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Ernst SM, Hofman MM, van der Horst TE, Paats MS, Heijboer FWJ, Aerts JGJV, Dumoulin DW, Cornelissen R, von der Thüsen JH, de Bruijn P, Hoop EOD, Mathijssen RHJ, Koolen SLW, Dingemans AMC. Hepatotoxicity in patients with non-small cell lung cancer treated with sotorasib after prior immunotherapy: a comprehensive clinical and pharmacokinetic analysis. EBioMedicine 2024; 102:105074. [PMID: 38507877 PMCID: PMC10960098 DOI: 10.1016/j.ebiom.2024.105074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Sotorasib given after immunotherapy could put patients at increased risk of hepatotoxicity. Therefore, there is a need to gain insight into the potential correlation between anti-PD-(L)1 treatment, anti-PD-(L)1 concentrations, sotorasib concentrations, and the incidence of hepatotoxicity during sotorasib. METHODS Patients with KRASG12C-mutated NSCLC treated with sotorasib were prospectively enrolled in our biomarker cohort study (NCT05221372). Plasma samples were collected prior and during sotorasib treatment for anti-PD-1 and sotorasib concentrations. ALT/AST/ALP/GGT increases were collected prospectively and graded according to CTCAEv5.0. Severe hepatotoxicity was defined as grade ≥3 ALT/AST/ALP/GGT increase. FINDINGS Of the 91 included patients, 80 (88%) received prior anti-PD-(L)1. Prior anti-PD-(L)1 and prior immune-related hepatotoxicity were associated with a higher incidence of severe hepatotoxicity (35% versus 0%, p = 0.016 and 75% versus 31%, p = 0.019, respectively). Patients with an interval of ≤6 weeks between anti-PD-(L)1 and sotorasib (n = 18) had a significantly higher incidence of severe hepatotoxicity than those with a 6-12 week (n = 24) and ≥12 week (n = 38) interval (83% versus 33% versus 13%, respectively, p < 0.0001). Sotorasib trough concentrations did not differ significantly between those with or without severe hepatotoxicity (106 versus 126 ng/mL, p = 0.16). Pembrolizumab concentrations were higher in those with severe hepatotoxicity versus those without (25.6 versus 6.1 μg/mL, p < 0.0001). INTERPRETATION In this preliminary prospective study, sotorasib after PD-(L)1 blockade was associated with severe hepatotoxicity, especially in patients with a short interval between treatments, prior immune-related hepatitis and higher anti-PD-1 plasma concentrations. Our results suggest a minimum interval of 6 weeks between anti-PD-(L)1 and sotorasib to minimize the risk of hepatotoxicity. FUNDING None.
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Affiliation(s)
- Sophie M Ernst
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Maaike M Hofman
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Tessa E van der Horst
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Marthe S Paats
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Frank W J Heijboer
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Joachim G J V Aerts
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Daphne W Dumoulin
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Robin Cornelissen
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Jan H von der Thüsen
- Department of Pathology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Peter de Bruijn
- Department of Medical Oncology, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Stijn L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands; Department of Pharmacy, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Anne-Marie C Dingemans
- Department of Respiratory Medicine, Erasmus MC Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands.
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