1
|
Su HC, Min J, Song Y, Liu LL, Liu LN, Zhang HL. A bioequivalence study of trifluridine/tipiracil tablets in Chinese metastatic colorectal cancer patients under fed conditions. Cancer Chemother Pharmacol 2023; 91:167-177. [PMID: 36622402 DOI: 10.1007/s00280-022-04501-8] [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: 09/14/2022] [Accepted: 12/18/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Colorectal cancer (CRC) is the second most common cause of cancer death worldwide. Trifluridine (FTD) remained at higher concentrations longer when administered along with tipiracil (TPI) compared with FTD alone. Lonsurf® is a combination formulation consisting of FTD and TPI. This study aimed to investigate the bioequivalence of FTD/TPI formulations in Chinese metastatic colorectal cancer (mCRC) patients. METHODS In this phase I, randomized, open-label, single-dose, two-sequence, four-cycle crossover study in mCRC patients, the bioequivalence of 60 mg (20 mg tablet, 3 tablets) of the test formulation and the reference formulation (Lonsurf®) was evaluated. Due to its high variability, the method of reference-scaled average bioequivalence (RSABE) was used to investigate the bioequivalence of the test and reference formulations. RESULTS Thirty-two patients were enrolled. 78.1% of the subjects were male, and the mean (standard deviation) age was 53.9 (SD = ± 9.0) years old. The time to reach the maximum plasma concentration (Tmax) was almost 2.0 h post-dose. The geometric least-squares mean ratios (GMRs) (test/reference) of Cmax and AUC0-t for FTD were 95.3% and 102.9%, respectively, with 90% confidence intervals (CIs) for the natural log-transformed ratios of Cmax and AUC0-t of 90.0-100.9% and 99.9-105.9%, while the GMRs of Cmax and AUC0-t for TPI were 95.7% and 100.7%, respectively, with 90% CIs of 90.5-101.2% and 97.0-104.7%. In addition, the GMRs of Cmax and AUC0-t for FTD's major metabolite, trifluorothymine (FTY), were 94.8 (90% CI 90.3-99.5%) and 99.33 (90% CI 96.9-101.9%), respectively. These were in accord with the FDA bioequivalence definition interval of 80-125%. CONCLUSION The test and reference FTD/TPI formulations were bioequivalent in Chinese mCRC patients under fed conditions.
Collapse
Affiliation(s)
- Hai-Chuan Su
- Department of Oncology, The Second Affiliated Hospital of Air Force Medical University, 1 Xinsi Road, Xi'an, 710038, People's Republic of China
| | - Jie Min
- Department of Oncology, The Second Affiliated Hospital of Air Force Medical University, 1 Xinsi Road, Xi'an, 710038, People's Republic of China
| | - Yang Song
- Department of Oncology, The Second Affiliated Hospital of Air Force Medical University, 1 Xinsi Road, Xi'an, 710038, People's Republic of China
| | - Li-Li Liu
- Department of Oncology, The Second Affiliated Hospital of Air Force Medical University, 1 Xinsi Road, Xi'an, 710038, People's Republic of China
| | - Lin-Na Liu
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, 1 Xinsi Road, Xi'an, 710038, People's Republic of China.
| | - He-Long Zhang
- Department of Oncology, The Second Affiliated Hospital of Air Force Medical University, 1 Xinsi Road, Xi'an, 710038, People's Republic of China.
| |
Collapse
|
2
|
Van Cutsem E, Hochster H, Shitara K, Mayer R, Ohtsu A, Falcone A, Yoshino T, Doi T, Ilson D, Arkenau HT, George B, Benhadji K, Makris L, Tabernero J. Pooled safety analysis from phase III studies of trifluridine/tipiracil in patients with metastatic gastric or gastroesophageal junction cancer and metastatic colorectal cancer. ESMO Open 2022; 7:100633. [PMID: 36455504 PMCID: PMC9808443 DOI: 10.1016/j.esmoop.2022.100633] [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: 08/10/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Trifluridine/tipiracil (FTD/TPI) showed clinical benefit, including improved survival and manageable safety in previously treated patients with metastatic colorectal (mCRC) or gastric/gastroesophageal junction (mGC/GEJC) cancer in the phase III RECOURSE and TAGS trials, respectively. A pooled analysis was conducted to further characterize FTD/TPI safety, including management of haematologic toxicities and use in patients with renal or hepatic impairment. PATIENTS AND METHODS Adults with ≥2 prior regimens for advanced mGC/GEJC or mCRC were randomized (2 : 1) to FTD/TPI [35 mg/m2 twice daily days 1-5 and 8-12 (28-day cycle); same dosage in both trials] or placebo plus best supportive care. Adverse events (AEs) were summarized in the safety population (patients who received ≥1 dose) and analysed by renal/hepatic function. RESULTS TAGS and RECOURSE included 335 and 533 FTD/TPI-treated and 168 and 265 placebo-treated patients, respectively. Overall safety of FTD/TPI was similar in TAGS and RECOURSE. Haematologic (neutropenia, anaemia) and gastrointestinal (nausea, diarrhoea) AEs were most commonly observed. Laboratory-assessed grade 3-4 neutropenia occurred in 37% (TAGS)/38% (RECOURSE) of FTD/TPI-treated patients (median onset: 29 days/55 days), and 96% (TAGS)/97% (RECOURSE) of cases resolved regardless of renal/hepatic function. Supportive medications for neutropenia were received by 17% (TAGS) and 9% (RECOURSE); febrile neutropenia was reported in 2% and 4%, respectively. Overall grade ≥3 AEs were more frequent in patients with moderate renal impairment [81% (TAGS); 85% (RECOURSE)] versus normal renal function (74%; 67%); anaemia and neutropenia were more common in patients with renal impairment. FTD/TPI safety (including haematologic AEs) was consistent across patients with normal and mildly impaired hepatic function. CONCLUSIONS These results support FTD/TPI as a well-tolerated treatment in patients with mGC/GEJC or mCRC, with a consistent safety profile. Safety was largely similar in patients with normal or mildly impaired renal/hepatic function; however, patients with renal impairment should be monitored for haematologic toxicities.
Collapse
Affiliation(s)
- E. Van Cutsem
- University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium,Correspondence to: Prof. Eric Van Cutsem, Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg/Leuven & KU Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel: +32-16-34-42-18; Fax: +32-16-34-44-19
| | - H. Hochster
- Rutgers Cancer Institute, New Brunswick, USA
| | - K. Shitara
- National Cancer Center Hospital East, Chiba, Japan
| | - R. Mayer
- Dana-Farber Cancer Institute, Boston, USA
| | - A. Ohtsu
- National Cancer Center Hospital East, Chiba, Japan
| | - A. Falcone
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - T. Yoshino
- National Cancer Center Hospital East, Chiba, Japan
| | - T. Doi
- National Cancer Center Hospital East, Chiba, Japan
| | - D.H. Ilson
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - H.-T. Arkenau
- Sarah Cannon Research Institute, Cancer Institute, University College London, London, UK
| | - B. George
- Medical College of Wisconsin, Milwaukee, USA
| | | | | | - J. Tabernero
- Vall d’Hebron Hospital Campus and Vall d’Hebron Institute of Oncology (VHIO), UVic-UCC, IOB-Quiron, Barcelona, Spain
| |
Collapse
|
3
|
Saif MW, Becerra CR, Fakih MG, Sun W, Popovic L, Krishnamurthi S, George TJ, Rudek MA, Shepard DR, Skopek J, Sramek V, Zaric B, Yamamiya I, Benhadji KA, Hamada K, He Y, Rosen L. A phase I, open-label study evaluating the safety and pharmacokinetics of trifluridine/tipiracil in patients with advanced solid tumors and varying degrees of renal impairment. Cancer Chemother Pharmacol 2021; 88:485-497. [PMID: 34097100 DOI: 10.1007/s00280-021-04308-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/30/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Trifluridine/tipiracil (FTD/TPI) is approved for advanced colorectal and gastric/gastroesophageal cancer; however, data in patients with renal impairment (RI) are limited. This phase I study evaluated FTD/TPI in patients with advanced solid tumors and varying degrees of RI to develop dosing guidance. METHODS Patients were enrolled into normal renal function (CrCl ≥ 90 mL/min), mild RI (CrCl 60-89 mL/min), or moderate RI (CrCl 30-59 mL/min) cohorts and administered the recommended FTD/TPI dose (35 mg/m2 twice daily, days 1-5 and 8-12; 28-day cycle). Based on interim pharmacokinetics/safety data, patients with severe RI (CrCl 15-29 mL/min) were enrolled and received FTD/TPI 20 mg/m2 twice daily. RESULTS Forty-three patients (normal renal function [n = 12]; mild RI [n = 12]; moderate RI [n = 11]; severe RI [n = 8]) were enrolled and treated. At steady state, compared to values in patients with normal renal function, FTD area under the curve (AUC) was not significantly different in patients with RI, but TPI AUC was significantly higher and increased with RI severity. FTD/TPI safety profile was consistent with prior experience, but grade ≥ 3 adverse events (AEs) were more frequent in the RI cohorts (83.3% [mild], 90.9% [moderate], 75.0% [severe], and normal [50.0%]). Hematologic AEs (anemia and neutropenia) were more frequent with RI. Overall, seven patients discontinued because of unrelated, nonhematologic AEs. CONCLUSION FTD/TPI is safe and tolerable at the recommended 35 mg/m2 dose in patients with mild/moderate RI and at the reduced 20 mg/m2 dose in patients with severe RI. TRIAL REGISTRATION NCT02301117, registration date: November 21, 2014.
Collapse
Affiliation(s)
- Muhammad Wasif Saif
- Medical Oncology, Northwell Health Cancer Institute, 1111 Marcus Avenue, Suite 216, Lake Success, NY, 11042, USA.
| | - Carlos R Becerra
- Texas Oncology, Baylor University Medical Center, Dallas, TX, USA
| | - Marwan G Fakih
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Weijing Sun
- Division of Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lazar Popovic
- Oncology Institute of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | | | - Thomas J George
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | | | - Jiri Skopek
- Thomayer Hospital Prague and Department of Biophysics and Informatics, First Medical Faculty, Prague, Czech Republic
| | - Vladimir Sramek
- Fakultni Nemocnice u Sv. Anny v Brně, Anesteziologicko Resustitační Klinika, Brno, Czech Republic
| | - Bojan Zaric
- Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | | | | | | | - Yaohua He
- Taiho Oncology, Inc., Princeton, NJ, USA
| | - Lee Rosen
- Division of Hematology-Oncology, University of California, Los Angeles, CA, USA
| |
Collapse
|
4
|
Yoshino T, Uetake H, Funato Y, Yamaguchi Y, Koyama T, Ozawa D, Tajiri M, Muro K. Post-marketing surveillance study of trifluridine/tipiracil in patients with metastatic colorectal cancer. Jpn J Clin Oncol 2021; 51:700-706. [PMID: 33438718 DOI: 10.1093/jjco/hyaa243] [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] [Received: 07/03/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The novel oral nucleoside antineoplastic agent trifluridine/tipiracil was approved for metastatic colorectal cancer in Japan in March 2014. In this post-marketing surveillance study, we investigated the safety and efficacy of trifluridine/tipiracil in a real-world setting, particularly haematological drug reactions classified according to the baseline renal and hepatic functions. METHODS We investigated patients with metastatic colorectal cancer who received trifluridine/tipiracil during the first four treatment cycles prospectively. The patients typically received 35 mg/m2 trifluridine/tipiracil twice daily on days 1-5 and 8-12 every 28 days. The primary objective was to assess the safety of trifluridine/tipiracil, but its efficacy was also evaluated. RESULTS Between July 2014 and June 2016, 860 patients were enrolled in the study, and the safety and efficacy of trifluridine/tipiracil were evaluated in 823 patients. Adverse drug reactions occurred in 89.7% of the patients. The most common adverse drug reactions were decreased white blood cell count (67.0%) and neutrophil count (63.9%). Haematological drug reactions of grade ≥3 were observed in 41.7% of the patients with normal renal function; 50.3, 65.6 and 78.9% of the patients had mild, moderate and severe renal impairments, respectively. Hepatic impairment was not associated with a higher incidence of haematological drug reactions. The median overall survival was 8.4 months, with a 1-year survival rate of 33.7%. CONCLUSION This post-marketing surveillance study further confirmed the safety and tolerability profile of trifluridine/tipiracil observed in a clinical study setting.
Collapse
Affiliation(s)
- Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroyuki Uetake
- Department of Specialized Surgeries, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | - Kei Muro
- Department of Clinical Oncology and Outpatient Treatment Center, Aichi Cancer Center Hospital, Aichi, Japan
| |
Collapse
|
5
|
Price T, Burge M, Chantrill L, Gibbs P, Pavlakis N, Shapiro J, Sjoquist K. Trifluridine/tipiracil: A practical guide to its use in the management of refractory metastatic colorectal cancer in Australia. Asia Pac J Clin Oncol 2020; 16 Suppl 1:3-12. [PMID: 32348018 DOI: 10.1111/ajco.13336] [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: 12/22/2022]
Abstract
Trifluridine/tipiracil is available on the Australian Pharmaceutical Benefits Scheme for the treatment of patients with metastatic colorectal cancer (mCRC) previously treated with, or not considered candidates for, fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-vascular endothelial growth factor agents and anti-epidermal growth factor receptor agents. This article reviews trifluridine/tipiracil clinical data and presents practical information on its use in the management of refractory mCRC in Australia. Whereas the primary mechanism of action of fluoropyrimidines such as fluorouracil (5-FU) and capecitabine is enzyme inhibition of nucleotide synthesis, trifluridine/tipiracil primarily acts by incorporation into DNA, resulting in DNA dysfunction. Trifluridine/tipiracil has activity in patients with 5-FU-resistant tumors and can be considered in patients with prior intolerance or toxicity to 5-FU. In the pivotal phase III RECOURSE trial evaluating trifluridine/tipiracil in chemotherapy-refractory mCRC, efficacy benefits were observed across all a priori prognostic subgroups including those defined by age (≥65 and ≥75 years), geographical origin, primary tumor site or KRAS status. Trifluridine/tipiracil therapy benefits appropriately selected patients who have an ECOG performance status of 0 or 1, with no more than mild hepatic impairment or mild-to-moderate renal impairment, and who are capable of adhering to oral therapy safely. Appropriate dosing, monitoring for adverse events and effective management of side effects are essential.
Collapse
Affiliation(s)
- Timothy Price
- The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Matthew Burge
- Royal Brisbane Hospital, University of Queensland, QLD, Australia
| | - Lorraine Chantrill
- Illawarra Shoalhaven Local Health District, Illawarra Cancer Care Centre, Wollongong Hospital, NSW, Australia.,University of New South Wales Sydney, NSW, Australia.,The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute, Parkville, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia.,Western Hospital, Footscray, VIC, Australia
| | | | - Jeremy Shapiro
- Cabrini Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Katrin Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia.,Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
| |
Collapse
|
6
|
Saif MW, Rosen L, Rudek MA, Sun W, Shepard DR, Becerra C, Yamashita F, Bebeau P, Winkler R. Open-label study to evaluate trifluridine/tipiracil safety, tolerability and pharmacokinetics in patients with advanced solid tumours and hepatic impairment. Br J Clin Pharmacol 2019; 85:1239-1246. [PMID: 30628113 DOI: 10.1111/bcp.13856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS Trifluridine/tipiracil (FTD/TPI) prolongs survival in refractory metastatic colorectal cancer, but limited data exist on its use in patients with hepatic impairment. This Phase I, open-label, nonrandomized study investigated the safety, tolerability and pharmacokinetics of FTD/TPI in patients with advanced solid tumours (except breast cancer) and varying degrees of hepatic impairment, to provide dosing recommendations. METHODS Patients aged ≥18 years with advanced solid tumours and normal hepatic function, or mild, moderate or severe hepatic impairment according to National Cancer Institute criteria, were planned to be enrolled. Patients received FTD/TPI 35 mg/m2 orally twice daily on days 1-5 and 8-12 of each 28-day cycle. RESULTS Twenty-four patients were enrolled to the normal hepatic function (n = 8) and mild (n = 10) and moderate (n = 6) hepatic impairment cohorts. Overall, 12 patients (50.0%) had at least 1 adverse event leading to study discontinuation. In the moderate hepatic impairment cohort, 5 of 6 patients experienced grade ≥ 3 elevation in bilirubin. No patients with severe hepatic impairment were enrolled. FTD area under the curve at steady state decreased by 18% and 22% in the mild and moderate cohorts, respectively; however, no clear change was observed in TPI area under the curve. CONCLUSIONS FTD/TPI can be safely administered in patients with normal hepatic function and mild hepatic impairment, with no initial dose adjustment. FTD/TPI is not recommended for use in patients with moderate hepatic impairment because of findings of grade 3 or 4 increased blood bilirubin. Therefore, FTD/TPI is not recommended for patients with moderate or severe hepatic impairment.
Collapse
Affiliation(s)
| | - Lee Rosen
- University of California, Los Angeles, CA, USA
| | | | | | | | - Carlos Becerra
- Texas Oncology, Baylor University Medical Center, Dallas, TX, USA
| | | | | | | |
Collapse
|