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Xia H, Wu H, Chen J, Xu X, Tan W, Xu RA. Inhibitory effect of imperatorin on dabrafenib metabolism in vitro and in vivo. Chem Biol Interact 2024; 399:111131. [PMID: 38964639 DOI: 10.1016/j.cbi.2024.111131] [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: 04/09/2024] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
Dabrafenib is a BRAF inhibitor that has been demonstrated to be efficacious in the treatment of melanoma and non-small-cell lung cancer patients with BRAF V600E mutations. The objective of this study was to investigate the effects of 51 traditional Chinese medicines on the metabolism of dabrafenib and to further investigate the inhibitory effect of imperatorin. The quantification of dabrafenib and its metabolite hydroxy-dabrafenib was carried out using a sensitive, rapid, and accurate assay method based on ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). The results of in vitro experiments showed that 20 drugs inhibited the metabolism of dabrafenib by more than 80 %. In a further study of imperatorin on dabrafenib, the half-maximal inhibitory concentration (IC50) values of imperatorin on dabrafenib were 0.22 μM and 3.68 μM in rat liver microsomes (RLM) and human liver microsomes (HLM), respectively, while the inhibition mechanisms were non-competitive and mixed type inhibition, respectively. The results of in vivo experiments demonstrated that in the presence of imperatorin, the AUC(0-t), AUC(0-∞), Cmax, and Tmax of dabrafenib were increased by 2.38-, 2.26-, 1.05-, and 6.10-fold, respectively, while CLz/F was decreased by 67.9 %. In addition, Tmax of hydroxy-dabrafenib was increased by 1.4-fold. The results of the research showed that imperatorin had a consistent inhibitory effect on dabrafenib in vitro and in vivo. When the concurrent use of dabrafenib and imperatorin is unavoidable, clinicians should closely monitor for potential adverse events and make timely adjustments to the administered dosage.
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Affiliation(s)
- Hailun Xia
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hualu Wu
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jie Chen
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinhao Xu
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Tan
- The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China.
| | - Ren-Ai Xu
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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2
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Mezi S, Botticelli A, Scagnoli S, Pomati G, Fiscon G, De Galitiis F, Di Pietro FR, Verkhovskaia S, Amirhassankhani S, Pisegna S, Gentile G, Simmaco M, Gohlke B, Preissner R, Marchetti P. The Impact of Drug-Drug Interactions on the Toxicity Profile of Combined Treatment with BRAF and MEK Inhibitors in Patients with BRAF-Mutated Metastatic Melanoma. Cancers (Basel) 2023; 15:4587. [PMID: 37760556 PMCID: PMC10526382 DOI: 10.3390/cancers15184587] [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: 08/08/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND BRAF and MEK inhibition is a successful strategy in managing BRAF-mutant melanoma, even if the treatment-related toxicity is substantial. We analyzed the role of drug-drug interactions (DDI) on the toxicity profile of anti-BRAF/anti-MEK therapy. METHODS In this multicenter, observational, and retrospective study, DDIs were assessed using Drug-PIN software (V 2/23). The association between the Drug-PIN continuous score or the Drug-PIN traffic light and the occurrence of treatment-related toxicities and oncological outcomes was evaluated. RESULTS In total, 177 patients with advanced BRAF-mutated melanoma undergoing BRAF/MEK targeted therapy were included. All grade toxicity was registered in 79% of patients. Cardiovascular toxicities occurred in 31 patients (17.5%). Further, 94 (55.9%) patients had comorbidities requiring specific pharmacological treatments. The median Drug-PIN score significantly increased when the target combination was added to the patient's home therapy (p-value < 0.0001). Cardiovascular toxicity was significantly associated with the Drug-PIN score (p-value = 0.048). The Drug-PIN traffic light (p = 0.00821) and the Drug-PIN score (p = 0.0291) were seen to be significant predictors of cardiotoxicity. Patients with low-grade vs. high-grade interactions showed a better prognosis regarding overall survival (OS) (p = 0.0045) and progression-free survival (PFS) (p = 0.012). The survival analysis of the subgroup of patients with cardiological toxicity demonstrated that patients with low-grade vs. high-grade DDIs had better outcomes in terms of OS (p = 0.0012) and a trend toward significance in PFS (p = 0.068). CONCLUSIONS DDIs emerged as a critical issue for the risk of treatment-related cardiovascular toxicity. Our findings support the utility of DDI assessment in melanoma patients treated with BRAF/MEK inhibitors.
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Affiliation(s)
- Silvia Mezi
- Department of Radiological, Oncological, and Anatomopathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (S.M.); (A.B.)
| | - Andrea Botticelli
- Department of Radiological, Oncological, and Anatomopathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (S.M.); (A.B.)
| | - Simone Scagnoli
- Department of Radiological, Oncological, and Anatomopathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (S.M.); (A.B.)
| | - Giulia Pomati
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (G.P.); (S.P.)
| | - Giulia Fiscon
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, 00161 Rome, Italy;
| | - Federica De Galitiis
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00144 Rome, Italy; (F.D.G.); (F.R.D.P.); (S.V.); (P.M.)
| | - Francesca Romana Di Pietro
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00144 Rome, Italy; (F.D.G.); (F.R.D.P.); (S.V.); (P.M.)
| | - Sofia Verkhovskaia
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00144 Rome, Italy; (F.D.G.); (F.R.D.P.); (S.V.); (P.M.)
| | - Sasan Amirhassankhani
- Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Via Palagi, 40126 Bologna, Italy;
| | - Simona Pisegna
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (G.P.); (S.P.)
| | - Giovanna Gentile
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, 00185 Rome, Italy; (G.G.); (M.S.)
- Unit of Laboratory and Advanced Molecular Diagnostics, ‘Sant’Andrea’ University Hospital, 00189 Rome, Italy
| | - Maurizio Simmaco
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, 00185 Rome, Italy; (G.G.); (M.S.)
- Unit of Laboratory and Advanced Molecular Diagnostics, ‘Sant’Andrea’ University Hospital, 00189 Rome, Italy
| | - Bjoern Gohlke
- Structural Bioinformatics Group, Institute for Physiology, Charité-University Medicine Berlin, 10117 Berlin, Germany; (B.G.); (R.P.)
| | - Robert Preissner
- Structural Bioinformatics Group, Institute for Physiology, Charité-University Medicine Berlin, 10117 Berlin, Germany; (B.G.); (R.P.)
| | - Paolo Marchetti
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00144 Rome, Italy; (F.D.G.); (F.R.D.P.); (S.V.); (P.M.)
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3
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Sun L, Mi K, Hou Y, Hui T, Zhang L, Tao Y, Liu Z, Huang L. Pharmacokinetic and Pharmacodynamic Drug-Drug Interactions: Research Methods and Applications. Metabolites 2023; 13:897. [PMID: 37623842 PMCID: PMC10456269 DOI: 10.3390/metabo13080897] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Because of the high research and development cost of new drugs, the long development process of new drugs, and the high failure rate at later stages, combining past drugs has gradually become a more economical and attractive alternative. However, the ensuing problem of drug-drug interactions (DDIs) urgently need to be solved, and combination has attracted a lot of attention from pharmaceutical researchers. At present, DDI is often evaluated and investigated from two perspectives: pharmacodynamics and pharmacokinetics. However, in some special cases, DDI cannot be accurately evaluated from a single perspective. Therefore, this review describes and compares the current DDI evaluation methods based on two aspects: pharmacokinetic interaction and pharmacodynamic interaction. The methods summarized in this paper mainly include probe drug cocktail methods, liver microsome and hepatocyte models, static models, physiologically based pharmacokinetic models, machine learning models, in vivo comparative efficacy studies, and in vitro static and dynamic tests. This review aims to serve as a useful guide for interested researchers to promote more scientific accuracy and clinical practical use of DDI studies.
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Affiliation(s)
- Lei Sun
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Kun Mi
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan 430000, China
| | - Yixuan Hou
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Tianyi Hui
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Lan Zhang
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Yanfei Tao
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Zhenli Liu
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan 430000, China
| | - Lingli Huang
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan 430000, China
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4
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Tan EY, Pazdirkova M, Taylor AJ, Singh N, Iyer GR. Evaluation of a Low-Fat Low-Calorie Meal on the Relative Bioavailability of Trametinib and Dabrafenib: Results From a Randomized, Open-Label, 2-Part Study in Healthy Participants. Clin Pharmacol Drug Dev 2023; 12:333-342. [PMID: 36662829 DOI: 10.1002/cpdd.1220] [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: 08/08/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Abstract
In this randomized, open-label, 2-part, 2 × 2 crossover, phase 1 study, the effect of a low-fat low-calorie (LFLC) meal on the relative bioavailability of a trametinib 2-mg tablet or dabrafenib 150-mg capsule was evaluated in healthy participants. Trametinib adjusted geometric mean ratios (90%CI) of fed : fasted for area under the concentration-time curve (AUC) from time 0 to the last quantifiable concentration and AUC from time 0 extrapolated to infinity were 0.76 (0.71-0.82) and 0.82 (0.77-0.88), respectively. For dabrafenib, the adjusted geometric mean ratios of AUC from time 0 to the last quantifiable concentration and AUC from time 0 extrapolated to infinity (90%CI) for fed:fasted were 0.85 (0.79-0.91) and 0.86 (0.80-0.92), respectively. Consumption of an LFLC meal delayed trametinib and dabrafenib absorption, with an increase in time to maximum concentration of ≈15 and ≈30 minutes, respectively, compared to the fasted state. These findings indicate that consumption of an LFLC meal reduced the bioavailability and delayed the absorption of trametinib and dabrafenib, supporting current recommendations to administer both drugs in the fasting state; however, an occasional LFLC meal is unlikely to affect the pharmacokinetics of the drugs once steady state is reached and, by consequence, not likely to alter the overall intended efficacy.
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Affiliation(s)
- Eugene Y Tan
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Amanda J Taylor
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Namrata Singh
- Novartis Healthcare Private Limited, Hyderabad, India
| | - Ganesh R Iyer
- Novartis Institute of Biomedical Research Inc., Cambridge, Massachusetts, USA
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Ridhwan MJM, Bakar SIA, Latip NA, Ghani NA, Ismail NH. A Comprehensive Analysis of Human CYP3A4 Crystal Structures as a Potential Tool for Molecular Docking-Based Site of Metabolism and Enzyme Inhibition Studies. JOURNAL OF COMPUTATIONAL BIOPHYSICS AND CHEMISTRY 2022; 21:259-285. [DOI: 10.1142/s2737416522300012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The notable ability of human liver cytochrome P450 3A4 (CYP3A4) to metabolize diverse xenobiotics encourages researchers to explore in-depth the mechanism of enzyme action. Numerous CYP3A4 protein crystal structures have been deposited in protein data bank (PDB) and are majorly used in molecular docking analysis. The quality of the molecular docking results depends on the three-dimensional CYP3A4 protein crystal structures from the PDB. Present review endeavors to provide a brief outline of some technical parameters of CYP3A4 PDB entries as valuable information for molecular docking research. PDB entries between 22 April 2004 and 2 June 2021 were compiled and the active sites were thoroughly observed. The present review identified 76 deposited PDB entries and described basic information that includes CYP3A4 from human genetic, Escherichia coli (E. coli) use for protein expression, crystal structure obtained from X-ray diffraction method, taxonomy ID 9606, Uniprot ID P08684, ligand–protein structure description, co-crystal ligand, protein site deposit and resolution ranges between 1.7[Formula: see text]Å and 2.95[Formula: see text]Å. The observation of protein–ligand interactions showed the various residues on the active site depending on the ligand. The residues Ala305, Ser119, Ala370, Phe304, Phe108, Phe213 and Phe215 have been found to frequently interact with ligands from CYP3A4 PDB. Literature surveys of 17 co-crystal ligands reveal multiple mechanisms that include competitive inhibition, noncompetitive inhibition, mixed-mode inhibition, mechanism-based inhibition, substrate with metabolite, inducer, or combination modes of action. This overview may help researchers choose a trustworthy CYP3A4 protein structure from the PDB database to apply the protein in molecular docking analysis for drug discovery.
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Affiliation(s)
- Mohamad Jemain Mohamad Ridhwan
- Faculty of Applied Sciences, Universiti Teknologi MARA (UiTM), Shah Alam 40450, Selangor, Malaysia
- Atta-ur-Rahman Institute for Natural Products Discovery, Universiti Teknologi MARA (UiTM), Puncak Alam 42300, Selangor, Malaysia
| | - Syahrul Imran Abu Bakar
- Faculty of Applied Sciences, Universiti Teknologi MARA (UiTM), Shah Alam 40450, Selangor, Malaysia
- Atta-ur-Rahman Institute for Natural Products Discovery, Universiti Teknologi MARA (UiTM), Puncak Alam 42300, Selangor, Malaysia
| | - Normala Abd Latip
- Atta-ur-Rahman Institute for Natural Products Discovery, Universiti Teknologi MARA (UiTM), Puncak Alam 42300, Selangor, Malaysia
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam 42300, Selangor, Malaysia
| | - Nurunajah Ab Ghani
- Faculty of Applied Sciences, Universiti Teknologi MARA (UiTM), Shah Alam 40450, Selangor, Malaysia
- Atta-ur-Rahman Institute for Natural Products Discovery, Universiti Teknologi MARA (UiTM), Puncak Alam 42300, Selangor, Malaysia
| | - Nor Hadiani Ismail
- Faculty of Applied Sciences, Universiti Teknologi MARA (UiTM), Shah Alam 40450, Selangor, Malaysia
- Atta-ur-Rahman Institute for Natural Products Discovery, Universiti Teknologi MARA (UiTM), Puncak Alam 42300, Selangor, Malaysia
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6
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Arkenau H, Taylor D, Xu X, Chitnis S, Llacer‐Perez C, Moore K, Nidamarthy PK, Ilankumaran P, De Vos‐Geelen J. Pharmacokinetic Interaction Between the MEK1/MEK2 Inhibitor Trametinib and Oral Contraceptives Containing Norethindrone and Ethinyl Estradiol in Female Patients With Solid Tumors. Clin Pharmacol Drug Dev 2022; 11:585-596. [PMID: 35157784 PMCID: PMC9304124 DOI: 10.1002/cpdd.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/27/2021] [Indexed: 11/12/2022]
Abstract
This phase 1 postapproval study assessed the effect of the mitogen-activated protein kinase kinase enzyme 1/enzyme 2 inhibitor trametinib (2 mg once daily, repeat dosing) on the pharmacokinetics of combined oral contraceptives (COCs) containing norethindrone (NE; 1 mg daily) and ethinyl estradiol (EE; 0.035 mg daily) in 19 female patients with solid tumors. Compared with NE/EE administered without trametinib, NE/EE administered with steady-state trametinib was associated with a clinically nonrelevant 20% increase in NE exposure (area under the curve [AUC]) and no effect on EE exposure (geometric mean ratio [geo-mean] of NE/EE + trametinib to NE/EE [90%CI]: NE AUC calculated to the end of a dosing interval at steady-state [AUCtau ] 1.20 [1.02-1.41]; NE AUC from time zero to the last measurable concentration sampling time [AUClast ] 1.2 [0.999-1.45]; EE AUCtau 1.06 [0.923-1.22]; EE AUClast 1.05 [0.883-1.25]). Maximum serum concentration (Cmax ) of NE increased by 13% and Cmax of EE decreased by 8.5% when dosed with steady-state trametinib compared with COCs administered alone (geo-mean ratio [90%CI]: NE Cmax 1.13 [0.933-1.36]; EE Cmax 0.915 [0.803-1.04]). These results indicate that repeat-dose trametinib does not lower exposure to NE or EE and, hence, is unlikely to impact the contraceptive efficacy of COCs. The pharmacokinetic parameters of trametinib and its metabolite M5 were consistent with historic data of trametinib alone. Coadministration of trametinib and COCs was generally well tolerated in this study, with observed safety signals consistent with the known safety profile of trametinib and no new reported safety events. Overall, the findings indicate that hormonal COCs can be coadministered in female patients who receive trametinib monotherapy without compromising the contraceptive efficacy.
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Affiliation(s)
- Hendrik‐Tobias Arkenau
- Sarah Cannon Research InstituteLondonUK
- Cancer InstituteUniversity College LondonLondonUK
| | | | - Xiaoying Xu
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | - Shripad Chitnis
- Novartis Institutes for BioMedical ResearchCambridgeMassachusettsUSA
| | | | - Kathleen Moore
- Stephenson Cancer CentreUniversity of OklahomaOklahoma CityOklahomaUSA
- Sarah Cannon Research InstituteNashvilleTennesseeUSA
| | | | | | - Judith De Vos‐Geelen
- Department of Internal MedicineDivision of Medical OncologyGROW, School for Oncology and Developmental BiologyMaastricht UMC+MaastrichtThe Netherlands
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7
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Ng TSC, Hu H, Kronister S, Lee C, Li R, Gerosa L, Stopka SA, Burgenske DM, Khurana I, Regan MS, Vallabhaneni S, Putta N, Scott E, Matvey D, Giobbie-Hurder A, Kohler RH, Sarkaria JN, Parangi S, Sorger PK, Agar NYR, Jacene HA, Sullivan RJ, Buchbinder E, Mikula H, Weissleder R, Miller MA. Overcoming differential tumor penetration of BRAF inhibitors using computationally guided combination therapy. SCIENCE ADVANCES 2022; 8:eabl6339. [PMID: 35486732 PMCID: PMC9054019 DOI: 10.1126/sciadv.abl6339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BRAF-targeted kinase inhibitors (KIs) are used to treat malignancies including BRAF-mutant non-small cell lung cancer, colorectal cancer, anaplastic thyroid cancer, and, most prominently, melanoma. However, KI selection criteria in patients remain unclear, as are pharmacokinetic/pharmacodynamic (PK/PD) mechanisms that may limit context-dependent efficacy and differentiate related drugs. To address this issue, we imaged mouse models of BRAF-mutant cancers, fluorescent KI tracers, and unlabeled drug to calibrate in silico spatial PK/PD models. Results indicated that drug lipophilicity, plasma clearance, faster target dissociation, and, in particular, high albumin binding could limit dabrafenib action in visceral metastases compared to other KIs. This correlated with retrospective clinical observations. Computational modeling identified a timed strategy for combining dabrafenib and encorafenib to better sustain BRAF inhibition, which showed enhanced efficacy in mice. This study thus offers principles of spatial drug action that may help guide drug development, KI selection, and combination.
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Affiliation(s)
- Thomas S. C. Ng
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Huiyu Hu
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Stefan Kronister
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
- Institute of Applied Synthetic Chemistry, Technische Universität Wien, Vienna, Austria
| | - Chanseo Lee
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
| | - Ran Li
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Luca Gerosa
- Laboratory of Systems Pharmacology, Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Sylwia A. Stopka
- Department of Neurosurgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Ishaan Khurana
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
| | - Michael S. Regan
- Department of Neurosurgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sreeram Vallabhaneni
- Laboratory of Systems Pharmacology, Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Niharika Putta
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
| | - Ella Scott
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
| | - Dylan Matvey
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rainer H. Kohler
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
| | - Jann N. Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter K. Sorger
- Laboratory of Systems Pharmacology, Department of Systems Biology, Harvard Medical School, Boston, MA, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Nathalie Y. R. Agar
- Department of Neurosurgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Heather A. Jacene
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ryan J. Sullivan
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Hannes Mikula
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
- Institute of Applied Synthetic Chemistry, Technische Universität Wien, Vienna, Austria
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Miles A. Miller
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Corresponding author.
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8
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Wang Z, Wang X, Wang Z, Fan X, Yan M, Jiang L, Xia Y, Cao J, Liu Y. Prediction of Drug-Drug Interaction Between Dabrafenib and Irinotecan via UGT1A1-Mediated Glucuronidation. Eur J Drug Metab Pharmacokinet 2022; 47:353-361. [PMID: 35147853 DOI: 10.1007/s13318-021-00740-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dabrafenib and irinotecan are two drugs that can be utilized to treat melanoma. A previous in vivo study has shown that dabrafenib enhances the antitumor activity of irinotecan in a xenograft model with unclear mechanism. OBJECTIVES This study aims to investigate the inhibition of dabrafenib on SN-38 (the active metabolite of irinotecan) glucuronidation, trying to elucidate the possible mechanism underlying the synergistic effect and to provide a basis for further development and optimization of this combination in clinical research. METHODS Recombinant human uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) and human liver microsomes (HLMs) were employed to catalyze the glucuronidation of SN-38 in vitro. Inhibition kinetic analysis and quantitative prediction study were combined to predict drug-drug interaction (DDI) potential in vivo. RESULTS Dabrafenib noncompetitively inhibited SN-38 glucuronidation in pooled HLMs and recombinant UGT1A1 with unbound inhibitor constant (Ki,u) values of 12.43 ± 0.28 and 3.89 ± 0.40 μM, respectively. Based on the in vitro Ki,u value and estimation of kinetic parameters, dabrafenib administered at 150 mg twice daily may result in about a 1-2% increase in the area under the curve (AUC) of SN-38 in vivo. However, the ratios of intra-enterocyte concentration of dabrafenib to Ki,u ([I]gut/Ki,u) are 2.73 and 8.72 in HLMs and recombinant UGT1A1, respectively, indicating a high risk of intestinal DDI when dabrafenib was used in combination with irinotecan. CONCLUSION Dabrafenib is a potent noncompetitive inhibitor of UGT1A1 and may bring potential risk of DDI when combined with irinotecan.
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Affiliation(s)
- Zhe Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China
| | - Xiaoyu Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China
| | - Zhen Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China
| | - Xiaoyu Fan
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China
| | - Mingrui Yan
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China
| | - Lili Jiang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China
| | - Yangliu Xia
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China
| | - Jun Cao
- Department of Occupational and Environmental Health, Dalian Medical University, No. 9 W. Lvshun South Road, Dalian, 116044, China.
| | - Yong Liu
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China.
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9
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Mechanistically Coupled PK (MCPK) Model to Describe Enzyme Induction and Occupancy Dependent DDI of Dabrafenib Metabolism. Pharmaceutics 2022; 14:pharmaceutics14020310. [PMID: 35214043 PMCID: PMC8875124 DOI: 10.3390/pharmaceutics14020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
Dabrafenib inhibits the cell proliferation of metastatic melanoma with the oncogenic BRAF(V600)-mutation. However, dabrafenib monotherapy is associated with pERK reactivation, drug resistance, and consequential relapse. A clinical drug-dose determination study shows increased pERK levels upon daily administration of more than 300 mg dabrafenib. To clarify whether such elevated drug concentrations could be reached by long-term drug accumulation, we mechanistically coupled the pharmacokinetics (MCPK) of dabrafenib and its metabolites. The MCPK model is qualitatively based on in vitro and quantitatively on clinical data to describe occupancy-dependent CYP3A4 enzyme induction, accumulation, and drug–drug interaction mechanisms. The prediction suggests an eight-fold increase in the steady-state concentration of potent desmethyl-dabrafenib and its inactive precursor carboxy-dabrafenib within four weeks upon 150 mg b.d. dabrafenib. While it is generally assumed that a higher dose is not critical, we found experimentally that a high physiological dabrafenib concentration fails to induce cell death in embedded 451LU melanoma spheroids.
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10
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Dabrafenib inhibits ABCG2 and cytochrome P450 isoenzymes; potential implications for combination anticancer therapy. Toxicol Appl Pharmacol 2021; 434:115797. [PMID: 34780725 DOI: 10.1016/j.taap.2021.115797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022]
Abstract
Dabrafenib is a BRAF inhibitor used in combination treatment of malignant melanoma and non-small cell lung carcinoma. In this study, we aimed to characterize its interactions with cytochrome P450 (CYP) isoenzymes and ATP-binding cassette (ABC) efflux transporters that have critical impact on the pharmacokinetics of drugs and play a role in drug resistance development. Using accumulation assays, we showed that dabrafenib inhibited ABCG2 and, less potently, ABCB1 transporter. We also confirmed dabrafenib as a CYP2C8, CYP2C9, CYP3A4, and CYP3A5 inhibitor. Importantly, inhibition of ABCG2 and CYP3A4 by dabrafenib led to the potentiation of cytotoxic effects of mitoxantrone and docetaxel toward respective resistant cell lines in drug combination studies. On the contrary, the synergistic effect was not consistently observed in ABCB1-expressing models. We further demonstrated that mRNA levels of ABCB1, ABCG2, ABCC1, and CYP3A4 were increased after 24 h and 48 h exposure to dabrafenib. Overall, our data confirm dabrafenib as a drug frequently and potently interacting with ABC transporters and CYP isoenzymes. This feature should be addressed with caution when administering dabrafenib to patients with polypharmacy but also could be utilized advantageously when designing new dabrafenib-containing drug combinations to improve the therapeutic outcome in drug-resistant cancer.
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11
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Motwani J, Eccles MR. Genetic and Genomic Pathways of Melanoma Development, Invasion and Metastasis. Genes (Basel) 2021; 12:1543. [PMID: 34680938 PMCID: PMC8535311 DOI: 10.3390/genes12101543] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
Melanoma is a serious form of skin cancer that accounts for 80% of skin cancer deaths. Recent studies have suggested that melanoma invasiveness is attributed to phenotype switching, which is a reversible type of cell behaviour with similarities to epithelial to mesenchymal transition. Phenotype switching in melanoma is reported to be independent of genetic alterations, whereas changes in gene transcription, and epigenetic alterations have been associated with invasiveness in melanoma cell lines. Here, we review mutational, transcriptional, and epigenomic alterations that contribute to tumour heterogeneity in melanoma, and their potential to drive melanoma invasion and metastasis. We also discuss three models that are hypothesized to contribute towards aspects of tumour heterogeneity and tumour progression in melanoma, namely the clonal evolution model, the cancer stem cell model, and the phenotype switching model. We discuss the merits and disadvantages of each model in explaining tumour heterogeneity in melanoma, as a precursor to invasion and metastasis.
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Affiliation(s)
- Jyoti Motwani
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand;
| | - Michael R. Eccles
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand;
- Maurice Wilkins Centre for Molecular Biodiscovery, Auckland 1010, New Zealand
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12
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Vendramin R, Katopodi V, Cinque S, Konnova A, Knezevic Z, Adnane S, Verheyden Y, Karras P, Demesmaeker E, Bosisio FM, Kucera L, Rozman J, Gladwyn-Ng I, Rizzotto L, Dassi E, Millevoi S, Bechter O, Marine JC, Leucci E. Activation of the integrated stress response confers vulnerability to mitoribosome-targeting antibiotics in melanoma. J Exp Med 2021; 218:e20210571. [PMID: 34287642 PMCID: PMC8424468 DOI: 10.1084/jem.20210571] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/10/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022] Open
Abstract
The ability to adapt to environmental stress, including therapeutic insult, contributes to tumor evolution and drug resistance. In suboptimal conditions, the integrated stress response (ISR) promotes survival by dampening cytosolic translation. We show that ISR-dependent survival also relies on a concomitant up-regulation of mitochondrial protein synthesis, a vulnerability that can be exploited using mitoribosome-targeting antibiotics. Accordingly, such agents sensitized to MAPK inhibition, thus preventing the development of resistance in BRAFV600E melanoma models. Additionally, this treatment compromised the growth of melanomas that exhibited elevated ISR activity and resistance to both immunotherapy and targeted therapy. In keeping with this, pharmacological inactivation of ISR, or silencing of ATF4, rescued the antitumoral response to the tetracyclines. Moreover, a melanoma patient exposed to doxycycline experienced complete and long-lasting response of a treatment-resistant lesion. Our study indicates that the repurposing of mitoribosome-targeting antibiotics offers a rational salvage strategy for targeted therapy in BRAF mutant melanoma and a therapeutic option for NRAS-driven and immunotherapy-resistant tumors.
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Affiliation(s)
- Roberto Vendramin
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Vicky Katopodi
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sonia Cinque
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Angelina Konnova
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Zorica Knezevic
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sara Adnane
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Yvessa Verheyden
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Panagiotis Karras
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, Vlaams Instituut voor Biotechnologie, Leuven, Belgium
- Department of Oncology, Laboratory for Molecular Cancer Biology, Katholieke Universiteit Leuven, Belgium
| | - Ewout Demesmaeker
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Lukas Kucera
- Czech Centre for Phenogenomics, Institute of Molecular Genetics of the Czech Academy of Sciences, Vestec, Czech Republic
| | - Jan Rozman
- Czech Centre for Phenogenomics, Institute of Molecular Genetics of the Czech Academy of Sciences, Vestec, Czech Republic
| | | | - Lara Rizzotto
- Trace, Leuven Cancer Institute, Katholieke Universiteit Leuven, Belgium
| | - Erik Dassi
- Laboratory of RNA Regulatory Networks, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Stefania Millevoi
- Cancer Research Centre of Toulouse, Institut national de la santé et de la recherche médicale Joint Research Unit 1037, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Laboratoire d’Excellence “TOUCAN,” Toulouse, France
| | - Oliver Bechter
- Department of General Medical Oncology, Leuven Cancer Institute, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Jean-Christophe Marine
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, Vlaams Instituut voor Biotechnologie, Leuven, Belgium
- Department of Oncology, Laboratory for Molecular Cancer Biology, Katholieke Universiteit Leuven, Belgium
| | - Eleonora Leucci
- Laboratory for RNA Cancer Biology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
- Trace, Leuven Cancer Institute, Katholieke Universiteit Leuven, Belgium
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13
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Fahmy A, Hopkins AM, Sorich MJ, Rowland A. Evaluating the utility of therapeutic drug monitoring in the clinical use of small molecule kinase inhibitors: a review of the literature. Expert Opin Drug Metab Toxicol 2021; 17:803-821. [PMID: 34278936 DOI: 10.1080/17425255.2021.1943357] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Orally administered small molecule kinase inhibitors (KI) are a key class of targeted anti-cancer medicines that have contributed substantially to improved survival outcomes in patients with advanced disease. Since the introduction of KIs in 2001, there has been a building body of evidence that the benefit derived from these drugs may be further enhanced by individualizing dosing on the basis of concentration.Areas covered: This review considers the rationale for individualized KI dosing and the requirements for robust therapeutic drug monitoring (TDM). Current evidence supporting TDM-guided KI dosing is presented and critically evaluated, and finally potential approaches to address translational challenges for TDM-guided KI dosing and alternate approaches to support individualization of KI dosing are discussed.Expert opinion: Intuitively, the individualization of KI dosing through an approach such as TDM-guided dosing has great potential to enhance the effectiveness and tolerability of these drugs. However, based on current literature evidence it is unrealistic to propose that TDM-guided KI dosing should be routinely implemented into clinical practice.
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Affiliation(s)
- Alia Fahmy
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Ashley M Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Andrew Rowland
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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14
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Zhang X, Zhao P, Wang Z, Xu X, Liu G, Tang Y, Li W. In Silico Prediction of CYP2C8 Inhibition with Machine-Learning Methods. Chem Res Toxicol 2021; 34:1850-1859. [PMID: 34255486 DOI: 10.1021/acs.chemrestox.1c00078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cytochrome P450 2C8 (CYP2C8) is a major drug-metabolizing enzyme in humans and is responsible for the metabolism of ∼5% drugs in clinical use. Thus, inhibition of CYP2C8, which causes potential adverse drug events, cannot be neglected. The in vitro drug interaction studies guidelines for industry issued by the FDA also point out that it needs to be determined whether investigated drugs are CYP2C8 inhibitors before clinical trials. However, current studies mainly focus on predicting the inhibitors of other major P450 enzymes, and the importance of CYP2C8 inhibition has been overlooked. Therefore, there is a need to develop models for identifying potential CYP2C8 inhibition. In this study, in silico classification models for predicting CYP2C8 inhibition were built by five machine-learning methods combined with nine molecular fingerprints. The performance of the models built was evaluated by test and external validation sets. The best model had AUC values of 0.85 and 0.90 for the test and external validation sets, respectively. The applicability domain was analyzed based on the molecular similarity and exhibited an impact on the improvement of prediction accuracy. Furthermore, several representative privileged substructures such as 1H-benzo[d]imidazole, 1-phenyl-1H-pyrazole, and quinoline were identified by information gain and substructure frequency analysis. Overall, our results would be helpful for the prediction of CYP2C8 inhibition.
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Affiliation(s)
- Xiaoxiao Zhang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai 200237, China
| | - Piaopiao Zhao
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai 200237, China
| | - Zhiyuan Wang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai 200237, China
| | - Xuan Xu
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai 200237, China
| | - Guixia Liu
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai 200237, China
| | - Yun Tang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai 200237, China
| | - Weihua Li
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai 200237, China
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15
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Yin H, Wang Z, Wang X, Lv X, Fan X, Yan M, Jia Y, Jiang L, Cao J, Liu Y. Inhibition of human UDP-glucuronosyltransferase enzyme by Dabrafenib: Implications for drug-drug interactions. Biomed Chromatogr 2021; 35:e5205. [PMID: 34192355 DOI: 10.1002/bmc.5205] [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: 03/18/2021] [Revised: 05/30/2021] [Accepted: 06/19/2021] [Indexed: 12/14/2022]
Abstract
Dabrafenib is a novel small molecule tyrosine kinase inhibitor (TKI) which is used to treat metastatic melanoma. The aim of this research was to survey the effects of dabrafenib on human UDP-glucuronosyltransferases (UGTs) and to evaluate the risk of drug-drug interactions (DDIs). The formation rates for 4-methylumbelliferone (4-MU) glucuronide and trifluoperazine-glucuronide in 12 recombinant human UGT isoforms with or without dabrafenib were measured and HPLC was used to investigate the inhibitory effects of dabrafenib on UGTs. Inhibition kinetic studies were also conducted. In vitro-in vivo extrapolation approaches were further used to predict the risk of DDI potentials of dabrafenib via inhibition of UGTs. Our data indicated that dabrafenib had a broad inhibitory effect on 4-MU glucuronidation by inhibiting the activities of UGTs, especially on UGT1A1, UGT1A7, UGT1A8, and UGT1A9, and dabrafenib could increase the area under the curve of co-administered drugs. Dabrafenib is a strong inhibitor of several UGTs and the co-administration of dabrafenib with drugs primarily metabolized by UGT1A1, 1A7, 1A8 or 1A9 may induce potential DDIs.
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Affiliation(s)
- Hang Yin
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
| | - Zhe Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
| | - Xiaoyu Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
| | - Xin Lv
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
| | - Xiaoyu Fan
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
| | - Mingrui Yan
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
| | - Yanyan Jia
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
| | - Lili Jiang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
| | - Jun Cao
- Department of Occupational and Environmental Health, Dalian Medical University, Dalian, China
| | - Yong Liu
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
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16
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Nebot N, Won CS, Moreno V, Muñoz-Couselo E, Lee DY, Gasal E, Bouillaud E. Evaluation of the Effects of Repeat-Dose Dabrafenib on the Single-Dose Pharmacokinetics of Rosuvastatin (OATP1B1/1B3 Substrate) and Midazolam (CYP3A4 Substrate). Clin Pharmacol Drug Dev 2021; 10:1054-1063. [PMID: 33932130 PMCID: PMC8453865 DOI: 10.1002/cpdd.937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/17/2021] [Indexed: 12/26/2022]
Abstract
Dabrafenib is an oral BRAF kinase inhibitor approved for the treatment of various BRAF V600 mutation–positive solid tumors. In vitro observations suggesting cytochrome P450 (CYP) 3A induction and organic anion transporting polypeptide (OATP) inhibition prompted us to evaluate the effect of dabrafenib 150 mg twice daily on the pharmacokinetics of midazolam 3 mg (CYP3A substrate) and rosuvastatin 10 mg (OATP1B1/1B3 substrate) in a clinical phase 1, open‐label, fixed‐sequence study in patients with BRAF V600 mutation–positive tumors. Repeat dabrafenib dosing resulted in a 2.56‐fold increase in rosuvastatin maximum observed concentration (Cmax), an earlier time to Cmax, but only a 7% increase in area under the concentration‐time curve from time 0 (predose) extrapolated to infinite time. Midazolam Cmax and AUC extrapolated to infinite time decreased by 47% and 65%, respectively, with little effect on time to Cmax. No new safety findings were reported. Exposure of drugs that are CYP3A4 substrates is likely to decrease when coadministered with dabrafenib. Concentrations of medicinal products that are sensitive OATP1B1/1B3 substrates may increase during the absorption phase.
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Affiliation(s)
- Noelia Nebot
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Christina S Won
- Novartis Institutes for BioMedical Research, East Hanover, New Jersey, USA
| | - Victor Moreno
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Eva Muñoz-Couselo
- VHIO - Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dung-Yang Lee
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Eduard Gasal
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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17
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Tudor DV, Bâldea I, Olteanu DE, Fischer-Fodor E, Piroska V, Lupu M, Călinici T, Decea RM, Filip GA. Celecoxib as a Valuable Adjuvant in Cutaneous Melanoma Treated with Trametinib. Int J Mol Sci 2021; 22:4387. [PMID: 33922284 PMCID: PMC8122835 DOI: 10.3390/ijms22094387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Melanoma patients stop responding to targeted therapies mainly due to mitogen activated protein kinase (MAPK) pathway re-activation, phosphoinositide 3 kinase/the mechanistic target of rapamycin (PI3K/mTOR) pathway activation or stromal cell influence. The future of melanoma treatment lies in combinational approaches. To address this, our in vitro study evaluated if lower concentrations of Celecoxib (IC50 in nM range) could still preserve the chemopreventive effect on melanoma cells treated with trametinib. MATERIALS AND METHODS All experiments were conducted on SK-MEL-28 human melanoma cells and BJ human fibroblasts, used as co-culture. Co-culture cells were subjected to a celecoxib and trametinib drug combination for 72 h. We focused on the evaluation of cell death mechanisms, melanogenesis, angiogenesis, inflammation and resistance pathways. RESULTS Low-dose celecoxib significantly enhanced the melanoma response to trametinib. The therapeutic combination reduced nuclear transcription factor (NF)-kB (p < 0.0001) and caspase-8/caspase-3 activation (p < 0.0001), inhibited microphthalmia transcription factor (MITF) and tyrosinase (p < 0.05) expression and strongly down-regulated the phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) signaling pathway more significantly than the control or trametinib group (p < 0.0001). CONCLUSION Low concentrations of celecoxib (IC50 in nM range) sufficed to exert antineoplastic capabilities and enhanced the therapeutic response of metastatic melanoma treated with trametinib.
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Affiliation(s)
- Diana Valentina Tudor
- Department of Physiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.V.T.); (I.B.); (M.L.); (R.M.D.); (G.A.F.)
| | - Ioana Bâldea
- Department of Physiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.V.T.); (I.B.); (M.L.); (R.M.D.); (G.A.F.)
| | - Diana Elena Olteanu
- Department of Physiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.V.T.); (I.B.); (M.L.); (R.M.D.); (G.A.F.)
| | - Eva Fischer-Fodor
- “Prof. Dr. Ion Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (E.F.-F.); (V.P.)
| | - Virag Piroska
- “Prof. Dr. Ion Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (E.F.-F.); (V.P.)
| | - Mihai Lupu
- Department of Physiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.V.T.); (I.B.); (M.L.); (R.M.D.); (G.A.F.)
| | - Tudor Călinici
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Roxana Maria Decea
- Department of Physiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.V.T.); (I.B.); (M.L.); (R.M.D.); (G.A.F.)
| | - Gabriela Adriana Filip
- Department of Physiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.V.T.); (I.B.); (M.L.); (R.M.D.); (G.A.F.)
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18
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Hakkola J, Hukkanen J, Turpeinen M, Pelkonen O. Inhibition and induction of CYP enzymes in humans: an update. Arch Toxicol 2020; 94:3671-3722. [PMID: 33111191 PMCID: PMC7603454 DOI: 10.1007/s00204-020-02936-7] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
The cytochrome P450 (CYP) enzyme family is the most important enzyme system catalyzing the phase 1 metabolism of pharmaceuticals and other xenobiotics such as herbal remedies and toxic compounds in the environment. The inhibition and induction of CYPs are major mechanisms causing pharmacokinetic drug–drug interactions. This review presents a comprehensive update on the inhibitors and inducers of the specific CYP enzymes in humans. The focus is on the more recent human in vitro and in vivo findings since the publication of our previous review on this topic in 2008. In addition to the general presentation of inhibitory drugs and inducers of human CYP enzymes by drugs, herbal remedies, and toxic compounds, an in-depth view on tyrosine-kinase inhibitors and antiretroviral HIV medications as victims and perpetrators of drug–drug interactions is provided as examples of the current trends in the field. Also, a concise overview of the mechanisms of CYP induction is presented to aid the understanding of the induction phenomena.
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Affiliation(s)
- Jukka Hakkola
- Research Unit of Biomedicine, Pharmacology and Toxicology, University of Oulu, POB 5000, 90014, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Janne Hukkanen
- Biocenter Oulu, University of Oulu, Oulu, Finland.,Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Miia Turpeinen
- Research Unit of Biomedicine, Pharmacology and Toxicology, University of Oulu, POB 5000, 90014, Oulu, Finland.,Administration Center, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi Pelkonen
- Research Unit of Biomedicine, Pharmacology and Toxicology, University of Oulu, POB 5000, 90014, Oulu, Finland.
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19
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Garrison DA, Talebi Z, Eisenmann ED, Sparreboom A, Baker SD. Role of OATP1B1 and OATP1B3 in Drug-Drug Interactions Mediated by Tyrosine Kinase Inhibitors. Pharmaceutics 2020; 12:E856. [PMID: 32916864 PMCID: PMC7559291 DOI: 10.3390/pharmaceutics12090856] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022] Open
Abstract
Failure to recognize important features of a drug's pharmacokinetic characteristics is a key cause of inappropriate dose and schedule selection, and can lead to reduced efficacy and increased rate of adverse drug reactions requiring medical intervention. As oral chemotherapeutic agents, tyrosine kinase inhibitors (TKIs) are particularly prone to cause drug-drug interactions as many drugs in this class are known or suspected to potently inhibit the hepatic uptake transporters OATP1B1 and OATP1B3. In this article, we provide a comprehensive overview of the published literature and publicly-available regulatory documents in this rapidly emerging field. Our findings indicate that, while many TKIs can potentially inhibit the function of OATP1B1 and/or OATP1B3 and cause clinically-relevant drug-drug interactions, there are many inconsistencies between regulatory documents and the published literature. Potential explanations for these discrepant observations are provided in order to assist prescribing clinicians in designing safe and effective polypharmacy regimens, and to provide researchers with insights into refining experimental strategies to further predict and define the translational significance of TKI-mediated drug-drug interactions.
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Affiliation(s)
| | | | | | - Alex Sparreboom
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA; (D.A.G.); (Z.T.); (E.D.E.)
| | - Sharyn D. Baker
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA; (D.A.G.); (Z.T.); (E.D.E.)
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20
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Creusot N, Gassiot M, Alaterre E, Chiavarina B, Grimaldi M, Boulahtouf A, Toporova L, Gerbal-Chaloin S, Daujat-Chavanieu M, Matheux A, Rahmani R, Gongora C, Evrard A, Pourquier P, Balaguer P. The Anti-Cancer Drug Dabrafenib Is a Potent Activator of the Human Pregnane X Receptor. Cells 2020; 9:cells9071641. [PMID: 32650447 PMCID: PMC7407672 DOI: 10.3390/cells9071641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022] Open
Abstract
The human pregnane X receptor (hPXR) is activated by a large set of endogenous and exogenous compounds and plays a critical role in the control of detoxifying enzymes and transporters regulating liver and gastrointestinal drug metabolism and clearance. hPXR is also involved in both the development of multidrug resistance and enhanced cancer cells aggressiveness. Moreover, its unintentional activation by pharmaceutical drugs can mediate drug–drug interactions and cause severe adverse events. In that context, the potential of the anticancer BRAF inhibitor dabrafenib suspected to activate hPXR and the human constitutive androstane receptor (hCAR) has not been thoroughly investigated yet. Using different reporter cellular assays, we demonstrate that dabrafenib can activate hPXR as efficiently as its reference agonist SR12813, whereas it does not activate mouse or zebrafish PXR nor hCAR. We also showed that dabrafenib binds to recombinant hPXR, induces the expression of hPXR responsive genes in colon LS174T-hPXR cancer cells and human hepatocytes and finally increases the proliferation in LS174T-hPXR cells. Our study reveals that by using a panel of different cellular techniques it is possible to improve the assessment of hPXR agonist activity for new developed drugs.
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Affiliation(s)
- Nicolas Creusot
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Matthieu Gassiot
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Elina Alaterre
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Barbara Chiavarina
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Marina Grimaldi
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Abdelhay Boulahtouf
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Lucia Toporova
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Sabine Gerbal-Chaloin
- IRMB, Université de Montpellier, INSERM, CHU Montpellier, 34090 Montpellier, France; (S.G.-C.); (M.D.-C.)
| | - Martine Daujat-Chavanieu
- IRMB, Université de Montpellier, INSERM, CHU Montpellier, 34090 Montpellier, France; (S.G.-C.); (M.D.-C.)
| | - Alice Matheux
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Roger Rahmani
- INRA UMR 1331 TOXALIM, 06560 Sophia Antipolis, France;
| | - Céline Gongora
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Alexandre Evrard
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Philippe Pourquier
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
- Correspondence: (P.P.); (P.B.); Tel.: +33-467613787 (P.P.); +33-467612409 (P.B.); Fax: +33-467613787 (P.P.); +33-467612337 (P.B.)
| | - Patrick Balaguer
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
- Correspondence: (P.P.); (P.B.); Tel.: +33-467613787 (P.P.); +33-467612409 (P.B.); Fax: +33-467613787 (P.P.); +33-467612337 (P.B.)
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21
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Abstract
Dabrafenib is a potent and selective inhibitor of BRAF-mutant kinase that is approved, as monotherapy or in combination with trametinib (mitogen-activated protein kinase (MAPK) kinase (MEK) inhibitor), for unresectable or metastatic BRAF-mutated melanoma, advanced non-small cell lung cancer and anaplastic thyroid cancer harbouring the BRAFV600E mutation. The recommended dose of dabrafenib is 150 mg twice daily (bid) under fasted conditions. After single oral administration of the recommended dose, the absolute oral bioavailability (F) of dabrafenib is 95%. Dabrafenib shows a time-dependent increase in apparent clearance (CL/F) following multiple doses, which is likely due to induction of its own metabolism through cytochrome P450 (CYP) 3A4. Therefore, steady state is reached only after 14 days of daily dose administration. Moreover, the extent of this auto-induction process is dependent on the dose, which explains why dabrafenib systemic exposure at steady state increases less than dose proportionally over the dose range of 75-300 mg bid. The main elimination route of dabrafenib is the oxidative metabolism via CYP3A4/2C8 and biliary excretion. Among the three major metabolites identified, hydroxy-dabrafenib appears to contribute to the pharmacological activity. Age, sex and body weight did not have any clinically significant influence on plasma exposure to dabrafenib. No dose adjustment is needed for patients with mild renal or hepatic impairment, whereas the impacts of severe impairment on dabrafenib pharmacokinetics remain unknown. Considering that dabrafenib is a substrate of CYP3A4/2C8 and is a CYP3A4/2B6/2C inducer, drug-drug interactions are expected with dabrafenib. The relationship between clinical outcomes and plasma exposure to dabrafenib and hydroxy-dabrafenib should be investigated more deeply.
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22
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Patel A, Wilson R, Harrell AW, Taskar KS, Taylor M, Tracey H, Riddell K, Georgiou A, Cahn AP, Marotti M, Hessel EM. Drug Interactions for Low-Dose Inhaled Nemiralisib: A Case Study Integrating Modeling, In Vitro, and Clinical Investigations. Drug Metab Dispos 2020; 48:307-316. [PMID: 32009006 DOI: 10.1124/dmd.119.089003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/27/2020] [Indexed: 11/22/2022] Open
Abstract
In vitro data for low-dose inhaled phosphoinositide 3-kinase delta inhibitor nemiralisib revealed that it was a substrate and a potent metabolism-dependent inhibitor of cytochrome P450 (P450) 3A4 and a P-glycoprotein (P-gp) substrate. An integrated in silico, in vitro, and clinical approach including a clinical drug interaction study as well as a bespoke physiologically based pharmacokinetic (PBPK) model was used to assess the drug-drug interaction (DDI) risk. Inhaled nemiralisib (100 µg, single dose) was coadministered with itraconazole, a potent P4503A4/P-gp inhibitor, following 200 mg daily administrations for 10 days in 20 male healthy subjects. Systemic exposure to nemiralisib (AUC0-inf) increased by 2.01-fold versus nemiralisib alone. To extrapolate the clinical data to other P4503A4 inhibitors, an inhaled PBPK model was developed using Simcyp software. Retrospective simulation of the victim risk showed good agreement between simulated and observed data (AUC0-inf ratio 2.3 vs. 2.01, respectively). Prospective DDI simulations predicted a weak but manageable drug interaction when nemiralisib was coadministered with other P4503A4 inhibitors, such as the macrolides clarithromycin and erythromycin (simulated AUC0-inf ratio of 1.7), both common comedications in the intended patient populations. PBPK and static mechanistic models were also used to predict a negligible perpetrator DDI effect for nemiralisib on other P4503A4 substrates, including midazolam (a sensitive probe substrate of P4503A4) and theophylline (a narrow therapeutic index drug and another common comedication). In summary, an integrated in silico, in vitro, and clinical approach including an inhalation PBPK model has successfully discharged any potential patient DDI risks in future nemiralisib clinical trials. SIGNIFICANCE STATEMENT: This paper describes the integration of in silico, in vitro, and clinical data to successfully discharge potential drug-drug interaction risks for a low-dose inhaled drug. This work featured assessment of victim and perpetrator risks of drug transporters and cytochrome P450 enzymes, utilizing empirical and mechanistic approaches combined with clinical data (drug interaction and human absorption, metabolism, and pharmacokinetics) and physiologically based pharmacokinetic modeling approaches to facilitate bespoke risk assessment in target patient populations.
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Affiliation(s)
- Aarti Patel
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Robert Wilson
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Andrew W Harrell
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Kunal S Taskar
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Maxine Taylor
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Helen Tracey
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Kylie Riddell
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Alex Georgiou
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Anthony P Cahn
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Miriam Marotti
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
| | - Edith M Hessel
- Drug Metabolism and Pharmacokinetics (A.P., A.W.H., K.S.T., M.T., H.T.) and Bioanalysis, Immunogenicity and Biomarkers (A.G.), GlaxoSmithKline R&D, Ware, United Kingdom; RD Projects Clinical Platforms & Sciences, GlaxoSmithKline R&D, Stevenage, United Kingdom (R.W.); Global Clinical and Data Operations, GlaxoSmithKline R&D, Ermington, Australia (K.R.); Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom (A.P.C.); Safety and Medical Governance, GlaxoSmithKline R&D, Stockley Park, Uxbridge, United Kingdom (M.M.); and Refractory Respiratory Inflammation Discovery Performance Unit, GlaxoSmithKline, Stevenage, United Kingdom (E.M.H.)
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23
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Fatunde OA, Brown SA. The Role of CYP450 Drug Metabolism in Precision Cardio-Oncology. Int J Mol Sci 2020; 21:E604. [PMID: 31963461 PMCID: PMC7014347 DOI: 10.3390/ijms21020604] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/13/2022] Open
Abstract
As many novel cancer therapies continue to emerge, the field of Cardio-Oncology (or onco-cardiology) has become crucial to prevent, monitor and treat cancer therapy-related cardiovascular toxicity. Furthermore, given the narrow therapeutic window of most cancer therapies, drug-drug interactions are prevalent in the cancer population. Consequently, there is an increased risk of affecting drug efficacy or predisposing individual patients to adverse side effects. Here we review the role of cytochrome P450 (CYP450) enzymes in the field of Cardio-Oncology. We highlight the importance of cardiac medications in preventive Cardio-Oncology for high-risk patients or in the management of cardiotoxicities during or following cancer treatment. Common interactions between Oncology and Cardiology drugs are catalogued, emphasizing the impact of differential metabolism of each substrate drug on unpredictable drug bioavailability and consequent inter-individual variability in treatment response or development of cardiovascular toxicity. This inter-individual variability in bioavailability and subsequent response can be further enhanced by genomic variants in CYP450, or by modifications of CYP450 gene, RNA or protein expression or function in various 'omics' related to precision medicine. Thus, we advocate for an individualized approach to each patient by a multidisciplinary team with clinical pharmacists evaluating a treatment plan tailored to a practice of precision Cardio-Oncology. This review may increase awareness of these key concepts in the rapidly evolving field of Cardio-Oncology.
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Affiliation(s)
- Olubadewa A. Fatunde
- Department of Medicine, University of Texas Health Science Center at Tyler–CHRISTUS Good Shepherd Medical Center, Longview, TX 75601, USA
| | - Sherry-Ann Brown
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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24
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Henderson CJ, Kapelyukh Y, Scheer N, Rode A, McLaren AW, MacLeod AK, Lin D, Wright J, Stanley LA, Wolf CR. An Extensively Humanized Mouse Model to Predict Pathways of Drug Disposition and Drug/Drug Interactions, and to Facilitate Design of Clinical Trials. Drug Metab Dispos 2019; 47:601-615. [PMID: 30910785 PMCID: PMC6505380 DOI: 10.1124/dmd.119.086397] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/04/2019] [Indexed: 02/06/2023] Open
Abstract
Species differences in drug metabolism and disposition can confound the extrapolation of in vivo PK data to man and also profoundly compromise drug efficacy studies owing to differences in pharmacokinetics, in metabolites produced (which are often pharmacologically active), and in differential activation of the transcription factors constitutive androstane receptor (CAR) and pregnane X receptor (PXR), which regulate the expression of such enzymes as P450s and drug transporters. These differences have gained additional importance as a consequence of the use of genetically modified mouse models for drug-efficacy testing and also patient-derived xenografts to predict individual patient responses to anticancer drugs. A number of humanized mouse models for cytochrome P450s, CAR, and PXR have been reported. However, the utility of these models has been compromised by the redundancy in P450 reactions across gene families, whereby the remaining murine P450s can metabolize the compounds being tested. To remove this confounding factor and create a mouse model that more closely reflects human pathways of drug disposition, we substituted 33 murine P450s from the major gene families involved in drug disposition, together with Car and Pxr, for human CAR, PXR, CYP1A1, CYP1A2, CYP2C9, CYP2D6, CYP3A4, and CYP3A7. We also created a mouse line in which 34 P450s were deleted from the mouse genome. Using model compounds and anticancer drugs, we demonstrated how these mouse lines can be applied to predict drug-drug interactions in patients and discuss here their potential application in the more informed design of clinical trials and the personalized treatment of cancer.
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Affiliation(s)
- C J Henderson
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - Y Kapelyukh
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - N Scheer
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - A Rode
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - A W McLaren
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - A K MacLeod
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - D Lin
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - J Wright
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - L A Stanley
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
| | - C R Wolf
- Systems Medicine, School of Medicine, University of Dundee, Jacqui Wood Cancer Centre, Ninewells Hospital, Dundee, United Kingdom (C.J.H., Y.K., C.R.W., A.M., K.M., D.L.); Taconic Biosciences Inc., Rensselaer, New York (N.S., A.R.); Independent Consultant, Putley, Ledbury, Herts, United Kingdom (J.W.); and Independent Consultant, Linlithgow, West Lothian, United Kingdom (L.A.S.)
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Nair PC, McKinnon RA, Miners JO. Computational Prediction of the Site(s) of Metabolism and Binding Modes of Protein Kinase Inhibitors Metabolized by CYP3A4. Drug Metab Dispos 2019; 47:616-631. [DOI: 10.1124/dmd.118.085167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/18/2019] [Indexed: 01/13/2023] Open
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Clinical Pharmacokinetic and Pharmacodynamic Considerations in the (Modern) Treatment of Melanoma. Clin Pharmacokinet 2019; 58:1029-1043. [DOI: 10.1007/s40262-019-00753-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pharmacokinetic and cytokine profiles of melanoma patients with dabrafenib and trametinib-induced pyrexia. Cancer Chemother Pharmacol 2019; 83:693-704. [DOI: 10.1007/s00280-019-03780-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/13/2019] [Indexed: 02/07/2023]
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Haraldsdottir S, Janku F, Poi M, Timmers C, Geyer S, Schaaf LJ, Sexton J, Wei L, Thurmond J, Velez-Bravo V, Stepanek VM, Bertino EM, Kendra K, Mortazavi A, Subbiah V, Phelps M, Shah MH. Phase I Trial of Dabrafenib and Pazopanib in BRAF Mutated Advanced Malignancies. JCO Precis Oncol 2018; 2:1-19. [DOI: 10.1200/po.17.00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Several tumor types carry BRAF mutations and vascular endothelial growth factor pathway upregulation. Resistance mechanisms to BRAF inhibitors can include platelet-derived growth factor-β upregulation. Dabrafenib, a BRAF inhibitor, and pazopanib, a multikinase inhibitor that targets vascular endothelial growth factor and platelet-derived growth factor, have not been combined previously. This phase I study was designed to evaluate the safety, pharmacokinetics, and pharmacodynamics of the combination. Patients and Methods Patients with any advanced BRAF mutated malignancy with adequate organ function were eligible. Prior use of dabrafenib or pazopanib was not allowed. Dosages started at dabrafenib 50 mg twice a day and pazopanib 400 mg daily on dose level (DL) 1, with maximum dosages of 150 mg twice a day and 800 mg daily on DL5. Pharmacokinetics and BRAF V600E plasma clone were measured, and efficacy was evaluated by imaging and tumor markers every 8 weeks. Results Twenty-three patients with 11 different tumor histologies were enrolled in five DLs. Two dose-limiting toxicities were observed—a grade 3 bowel perforation on DL3 and grade 3 arthralgia on DL5. Common drug-related adverse events included nausea (52%), skin papules (43%), diarrhea (39%), hand-foot syndrome (30%), anemia (26%), rash (22%), vomiting (22%), hypophosphatemia (22%), and transaminitis (22%). Five patients (22%) experienced a partial response, including low-grade ovarian serous carcinoma, thyroid cancer, and glioblastoma multiforme, and two patients (appendiceal and thyroid cancer) had stable disease > 6 months. Pharmacokinetic measurements revealed pazopanib levels < 17.5 μg/mL in 80% of treated patients at steady state, particularly at DL5. BRAF V600E plasma copies correlated with response and progression. Conclusion Combination dabrafenib and pazopanib had no unexpected toxicities, and durable partial responses were observed at DL3 or greater. Dose escalation beyond DL5 may be considered as pazopanib levels were suboptimal as a result of drug interaction with dabrafenib.
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Affiliation(s)
- Sigurdis Haraldsdottir
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Filip Janku
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Ming Poi
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Cynthia Timmers
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Susan Geyer
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Larry J. Schaaf
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Jennifer Sexton
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Lai Wei
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Jennifer Thurmond
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Vivianne Velez-Bravo
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Vanda M. Stepanek
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Erin M. Bertino
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Kari Kendra
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Amir Mortazavi
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Vivek Subbiah
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Mitch Phelps
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
| | - Manisha H. Shah
- Sigurdis Haraldsdottir, Ming Poi, Cynthia Timmers, Susan Geyer, Larry J. Schaaf, Jennifer Sexton, Lai Wei, Jennifer Thurmond, Erin M. Bertino, Kari Kendra, Amir Mortazavi, Mitch Phelps, and Manisha H. Shah, Ohio State University Medical Center, Columbus, OH; Sigurdis Haraldsdottir, Stanford University, Stanford, CA; Filip Janku, Vivianne Velez-Bravo, Vanda M. Stepanek, and Vivek Subbiah, University of Texas MD Anderson Cancer Center, Houston, TX; and Susan Geyer, University of South Florida, Tampa, FL
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Filppula AM, Mustonen TM, Backman JT. In Vitro Screening of Six Protein Kinase Inhibitors for Time-Dependent Inhibition of CYP2C8 and CYP3A4: Possible Implications with regard to Drug-Drug Interactions. Basic Clin Pharmacol Toxicol 2018; 123:739-748. [DOI: 10.1111/bcpt.13088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/25/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Anne M. Filppula
- Department of Clinical Pharmacology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Tiffany M. Mustonen
- Department of Clinical Pharmacology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Janne T. Backman
- Department of Clinical Pharmacology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Gazzé G. Combination therapy for metastatic melanoma: a pharmacist's role, drug interactions & complementary alternative therapies. Melanoma Manag 2018; 5:MMT07. [PMID: 30459938 PMCID: PMC6240885 DOI: 10.2217/mmt-2017-0026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/17/2018] [Indexed: 02/08/2023] Open
Abstract
The incidence of metastatic melanoma has been increasing dramatically over the last decades. Yet, there have been many new innovative therapies, such as targeted therapies and checkpoint inhibitors, which have made progress in survival for these patients. The oncology pharmacist is part of the healthcare team and can help in optimizing these newer therapies. There will be discussion about combination therapies, the oncology pharmacist's role, and issues at the core of his interest, such as drug interactions and complementary and alternative therapies.
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Affiliation(s)
- Gabriel Gazzé
- McGill University Health Center – Royal Victoria Hospital, 1001, boul. Decarie, Montreal, Quebec, H4A 3J1 Canada
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Abstract
Melanoma is a major public health problem. In recent years, it has been shown that melanoma can be characterized by specific oncogenes mutations such as the BRAF mutation, leading to the development of new therapeutic drugs. Dabrafenib is an inhibitor of BRAF, approved as a first-line treatment of metastatic or unresectable stage 3 or 4 melanoma with the BRAF mutation. Few studies have evaluated the drug interaction potential of dabrafenib. This molecule is an enzyme inducer that increases the synthesis of drug-metabolizing enzymes, including CYP3A4, CYP2B6, CYP2C8, CYP2C9, CYP2C19, and UGT enzymes. Accordingly, the plasma concentrations of drugs metabolized by these enzymes are decreased. The decrease in plasma concentrations may cause a reduction or even loss of the clinical effect of these drugs. Many drugs metabolized by these enzymes may be affected, especially midazolam, warfarin, or rifampicin. However, interactions with immunosuppressants have not been described. Everolimus and tacrolimus are two immunosuppressive drugs metabolized by CYP3A4. We report a case of drug interaction between dabrafenib and immunosuppressive drugs (everolimus, tacrolimus), observed in a transplanted heart patient, requiring dosage adjustment of its immunosuppressive treatment to avoid graft rejection.
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Dhillon S. Dabrafenib plus Trametinib: a Review in Advanced Melanoma with a BRAF (V600) Mutation. Target Oncol 2017; 11:417-28. [PMID: 27246822 DOI: 10.1007/s11523-016-0443-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The BRAF inhibitor dabrafenib (Tafinlar(®)) and the MEK inhibitor trametinib (Mekinist(®)) are indicated, as monotherapy or in combination with each other, for the treatment of patients with unresectable or metastatic melanoma with a BRAF (V600) mutation. This article reviews the therapeutic efficacy and tolerability of combination treatment with dabrafenib and trametinib in this indication and summarizes relevant pharmacological data. Dabrafenib plus trametinib significantly prolonged progression-free survival (PFS) and overall survival (OS), improved objective response rates (ORRs) and preserved health-related quality of life (HR-QOL) to a greater extent than dabrafenib (in the double-blind COMBI-d study) and vemurafenib (in the open-label COMBI-v study) in two large, randomized, phase III studies in treatment-naïve patients with unresectable or metastatic melanoma with BRAF (V600E/K) mutation. Limited treatment benefit with the combination was also seen in patients who had progressed on prior BRAF inhibitor therapy, as indicated by ORRs of ≤ 15 % and stable disease in ≤ 50 % of patients in small phase I and II studies. Combination therapy did not increase overall toxicity relative to dabrafenib or vemurafenib monotherapy, with most adverse events (AEs) mild or moderate in severity and generally manageable. Fewer skin-related AEs (e.g. cutaneous malignancies, hyperkeratinosis and hand-foot syndrome) were reported with combination therapy than with dabrafenib or vemurafenib, probably because of reduced paradoxical activation of the MAPK pathway. Thus, dabrafenib plus trametinib provides an important treatment option for patients with BRAF (V600) mutation-positive unresectable or metastatic melanoma.
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Affiliation(s)
- Sohita Dhillon
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand.
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Simple and cost-effective liquid chromatography-mass spectrometry method to measure dabrafenib quantitatively and six metabolites semi-quantitatively in human plasma. Anal Bioanal Chem 2017; 409:3749-3756. [PMID: 28429064 PMCID: PMC5427163 DOI: 10.1007/s00216-017-0316-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 01/07/2023]
Abstract
Dabrafenib is an inhibitor of BRAF V600E used for treating metastatic melanoma but a majority of patients experience adverse effects. Methods to measure the levels of dabrafenib and major metabolites during treatment are needed to allow development of individualized dosing strategies to reduce the burden of such adverse events. In this study, an LC-MS/MS method capable of measuring dabrafenib quantitatively and six metabolites semi-quantitatively is presented. The method is fully validated with regard to dabrafenib in human plasma in the range 5–5000 ng/mL. The analytes were separated on a C18 column after protein precipitation and detected in positive electrospray ionization mode using a Xevo TQ triple quadrupole mass spectrometer. As no commercial reference standards are available, the calibration curve of dabrafenib was used for semi-quantification of dabrafenib metabolites. Compared to earlier methods the presented method represents a simpler and more cost-effective approach suitable for clinical studies. Combined multi reaction monitoring transitions of dabrafenib and metabolites in a typical case sample. ![]()
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Rousset M, Titier K, Bouchet S, Dutriaux C, Pham-Ledard A, Prey S, Canal-Raffin M, Molimard M. An UPLC-MS/MS method for the quantification of BRAF inhibitors (vemurafenib, dabrafenib) and MEK inhibitors (cobimetinib, trametinib, binimetinib) in human plasma. Application to treated melanoma patients. Clin Chim Acta 2017; 470:8-13. [PMID: 28412197 DOI: 10.1016/j.cca.2017.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/24/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
Abstract
Targeted therapies for cancers are fast-growing therapies. For instance kinase inhibitors such as BRAF inhibitors (BRAFi) and MEK inhibitors (MEKi) are increasingly used to treat malignant melanoma. The metabolic profile of these drugs can result in great interindividual variability, justifying therapeutic drug monitoring (TDM). We describe a rapid and specific method for quantification of 2 BRAFi (vemurafenib, dabrafenib) and 3 MEKi (cobimetinib, trametinib and binimetinib). Chromatography was performed on a Waters Acquity-UPLC system with CORTECS C18+ column, under a gradient of 10% acetic acid in water/acetonitrile. An Acquity-TQD® with electrospray ionization was used for detection. Samples were prepared by solid phase extraction (Oasis® MCX microElution) before injection in the system. Calibration curves ranges from 0.4 to 100μg/ml for vemurafenib, from 1 to 1000ng/ml for dabrafenib, from 0.5 to 500ng/ml for cobimetinib and binimetinib, and from 0.75 to 250ng/ml for trametinib. At all concentrations the bias was within ±15% of the nominal concentrations and precision was ≤15%. All results were within the acceptance criteria of the EMA guidelines on method validation. This rapid, sensitive and specific UPLC-MS/MS method can perform simultaneous quantification of targeted therapies used in malignant melanoma and is usable for routine TDM.
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Affiliation(s)
- Marine Rousset
- Department of Pharmacology, University Hospital Bordeaux, F-33000, France; Univ. Bordeaux INSERM, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000 Bordeaux, France.
| | - Karine Titier
- Department of Pharmacology, University Hospital Bordeaux, F-33000, France
| | - Stephane Bouchet
- Department of Pharmacology, University Hospital Bordeaux, F-33000, France; Univ. Bordeaux INSERM, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000 Bordeaux, France
| | - Caroline Dutriaux
- Department of Dermatology, University Hospital Bordeaux, F-33000, France
| | - Anne Pham-Ledard
- Department of Dermatology, University Hospital Bordeaux, F-33000, France; EA2406 Histology and Molecular Pathology of Tumors, University of Bordeaux, F-33000, France
| | - Sorilla Prey
- Department of Dermatology, University Hospital Bordeaux, F-33000, France
| | - Mireille Canal-Raffin
- Department of Pharmacology, University Hospital Bordeaux, F-33000, France; Univ. Bordeaux INSERM, Bordeaux Population Health Research Center, team Cancer-environnement-EPICENE, UMR 1219, F-33000 Bordeaux, France
| | - Mathieu Molimard
- Department of Pharmacology, University Hospital Bordeaux, F-33000, France; Univ. Bordeaux INSERM, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000 Bordeaux, France
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Ellens H, Johnson M, Lawrence SK, Watson C, Chen L, Richards-Peterson LE. Prediction of the Transporter-Mediated Drug-Drug Interaction Potential of Dabrafenib and Its Major Circulating Metabolites. Drug Metab Dispos 2017; 45:646-656. [PMID: 28320730 DOI: 10.1124/dmd.116.073932] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/15/2016] [Indexed: 01/28/2023] Open
Abstract
The BRAF inhibitor dabrafenib was recently approved for the treatment of certain BRAF V600 mutation-positive tumors, either alone or in combination therapy with the mitogen-activated extracellular signal regulated kinase 1 (MEK1) and MEK2 inhibitor, trametinib. This article presents the dabrafenib transporter-mediated drug-drug interaction (DDI) risk assessment, which is currently an important part of drug development, regulatory submission, and drug registration. Dabrafenib and its major circulating metabolites (hydroxy-, carboxy-, and desmethyl-dabrafenib) were investigated as inhibitors of the clinically relevant transporters P-gp, BCRP, OATP1B1, OATP1B3, OCT2, OAT1, and OAT3. The DDI Guidance risk assessment decision criteria for inhibition of BCRP, OATP1B1 and OAT3 were slightly exceeded and therefore a minor DDI effect resulting from inhibition of these transporters remained possible. Biliary secretion is the major excretion pathway of dabrafenib-related material (71.1% of orally administered radiolabeled dose recovered in feces), whereas urinary excretion was observed as well (22.7% of the dose). In vitro uptake into human hepatocytes of the dabrafenib metabolites, but not of dabrafenib parent compound, was mediated, at least in part, by hepatic uptake transporters. The transporters responsible for uptake of the pharmacologically active hydroxy- and desmethyl dabrafenib could not be identified, whereas carboxy-dabrafenib was a substrate of several OATPs. Dabrafenib, hydroxy-, and desmethyl-dabrafenib were substrates of P-gp and BCRP, whereas carboxy-dabrafenib was not. Although a small increase in exposure to carboxy-dabrafenib upon inhibition of OATPs and an increase in exposure to desmethyl-dabrafenib upon inhibition of P-gp or BCRP cannot be excluded, the clinical significance of such increases is likely to be low.
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Affiliation(s)
- Harma Ellens
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Marta Johnson
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Sarah K Lawrence
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Cory Watson
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Liangfu Chen
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, King of Prussia, Pennsylvania
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Gay C, Toulet D, Le Corre P. Pharmacokinetic drug-drug interactions of tyrosine kinase inhibitors: A focus on cytochrome P450, transporters, and acid suppression therapy. Hematol Oncol 2016; 35:259-280. [DOI: 10.1002/hon.2335] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/04/2016] [Accepted: 07/04/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Caroline Gay
- Pôle Pharmacie; Service Hospitalo-Universitaire de Pharmacie; CHU de Rennes Rennes Cedex France
| | - Delphine Toulet
- Pôle Pharmacie; Service Hospitalo-Universitaire de Pharmacie; CHU de Rennes Rennes Cedex France
| | - Pascal Le Corre
- Pôle Pharmacie; Service Hospitalo-Universitaire de Pharmacie; CHU de Rennes Rennes Cedex France
- Laboratoire de Pharmacie Galénique, Biopharmacie et Pharmacie Clinique; IRSET U1085, Faculté de Pharmacie, Université de Rennes 1; Rennes Cedex France
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37
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Backman JT, Filppula AM, Niemi M, Neuvonen PJ. Role of Cytochrome P450 2C8 in Drug Metabolism and Interactions. Pharmacol Rev 2016; 68:168-241. [PMID: 26721703 DOI: 10.1124/pr.115.011411] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
During the last 10-15 years, cytochrome P450 (CYP) 2C8 has emerged as an important drug-metabolizing enzyme. CYP2C8 is highly expressed in human liver and is known to metabolize more than 100 drugs. CYP2C8 substrate drugs include amodiaquine, cerivastatin, dasabuvir, enzalutamide, imatinib, loperamide, montelukast, paclitaxel, pioglitazone, repaglinide, and rosiglitazone, and the number is increasing. Similarly, many drugs have been identified as CYP2C8 inhibitors or inducers. In vivo, already a small dose of gemfibrozil, i.e., 10% of its therapeutic dose, is a strong, irreversible inhibitor of CYP2C8. Interestingly, recent findings indicate that the acyl-β-glucuronides of gemfibrozil and clopidogrel cause metabolism-dependent inactivation of CYP2C8, leading to a strong potential for drug interactions. Also several other glucuronide metabolites interact with CYP2C8 as substrates or inhibitors, suggesting that an interplay between CYP2C8 and glucuronides is common. Lack of fully selective and safe probe substrates, inhibitors, and inducers challenges execution and interpretation of drug-drug interaction studies in humans. Apart from drug-drug interactions, some CYP2C8 genetic variants are associated with altered CYP2C8 activity and exhibit significant interethnic frequency differences. Herein, we review the current knowledge on substrates, inhibitors, inducers, and pharmacogenetics of CYP2C8, as well as its role in clinically relevant drug interactions. In addition, implications for selection of CYP2C8 marker and perpetrator drugs to investigate CYP2C8-mediated drug metabolism and interactions in preclinical and clinical studies are discussed.
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Affiliation(s)
- Janne T Backman
- Department of Clinical Pharmacology, University of Helsinki (J.T.B., A.M.F., M.N., P.J.N.), and Helsinki University Hospital, Helsinki, Finland (J.T.B., M.N., P.J.N.)
| | - Anne M Filppula
- Department of Clinical Pharmacology, University of Helsinki (J.T.B., A.M.F., M.N., P.J.N.), and Helsinki University Hospital, Helsinki, Finland (J.T.B., M.N., P.J.N.)
| | - Mikko Niemi
- Department of Clinical Pharmacology, University of Helsinki (J.T.B., A.M.F., M.N., P.J.N.), and Helsinki University Hospital, Helsinki, Finland (J.T.B., M.N., P.J.N.)
| | - Pertti J Neuvonen
- Department of Clinical Pharmacology, University of Helsinki (J.T.B., A.M.F., M.N., P.J.N.), and Helsinki University Hospital, Helsinki, Finland (J.T.B., M.N., P.J.N.)
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38
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Bolleddula J, Chowdhury SK. Carbon-carbon bond cleavage and formation reactions in drug metabolism and the role of metabolic enzymes. Drug Metab Rev 2015; 47:534-57. [PMID: 26390887 DOI: 10.3109/03602532.2015.1086781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Elimination of xenobiotics from the human body is often facilitated by a transformation to highly water soluble and more ionizable molecules. In general, oxidation-reduction, hydrolysis, and conjugation reactions are common biotransformation reactions that are catalyzed by various metabolic enzymes including cytochrome P450s (CYPs), non-CYPs, and conjugative enzymes. Although carbon-carbon (C-C) bond formation and cleavage reactions are known to exist in plant secondary metabolism, these reactions are relatively rare in mammalian metabolism and are considered exceptions. However, various reactions such as demethylation, dealkylation, dearylation, reduction of alkyl chain, ring expansion, ring contraction, oxidative elimination of a nitrile through C-C bond cleavage, and dimerization, and glucuronidation through C-C bond formation have been reported for drug molecules. Carbon-carbon bond cleavage reactions for drug molecules are primarily catalyzed by CYP enzymes, dimerization is mediated by peroxidases, and C-glucuronidation is catalyzed by UGT1A9. This review provides an overview of C-C bond cleavage and formation reactions in drug metabolism and the metabolic enzymes associated with these reactions.
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Affiliation(s)
- Jayaprakasam Bolleddula
- a Department of Drug Metabolism and Pharmacokinetics , Takeda Pharmaceuticals International Co. , Cambridge , MA , USA
| | - Swapan K Chowdhury
- a Department of Drug Metabolism and Pharmacokinetics , Takeda Pharmaceuticals International Co. , Cambridge , MA , USA
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Reese MJ, Bowers GD, Humphreys JE, Gould EP, Ford SL, Webster LO, Polli JW. Drug interaction profile of the HIV integrase inhibitor cabotegravir: assessment from in vitro studies and a clinical investigation with midazolam. Xenobiotica 2015; 46:445-56. [PMID: 26340566 DOI: 10.3109/00498254.2015.1081993] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
1. Cabotegravir (CAB; GSK1265744) is a potent HIV integrase inhibitor in clinical development as an oral lead-in tablet and long-acting injectable for the treatment and prevention of HIV infection. 2. This work investigated if CAB was a substrate for efflux transporters, the potential for CAB to interact with drug-metabolizing enzymes and transporters to cause clinical drug interactions, and the effect of CAB on the pharmacokinetics of midazolam, a CYP3A4 probe substrate, in humans. 3. CAB is a substrate for Pgp and BCRP; however, its high intrinsic membrane permeability limits the impact of these transporters on its intestinal absorption. 4. At clinically relevant concentrations, CAB did not inhibit or induce any of the CYP or UGT enzymes evaluated in vitro and had no effect on the clinical pharmacokinetics of midazolam. 5. CAB is an inhibitor of OAT1 (IC50 0.81 µM) and OAT3 (IC50 0.41 µM) but did not or only weakly inhibited Pgp, BCRP, MRP2, MRP4, MATE1, MATE2-K, OATP1B1, OATP1B3, OCT1, OCT2 or BSEP. 6. Based on regulatory guidelines and quantitative extrapolations, CAB has a low propensity to cause clinically significant drug interactions, except for coadministration with OAT1 or OAT3 substrates.
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Affiliation(s)
- Melinda J Reese
- a Drug Metabolism and Pharmacokinetics, GlaxoSmithKline , Research Triangle Park , NC , USA and
| | - Gary D Bowers
- a Drug Metabolism and Pharmacokinetics, GlaxoSmithKline , Research Triangle Park , NC , USA and
| | - Joan E Humphreys
- a Drug Metabolism and Pharmacokinetics, GlaxoSmithKline , Research Triangle Park , NC , USA and
| | | | - Susan L Ford
- b Clinical Platforms and Sciences, GlaxoSmithKline , RTP , NC , USA
| | - Lindsey O Webster
- a Drug Metabolism and Pharmacokinetics, GlaxoSmithKline , Research Triangle Park , NC , USA and
| | - Joseph W Polli
- a Drug Metabolism and Pharmacokinetics, GlaxoSmithKline , Research Triangle Park , NC , USA and
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40
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Suttle AB, Grossmann KF, Ouellet D, Richards-Peterson LE, Aktan G, Gordon MS, LoRusso PM, Infante JR, Sharma S, Kendra K, Patel M, Pant S, Arkenau HT, Middleton MR, Blackman SC, Botbyl J, Carson SW. Assessment of the drug interaction potential and single- and repeat-dose pharmacokinetics of the BRAF inhibitor dabrafenib. J Clin Pharmacol 2014; 55:392-400. [DOI: 10.1002/jcph.437] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/24/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Jeffrey R. Infante
- Sarah Cannon Research Institute/Tennessee Oncology; PLLC; Nashville TN USA
| | - Sunil Sharma
- Huntsman Cancer Institute; University of Utah; Salt Lake City UT USA
| | | | - Manish Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists; Sarasota FL USA
| | - Shubham Pant
- Sarah Cannon Research Institute/University of Oklahoma; Oklahoma City OK USA
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute, United Kingdom and University College London; London UK
| | - Mark R. Middleton
- Department of Oncology; National Institute for Health Research Biomedical Research Centre; Oxford UK
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