1
|
Simons E, Camidge DR. Lung Cancer Oncogene-Directed Therapy, Fertility, and Pregnancy. J Thorac Oncol 2024; 19:866-876. [PMID: 38185202 DOI: 10.1016/j.jtho.2024.01.003] [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: 09/06/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Alterations in the highly actionable lung cancer oncogenes, EGFR, ALK, and ROS1, occur across the age spectrum. Pregnancy and plans for motherhood consequently overlap with diagnoses of advanced oncogene-driven NSCLC. Guidelines for cytotoxic agents and pregnancy are well established. Nevertheless, accessible data on targeted lung cancer therapy during pregnancy or egg retrieval has not been collated previously, nor have the issues of reproduction in the setting of specific oncogene-addicted advanced NSCLC been widely discussed. METHODS We performed a narrative review of ex vivo placenta perfusion studies, pharmacologic characteristics, mutagenicity, animal embryo-fetal development studies, and case reports of pathways to motherhood, pregnancies, and egg retrieval while on EGFR-, ALK-, or ROS1-targeted therapy. RESULTS EGFR inhibitors may reduce female fertility while on therapy owing to decrease in corpora lutea. Odds of pregnancy in women on EGFR and ALK inhibitors may be reduced owing to potential increase in postimplantation loss found in animals. Crizotinib and entrectinib exhibit in vitro mutagenic potential. Several effects on human pregnancies have been noted; however, 11 EGFR and ALK tyrosine kinase inhibitor-exposed infants have been documented free of substantial adverse health effects by ages 4 months to 2 years. Successful gestational surrogacy has been reported in two women treated with crizotinib. Adoption and termination approaches have also been undertaken by some patients. CONCLUSIONS Reproduction may not be out of reach for some patients with advanced NSCLC. Additional explorations of the impact and optimal timing of targeted therapy in egg capture and pregnancy are needed. Wider scientific and societal discussion about the issues of reproduction in advanced NSCLC is warranted.
Collapse
Affiliation(s)
- Emily Simons
- University of Colorado Cancer Center, Aurora, Colorado; Banner MD Anderson Cancer Center, Loveland, Colorado.
| | | |
Collapse
|
2
|
Eliesen GA, Fransen M, van Hove H, van den Broek PH, Greupink R. Placental transfer of tofacitinib in the ex vivo dual-side human placenta perfusion model. Curr Res Toxicol 2024; 6:100149. [PMID: 38292667 PMCID: PMC10825226 DOI: 10.1016/j.crtox.2024.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Tofacitinib is a small molecule Janus kinase (JAK) inhibitor, introduced to the European market in 2017, for the treatment of rheumatoid arthritis, psoriatic arthritis and ulcerative colitis. In the treatment of women with autoimmune diseases, pregnancy is a relevant issue, as such diseases typically affect women in their reproductive years. Currently, there is limited data on the use of tofacitinib during pregnancy. To estimate the extent of placental transfer in the absence of clinical data, we conducted ex vivo dual-side perfused human placental cotyledon perfusions. Term placentas were perfused for 180 min with tofacitinib (100 nM, added to the maternal circuit) in a closed-closed configuration. At the end of the perfusions, drug concentrations in the maternal and fetal reservoirs were near equilibrium, at 35.6 ± 5.5 and 24.8 ± 4.7 nM, respectively. Transfer of tofacitinib was similar to that observed for the passive diffusion marker antipyrine (100 µg/mL, added to the maternal reservoir). Final antipyrine maternal and fetal concentrations amounted to 36.9 ± 3.0 and 36.7 ± 1.3 µg/mL, respectively. In conclusion, in the ex vivo perfused placenta tofacitinib traverses the placental barrier rapidly and extensively. This suggests that substantial fetal tofacitinib exposure will take place after maternal drug dosing.
Collapse
Affiliation(s)
- Gaby A.M. Eliesen
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
- Centre for Safety of Substances and Products, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Milou Fransen
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hedwig van Hove
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Petra H.H. van den Broek
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rick Greupink
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
3
|
Predicting fetal exposure of crizotinib during pregnancy: Combining human ex vivo placenta perfusion data with physiologically-based pharmacokinetic modeling. Toxicol In Vitro 2022; 85:105471. [PMID: 36096459 DOI: 10.1016/j.tiv.2022.105471] [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: 04/22/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/22/2022]
Abstract
Commercially available physiologically-based pharmacokinetic (PBPK) modeling platforms increasingly allow estimations of fetal exposure to xenobiotics. We aimed to explore a physiology-based approach in which literature data from ex vivo placenta perfusion studies are used to parameterize Simcyp's pregnancy-PBPK (p-PBPK) model, taking crizotinib as an example. First, a physiologically-based semi-mechanistic placenta (PBMP) model was developed in MATLAB to analyze placenta perfusion data of crizotinib. Mixed-effects modeling was performed to derive intrinsic unbound clearance values across the maternal-placental barrier and fetal-placental barrier. Values were then used for parameterization of the p-PBPK model. The PBMP model adequately described the perfusion data. Clearance was estimated to be 71 mL/min and 535 mL/min for the maternal placental uptake and efflux, and 8 mL/min and 163 mL/min for fetal placental uptake and efflux, respectively. For oral dosing of 250 mg twice daily, p-PBPK modeling predicted a Cmax and AUC0-τ of 0.08 mg/L and 0.78 mg/L*h in the umbilical vein at steady-state, respectively. In placental tissue, a Cmax of 5.04 mg/L was predicted. In conclusion, PBMP model-based data analysis and the associated p-PBPK modeling approach illustrate how ex vivo placenta perfusion data may be used for fetal exposure predictions.
Collapse
|
4
|
van Hove H, Mathiesen L, Freriksen J, Vähäkangas K, Colbers A, Brownbill P, Greupink R. Placental transfer and vascular effects of pharmaceutical drugs in the human placenta ex vivo: A review. Placenta 2022; 122:29-45. [DOI: 10.1016/j.placenta.2022.03.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
|
5
|
Boudy AS, Grausz N, Selleret L, Gligorov J, Thomassin-Naggara I, Touboul C, Daraï E, Cadranel J. Use of tyrosine kinase inhibitors during pregnancy for oncogenic-driven advanced non-small cell lung carcinoma. Lung Cancer 2021; 161:68-75. [PMID: 34543940 DOI: 10.1016/j.lungcan.2021.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Lung cancer associated with pregnancy is rare but on the increase. The use of tyrosine kinase inhibitor (TKI) therapy for advanced oncogenic-driven non-small cell lung carcinoma (NSCLC) has improved overall survival. Oncological and obstetric outcomes of patients diagnosed with NSCLC and treated by TKIs during pregnancy have been poorly evaluated. METHODS Three cases of NSCLC treated by TKIs during pregnancy were collected from the prospective database of the Cancer Associé à La Grossesse (CALG) network (France) in addition to eight cases identified by a systematic review performed between 2000 and 2021. RESULTS Among the eleven reported patients, six received an EGFR- and five an ALK-TKI. All patients were young nonsmokers and four had brain metastases at diagnosis. TKI treatment was initiated during the first trimester for three patients. Premature delivery was induced in 10/11 patients. Anamnios occurred in one patient treated by osimertinib and trastuzumab. Five newborns were hypotrophic. No newborn malformations were observed. Diffusion of the TKIs, confirmed by blood cord sampling, represented about 1/3 (EGFR-TKI) and 1/8 (ALK-TKI) of the maternal concentration. No developmental abnormalities were observed in the children (follow-up 30 months). The anti-tumor efficacy and tolerance of TKIs, when reported, appears similar to that described in the general population. CONCLUSIONS Our results support the rationale for using TKIs during pregnancy, both in terms of maternal NSCLC disease control and the relatively mild effects on the fetus. Our data will serve to better inform patients about the risks associated with TKIs used during pregnancy, contributing to shared decision making.
Collapse
Affiliation(s)
- Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France.
| | - Noémie Grausz
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France
| | - Joseph Gligorov
- Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Isabelle Thomassin-Naggara
- Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France; Department of Radiology, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Jacques Cadranel
- Department of Pulmonology and Thoracic Oncology, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Tenon and GRC 04 Theranoscan, Sorbonne Université, Paris 75970, France.
| |
Collapse
|
6
|
Yang L, He YT, Kang J, Zheng MY, Chen ZH, Yan HH, Zhang XC, Yang JJ, Wu YL, Zhou Q. Clinical features and intervention timing in patients with pregnancy-associated non-small-cell lung cancer. J Thorac Dis 2021; 13:4125-4136. [PMID: 34422342 PMCID: PMC8339795 DOI: 10.21037/jtd-21-234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/27/2021] [Indexed: 12/18/2022]
Abstract
Background There is no standard procedure available to diagnose and treat with pregnancy-associated non-small cell lung cancer (NSCLC). The present study was to investigate the clinical and molecular features, and the proper intervention timing for this population. Methods This is a retrospective, pooled analysis. Cases from Guangdong Lung Cancer Institute and other published cases were collected and reviewed. The overall survival (OS) was analyzed according to the diagnosis timing, the treatment timing and the molecular character. The safety profile during pregnancy was also evaluated. Results Seventy-seven cases were collected including 11 patients from our center. The anaplastic lymphoma kinase (ALK) gene rearrangement and epidermal growth factor receptor (EGFR) mutation rates were 47% and 32%, respectively. The OS of patients treated during pregnancy, after delivery, and those not treated differed significantly [12 months vs. not reached (NR) vs. 1 month; P<0.001]. However, the OS between patients treated during pregnancy and after delivery was similar (P=0.173). Patients with ALK or EGFR exhibited a significantly better OS than those with wild-type [NR vs. 22 months vs. 8 months; P<0.001; hazard ratio (HR) =0.02, 95% confidence interval (CI): 0.00–0.22; HR =0.08, 95% CI: 0.01–0.76]. Fetal complications were observed in babies whose mothers were treated during pregnancy. Conclusions The pregnancy-associated NSCLC population exhibited a high prevalence of driver genes and a promising effect of targeted therapy. No significant difference in the OS was observed between patients treated during pregnancy and patients treated after delivery.
Collapse
Affiliation(s)
- Lei Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yun-Ting He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Kang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming-Ying Zheng
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi-Hong Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xu-Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin-Ji Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
7
|
Benoit L, Mir O, Vialard F, Berveiller P. Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents. Cancers (Basel) 2021; 13:1238. [PMID: 33799824 PMCID: PMC8000411 DOI: 10.3390/cancers13061238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
The occurrence of cancer during pregnancy is observed in 1 in 1000 pregnancies and is expected to increase given the trend of delaying childbearing. While breast cancer is the most common, the incidence of other cancers, such as cervical, ovarian, and lung cancers as well as hemopathies and melanomas, is also increasing. Thus, cancer occurrence in pregnant women raises questions of management during pregnancy and, especially, assessment of the treatment benefit-risk ratio to ensure optimal management for the mother while ensuring the safety of the fetus. Chemotherapy remains a cornerstone of cancer management. If the use of anticancer agents appears possible during pregnancy, while avoiding the first trimester, the extent of placental transfer of different anticancer agents varies considerably thereafter. Furthermore, the significant physiological pharmacokinetic variations observed in pregnant women may have an impact on the placental transfer of anticancer agents. Given the complexity of predicting placental transfer of anticancer agents, preclinical studies are therefore mandatory. The aim of this review was to provide updated data on in vivo and ex vivo transplacental transfer of anticancer agents used in the management of the most common pregnancy-associated cancers to better manage these highly complex cases.
Collapse
Affiliation(s)
- Laure Benoit
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Gynecology and Obstetrics, 78300 Poissy, France;
| | - Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, 94800 Villejuif, France;
| | - François Vialard
- Université Paris-Saclay, UMR 1198, INRAE, BREED, RHuMA, 78350 Jouy-en-Josas, France;
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Genetics, 78300 Poissy, France
| | - Paul Berveiller
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Gynecology and Obstetrics, 78300 Poissy, France;
- Université Paris-Saclay, UMR 1198, INRAE, BREED, RHuMA, 78350 Jouy-en-Josas, France;
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
| |
Collapse
|
8
|
Lorenzi E, Simonelli M, Persico P, Dipasquale A, Santoro A. Risks of molecular targeted therapies to fertility and safety during pregnancy: a review of current knowledge and future needs. Expert Opin Drug Saf 2021; 20:503-521. [PMID: 33600273 DOI: 10.1080/14740338.2021.1893299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION As the population of young cancer survivors is increasing and a trend toward postponing pregnancy later in life is reported, more efforts are focused toward understanding treatment-induced sequelae, in particular, the effects of cancer and/or treatment on fertility. AREA COVERED Whereas the fertility risk of cytotoxic agents for both men and women is well recognized, the impact of molecular-targeted therapy (MTT) on fertility parameters, their teratogenic potential and pregnancy outcome/management in case of an accidental exposure are not established. We update available clinical data on the impact of new MTTs on fertility in both sexes, their potential teratogenic effects and the outcome of pregnancy during accidental exposure. Agents are categorized by class and the potential relevance of their target signaling pathways to gonadal maturation. EXPERT OPINION The majority of MTTs have worrying preclinical data discouraging their use during pregnancy and reinforcing the idea that they can induce impairment in gonadal function. However, it does not mean that all MTTs result in permanent infertility and that they should be completely avoided during pregnancy. The current review provides a critical evaluation on the most commonly used MTTs, offering a possible guide for clinicians.
Collapse
Affiliation(s)
- Elena Lorenzi
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Matteo Simonelli
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Pasquale Persico
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Angelo Dipasquale
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Armando Santoro
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| |
Collapse
|
9
|
Schakenraad L, Van Es MJ, Meerman JJ, Van den Broek PHH, Van Hove H, Van Drongelen J, Eliesen GAM, Russel FGM, Greupink R. Transfer of uremic solutes across the human term placenta: An ex vivo study in the dual-side perfused cotyledon. Placenta 2021; 104:220-231. [PMID: 33429119 DOI: 10.1016/j.placenta.2020.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/25/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION An increasing number of women becomes pregnant while suffering from chronic kidney disease (CKD). As a result of decreased renal function, uremic solutes circulate at high levels in the maternal circulation. This study aimed to acquire more knowledge about the placental transfer of uremic solutes across the human placenta. METHODS Placental transfer was studied in healthy term placentas, via the ex vivo dual-side human cotyledon perfusion technique (closed-closed set-up for both maternal and fetal circulations). Uremic solute concentrations in maternal and fetal perfusates were measured via LC-MS/MS over 180 min of perfusion. RESULTS We found that the studied compounds demonstrated different degrees of placental transfer. Fetal-to-maternal perfusate ratios at t = 180 min were for anthranilic acid 1.00 ± 0.02, indole-3-acetic acid 0.47 ± 0.08, hippuric acid 0.36 ± 0.18, l-arabinitol 0.33 ± 0.04, indoxyl sulfate 0.33 ± 0.11, neopterin 0.28 ± 0.14 and kynurenic acid 0.13 ± 0.03. All uremic solutes studied also emerged in the perfusates when cotyledons were perfused in the absence of uremic solute concentrations added to the maternal reservoir. For kynurenin these concentrations were so high, it complicated the calculation of a transfer ratio for the exogenously administered compound. DISCUSSION After 180 min of exposure the extent of placental transfer differs substantially for the solutes studied, reflecting different transfer rates. Future studies should investigate to what extent specific uremic solutes reach the fetal circulation in vivo and how they may interfere with organ function and development of the unborn child.
Collapse
Affiliation(s)
- L Schakenraad
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M J Van Es
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J J Meerman
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P H H Van den Broek
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H Van Hove
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J Van Drongelen
- Department of Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - G A M Eliesen
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - F G M Russel
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R Greupink
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|
10
|
Eliesen GAM, van Hove H, Meijer MH, van den Broek PHH, Pertijs J, Roeleveld N, van Drongelen J, Russel FGM, Greupink R. Toxicity of anticancer drugs in human placental tissue explants and trophoblast cell lines. Arch Toxicol 2020; 95:557-571. [PMID: 33083868 PMCID: PMC7870638 DOI: 10.1007/s00204-020-02925-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/05/2020] [Indexed: 12/28/2022]
Abstract
The application of anticancer drugs during pregnancy is associated with placenta-related adverse pregnancy outcomes. Therefore, it is important to study placental toxicity of anticancer drugs. The aim of this study was to compare effects on viability and steroidogenesis in placental tissue explants and trophoblast cell lines. Third trimester placental tissue explants were exposed for 72 h (culture day 4–7) to a concentration range of doxorubicin, paclitaxel, cisplatin, carboplatin, crizotinib, gefitinib, imatinib, or sunitinib. JEG-3, undifferentiated BeWo, and syncytialised BeWo cells were exposed for 48 h to the same drugs and concentrations. After exposure, tissue and cell viability were assessed and progesterone and estrone levels were quantified in culture medium. Apart from paclitaxel, all compounds affected both cell and tissue viability at clinically relevant concentrations. Paclitaxel affected explant viability moderately, while it reduced cell viability by 50% or more in all cell lines, at 3–10 nM. Doxorubicin (1 µM) reduced viability in explants to 83 ± 7% of control values, whereas it fully inhibited viability in all cell types. Interference with steroid release in explants was difficult to study due to large variability in measurements, but syncytialised BeWo cells proved suitable for this purpose. We found that 1 µM sunitinib reduced progesterone release to 76 ± 6% of control values, without affecting cell viability. While we observed differences between the models for paclitaxel and doxorubicin, most anticancer drugs affected viability significantly in both placental explants and trophoblast cell lines. Taken together, the placenta should be recognized as a potential target organ for toxicity of anticancer drugs.
Collapse
Affiliation(s)
- Gaby A M Eliesen
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, (Route 137), PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Hedwig van Hove
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, (Route 137), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maartje H Meijer
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, (Route 137), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Petra H H van den Broek
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, (Route 137), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jeanne Pertijs
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, (Route 137), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans G M Russel
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, (Route 137), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rick Greupink
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, (Route 137), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Zhang X, Cheng X, Yu Y, Lei B, Yu Y. Insight into the transplacental transport mechanism of methoxylated polybrominated diphenyl ethers using a BeWo cell monolayer model. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 265:114836. [PMID: 32454380 DOI: 10.1016/j.envpol.2020.114836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/02/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
Methoxylated polybrominated diphenyl ethers (MeO-PBDEs), a type of emerging environmental contaminants, can accumulate through the food chain and eventually enter the human body. For pregnant women, these chemicals may be transplacentally transported to their fetuses, causing early intrauterine exposure. This study was designed to explore the transport process and characteristics of MeO-PBDEs using a BeWo cell monolayer model to simulate the placental barrier effect. Concentration-dependent transplacental transport indicates that the transport of MeO-PBDEs may be dominated by passive diffusion within the studied concentration range. According to the apparent permeability coefficients, MeO-BDE congeners investigated can be classified as poorly transported compounds, with the exception of MeO-BDE28. Time-dependent transplacental transport was observed (R2 = 0.97-0.99), which showed that the intracellular accumulation of MeO-PBDEs followed pseudo-first-order kinetics process. The transport process of MeO-PBDEs in the BeWo cell assay was not found to be sensitive to the pH of 6.5-7.4. An efflux transporter, breast cancer resistance protein, may be involved in the transport process of some MeO-PBDE congeners, and influx transporters, including organic anion transporters and organic cation transporters, may also be involved in the transport process. Although the present results indicated the possible transplacental transport mechanism, more molecular biological studies should be conducted to advance the understanding of the transport mechanisms.
Collapse
Affiliation(s)
- Xiaolan Zhang
- Institute of Environmental Pollution and Health, School of Environmental and Chemical Engineering, Shanghai University, Shanghai, 200444, PR China
| | - Xiaomeng Cheng
- Institute of Environmental Pollution and Health, School of Environmental and Chemical Engineering, Shanghai University, Shanghai, 200444, PR China
| | - Yuling Yu
- Institute of Environmental Pollution and Health, School of Environmental and Chemical Engineering, Shanghai University, Shanghai, 200444, PR China
| | - Bingli Lei
- Institute of Environmental Pollution and Health, School of Environmental and Chemical Engineering, Shanghai University, Shanghai, 200444, PR China
| | - Yingxin Yu
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, Guangzhou Key Laboratory Environmental Catalysis and Pollution Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, PR China; Institute of Environmental Pollution and Health, School of Environmental and Chemical Engineering, Shanghai University, Shanghai, 200444, PR China.
| |
Collapse
|
12
|
Freriksen JJM, Schalkwijk S, Colbers AP, Abduljalil K, Russel FGM, Burger DM, Greupink R. Assessment of Maternal and Fetal Dolutegravir Exposure by Integrating Ex Vivo Placental Perfusion Data and Physiologically-Based Pharmacokinetic Modeling. Clin Pharmacol Ther 2020; 107:1352-1361. [PMID: 31868223 PMCID: PMC7325314 DOI: 10.1002/cpt.1748] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 12/13/2022]
Abstract
Antiretroviral therapy during pregnancy reduces the risk of vertical HIV‐1 transmission. However, drug dosing is challenging as pharmacokinetics (PK) may be altered during pregnancy. We combined a pregnancy physiologically‐based pharmacokinetic (PBPK) modeling approach with data on placental drug transfer to simulate maternal and fetal exposure to dolutegravir (DTG). First, a PBPK model for DTG exposure in healthy volunteers was established based on physiological and DTG PK data. Next, the model was extended with a fetoplacental unit using transplacental kinetics obtained by performing ex vivo dual‐side human cotyledon perfusion experiments. Simulations of fetal exposure after maternal dosing in the third trimester were in accordance with clinically observed DTG cord blood data. Furthermore, the predicted fetal trough plasma concentration (Ctrough) following 50 mg q.d. dosing remained above the concentration that results in 90% of viral inhibition. Our integrated approach enables simulation of maternal and fetal DTG exposure, illustrating this to be a promising way to assess DTG PK during pregnancy.
Collapse
Affiliation(s)
- Jolien J M Freriksen
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stein Schalkwijk
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela P Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Frans G M Russel
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rick Greupink
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Puccini A, Marín-Ramos NI, Bergamo F, Schirripa M, Lonardi S, Lenz HJ, Loupakis F, Battaglin F. Safety and Tolerability of c-MET Inhibitors in Cancer. Drug Saf 2019; 42:211-233. [PMID: 30649748 PMCID: PMC7491978 DOI: 10.1007/s40264-018-0780-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The role of aberrant hepatocyte growth factor receptor (c-MET, also known as tyrosine-protein kinase MET)/hepatocyte growth factor (HGF) signaling in cancer progression and invasion has been extensively studied. c-MET inhibitors have shown promising pre-clinical and early phase clinical trial anti-tumor activity in several tumor types, although results of most phase III trials with these agents have been negative. To date, two small molecule c-MET inhibitors, cabozantinib and crizotinib, have been approved by regulatory authorities for the treatment of selected cancer types, but several novel c-MET inhibitors (either monoclonal antibodies or small molecule c-MET tyrosine kinase inhibitors) and treatment combinations are currently under study in different settings. Here we provide an overview of the mechanism of action and rationale of c-MET inhibition in cancer, the efficacy of approved agents, and novel promising c-MET-inhibitors and novel targeted combination strategies under development in different cancer types, with a focus on the safety profile and tolerability of these compounds.
Collapse
Affiliation(s)
- Alberto Puccini
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 5410, Los Angeles, CA, 90033, USA
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nagore I Marín-Ramos
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Francesca Bergamo
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marta Schirripa
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Sara Lonardi
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 5410, Los Angeles, CA, 90033, USA
| | - Fotios Loupakis
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Francesca Battaglin
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 5410, Los Angeles, CA, 90033, USA.
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| |
Collapse
|
14
|
Jensen KH, Persson G, Storgaard L, Nielsen BB, Pedersen BW, Maroun LL, Huitema A, Pøhl M. Antineoplastic treatment with crizotinib during pregnancy: a case report. Acta Oncol 2019; 58:121-122. [PMID: 30101631 DOI: 10.1080/0284186x.2018.1497302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Kristian H. Jensen
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Gitte Persson
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Storgaard
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitte B. Nielsen
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Berit W. Pedersen
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisa L. Maroun
- Department of Pathology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Alwin Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht Utrecht University, Utrecht, The Netherlands
| | - Mette Pøhl
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
15
|
Clinical Pharmacokinetics of Anaplastic Lymphoma Kinase Inhibitors in Non-Small-Cell Lung Cancer. Clin Pharmacokinet 2018; 58:403-420. [DOI: 10.1007/s40262-018-0689-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
16
|
Padrão E, Melo C, Fernandes G, Magalhães A. Lung cancer in pregnancy – Report of a case treated with crizotinib. Pulmonology 2018; 24:205-207. [DOI: 10.1016/j.pulmoe.2018.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/26/2018] [Indexed: 12/14/2022] Open
|
17
|
Ke AB, Greupink R, Abduljalil K. Drug Dosing in Pregnant Women: Challenges and Opportunities in Using Physiologically Based Pharmacokinetic Modeling and Simulations. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2018; 7:103-110. [PMID: 29349870 PMCID: PMC5824116 DOI: 10.1002/psp4.12274] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 01/04/2023]
Abstract
The unmet medical need of providing evidence‐based pharmacotherapy for pregnant women is recognized by the regulatory bodies. Physiologically based pharmacokinetic (PBPK) modeling offers an attractive platform to quantify anticipated changes in the pharmacokinetics (PKs) of drugs during pregnancy. Recent publications applying a pregnancy PBPK module to the prediction of maternal and fetal exposure of drugs are summarized. Future opportunities to use PBPK models to predict breast milk exposure and assess human fetotoxicity risks are presented.
Collapse
Affiliation(s)
- Alice Ban Ke
- Simcyp Limited (a Certara company), Sheffield, UK
| | - Rick Greupink
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | | |
Collapse
|