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Di Cosimo S, Pérez-García JM, Bellet M, Dalenc F, Gil Gil MJ, Ruiz-Borrego M, Gavilá J, Aguirre E, Schmid P, Marmé F, Gligorov J, Schneeweiss A, Albanell J, Zamora P, Wheatley D, Martínez de Dueñas E, Amillano K, Shimizu E, Sampayo-Cordero M, Cortés J, Llombart-Cussac A. Impact of coadministration of proton-pump inhibitors and palbociclib in hormone receptor-positive/HER2-negative advanced breast cancer. Breast 2024; 76:103761. [PMID: 38880077 PMCID: PMC11228587 DOI: 10.1016/j.breast.2024.103761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/28/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND The capsule formulation of CDK4/6 inhibitor palbociclib has reduced solubility at gastric pH > 4.5 and may have decreased activity when used with proton-pump inhibitors (PPI). Herein, we report the effect of PPI on palbociclib capsule activity and safety in the PARSIFAL study. METHODS First-line endocrine-sensitive, hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) patients received palbociclib capsules plus fulvestrant or letrozole. The primary endpoint was progression-free survival (PFS). This post-hoc analysis compared PPI use. Patients were PPI-naïve (N-PPI) if not on PPI during the study, and either early (E-PPI) or long-term PPI (LT-PPI) if on PPI at study entry or for at least ≥⅔ of treatment, respectively. PPI groups were not mutually exclusive. RESULTS Among 486 patients, 66.9 % were N-PPI, 13.2 % E-PPI, 18.7 % LT-PPI, and 11.5 % of the PPI users were defined as neither. Median PFS (mPFS) was 29.6 months in the study population, 28.7 months in N-PPI, 23.0 months in E-PPI (Hazard Ratio [HR] 1.5; 95%Confidence Interval [CI] 1.1-2.2; p = 0.024), and 23.0 months in LT-PPI (HR 1.4; 95%CI 1.0-1.9; p = 0.035). By landmark analysis, PPI use was associated with poorer mPFS at 3 and 12 months. Grade ≥3 hematological adverse events occurred in 71.7 % of N-PPI, 57.8 % of E-PPI (p = 0.021), and 54.9 % of LT-PPI (p = 0.003). Dose reductions and dosing delays due to hematological toxicity occurred in 70.8 % of N-PPI, 56.3 % of E-PPI (p = 0.018), and 52.7 % of LT-PPI (p = 0.002). CONCLUSIONS PPI use may reduce palbociclib capsule toxicity, dose modifications, and clinical activity in HR+/HER2- ABC.
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Affiliation(s)
- Serena Di Cosimo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, NJ, United States
| | - José Manuel Pérez-García
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, NJ, United States; International Breast Cancer Center (IBCC), Pangaea Oncology, Quirón Group, Barcelona, Spain
| | - Meritxell Bellet
- Vall d'Hebrón University Hospital, Medical Oncology Department, Spain; Vall d'Hebrón Institute of Oncology (VHIO), Barcelona, Spain
| | - Florence Dalenc
- Oncopole Claudius Regaud-IUCT, CRCT, Inserm, Department of Medical Oncology, Toulouse, France
| | - Miguel J Gil Gil
- Institut Català d'Oncologia, Breast Cancer Unit and Medical Oncology Department, IDIBELL, L'Hospitalet, Barcelona, Spain
| | - Manuel Ruiz-Borrego
- Hospital Universitario Virgen del Rocío, Medical Oncology Department, Seville, Spain
| | - Joaquín Gavilá
- Fundación Instituto Valenciano de Oncología, Medical Oncology Department, Valencia, Spain
| | - Elena Aguirre
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, NJ, United States
| | - Peter Schmid
- Barts ECMC, Barts Cancer Institute, Queen Mary University of London, Barts Hospital NHS Trust, London, United Kingdom
| | - Frederik Marmé
- University Hospital Mannheim, Germany; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie, AP-HP Sorbonne Université, Paris, France
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Joan Albanell
- Hospital del Mar, Medical Oncology, Barcelona, Spain
| | - Pilar Zamora
- Hospital Universitario La Paz, Medical Oncology Department, Madrid, Spain
| | | | | | - Kepa Amillano
- Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Eileen Shimizu
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, NJ, United States
| | - Miguel Sampayo-Cordero
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, NJ, United States
| | - Javier Cortés
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, NJ, United States; International Breast Cancer Center (IBCC), Pangaea Oncology, Quirón Group, Barcelona, Spain; Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - Antonio Llombart-Cussac
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, NJ, United States; Hospital Arnau de Vilanova, Valencia, Spain; Universidad Católica de Valencia, Valencia, Spain.
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Soledad Poetto A, Posocco B, Zanchetta M, Gagno S, Orleni M, Canil G, Alberti M, Puglisi F, Toffoli G. "A new LC-MS/MS method for the simultaneous quantification of abemaciclib, its main active metabolites M2 and M20, and letrozole for therapeutic drug monitoring". J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1207:123403. [PMID: 35940043 DOI: 10.1016/j.jchromb.2022.123403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022]
Abstract
Abemaciclib (ABEMA) is the last CDKi approved for the treatment of breast cancer. Adverse reactions to this drug are not experienced in the same manner by the entire patient population but in case of severe toxicity dose reductions and therapy discontinuation are required, suggesting that a TDM-guided treatment could be beneficial for these patients. ABEMA is extensively metabolized by the liver. The most abundant active metabolites are M2 and M20. This CDKi is administered together with anti-estrogen drugs, such as letrozole (LETRO). The aim of this work was to develop and validate a LC-MS/MS method for the simultaneous quantification of ABEMA, M2, M20, and LETRO. The chromatographic separation of the analytes was obtained using a SIL-20AC XR auto-sampler coupled to LC-20AD UFLC Prominence XR pumps (Shimadzu, Tokyo, Japan). The chromatographic column employed was an XTerra MS C18, (3,5 µm, 125 Å, 50x2.1 mm) coupled with a Security Guard Cartridge (MS C18, 125 Å, 3.9x5 mm) provided by Waters. Detection was performed by an API 4000 QTrap (SCIEX) mass spectrometer. The presented analytical method was fully validated according to EMA and FDA guidelines on bioanalytical method validation. Linearity was confirmed on 10 independent tests (R2 within 0.997-1.000) over the concentration ranges of 40-800 ng/mL for ABEMA, 10-200 ng/mL for M2 and M20, 20-400 ng/mL for LETRO. The method was applied to analyze plasma samples from patients enrolled in a clinical trial, collected at Cmin. Incurred sample reanalysis was performed on a set of 30 samples, confirming the reproducibility of the analytical method.
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Affiliation(s)
- Ariana Soledad Poetto
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; Doctoral School in Pharmacological Sciences, University of Padua, Lgo Meneghetti 2, 35131 Padova, Italy
| | - Bianca Posocco
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Martina Zanchetta
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Sara Gagno
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Marco Orleni
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; Doctoral School in Pharmacological Sciences, University of Padua, Lgo Meneghetti 2, 35131 Padova, Italy
| | - Giovanni Canil
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Martina Alberti
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
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Gebbia V, Valerio MR, Firenze A, Vigneri P. Abemaciclib: safety and effectiveness of a unique cyclin-dependent kinase inhibitor. Expert Opin Drug Saf 2020; 19:945-954. [PMID: 32552035 DOI: 10.1080/14740338.2020.1781814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The discovery and the clinical availability of novel cyclin-dependent kinases 4 and 6 inhibitors have profoundly changed the therapeutic scenario of metastatic hormone receptor-positive breast carcinoma. Among these inhibitors, abemaciclib can induce potent and sustained cell cycle arrest and immune system stimulation. AREAS COVERED This review summarizes the safety profile and clinical efficacy data on abemaciclib alone or in combination with aromatase inhibitors or fulvestrant in metastatic hormone receptor-positive breast carcinoma. The management of patients treated with abemaciclib is the object of this paper. EXPERT OPINION As shown in phase 2 and 3 clinical trials on efficacy and tolerability, abemaciclib is a potentially convenient, safe, and effective agent for the treatment of patients with advanced hormone receptor-positive patients. Orally administered abemaciclib in combination with aromatase inhibitors or fulvestrant has the potential to allow significant improvement in survival outcomes, quality of life, response rate, and duration of response even in poor prognosis subgroups. Adequate patients' information, clinical selection, and prompt, proactive management of side effects are mandatory.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer , Palermo, Italy.,Department of Internal Medicine "Promise", University of Palermo , Palermo, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Policlinic P. Giaccone, Palermo, University of Palermo , Palermo, Italy
| | - Alberto Firenze
- Risk Management Unit, Policlinic P. Giaccone, Palermo, University of Palermo , Palermo, Italy
| | - Paolo Vigneri
- Medical Oncology Unit, Policlinic "G. Rodolico", University of Catania , Catania, Italy
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Thakkar D, Kate AS. Update on metabolism of abemaciclib: In silico, in vitro, and in vivo metabolite identification and characterization using high resolution mass spectrometry. Drug Test Anal 2020; 12:331-342. [PMID: 31697023 DOI: 10.1002/dta.2725] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/23/2019] [Accepted: 10/24/2019] [Indexed: 12/19/2022]
Abstract
Abemaciclib was approved by the US Food and Drug Administration in 2015 as an advanced treatment for metastatic breast cancer. Identification and characterization of limited numbers of abemaciclib metabolites have been reported in the literature. Therefore, the current study focused on the investigation of the in vitro and in vivo metabolic fate of abemaciclib using high resolution mass spectrometry. Initially, a vulnerable site of metabolism was predicted by the Xenosite web predictor tool. Later, in vitro metabolites were identified from pooled rat liver microsomes, rat S9 fractions, and human liver microsomes. Finally, in vivo metabolites have been detected in plasma, urine, and feces matrix of male Sprague-Dawley rats. A total of 12 putative metabolites (11 phase I and 1 phase II) of abemaciclib and their metabolic pathways were proposed by considering accurate mass, mass fragmentation pattern, nitrogen rule, and ring double bonds of the detected metabolites. Abemaciclib was metabolized via hydroxylation, N-oxidation, N-dealkylation, oxidative deamination followed by reduction and sulfate conjugation. In the human liver microsomes, maximum numbers of metabolites (11 metabolites) were observed, from which M7, M8, M9, and M11 were human specific.
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Affiliation(s)
- Disha Thakkar
- National Institute of Pharmaceutical Education and Research-Ahmedabad, Palaj Gandhinagar Gujarat, India
| | - Abhijeet S Kate
- National Institute of Pharmaceutical Education and Research-Ahmedabad, Palaj Gandhinagar Gujarat, India
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Raschi E, De Ponti F. Strategies for Early Prediction and Timely Recognition of Drug-Induced Liver Injury: The Case of Cyclin-Dependent Kinase 4/6 Inhibitors. Front Pharmacol 2019; 10:1235. [PMID: 31708776 PMCID: PMC6821876 DOI: 10.3389/fphar.2019.01235] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
The idiosyncratic nature of drug-induced liver injury (DILI) represents a current challenge for drug developers, regulators and clinicians. The myriad of agents (including medications, herbals, and dietary supplements) with recognized DILI potential not only strengthens the importance of the post-marketing phase, when urgent withdrawal sometimes occurs for rare unanticipated liver toxicity, but also shows the imperfect predictivity of pre-clinical models and the lack of validated biomarkers beyond traditional, non-specific liver function tests. After briefly reviewing proposed key mechanisms of DILI, we will focus on drug-related risk factors (physiochemical and pharmacokinetic properties) recently proposed as predictors of DILI and use cyclin-dependent kinase 4/6 inhibitors, relatively novel oral anticancer medications approved for breast cancer, as a case study to discuss the feasibility of early detection of DILI signals during drug development: published data from pivotal clinical trials, unpublished post-marketing reports of liver adverse events, and pharmacokinetic properties will be used to provide a comparative evaluation of their liver safety and gain insight into drug-related risk factors likely to explain the observed differences.
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Affiliation(s)
- Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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