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Patera AC, Maidment J, Maroj B, Mohamed A, Twomey K. A Science-Based Methodology Framework for the Assessment of Combination Safety Risks in Clinical Trials. Pharmaceut Med 2023; 37:183-202. [PMID: 37099245 DOI: 10.1007/s40290-023-00465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/27/2023]
Abstract
Multiple components factor into the assessment of combination safety risks when two or more novel individual products are used in combination in clinical trials. These include, but are not limited to, biology, biochemistry, pharmacology, class effects, and preclinical and clinical findings (such as adverse drug reactions, drug target and mechanism of action, target expression, signaling, and drug-drug interactions). This paper presents a science-based methodology framework for the assessment of combination safety risks when two or more investigational products are used in clinical trials. The aim of this methodology framework is to improve prediction of the risks, to enable the appropriate safety risk mitigation and management to be put in place for the combination, and the development of the project combination safety strategy.
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Affiliation(s)
- Andriani C Patera
- Patient Safety Oncology, Oncology R&D, AstraZeneca, 101 Orchard Ridge Way, Gaithersburg, MD, 20878, USA.
| | - Julie Maidment
- Patient Safety Oncology, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Brijesh Maroj
- Patient Safety Oncology, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Ahmed Mohamed
- Patient Safety Oncology, Oncology R&D, AstraZeneca, 101 Orchard Ridge Way, Gaithersburg, MD, 20878, USA
| | - Ken Twomey
- Patient Safety Oncology, Oncology R&D, AstraZeneca, Cambridge, UK
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Choudhury AD, Higano CS, de Bono JS, Cook N, Rathkopf DE, Wisinski KB, Martin-Liberal J, Linch M, Heath EI, Baird RD, García-Carbacho J, Quintela-Fandino M, Barry ST, de Bruin EC, Colebrook S, Hawkins G, Klinowska T, Maroj B, Moorthy G, Mortimer PG, Moschetta M, Nikolaou M, Sainsbury L, Shapiro GI, Siu LL, Hansen AR. A Phase I Study Investigating AZD8186, a Potent and Selective Inhibitor of PI3Kβ/δ, in Patients with Advanced Solid Tumors. Clin Cancer Res 2022; 28:2257-2269. [PMID: 35247924 PMCID: PMC9662946 DOI: 10.1158/1078-0432.ccr-21-3087] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/21/2021] [Accepted: 03/01/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To characterize safety and tolerability of the selective PI3Kβ inhibitor AZD8186, identify a recommended phase II dose (RP2D), and assess preliminary efficacy in combination with abiraterone acetate or vistusertib. PATIENTS AND METHODS This phase I open-label study included patients with advanced solid tumors, particularly prostate cancer, triple-negative breast cancer, and squamous non-small cell lung cancer. The study comprised four arms: (i) AZD8186 monotherapy dose finding; (ii) monotherapy dose expansion; (iii) AZD8186/abiraterone acetate (with prednisone); and (iv) AZD8186/vistusertib. The primary endpoints were safety, tolerability, and identification of the RP2D of AZD8186 monotherapy and in combination. Secondary endpoints included pharmacokinetics (PK), pharmacodynamics, and tumor and prostate-specific antigen (PSA) responses. RESULTS In total, 161 patients were enrolled. AZD8186 was well tolerated across all study arms, the most common adverse events being gastrointestinal symptoms. In the monotherapy dose-finding arm, four patients experienced dose-limiting toxicities (mainly rash). AZD8186 doses of 60-mg twice daily [BID; 5 days on, 2 days off (5:2)] and 120-mg BID (continuous and 5:2 dosing) were taken into subsequent arms. The PKs of AZD8186 were dose proportional, without interactions with abiraterone acetate or vistusertib, and target inhibition was observed in plasma and tumor tissue. Monotherapy and combination therapy showed preliminary evidence of limited antitumor activity by imaging and, in prostate cancer, PSA reduction. CONCLUSIONS AZD8186 monotherapy had an acceptable safety and tolerability profile, and combination with abiraterone acetate/prednisone or vistusertib was also tolerated. There was preliminary evidence of antitumor activity, meriting further exploration of AZD8186 in subsequent studies in PI3Kβ pathway-dependent cancers.
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Affiliation(s)
- Atish D. Choudhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Celestia S. Higano
- Department of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Johann S. de Bono
- Drug Development Unit, The Institute of Cancer Research and Royal Marsden, London, United Kingdom
| | - Natalie Cook
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Dana E. Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, New York
| | - Kari B. Wisinski
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin
| | - Juan Martin-Liberal
- Medical Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mark Linch
- University College London (UCL) Cancer Institute and UCL Hospital, London, United Kingdom
| | - Elisabeth I. Heath
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Javier García-Carbacho
- Department of Medical Oncology (Hospital Clinic Barcelona)/Translational Genomics and Targeted Therapies in Solid Tumors (IDIBAPS), Barcelona, Spain
| | | | | | | | | | | | | | - Brijesh Maroj
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Ganesh Moorthy
- Clinical Pharmacology & Quantitative Pharmacology (CPQP), Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Boston, Massachusetts
| | | | | | | | - Liz Sainsbury
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Geoffrey I. Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aaron R. Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Corresponding Author: Aaron R. Hansen, Princess Margaret Cancer Center, 700 University Avenue, Suite 7-623, Toronto, ON M5G 1×6, Canada. E-mail:
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Voronova V, Cullberg M, Delff P, Parkinson J, Dota C, Schiavon G, Maroj B, Rekić D, Cheung SYA. Concentration-QT modeling shows no evidence of clinically significant QT interval prolongation with capivasertib at expected therapeutic concentrations. Br J Clin Pharmacol 2021; 88:858-864. [PMID: 34309049 PMCID: PMC9292875 DOI: 10.1111/bcp.15006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/15/2021] [Accepted: 07/03/2021] [Indexed: 12/04/2022] Open
Abstract
Pharmacokinetics‐matched digital electrocardiogram data (n = 503 measurements from 180 patients) collected in a first‐in‐human, multi‐part, dose‐escalation (from 80 to 800 mg) and dose expansion (at 480 mg) phase 1 study in patients with advanced solid malignancies, were used to assess potential risk of QT prolongation associated with the AKT inhibitor capivasertib. The relationship between plasma drug concentrations and baseline‐adjusted Fridericia‐corrected QT (ΔQTcF) values was estimated using a prespecified linear mixed‐effects model. The model provided an unbiased reproduction of the experimental data set, estimating a small but positive correlation between capivasertib concentration and ΔQTcF. At the expected therapeutic dose (400 mg twice daily) the predicted mean ΔQTcF at the steady state maximum concentration was 3.97 ms with an upper limit of the 90% CI of 5.07 ms; below the 10 ms limit proposed by ICH E14 guidance. This analysis suggests that capivasertib is not expected to present a clinically significant risk for QT prolongation that is associated with pro‐arrhythmic effects.
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Affiliation(s)
| | - Marie Cullberg
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Gothenburg, Sweden
| | - Philip Delff
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Boston, MA, USA.,Now at Vertex Pharmaceuticals, Boston, MA, USA
| | - Joanna Parkinson
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Gothenburg, Sweden
| | - Corina Dota
- Cardiovascular Safety Center of Excellence, Oncology R&D, AstraZeneca R&D, Gothenburg, Sweden
| | - Gaia Schiavon
- Late Development Oncology, Oncology R&D, AstraZeneca R&D, Cambridge, UK
| | - Brijesh Maroj
- Patient Safety Oncology, Global Medicines Development, AstraZeneca R&D, Cambridge, UK
| | - Dinko Rekić
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Gothenburg, Sweden
| | - S Y Amy Cheung
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Cambridge, UK.,Now at Certara, Princeton, NJ, USA
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