess the bioavailability of crushed and finely ground venetoclax tablets relative to whole tablets. METHODS An open-label, randomized, 3-way, crossover study in 15 healthy adult females was conducted. Venetoclax tablets were administered orally in a crushed, ground or intact form on Day 1 of each period with water following a high-fat breakfast. Pharmacokinetic samples were collected up to 72 hours postdosing. FINDINGS The crushed and ground tablets met the bioequivalence criteria (0.80-1.25) relative to the intact tablets with respect to area under the concentration-time curve to time of the last measurable concentration (AUCt) and to infinite time (AUCinf) but exhibited a slightly lower maximum plasma concentration (Cmax). This was not considered clinically significant as only venetoclax overall exposure (AUC) has been shown to correlate with clinical efficacy. There was no change in the physical appearance and the evaluated physicochemical properties of crushed and ground venetoclax tablets after 72 hours of storage at 25°C/60% relative humidity. IMPLICATIONS Crushing or grinding venetoclax tablets before administration could be considered as a viable alternative method of administration for patients who have difficulty swallowing whole venetoclax tablets or patients requiring nasogastric tube feeding. CLINICALTRIALS GOV IDENTIFIERS NCT05909553, registered June 12, 2023.
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Affiliation(s)
| | | | | | | | - Rong Deng
- Genentech Inc., South San Francisco, California
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Salem AH, Menon RM. Clinical pharmacokinetics and pharmacodynamics of venetoclax, a selective B-cell lymphoma-2 inhibitor. Clin Transl Sci 2024; 17:e13807. [PMID: 38778732 PMCID: PMC11112299 DOI: 10.1111/cts.13807] [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: 12/13/2023] [Revised: 02/29/2024] [Accepted: 03/22/2024] [Indexed: 05/25/2024] Open
Abstract
Venetoclax, a highly potent BCL-2 inhibitor, is indicated for treatment of some hematologic malignancies as monotherapy, and/or in combination with other agents. Venetoclax pharmacokinetics has been extensively characterized in patients and healthy participants. After oral dosing, the median time to reach maximum plasma concentration ranged from 5 to 8 h and harmonic mean half-life ranged from 14 to 18 h. Food increases venetoclax bioavailability by 3-5-fold and venetoclax should be administered with food to ensure adequate and consistent bioavailability. Venetoclax is eliminated via cytochrome P450 (CYP)3A metabolism, and a negligible amount of unchanged drug is excreted in urine. Strong CYP3A/P-glycoprotein inhibitors increased venetoclax exposures (AUC) by 1.44- to 6.90-fold while a significant decrease (71%) has been observed when dosed with strong CYP3 inducers. Venetoclax does not inhibit or induce CYP enzymes or transporters. Venetoclax pharmacokinetics is not appreciably altered by age, weight, sex, but the exposure is up to twofold higher in participants from Asian countries. Mild-to-severe renal impairment or end-stage renal disease do not alter venetoclax exposures, and venetoclax is not cleared by dialysis. Although mild-to-moderate hepatic impairment does not affect venetoclax exposures, twofold higher exposure was observed in subjects with severe hepatic impairment. Venetoclax exposure is comparable across patients with different hematologic malignancies and healthy participants. Overall, venetoclax exposure is only affected by food and CYP3A modulators and is only higher in Asian subjects and subjects with severe hepatic impairment. Venetoclax exposure-response relationships are malignancy-dependent and can be different between monotherapy and combination therapy.
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Affiliation(s)
- Ahmed Hamed Salem
- Faculty of PharmacyAin Shams UniversityCairoEgypt
- AbbVie Inc.North ChicagoIllinoisUSA
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Badawi M, Coppola S, Eckert D, Gopalakrishnan S, Engelhardt B, Doelger E, Huang W, Dobkowska E, Kumar S, Menon RM, Salem AH. Venetoclax in biomarker-selected multiple myeloma patients: Impact of exposure on clinical efficacy and safety. Hematol Oncol 2024; 42:e3222. [PMID: 37740931 DOI: 10.1002/hon.3222] [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: 06/23/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/25/2023]
Abstract
Venetoclax, a potent BCL-2 inhibitor, is currently under development for treatment of t(11;14) Multiple myeloma (MM). The objective of this research was to investigate the exposure-response relationships of venetoclax for a phase 1/2 study evaluating venetoclax monotherapy or in combination with dexamethasone in relapsed or refractory MM. A total of 117 patients receiving venetoclax at 300, 600, 800, 900, or 1200 mg were included in the analysis. The impact of venetoclax exposures on efficacy (objective response rate [ORR], progression-free survival [PFS] and overall survival [OS]) as well as safety (treatment-emergent adverse effects (grade ≥3) of neutropenia, infection, and any grade of serious treatment-emergent adverse effects) was evaluated. In the t(11;14)-positive subpopulation, venetoclax exposure relationships to PFS and OS indicated a trend of longer PFS and OS with higher exposures. Moreover, logistic regression analyses for clinical response (ORR and ≥VGPR rate) demonstrated a statistically significant (p < 0.05) relationship with exposure. Evaluation of the exposure-safety relationships demonstrated a lack of a relationship between venetoclax exposures (AUCavg ) and grade ≥3 infections, grade ≥3 neutropenia, grade ≥3 treatment-emergent adverse events or any grade serious treatment-emergent adverse events. These findings support further study of venetoclax at 800 mg QD dose in combination with dexamethasone in the t(11;14)-positive patient population where increased efficacy was observed without an increase in safety events.Clinical Trial: NCT01794520 registered 20 February 2013.
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Affiliation(s)
- Mohamed Badawi
- Clinical Pharmacology, AbbVie, Inc, North Chicago, Illinois, USA
| | - Sheryl Coppola
- Clinical Pharmacology, AbbVie, Inc, North Chicago, Illinois, USA
| | - Doerthe Eckert
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen Am Rhein, Germany
| | - Sathej Gopalakrishnan
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen Am Rhein, Germany
| | - Benjamin Engelhardt
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen Am Rhein, Germany
| | - Eva Doelger
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen Am Rhein, Germany
| | - Weize Huang
- Clinical Pharmacology, Genentech Inc, South San Francisco, California, USA
| | - Edyta Dobkowska
- Clinical Development, Pharmacyclics Switzerland GmbH, An AbbVie Company, Schaffhausen, Switzerland
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajeev M Menon
- Clinical Pharmacology, AbbVie, Inc, North Chicago, Illinois, USA
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Gopalakrishnan S, Menon R, Suleiman AA, Kater AP, Stilgenbauer S, Seymour JF, Chyla B, Lu T, Young Kim S, Roberts AW, Woyach JA, Mensing S, Salem AH. Relationship Between Venetoclax Exposure and Undetectable Minimal Residual Disease Rates in Relapsed/Refractory Patients With Chronic Lymphocytic Leukemia: A Pooled Analysis of Six Clinical Studies. Hemasphere 2023; 7:e983. [PMID: 38026788 PMCID: PMC10659710 DOI: 10.1097/hs9.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
| | - Rajeev Menon
- Clinical Pharmacology, AbbVie, North Chicago, IL, USA
| | | | - Arnon P. Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, on behalf of HOVON CLL WG, Amsterdam, The Netherlands
| | - Stephan Stilgenbauer
- Division of CLL, Department III of Internal Medicine, Ulm University, Ulm, Germany
| | - John F. Seymour
- Department of Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, University of Melbourne, Parkville, VIC, Australia
| | - Brenda Chyla
- Precision Medicine Oncology, AbbVie, North Chicago, IL, USA
| | - Tong Lu
- Genentech Inc, South San Francisco, CA, USA
| | - Su Young Kim
- Oncology Development, AbbVie, North Chicago, IL, USA
| | - Andrew W. Roberts
- Department of Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, University of Melbourne, Parkville, VIC, Australia
| | - Jennifer A. Woyach
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Sven Mensing
- Clinical Pharmacology, AbbVie, Ludwigshafen, Germany
| | - Ahmed Hamed Salem
- Clinical Pharmacology, AbbVie, North Chicago, IL, USA
- Clinical Pharmacy, Ain Shams University, Cairo, Egypt
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Badawi M, Chen X, Marroum P, Suleiman AA, Mensing S, Koenigsdorfer A, Schiele JT, Palenski T, Samineni D, Hoffman D, Menon R, Salem AH. Bioavailability Evaluation of Venetoclax Lower-Strength Tablets and Oral Powder Formulations to Establish Interchangeability with the 100 mg Tablet. Clin Drug Investig 2022; 42:657-668. [PMID: 35829925 PMCID: PMC9338003 DOI: 10.1007/s40261-022-01172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Venetoclax is an approved BCL-2 inhibitor, currently under evaluation in different hematological malignancies in adult and pediatric populations. Venetoclax is available as 10, 50, and 100 mg tablets. To provide an alternative to patients who find taking the commonly prescribed 100 mg tablet a challenge, the interchangeability of lower-strength tablets with the 100 mg tablet was investigated. Additionally, newly developed oral suspension powder formulations to facilitate dosing in pediatrics were evaluated. METHODS Pharmacokinetic data from 80 healthy female participants from three phase I studies were utilized to evaluate the bioavailability of (1) 10 and 50 mg tablets relative to a 100 mg tablet; (2) 0.72 and 7.2% (drug to total weight) oral powder formulations relative to the 100 mg tablet; and (3) oral powder formulations administered using different vehicles (apple juice, apple sauce, and yogurt) relative to water under fed conditions. RESULTS Bioavailability assessments at a 100 mg dose of venetoclax demonstrated bioequivalence across the 10, 50, and 100 mg tablet strengths. Oral powder formulations met the bioequivalence criteria (0.80-1.25) with respect to area under the concentration-time curve to time of the last measurable concentration (AUCt) and to infinite time (AUC∞) but exhibited a slightly lower maximum plasma concentration (Cmax). Exposure-response analyses were utilized to demonstrate that the lower Cmax observed with the powder formulations is not clinically meaningful. The delivery vehicles tested did not affect the bioavailability of venetoclax oral powder formulations. CONCLUSIONS The smaller-sized tablets (10 and 50 mg) and the newly developed oral powder formulations of venetoclax can be used interchangeably with the 100 mg tablets to improve the patients' experience, while maintaining adequate exposure. CLINICAL TRIALS IDENTIFIERS: NCT01682616, 11 September 2012; NCT02005471, 9 December 2013; NCT02242942, 17 September 2014; NCT02203773, 30 July 2014; NCT02287233, 10 November 2014; NCT02993523, 15 December 2016; NCT03069352, 3 March 2017.
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Affiliation(s)
- Mohamed Badawi
- Clinical Pharmacology and Pharmacometrics (R4PK/AP31), AbbVie Inc, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA
| | - Xin Chen
- Data and Statistical Sciences, AbbVie Inc, North Chicago, IL, USA
| | - Patrick Marroum
- Clinical Pharmacology and Pharmacometrics (R4PK/AP31), AbbVie Inc, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA
| | - Ahmed A Suleiman
- Clinical Pharmacology and Pharmacometrics, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Sven Mensing
- Clinical Pharmacology and Pharmacometrics, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Anette Koenigsdorfer
- Drug Product Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Julia Teresa Schiele
- Drug Product Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Tammy Palenski
- Clinical Development, AbbVie Inc, North Chicago, IL, USA
| | - Divya Samineni
- Clinical Pharmacology, Genentech, Inc, South San Francisco, CA, USA
| | - David Hoffman
- Data and Statistical Sciences, AbbVie Inc, North Chicago, IL, USA
| | - Rajeev Menon
- Clinical Pharmacology and Pharmacometrics (R4PK/AP31), AbbVie Inc, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA
| | - Ahmed Hamed Salem
- Clinical Pharmacology and Pharmacometrics (R4PK/AP31), AbbVie Inc, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA.
- Clinical Pharmacy, Ain Shams University, Cairo, Egypt.
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Samineni D, Gibiansky L, Wang B, Vadhavkar S, Rajwanshi R, Tandon M, Sinha A, Al-Sawaf O, Fischer K, Hallek M, Salem AH, Li C, Miles D. Pharmacokinetics and Exposure-Response Analysis of Venetoclax + Obinutuzumab in Chronic Lymphocytic Leukemia: Phase 1b Study and Phase 3 CLL14 Trial. Adv Ther 2022; 39:3635-3653. [PMID: 35708885 PMCID: PMC9309146 DOI: 10.1007/s12325-022-02170-w] [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: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study aims to investigate pharmacokinetics (PK) and exposure-response parameters of the 400 mg once-daily venetoclax dose regimen in combination with obinutuzumab, which was approved for the first-line (1L) treatment of chronic lymphocytic leukemia (CLL) based on data from the phase 3 CLL14 study and the phase 1b dose-finding GP28331 study. METHODS Parameter estimates and uncertainty, which were estimated by a previously developed population PK (popPK) model, were used as informative priors for this analysis. They were re-estimated, and then used to evaluate additional covariate effects, describe venetoclax PK when administered with obinutuzumab, and provide empirical Bayes estimates of PK parameters and exposure. Exposure-progression-free survival (PFS) and exposure-safety relationships were assessed using data from CLL14, with steady-state nominal venetoclax exposure (CmeanSS,nominal) as the predictor variable. Exposure-safety analyses were conducted using logistic regression for selected treatment-emergent grade ≥ 3 adverse events (AEs) and serious AEs (SAEs). Dose intensities were summarized by tertiles of CmeanSS,nominal. RESULTS PK data from 274 patients (CLL14, n = 194; GP28331, n = 80) were included. The final model provided good fit of the observed data. Obinutuzumab co-administration, history of prior treatments, and disease severity at baseline had no appreciable influence on venetoclax steady-state exposure. No significant correlations were observed between venetoclax exposure and PFS, or between venetoclax exposure and the probability of treatment-emergent grade ≥ 3 neutropenia, grade ≥ 3 thrombocytopenia, grade ≥ 3 infections, and SAEs. Median dose intensities for venetoclax and obinutuzumab remained similar across venetoclax exposure tertiles. CONCLUSION PopPK and exposure-efficacy, exposure-safety, and exposure-tolerability analyses support the 400 mg once-daily venetoclax dose plus obinutuzumab for 1L treatment in patients with CLL. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers NCT02242942 and NCT02339181.
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Affiliation(s)
- Divya Samineni
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA.
| | | | - Bei Wang
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | | | | | | | | | - Othman Al-Sawaf
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, Cologne, Germany
| | - Kirsten Fischer
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, Cologne, Germany
| | - Ahmed Hamed Salem
- AbbVie Inc., North Chicago, IL, USA.,Department of Clinical Pharmacy, Ain Shams University, Cairo, Egypt
| | - Chunze Li
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | - Dale Miles
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
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Brackman D, Eckert D, Menon R, Salem AH, Potluri J, Smith BD, Wei AH, Hayslip J, Miles D, Mensing S, Gopalakrishnan S, Zha J. Venetoclax Exposure-Efficacy and Exposure-Safety Relationships in Patients with Treatment-Naïve Acute Myeloid Leukemia Who Are Ineligible for Intensive Chemotherapy. Hematol Oncol 2022; 40:269-279. [PMID: 35043428 PMCID: PMC9303465 DOI: 10.1002/hon.2964] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 01/11/2022] [Indexed: 11/11/2022]
Abstract
This study evaluated venetoclax population pharmacokinetics (popPK) in patients with treatment‐naïve acute myeloid leukemia and assessed the relationship between venetoclax exposure and clinical response for venetoclax in combination with either a hypomethylating agent (HMA) or low‐dose cytarabine (LDAC). A total of 771 patients who received venetoclax from 5 Phase 1–3 studies were included in the popPK model. Exposure‐response analyses included data from 575 patients for venetoclax/placebo plus HMA and 279 patients for venetoclax/placebo plus LDAC. The popPK model successfully characterized venetoclax plasma concentrations over time and confirmed venetoclax exposure did not vary significantly with age, weight, sex, mild to moderate hepatic impairment, or mild to severe renal impairment. Asian patients had 67% higher mean relative bioavailability than non‐Asian patients, however the range of exposures in Asian patients was similar to non‐Asian patients. For all efficacy endpoints with both treatment combinations, efficacy was higher in the venetoclax treatment groups compared with the respective control arm of placebo plus azacitidine or LDAC. Within patients who received venetoclax, no significant exposure‐efficacy relationships were identified for either treatment combination, indicating that the beneficial effects of venetoclax were already maximized in the dose ranges studied. There was no apparent effect of venetoclax exposure on treatment‐emergent Grade ≥3 thrombocytopenia or infections for either combination. Rates of treatment‐emergent Grade ≥3 neutropenia were higher in the venetoclax treatment arms compared with the respective control arms; however, within patients who received venetoclax, there was only a shallow relationship or no apparent relationship with venetoclax exposure for venetoclax plus HMA or LDAC, respectively. Along with the efficacy and safety data previously published, the exposure‐response analyses support the venetoclax dose regimens of 400 mg once daily (QD) plus HMA and 600 mg QD plus LDAC in treatment‐naïve AML patients who are ineligible for intensive chemotherapy.
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Affiliation(s)
| | | | | | | | | | - B Douglas Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Andrew H Wei
- The Alfred Hospital and Monash University, Melbourne, Australia
| | | | | | - Sven Mensing
- AbbVie Deutschland GmbH Co. KG, Ludwigshafen, Germany
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It's time to die: BH3 mimetics in solid tumors. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2021; 1868:118987. [PMID: 33600840 DOI: 10.1016/j.bbamcr.2021.118987] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/31/2022]
Abstract
The removal of cells by apoptosis is an essential process regulating tissue homeostasis. Cancer cells acquire the ability to circumvent apoptosis and survive in an unphysiological tissue context. Thereby, the Bcl-2 protein family plays a key role in the initiation of apoptosis, and overexpression of the anti-apoptotic Bcl-2 proteins is one of the molecular mechanisms protecting cancer cells from apoptosis. Recently, small molecules targeting the anti-apoptotic Bcl-2 family proteins have been identified, and with venetoclax the first of these BH3 mimetics has been approved for the treatment of leukemia. In solid tumors the anti-apoptotic Bcl-2 family proteins Mcl-1 and Bcl-xL are frequently overexpressed or genetically amplified. In this review, we summarize the role of Mcl-1 and Bcl-xL in solid tumors and compare the different BH3 mimetics targeting Mcl-1 or Bcl-xL.
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Bayesian Population Model of the Pharmacokinetics of Venetoclax in Combination with Rituximab in Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia: Results from the Phase III MURANO Study. Clin Pharmacokinet 2020; 58:1621-1634. [PMID: 31209657 DOI: 10.1007/s40262-019-00788-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Venetoclax is a selective B-cell lymphoma-2 (BCL-2) inhibitor approved for use as monotherapy or with rituximab in patients with chronic lymphocytic leukemia (CLL). The objectives of the current analysis of observed data from adult patients randomized to venetoclax-rituximab in the phase III MURANO study were to characterize venetoclax pharmacokinetics (PKs) using a Bayesian approach, evaluate whether a previously developed population PK model for venetoclax can describe the PKs of venetoclax when administered with rituximab, and to determine post hoc estimates of PK parameters for the exposure-response analysis. METHODS Parameter estimates and uncertainty estimated by a population PK model were used as priors. Additional covariate effects (CLL risk status, geographic region, and 17p deletion [del(17p)] status) were added to the model. The updated model was used to describe venetoclax PKs after repeated dosing in combination with rituximab, and to determine post hoc estimates of PK parameters for exposure-response analysis. RESULTS The PK analysis included 600 quantifiable venetoclax PK samples from 182 patients in the MURANO study. Model evaluation using standard diagnostic plots, visual predictive checks, and normalized prediction distribution error plots indicated no model deficiencies. There was no significant relationship between venetoclax apparent clearance (CL/F) and bodyweight, age, sex, mild and moderate hepatic and renal impairment, or coadministration of weak cytochrome P450 3A inhibitors. The chromosomal abnormality del(17p) and CLL risk status had no apparent effect on the PKs of venetoclax. A minimal increase in venetoclax CL/F (approximately 7%) was observed after coadministration with rituximab. CL/F was 30% lower in patients from Central and Eastern Europe (n = 60) or Asia (n = 4) compared with other regions (95% confidence interval [CI] 21-39%). Apparent central volume of distribution was 30% lower (95% CI 22-38%) in females (n = 56) compared with males (n = 126). No clinically significant impact of region or sex was observed on key safety and efficacy outcomes. CONCLUSIONS The Bayesian model successfully characterized venetoclax PKs over time and confirmed key covariates affecting PKs in the MURANO study. The model was deemed appropriate for further use in simulations and for generating individual patient PK parameters for subsequent exposure-response evaluation.
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