1
|
Pluim D, Buitelaar P, de Jong KAM, Rosing H, Brandsma D, Huitema ADR, Beijnen JH. ELISA assay for the quantification of ipilimumab in human serum, plasma, milk, and cerebrospinal fluid. J Pharm Biomed Anal 2024; 245:116140. [PMID: 38701533 DOI: 10.1016/j.jpba.2024.116140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/02/2024] [Accepted: 04/06/2024] [Indexed: 05/05/2024]
Abstract
Ipilimumab is an immune checkpoint inhibitor of the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). Ipilimumab has become part of the standard of care for different types of cancer. The efficacy of these treatments is limited due to immune-related toxicity and high economic costs. Dose rationalization studies based on pharmacokinetic data may help to address these limitations. For this purpose, more sensitive analytical methods are needed. We report the development and validation of the first enzyme-linked immunosorbent assay (ELISA) for sensitive determination of ipilimumab concentrations in human serum, plasma, cerebrospinal fluid (CSF), and milk. Our assay is based on the specific capture of ipilimumab by immobilized CTLA-4. The lower limit of quantifications of ipilimumab in serum, plasma, and milk are 50 ng/mL and 10 ng/mL in CSF. The ELISA method showed long-term storage stability for at least one year at -80°C and was successfully cross-validated with ultraperformance liquid chromatography coupled with tandem mass spectrometry. The ELISA method is reliable, relatively inexpensive, and can be used in serum, plasma, CSF, and milk from patients treated with ipilimumab, as evidenced by the analysis of real clinical samples.
Collapse
Affiliation(s)
- Dick Pluim
- Division of Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Pauline Buitelaar
- Division of Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Karen A M de Jong
- Division of Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dieta Brandsma
- Department of Neuro-oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Division of Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jos H Beijnen
- Division of Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
2
|
van der Heijden LT, Ribbers CA, Vermunt MAC, Pluim D, Acda M, Tibben M, Rosing H, Douma JAJ, Naipal K, Bergman AM, Beijnen JH, Huitema ADR, Opdam FL. Is Higher Docetaxel Clearance in Prostate Cancer Patients Explained by Higher CYP3A? An In Vivo Phenotyping Study with Midazolam. J Clin Pharmacol 2024; 64:155-163. [PMID: 37789682 DOI: 10.1002/jcph.2362] [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: 05/23/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023]
Abstract
Patients with prostate cancer (PCa) have a lower docetaxel exposure for both intravenous (1.8-fold) and oral administration (2.4-fold) than patients with other solid cancers, which could influence efficacy and toxicity. An altered metabolism by cytochrome P450 3A (CYP3A) due to castration status might explain the observed difference in docetaxel pharmacokinetics. In this in vivo phenotyping, pharmacokinetic study, CYP3A activity defined by midazolam clearance (CL) was compared between patients with PCa and male patients with other solid tumors. All patients with solid tumors who did not use CYP3A-modulating drugs were eligible for participation. Patients received 2 mg midazolam orally and 1 mg midazolam intravenously on 2 consecutive days. Plasma concentrations were measured with a validated liquid chromatography-tandem mass spectrometry method. Genotyping was performed for CYP3A4 and CYP3A5. Nine patients were included in each group. Oral midazolam CL was 1.26-fold higher in patients with PCa compared to patients with other solid tumors (geometric mean [coefficient of variation], 94.1 [33.5%] L/h vs 74.4 [39.1%] L/h, respectively; P = .08). Intravenous midazolam CL did not significantly differ between the 2 groups (P = .93). Moreover, the metabolic ratio of midazolam to 1'-hydroxy midazolam did not differ between the 2 groups for both oral administration (P = .67) and intravenous administration (P = .26). CYP3A4 and CYP3A5 genotypes did not influence midazolam pharmacokinetics. The observed difference in docetaxel pharmacokinetics between both patient groups therefore appears to be explained neither by a difference in midazolam CL nor by a difference in metabolic conversion rate of midazolam.
Collapse
Affiliation(s)
- Lisa T van der Heijden
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Claire A Ribbers
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marit A C Vermunt
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dick Pluim
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Manon Acda
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Matthijs Tibben
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joeri A J Douma
- Department of Clinical Pharmacology, Division of Medical Oncology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, The Netherlands
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Kishan Naipal
- Department of Clinical Pharmacology, Division of Medical Oncology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, The Netherlands
| | - Andre M Bergman
- Department of Clinical Pharmacology, Division of Medical Oncology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, The Netherlands
- Department of Oncogenomics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Pharmacology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht Utrecht University, Utrecht, The Netherlands
- Department of Pharmacology, Princess Maxima Center, Utrecht, The Netherlands
| | - Frans L Opdam
- Department of Clinical Pharmacology, Division of Medical Oncology, Antoni van Leeuwenhoek/The Netherlands Cancer Institute, The Netherlands
| |
Collapse
|
3
|
Baarslag MA, Heimovaara JH, Borgers JSW, van Aerde KJ, Koenen HJPM, Smeets RL, Buitelaar PLM, Pluim D, Vos S, Henriet SSV, de Groot JWB, van Grotel M, Rosing H, Beijnen JH, Huitema ADR, Haanen JBAG, Amant F, Gierenz N. Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab. N Engl J Med 2023; 389:1790-1796. [PMID: 37937778 DOI: 10.1056/nejmoa2308135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Immune checkpoint blockade has become standard treatment for many types of cancer. Such therapy is indicated most often in patients with advanced or metastatic disease but has been increasingly used as adjuvant therapy in those with early-stage disease. Adverse events include immune-related organ inflammation resembling autoimmune diseases. We describe a case of severe immune-related gastroenterocolitis in a 4-month-old infant who presented with intractable diarrhea and failure to thrive after in utero exposure to pembrolizumab. Known causes of the symptoms were ruled out, and the diagnosis of pembrolizumab-induced immune-related gastroenterocolitis was supported by the results of histopathological assays, immunophenotyping, and analysis of the level of antibodies against programmed cell death protein 1 (PD-1). The infant's condition was successfully treated with prednisolone and infliximab.
Collapse
MESH Headings
- Humans
- Infant
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Enteritis/chemically induced
- Enteritis/diagnosis
- Enteritis/drug therapy
- Enteritis/immunology
- Neoplasms/drug therapy
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Immune Checkpoint Inhibitors/administration & dosage
- Immune Checkpoint Inhibitors/adverse effects
- Immune Checkpoint Inhibitors/therapeutic use
- Failure to Thrive/chemically induced
- Failure to Thrive/immunology
- Diarrhea, Infantile/chemically induced
- Diarrhea, Infantile/immunology
- Gastroenteritis/chemically induced
- Gastroenteritis/diagnosis
- Gastroenteritis/drug therapy
- Gastroenteritis/immunology
- Enterocolitis/chemically induced
- Enterocolitis/diagnosis
- Enterocolitis/drug therapy
- Enterocolitis/immunology
- Programmed Cell Death 1 Receptor/immunology
Collapse
Affiliation(s)
- Manuel A Baarslag
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Joosje H Heimovaara
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jessica S W Borgers
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Koen J van Aerde
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Hans J P M Koenen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Ruben L Smeets
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Pauline L M Buitelaar
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Dick Pluim
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Shoko Vos
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Stefanie S V Henriet
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jan Willem B de Groot
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Martine van Grotel
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Hilde Rosing
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jos H Beijnen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Alwin D R Huitema
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - John B A G Haanen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Frédéric Amant
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Nicole Gierenz
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| |
Collapse
|
4
|
de Jong K, Damoiseaux D, Pluim D, Rosing H, Beijnen JH, van Thienen H, Dorlo TPC, Huitema ADR, Amant F. High accumulation of nivolumab in human breast milk: A case report. Biomed Pharmacother 2023; 166:115354. [PMID: 37625324 DOI: 10.1016/j.biopha.2023.115354] [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: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Nivolumab is an immunotherapeutic monoclonal antibody (mAb) that is used for the treatment of several types of cancer. The evidence on its use during lactation is lacking. Here, we report on a 39-year-old woman with metastasized melanoma who was treated with 480 mg nivolumab every four weeks during lactation. Breast milk samples were collected over the course of 34 days, including two cycles of nivolumab. The highest measured concentration of nivolumab during the first cycle was 503 ng/mL at day 13. The cumulative relative infant dose (RID) over the first cycle (28 days) was 9.8 %. The highest overall measured nivolumab concentration was 519 ng/mL at day 33, five days after administration of the second nivolumab cycle. Nivolumab seems to accumulate in breast milk over two consecutive cycles, hence the RIDs of consecutive cycles are expected to be higher. To draw further conclusions regarding safety of breastfeeding during nivolumab therapy, more information about the oral bioavailability of nivolumab in newborns, the nivolumab steady-state concentrations in breast milk and its pharmacodynamic effects are needed.
Collapse
Affiliation(s)
- Karen de Jong
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David Damoiseaux
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands,.
| | - Dick Pluim
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands,; Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Hans van Thienen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Thomas P C Dorlo
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands,; Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands,; Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands,; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frédéric Amant
- Department of Gynecology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Gynecologic Oncology, UZ Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Embaby A, Kutzera J, Geenen JJ, Pluim D, Hofland I, Sanders J, Lopez-Yurda M, Beijnen JH, Huitema ADR, Witteveen PO, Steeghs N, van Haaften G, van Vugt MATM, de Ridder J, Opdam FL. WEE1 inhibitor adavosertib in combination with carboplatin in advanced TP53 mutated ovarian cancer: A biomarker-enriched phase II study. Gynecol Oncol 2023; 174:239-246. [PMID: 37236033 DOI: 10.1016/j.ygyno.2023.05.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE In the first part of this phase II study (NCT01164995), the combination of carboplatin and adavosertib (AZD1775) was shown to be safe and effective in patients with TP53 mutated platinum-resistant ovarian cancer (PROC). Here, we present the results of an additional safety and efficacy cohort and explore predictive biomarkers for resistance and response to this combination treatment. METHODS This is a phase II, open-label, non-randomized study. Patients with TP53 mutated PROC received carboplatin AUC 5 mg/ ml·min intravenously and adavosertib 225 mg BID orally for 2.5 days in a 21-day cycle. The primary objective is to determine the efficacy and safety of carboplatin and adavosertib. Secondary objectives include progression-free survival (PFS), changes in circulating tumor cells (CTC) and exploration of genomic alterations. RESULTS Thirty-two patients with a median age of 63 years (39-77 years) were enrolled and received treatment. Twenty-nine patients were evaluable for efficacy. Bone marrow toxicity, nausea and vomiting were the most common adverse events. Twelve patients showed partial response (PR) as best response, resulting in an objective ORR of 41% in the evaluable patients (95% CI: 23%-61%). The median PFS was 5.6 months (95% CI: 3.8-10.3). In patients with tumors harboring CCNE1 amplification, treatment efficacy was slightly but not significantly better. CONCLUSIONS Adavosertib 225 mg BID for 2.5 days and carboplatin AUC 5 could be safely combined and showed anti-tumor efficacy in patients with PROC. However, bone marrow toxicity remains a point of concern, since this is the most common reason for dose reductions and dose delays.
Collapse
Affiliation(s)
- Alaa Embaby
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - Joachim Kutzera
- Department of Genetics, Utrecht University, Utrecht, the Netherlands
| | - Jill J Geenen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Dick Pluim
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ingrid Hofland
- Core Facility Molecular Pathology & Biobanking, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Joyce Sanders
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marta Lopez-Yurda
- Biometrics Department, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jos H Beijnen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Pharmacy, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Pharmacy, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gijs van Haaften
- Department of Genetics, Utrecht University, Utrecht, the Netherlands
| | - Marcel A T M van Vugt
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeroen de Ridder
- Center for Molecular Medicine and Oncode Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans L Opdam
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| |
Collapse
|
6
|
de With M, Knikman J, de Man FM, Lunenburg CATC, Henricks LM, van Kuilenburg ABP, Maring JG, van Staveren MC, de Vries N, Rosing H, Beijnen JH, Pluim D, Modak A, Imholz ALT, van Schaik RHN, Schellens JHM, Gelderblom H, Cats A, Guchelaar HJ, Mathijssen RHJ, Swen JJ, Meulendijks D. Dihydropyrimidine Dehydrogenase Phenotyping Using Pretreatment Uracil: A Note of Caution Based on a Large Prospective Clinical Study. Clin Pharmacol Ther 2022; 112:62-68. [PMID: 35397172 PMCID: PMC9322339 DOI: 10.1002/cpt.2608] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 02/22/2022] [Accepted: 04/01/2022] [Indexed: 11/12/2022]
Abstract
In clinical practice, 25-30% of the patients treated with fluoropyrimidines experience severe fluoropyrimidine-related toxicity. Extensively clinically validated DPYD genotyping tests are available to identify patients at risk of severe toxicity due to decreased activity of dihydropyrimidine dehydrogenase (DPD), the rate limiting enzyme in fluoropyrimidine metabolism. In April 2020, the European Medicines Agency recommended that, as an alternative for DPYD genotype-based testing for DPD deficiency, also phenotype testing based on pretreatment plasma uracil levels is a suitable method to identify patients with DPD deficiency. Although the evidence for genotype-directed dosing of fluoropyrimidines is substantial, the level of evidence supporting plasma uracil levels to predict DPD activity in clinical practice is limited. Notwithstanding this, uracil-based phenotyping is now used in clinical practice in various countries in Europe. We aimed to determine the value of pretreatment uracil levels in predicting DPD deficiency and severe treatment-related toxicity. To this end, we determined pretreatment uracil levels in 955 patients with cancer, and assessed the correlation with DPD activity in peripheral blood mononuclear cells (PBMCs) and fluoropyrimidine-related severe toxicity. We identified substantial issues concerning the use of pretreatment uracil in clinical practice, including large between-center study differences in measured pretreatment uracil levels, most likely as a result of pre-analytical factors. Importantly, we were not able to correlate pretreatment uracil levels with DPD activity nor were uracil levels predictive of severe treatment-related toxicity. We urge that robust clinical validation should first be performed before pretreatment plasma uracil levels are used in clinical practice as part of a dosing strategy for fluoropyrimidines.
Collapse
Affiliation(s)
- Mirjam de With
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands.,Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jonathan Knikman
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Femke M de Man
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Carin A T C Lunenburg
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda M Henricks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - André B P van Kuilenburg
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan G Maring
- Department of Pharmacy, Isala Hospital, Zwolle, The Netherlands.,Isala Diaconessen Hospital, Meppel, The Netherlands
| | - Maurice C van Staveren
- Department of Clinical Pharmacy and Toxicology, Treant Healthgroup, Scheper Hospital, Emmen, The Netherlands
| | - Niels de Vries
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Dick Pluim
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anil Modak
- Cambridge Isotope Laboratories, Tewksbury, Massachusetts, USA
| | - Alex L T Imholz
- Department of Internal Medicine, Deventer Hospital, Deventer, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan H M Schellens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemieke Cats
- Division of Medical Oncology, Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Network for Personalised Therapeutics (LNPT), Leiden, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Network for Personalised Therapeutics (LNPT), Leiden, The Netherlands
| | - Didier Meulendijks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Late Development Oncology, AstraZeneca, Cambridge, UK
| |
Collapse
|
7
|
Embaby A, Geenen JJ, Kutzera J, Pluim D, Lopez-Yurda MI, Beijnen JH, Huitema A, Witteveen P, Steeghs N, van Haaften G, van Vugt MA, de Ridder J, Opdam F. Adavosertib in combination with carboplatin in advanced TP53-mutated platinum-resistant ovarian cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5516 Background: Ovarian cancer is globally the second most common cause of death among women with gynecologic malignancies. Despite high initial response rates, the overall prognosis of this patient population remains poor. The majority of advanced ovarian cancers will become platinum resistant defined by recurrence within six months after completion of platinum therapy. In the first part of the current phase II study, the combination of carboplatin and the Wee1 inhibitor adavosertib (AZD1775), showed to be safe and effective in patients with TP53 mutated platinum resistant ovarian cancer. The aim of this additional cohort is to gain more information about the safety and efficacy of the combination and to explore predictive biomarkers for resistance and response to adavosertib. Methods: In this additional cohort 29 evaluable were treated with carboplatin AUC 5 mg/ ml·min and adavosertib 225 mg BID for 2.5 days in a 21-day cycle. The anti-tumor activity was assessed according to RECIST 1.1. Pre-, on- and post-treatment biopsies were obtained to explore genetic determinants of drug resistance and response to adavosertib. Results: A total of 32 patients with a median age of 62 years (39-77 years) were enrolled in this cohort. All patients had carboplatin/paclitaxel as first line therapy. Six patients received a second-line non-platinum containing regimen. Median platinum free interval was 5.8 months (range 1.7 – 11.9). Twenty-nine patients were evaluable for efficacy. Grade 1-2 bone marrow toxicity, nausea, vomiting and fatigue were the most common adverse events. Dose reductions of carboplatin and/or adavosertib were made in 15/29 evaluable patients (52%). Dose delays occurred in the majority of patients (76%), mostly due to neutropenia and thrombocytopenia. Twelve patients showed PR as best response, resulting in an ORR of 38% in the intention-to-treat population (95% CI 21%-56%). The median PFS was 5.6 months (range 1.1-32 months, 95% CI 4.2-7.0) and median duration of response was 5.3 months (95% CI 0.13-10.5). Conclusions: Adavosertib 225 mg BID for 2.5 days and carboplatin AUC 5 in a 21-day cycle could be safely combined and shows promising anti-tumor efficacy in patients with platinum resistant ovarian cancer. Bone marrow toxicity remains the most common reason for dose reductions and dose delays. Translational biomarker results (CCNE1 analysis as potential predictive marker for response and resistance and WGS) to better understand the anti-tumor activity of the combination are pending. Clinical trial information: NCT01164995.
Collapse
Affiliation(s)
- Alaa Embaby
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Jill Jacqueline Geenen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Joachim Kutzera
- Institute of Human Genetics, University Medical Center Leipzig, Leipzig, Germany
| | - Dick Pluim
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Jos H. Beijnen
- Department of Pharmacy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Alwin Huitema
- Department of Pharmacy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Petronella Witteveen
- Department of Medical Oncology, Cancer Center University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Gijs van Haaften
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel A.T.M. van Vugt
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Jeroen de Ridder
- Center for Molecular Medicine and Oncode Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frans Opdam
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| |
Collapse
|
8
|
Duinkerken CW, de Weger VA, Dreschler WA, van der Molen L, Pluim D, Rosing H, Nuijen B, Hauptmann M, Beijnen JH, Balm AJM, de Boer JP, Burgers JA, Marchetti S, Schellens JHM, Zuur CL. Transtympanic Sodium Thiosulfate for Prevention of Cisplatin-Induced Ototoxicity: A Randomized Clinical Trial. Otol Neurotol 2021; 42:678-685. [PMID: 33710154 DOI: 10.1097/mao.0000000000003069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine safety, feasibility, and preliminary activity of transtympanic injection of sodium thiosulfate (STS) against cisplatin-induced hearing loss (CIHL).DESIGN Randomized controlled trial.SETTING Tertiary cancer hospital.PATIENTS Adults to be treated with high-dose cisplatin (≥ 75 mg/m2).INTERVENTION Selected by randomization, 0.1 M STS gel on one side and placebo gel on the other side was transtympanically applied to the middle ear 3 hours before cisplatin administration. After amendment, the placebo ear was left untreated. MAIN OUTCOME MEASURE Primary outcome was safety and feasibility. Secondary outcomes included pharmacokinetic analysis of systemic cisplatin and preliminary activity of STS. Clinically relevant CIHL was defined as a ≥ 10 dB threshold shift at pure-tone average 8-10-12.5 kHz (PTA8-12.5). Response to STS was defined as a threshold shift at PTA8-12.5 in the STS-treated ear of ≥ 10 dB smaller than the untreated ear. RESULTS Twelve patients were treated. Average CIHL at PTA8-12.5 was 12.7 dB in untreated ears and 8.8 dB SPL in STS-treated ears (p = 0.403). Four patients did not develop CIHL. Four out of eight patients with CIHL responded to STS: CIHL at PTA8-12.5 in STS-treated ears was 18.4 dB less compared to untreated ears (p = 0.068). Grade 1 adverse events were reported. Pharmacokinetic results were available for 11 patients. CONCLUSION Transtympanic application of STS was safe and feasible. Based on our pharmacokinetic analysis, we postulate that transtympanic STS does not interfere with the systemically available cisplatin. Our results provide a preliminary proof of concept for transtympanic application of STS in preventing CIHL and warrants further evaluation on a larger scale.
Collapse
Affiliation(s)
- Charlotte W Duinkerken
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Amsterdam
- Department of Otolaryngology, Leiden University Medical Centre, Leiden
| | - Vincent A de Weger
- Division of Clinical Pharmacology
- Division of Pharmacology, the Netherlands Cancer Institute, Amsterdam
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar
| | | | - Lisette van der Molen
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Amsterdam
| | - Dick Pluim
- Division of Pharmacology, the Netherlands Cancer Institute, Amsterdam
| | | | | | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Jos H Beijnen
- Division of Clinical Pharmacology
- Department of Pharmacy and Pharmacology
| | - Alfons J M Balm
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Amsterdam
- Department of Maxillofacial Surgery, Amsterdam University Medical Centre
| | | | - Jacobus A Burgers
- Department of Thoracic Oncology, the Netherlands Cancer Institute, Amsterdam
| | | | - Jan H M Schellens
- Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht
| | - Charlotte L Zuur
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Amsterdam
- Department of Maxillofacial Surgery, Amsterdam University Medical Centre
- Cell Biology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
9
|
van Eijk M, Pluim D, Dorlo TPC, Marchetti S, Huitema ADR, Beijnen JH. Investigating the influence of relevant pharmacogenetic variants on the pharmacokinetics and pharmacodynamics of orally administered docetaxel combined with ritonavir. Pharmacogenomics J 2021; 21:336-345. [PMID: 33649517 DOI: 10.1038/s41397-021-00213-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
The anticancer drug docetaxel exhibits large interpatient pharmacokinetic and pharmacodynamic variability. In this study, we aimed to assess the functional significance of 14 polymorphisms in the CYP3A, CYP1B1, ABCB1, ABCC2, and SLCO1B3 genes for the pharmacokinetics and pharmacodynamics of oral docetaxel, co-administered with ritonavir. None of the tested CYP3A, ABCB1, ABCC2, and SLCO1B3 genotypes and diplotypes showed a significant relation with an altered bioavailability or clearance of either docetaxel or ritonavir. Similarly, no clear effect of CYP1B1 genotype on clinical outcomes was observed in a subgroup of non-small cell lung cancer (NSCLC) patients. Our post hoc power analysis indicated that our pharmacogenetic-pharmacokinetic analysis was only powered for relatively high effect sizes, which were to be expected given the high interpatient variability. This makes it unlikely that future studies will explain the high observed interpatient variability in oral docetaxel pharmacokinetics as a result of any of these separate polymorphisms and diplotypes.
Collapse
Affiliation(s)
- Maarten van Eijk
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Dick Pluim
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Thomas P C Dorlo
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Serena Marchetti
- Division of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
10
|
de Haan R, van den Heuvel MM, van Diessen J, Peulen HMU, van Werkhoven E, de Langen AJ, Lalezari F, Pluim D, Verwijs-Janssen M, Vens C, Schellens JHM, Steeghs N, Verheij M, van Triest B. Phase I and Pharmacologic Study of Olaparib in Combination with High-dose Radiotherapy with and without Concurrent Cisplatin for Non-Small Cell Lung Cancer. Clin Cancer Res 2021; 27:1256-1266. [PMID: 33262140 DOI: 10.1158/1078-0432.ccr-20-2551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify an MTD of olaparib, a PARP inhibitor, in combination with loco-regional radiotherapy with/without cisplatin for the treatment of non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Olaparib dose was escalated in two groups: radiotherapy (66 Gy/24 fractions in 2.75 Gy/fraction) with and without daily cisplatin (6 mg/m2), using time-to-event continual reassessment method with a 1-year dose-limiting toxicity (DLT) period. The highest dose level with a DLT probability <15% was defined as MTD. Poly ADP-ribose (PAR) inhibition and radiation-induced PAR-ribosylation (PARylation) were determined in peripheral blood mononuclear cells. RESULTS Twenty-eight patients with loco-regional or oligometastatic disease (39%) were treated: 11 at olaparib 25 mg twice daily and 17 at 25 mg once daily. The lowest dose level with cisplatin was above the MTD due to hematologic and late esophageal DLT. The MTD without cisplatin was olaparib 25 mg once daily. At a latency of 1-2.8 years, severe pulmonary adverse events (AE) were observed in 5 patients across all dose levels, resulting in 18% grade 5 pulmonary AEs. Exploratory analyses indicate an association with the radiation dose to the lungs. At the MTD, olaparib reduced PAR levels by more than 95% and abolished radiation-induced PARylation. Median follow-up of survivors was 4.1 years. Two-year loco-regional control was 84%, median overall survival in patients with locally advanced NSCLC was 28 months. CONCLUSIONS Combined mildly hypofractionated radiotherapy and low-dose daily cisplatin and olaparib was not tolerable due to esophageal and hematologic toxicity. Severe pulmonary toxicity was observed as well, even without cisplatin. More conformal radiotherapy schedules with improved pulmonary and esophageal sparing should be explored.
Collapse
Affiliation(s)
- Rosemarie de Haan
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michel M van den Heuvel
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Judi van Diessen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Heike M U Peulen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ferry Lalezari
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dick Pluim
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Manon Verwijs-Janssen
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Conchita Vens
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| |
Collapse
|
11
|
Geenen JJJ, Dackus GMHE, Schouten PC, Pluim D, Marchetti S, Sonke GS, Jóźwiak K, Huitema ADR, Beijnen JH, Schellens JHM, Linn SC. A Phase I dose-escalation study of two cycles carboplatin-olaparib followed by olaparib monotherapy in patients with advanced cancer. Int J Cancer 2021; 148:3041-3050. [PMID: 33539540 PMCID: PMC8248128 DOI: 10.1002/ijc.33498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/20/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/21/2022]
Abstract
Preclinical studies have shown synergistic effects when combining PARP1/2 inhibitors and platinum drugs in BRCA1/2 mutated cancer cell models. After a formulation change of olaparib from capsules to tablets, we initiated a dose finding study of olaparib tablets bidaily (BID) continuously with carboplatin to prepare comparative studies in this patient group. Patients were included in a 3 + 3 dose‐escalation schedule: olaparib 25 mg BID and carboplatin area under the curve (AUC) 3 mg*min/mL d1/d22, olaparib 25 mg BID and carboplatin AUC 4 mg*min/mL d1/d22, followed by increasing dose‐levels of olaparib from 50 mg BID, 75 mg BID, to 100 mg BID with carboplatin at AUC 4 mg*min/mL d1/d22. After two cycles, patients continued olaparib 300 mg BID as monotherapy. Primary objective was to assess the maximum tolerable dose (MTD). Twenty‐four patients with a confirmed diagnosis of advanced cancer were included. Most common adverse events were nausea (46%), fatigue (33%) and platelet count decrease (33%). Dose‐level 3 (olaparib 75 mg BID and carboplatin AUC 4 mg*min/mL; n = 6) was defined as MTD. Fourteen out of 24 patients (56%) had a partial response as best response (RECIST 1.1). Systemic exposure of the olaparib tablet formulation appeared comparable to the previous capsule formulation with olaparib tablet AUC0‐12 of 16.3 μg/mL*h at MTD. Polymers of ADP‐ribose levels in peripheral blood mononuclear cells were reduced by 98.7% ± 0.14% at Day 8 compared to Day 1 for dose‐level 3. Olaparib tablets 75 mg BID and carboplatin AUC 4 mg*min/mL for two cycles preceding olaparib monotherapy 300 mg is a feasible and tolerable treatment schedule for patients with advanced cancer.
What's new?
Preclinical studies have shown synergistic effects when combining PARP1/2‐inhibitors and platinum drugs in BRCA1/2 mutated cancer cell models. This phase I trial of olaparib tablets combined with carboplatin in advanced cancer patients showed that the combination has an acceptable side‐effect profile. The maximum tolerable dose was olaparib tablets 75 mg BID and carboplatin AUC 4 mg*min/ml. The observed preliminary anti‐tumor activity was encouraging, with 58% of patients having a decrease in tumor volume of more than 30%. This study shows that the tablet formulation of olaparib can be administered safely in combination with carboplatin, compared to the previous capsule formulation.
Collapse
Affiliation(s)
- Jill J J Geenen
- Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gwen M H E Dackus
- Department of Molecular Pathology, Antoni van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pathology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Philip C Schouten
- Department of Molecular Pathology, Antoni van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dick Pluim
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Serena Marchetti
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology, Antoni van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Alwin D R Huitema
- Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, Utrecht University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Faculty of Science, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands
| | - Jos H Beijnen
- Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, Utrecht University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Faculty of Science, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands
| | - Jan H M Schellens
- Faculty of Science, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands
| | - Sabine C Linn
- Department of Molecular Pathology, Antoni van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pathology, Utrecht University Medical Center, Utrecht, The Netherlands.,Department of Medical Oncology, Antoni van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
12
|
De Haan R, Pluim D, Verwijs M, Sonke G, Van den Heuvel M, Van Triest B, Vens C, Verheij M. OC-0438: Clinical pharmacodynamics support biological effectivity of low dose olaparib as radiosensitizer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
13
|
Jansen AME, Sriram JD, Pluim D, Maas RJH, van Groningen H, Piet B, Ter Heine R. Therapeutic Exposure and Successful Response to Pembrolizumab in a Patient With Non-Small-Cell Lung Cancer Despite Significant Renal Loss Due to Paraneoplastic Nephrotic Syndrome. Clin Lung Cancer 2020; 22:e220-e223. [PMID: 33189593 DOI: 10.1016/j.cllc.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A M E Jansen
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - J D Sriram
- Department of Pulmonology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D Pluim
- Division of Pharmacology, Netherlands Cancer Institute, Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, The Netherlands
| | - R J H Maas
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H van Groningen
- Department of Pulmonology, Elkerliek Hospital, Helmond, The Netherlands
| | - B Piet
- Department of Pulmonology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Ter Heine
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
14
|
Roosendaal J, Jacobs BAW, Pluim D, Rosing H, de Vries N, van Werkhoven E, Nuijen B, Beijnen JH, Huitema ADR, Schellens JHM, Marchetti S. Phase I pharmacological study of continuous chronomodulated capecitabine treatment. Pharm Res 2020; 37:89. [PMID: 32382808 PMCID: PMC7205843 DOI: 10.1007/s11095-020-02828-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
Purpose Capecitabine is an oral pre-pro-drug of the anti-cancer drug 5-fluorouracil (5-FU). The biological activity of the 5-FU degrading enzyme, dihydropyrimidine dehydrogenase (DPD), and the target enzyme thymidylate synthase (TS), are subject to circadian rhythmicity in healthy volunteers. The aim of this study was to determine the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), safety, pharmacokinetics (PK) and pharmacodynamics (PD) of capecitabine therapy adapted to this circadian rhythm (chronomodulated therapy). Methods Patients aged ≥18 years with advanced solid tumours potentially benefitting from capecitabine therapy were enrolled. A classical dose escalation 3 + 3 design was applied. Capecitabine was administered daily without interruptions. The daily dose was divided in morning and evening doses that were administered at 9:00 h and 24:00 h, respectively. The ratio of the morning to the evening dose was 3:5 (morning: evening). PK and PD were examined on treatment days 7 and 8. Results A total of 25 patients were enrolled. The MTD of continuous chronomodulated capecitabine therapy was established at 750/1250 mg/m2/day, and was generally well tolerated. Circadian rhythmicity in the plasma PK of capecitabine, dFCR, dFUR and 5-FU was not demonstrated. TS activity was induced and DPD activity demonstrated circadian rhythmicity during capecitabine treatment. Conclusion The MTD of continuous chronomodulated capecitabine treatment allows for a 20% higher dose intensity compared to the approved regimen (1250 mg/m2 bi-daily on day 1–14 of every 21-day cycle). Chronomodulated treatment with capecitabine is promising and could lead to improved tolerability and efficacy of capecitabine. Electronic supplementary material The online version of this article (10.1007/s11095-020-02828-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jeroen Roosendaal
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands.
| | - Bart A W Jacobs
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands.,Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Dick Pluim
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands
| | - Niels de Vries
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Bastiaan Nuijen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands.,Science Faculty, Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, P.O. Box 80082, 3508, TB, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Jan H M Schellens
- Science Faculty, Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, P.O. Box 80082, 3508, TB, Utrecht, The Netherlands
| | - Serena Marchetti
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| |
Collapse
|
15
|
van Bussel MTJ, Pluim D, Milojkovic Kerklaan B, Bol M, Sikorska K, Linders DTC, van den Broek D, Beijnen JH, Schellens JHM, Brandsma D. Circulating epithelial tumor cell analysis in CSF in patients with leptomeningeal metastases. Neurology 2020; 94:e521-e528. [PMID: 31907288 DOI: 10.1212/wnl.0000000000008751] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The primary objective was to determine the sensitivity and specificity of epithelial cell adhesion molecule (EpCAM) immunoflow cytometry circulating tumor cells (CTC) analysis in CSF in patients with suspected leptomeningeal metastases (LM). The secondary objective was to explore the distribution of driver mutations in the primary tumor, plasma, cell free CSF (cfCSF), and isolated CTC from CSF in non-small cell lung cancer (NSCLC). METHODS We tested the performance of the CTC assay vs CSF cytology in a prospective study in 81 patients with a clinical suspicion of LM but a nonconfirmatory MRI. In an NSCLC subcohort, we analyzed circulating tumor (ct)DNA of the selected driver mutations by digital droplet PCR (ddPCR). RESULTS The sensitivity of the CTC assay was 94% (95% confidence interval [CI] 80-99) and the specificity was 100% (95% CI 91-100) at the optimal cutoff of 0.9 CTC/mL. The sensitivity of cytology was 76% (95% CI 58-89). Twelve of the 23 patients with NSCLC had mutated epidermal growth factor receptor (EGFR). All 5 tested patients with LM demonstrated the primary EGFR driver mutation in cfCSF. The driver mutation could also be detected in CTC isolated from CSF. CONCLUSION CTC in CSF are detected with a high sensitivity for the diagnosis of LM. ddPCR can determine EGFR mutations in both cfCSF and isolated CTC from CSF of patients with EGFR-mutated NSCLC and LM. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that EpCAM-based immunoflow cytometry analysis of CSF accurately identifies patients with LM.
Collapse
Affiliation(s)
- Mark T J van Bussel
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dick Pluim
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Bojana Milojkovic Kerklaan
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Mijke Bol
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Karolina Sikorska
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dorothé T C Linders
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Daan van den Broek
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Jos H Beijnen
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Jan H M Schellens
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dieta Brandsma
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands.
| |
Collapse
|
16
|
Haan RD, Pluim D, Verwijs M, Sonke G, Heuvel MVD, Triest BV, Verheij M, Vens C. Abstract C009: Clinical pharmacokinetic and pharmacodynamic analyses support biological effectivity of the PARP inhibitor olaparib as radiosensitizer at low doses. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-c009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: PARP inhibitors are promising radiosensitizers. Currently identified recommended phase II doses of PARP inhibitors in combination with radiotherapy are 10-fold lower than the EMA and FDA approved dose as single agent. The purpose of this study is to investigate the biologically effective dose range of olaparib for its use as radiosensitizer by assessing pharmacokinetics (PK) and pharmacodynamics (PD). Both the inhibition of pre-treatment PAR levels and the inhibition of radiation induced PARylation therefore have to be determined. Methods: We included PK and PD samples of all NSCLC and breast cancer patients treated at olaparib doses up to 50mg bi-daily (BID) in two phase 1 trials combining radical radiotherapy with olaparib. Plasma samples were collected for PK analysis (ranging from steady state pre-dose olaparib until +12/24 hrs after intake) and peripheral blood mononuclear cells (PBMCs) for PD analysis (pre-treatment, +3 hrs and +12/24 hrs after olaparib intake). Breast cancer patients with the primary tumor in situ had biopsies taken pre-treatment and during olaparib treatment (+3 hrs after intake) before the first fraction of radiotherapy. Olaparib concentrations were determined by HPLC-MS/MS. PAR levels were determined by commercially available ELISA, following both the NCI protocol and REP assay (de Haan et al, 2017) that includes ex vivo irradiation of intact cells to activate PARylation by PARP. PAR levels determined by the REP assay were used to calculate PAR level inhibition during treatment. Results: PK/PD data from blood samples were available from 28 NSCLC patients and 7 breast cancer patients treated with radical radiotherapy and olaparib (17 at 25mg once daily (QD), 14 at 25mg BID and 4 at 50mg BID). Repeat biopsies were available from six out of seven breast cancer patients. The plasma olaparib concentrations increased with the dose levels and showed an expected wide intra-patient variation. In tumors the olaparib concentration varied between 178 and 1441 ng/g with a median tumor to plasma ratio of 0.47. PD analyses demonstrate a significant reduction in PAR levels in PBMCs during olaparib treatment (>95% at +3 hrs after olaparib intake for all dose levels, >90% at +12 hrs in the 25mg BID dose level and 66-99% at +24 hrs in the 25mg QD dose level; all p<0.0001). In pre-treatment samples, ex vivo radiation induced PAR levels by 66-fold (range 23 to 174). This radiation induced PARylation was abolished during olaparib treatment. Compared to corresponding pre-treatment PBMC samples, PAR levels in pre-treatment tumor biopsy samples were higher in all but one patient (median 7-fold higher, range 0.6-60), and increased by only 1.5-fold after ex vivo radiation. Also in tumors, olaparib abolished radiation induced PARylation. PAR levels were reduced by 89% (range 83-99.7%, p<0.0001). Conclusion: Olaparib doses as low as 25mg once and twice daily inhibit PARP activation by irradiation and reduce PAR levels >95% in PBMCs and >83% in tumors, thereby showing biological effectivity. The tumor olaparib concentrations determined in this study were all within a range that has been shown to radiosensitize in preclinical models. Together this supports further development of PARP inhibitors as radiosensitizer at low doses.
Citation Format: Rosemarie de Haan, Dick Pluim, Manon Verwijs, Gabe Sonke, Michel van den Heuvel, Baukelien van Triest, Marcel Verheij, Conchita Vens. Clinical pharmacokinetic and pharmacodynamic analyses support biological effectivity of the PARP inhibitor olaparib as radiosensitizer at low doses [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr C009. doi:10.1158/1535-7163.TARG-19-C009
Collapse
Affiliation(s)
| | - Dick Pluim
- 1the Netherlands Cancer Institute, Amsterdam
| | | | - Gabe Sonke
- 1the Netherlands Cancer Institute, Amsterdam
| | | | | | | | | |
Collapse
|
17
|
Pluim D, Ros W, Miedema IHC, Beijnen JH, Schellens JHM. Multiparameter Flow Cytometry Assay for Quantification of Immune Cell Subsets, PD‐1 Expression Levels and PD‐1 Receptor Occupancy by Nivolumab and Pembrolizumab. Cytometry A 2019; 95:1053-1065. [DOI: 10.1002/cyto.a.23873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/03/2019] [Accepted: 07/19/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Dick Pluim
- Division of PharmacologyNetherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AVL) Amsterdam The Netherlands
| | - Willeke Ros
- Division of PharmacologyNetherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AVL) Amsterdam The Netherlands
| | - Iris H. C. Miedema
- Division of PharmacologyNetherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AVL) Amsterdam The Netherlands
| | - Jos H. Beijnen
- Department of Clinical PharmacologyNetherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AVL) Amsterdam The Netherlands
- Department of Pharmacy and PharmacologyNetherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AVL) Amsterdam The Netherlands
- Utrecht Institute of Pharmaceutical Sciences (UIPS)Utrecht University Utrecht The Netherlands
| | - Jan H. M. Schellens
- Division of PharmacologyNetherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AVL) Amsterdam The Netherlands
- Department of Clinical PharmacologyNetherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AVL) Amsterdam The Netherlands
- Utrecht Institute of Pharmaceutical Sciences (UIPS)Utrecht University Utrecht The Netherlands
- Division of Medical OncologyNetherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AVL) Amsterdam The Netherlands
| |
Collapse
|
18
|
Geenen JJ, Dackus G, Schouten PC, Pluim D, Marchetti S, Sonke GS, Huitema A, Beijnen JH, Schellens JHM, Linn SC. A phase I dose-escalation study of two cycles carboplatin-olaparib followed by olaparib monotherapy in patients with advanced cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3118 Background: The PARP-inhibitor olaparib has single-agent activity in BRCA mutated breast and ovarian cancer. Preclinical studies show synergistic effects when combining PARP-inhibitors and platinum drugs in BRCA1/2 mutated cancer cell models. A formulation change from olaparib capsules to tablets initiated a new dose finding study of olaparib tablets BID continuously with carboplatin. Methods: Patients were included in a 3+3 dose-escalation schedule in the following dose-levels: olaparib 25mg BID and carboplatin AUC 3 d1/d22, olaparib 25mg BID and carboplatin AUC 4 d1/d22, olaparib 50mg BID and carboplatin AUC4 d1/d22, olaparib 75mg and carboplatin AUC 4 d1/d22 and olaparib 100mg BID and carboplatin AUC 4 d1/d22. After two cycles patients continued olaparib 300mg BID as monotherapy. Primary objective was to assess the Maximum Tolerable Dose (MTD). Secondary objectives were to investigate the preliminary response rate, pharmacodynamics and systemic exposure. Results: In total 24 patients were included with breast cancer (n = 18), ovarian cancer (n = 3), melanoma (n = 1), colorectal cancer (n = 1) and esophageal cancer (n = 1). Nineteen out of 24 patients had a germline BRCA mutation (79%). Most common AEs were nausea (46%), fatigue (33%) and platelet count decrease (33%). The majority of AEs (83%) were grade 1/2 in severity. Because two dose-limiting toxicities (consisting of ≥ 7 days dose delay of cycle 2 or missing ≥ 5 doses of olaparib due to hematologic toxicity) occurred in dose-level 4, dose-level 3 (olaparib 75mg and carboplatin AUC 4; n = 6 patients) was determined to be the MTD. Fourteen out of 24 patients (56%) had a partial response as best response, according to RECIST 1.1. Systemic exposure of the olaparib tablet formulation appeared comparable to the previous capsule formulation with an olaparib tablet AUC0-14 of 16.3 μg/ml*h at MTD. PARP activity in PBMCs was decreased by 98.7% ± 0.14% at day eight compared to day one for dose-level 3. Conclusions: Olaparib tablets 75mg BID and carboplatin AUC 4 for two cycles preceding olaparib monotherapy is a feasible and tolerable treatment schedule with encouraging clinical antitumor activity. Clinical trial information: NCT02418624.
Collapse
Affiliation(s)
| | - Gwen Dackus
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Philip C. Schouten
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Dick Pluim
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Gabe S. Sonke
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Alwin Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | | | - Sabine C. Linn
- Department of Medical Oncology-Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, Netherlands
| |
Collapse
|
19
|
Henricks LM, Jacobs BAW, Meulendijks D, Pluim D, van den Broek D, de Vries N, Rosing H, Beijnen JH, Huitema ADR, Guchelaar H, Cats A, Schellens JHM. Food-effect study on uracil and dihydrouracil plasma levels as marker for dihydropyrimidine dehydrogenase activity in human volunteers. Br J Clin Pharmacol 2018; 84:2761-2769. [PMID: 30047584 PMCID: PMC6256055 DOI: 10.1111/bcp.13719] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/05/2018] [Accepted: 07/14/2018] [Indexed: 12/31/2022] Open
Abstract
AIMS This study aimed to determine the effect of food intake on uracil and dihydrouracil plasma levels. These levels are a promising marker for dihydropyrimidine dehydrogenase activity and for individualizing fluoropyrimidine anticancer therapy. METHODS A randomized, cross-over study in 16 healthy volunteers was performed, in which subjects were examined in fasted and fed state on two separate days. In fed condition, a high-fat, high-caloric breakfast was consumed between 8:00 h and 8:30 h. Whole blood for determination of uracil, dihydrouracil and uridine plasma levels was drawn on both test days at predefined time points between 8:00 h and 13:00 h. RESULTS Uracil levels were statistically significantly different between fasting and fed state. At 13:00 h, the mean uracil level in fasting state was 12.6 ± 3.7 ng ml-1 and after a test meal 9.4 ± 2.6 ng ml-1 (P < 0.001). Dihydrouracil levels were influenced by food intake as well (mean dihydrouracil level at 13:00 h in fasting state 147.0 ± 36.4 ng ml-1 and in fed state 85.7 ± 22.1 ng ml-1 , P < 0.001). Uridine plasma levels showed curves with similar patterns as for uracil. CONCLUSIONS It was shown that both uracil and dihydrouracil levels were higher in fasting state than in fed state. This is hypothesized to be an direct effect of uridine plasma levels, which were previously shown to be elevated in fasting state and reduced after intake of food. These findings show that, when assessing plasma uracil and dihydrouracil levels for adaptive fluoropyrimidine dosing in clinical practice, sampling should be done between 8:00 h and 9:00 h after overnight fasting to avoid bias caused by circadian rhythm and food effects.
Collapse
Affiliation(s)
- Linda M. Henricks
- Division of PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Clinical Pharmacology, Division of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Bart A. W. Jacobs
- Department of Pharmacy & PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Didier Meulendijks
- Division of PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Clinical Pharmacology, Division of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Dutch Medicines Evaluation Board (CBG‐MEB)UtrechtThe Netherlands
| | - Dick Pluim
- Division of PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Clinical Pharmacology, Division of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Daan van den Broek
- Department of Clinical ChemistryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Niels de Vries
- Department of Pharmacy & PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Hilde Rosing
- Department of Pharmacy & PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Jos H. Beijnen
- Department of Pharmacy & PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Alwin D. R. Huitema
- Department of Pharmacy & PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Clinical PharmacyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Henk‐Jan Guchelaar
- Department of Clinical Pharmacy and ToxicologyLeiden University Medical CenterLeidenThe Netherlands
| | - Annemieke Cats
- Department of Gastrointestinal Oncology, Division of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Jan H. M. Schellens
- Division of PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Clinical Pharmacology, Division of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| |
Collapse
|
20
|
Jacobs BAW, Pluim D, van der Laan P, Tzani A, Beijnen JH, Schellens JHM. Development and validation of a quantitative method for thymidine phosphorylase activity in peripheral blood mononuclear cells. Nucleosides Nucleotides Nucleic Acids 2018; 37:436-454. [PMID: 30285552 DOI: 10.1080/15257770.2018.1498270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The enzyme thymidine phosphorylase (TP) is important for activation of capecitabine and 5-fluorouracil. Assessment of TP phenotype might be suitable for identification of patients at risk of fluoropyrimidine-induced toxicity. In this paper, we describe the development and validation an assay for TP activity in peripheral blood mononuclear cells (PBMCs). The assay was based on ex vivo conversion of the TP substrate thymidine to thymine. The amount of thymine formed was determined by high-performance liquid chromatography - ultraviolet detection (HPLC-UV) with 5-bromouracil as internal standard. Lymphocytes and monocytes were purified from isolated PBMCs to examine cell-specific TP activity. TP activity in PBMCs demonstrated Michaelis-Menten kinetics. The lower limit of quantification was 2.3 µg PBMC protein and assay linearity was demonstrated up to 22.7 µg PBMC protein. Within-day and between-day precisions were ≤9.2% and ≤6.0%, respectively. Adequate stability TP activity was demonstrated after long-term storage of PBMC dry pellets and lysates at -80 °C. In monocytes, TP activity was approximately 3 times higher than in lymphocytes. Clinical applicability was demonstrated in samples that were collected from five cancer patients. A simple, precise and sensitive HPLC-UV assay for quantification of TP activity in PBMCs was developed that can be applied for clinical research.
Collapse
Affiliation(s)
- Bart A W Jacobs
- a Department of Clinical Pharmacology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,b Department of Pharmacy & Pharmacology , The Netherlands Cancer Institute and MC Slotervaart , Amsterdam , The Netherlands
| | - Dick Pluim
- a Department of Clinical Pharmacology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Pia van der Laan
- a Department of Clinical Pharmacology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Anna Tzani
- a Department of Clinical Pharmacology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Jos H Beijnen
- a Department of Clinical Pharmacology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,b Department of Pharmacy & Pharmacology , The Netherlands Cancer Institute and MC Slotervaart , Amsterdam , The Netherlands.,c Science Faculty, Utrecht Institute for Pharmaceutical Sciences (UIPS) , Division of Pharmaco-epidemiology & Clinical Pharmacology, Utrecht University , Utrecht , The Netherlands
| | - Jan H M Schellens
- a Department of Clinical Pharmacology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Science Faculty, Utrecht Institute for Pharmaceutical Sciences (UIPS) , Division of Pharmaco-epidemiology & Clinical Pharmacology, Utrecht University , Utrecht , The Netherlands
| |
Collapse
|
21
|
Roosendaal J, Jacobs B, Pluim D, Rosing H, Nuijen B, Beijnen J, Huitema A, Schellens J, Marchetti S. Phase I pharmacological study of continuous chronomodulated capecitabine treatment. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Ceppi P, Siddiqui A, Gollavilli P, Pluim D, Saatci O, Annaratone L, Asangani I, Schellens J, Marchio C, Sahin O. SPOT-003 Thymidylate synthase maintains the undifferentiated state of aggressive breast cancers. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
23
|
de Haan R, Pluim D, van Triest B, van den Heuvel M, Peulen H, van Berlo D, George J, Verheij M, Schellens JHM, Vens C. Improved pharmacodynamic (PD) assessment of low dose PARP inhibitor PD activity for radiotherapy and chemotherapy combination trials. Radiother Oncol 2017; 126:443-449. [PMID: 29150161 DOI: 10.1016/j.radonc.2017.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND PARP inhibitors are currently evaluated in combination with radiotherapy and/or chemotherapy. As sensitizers, PARP inhibitors are active at very low concentrations therefore requiring highly sensitive pharmacodynamic (PD) assays. Current clinical PD-assays partly fail to provide such sensitivities. The aim of our study was to enable sensitive PD evaluation of PARP inhibitors for clinical sensitizer development. MATERIAL AND METHODS PBMCs of healthy individuals and of olaparib and radiotherapy treated lung cancer patients were collected for ELISA-based PD-assays. RESULTS PAR-signal amplification by ex vivo irradiation enabled an extended quantification range for PARP inhibitory activities after ex vivo treatment with inhibitors. This "radiation-enhanced-PAR" (REP) assay provided accurate IC50 values thereby also revealing differences among healthy individuals. Implemented in clinical radiotherapy combination Phase I trials, the REP-assay showed sensitive detection of PARP inhibition in patients treated with olaparib and establishes strong PARP inhibitory activities at low daily doses. CONCLUSIONS Combination trials of radiotherapy and novel targeted agent(s) often require different and more sensitive PD assessments than in the monotherapy setting. This study shows the benefit and relevance of sensitive and adapted PD-assays for such combination purposes and provides proof of clinically relevant cellular PARP inhibitory activities at low daily olaparib doses.
Collapse
Affiliation(s)
- Rosemarie de Haan
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Biological Stress Response, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dick Pluim
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michel van den Heuvel
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heike Peulen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Damien van Berlo
- Division of Biological Stress Response, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marcel Verheij
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Biological Stress Response, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan H M Schellens
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmaceutical Sciences, Utrecht University, The Netherlands
| | - Conchita Vens
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Biological Stress Response, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| |
Collapse
|
24
|
van Bussel M, Pluim D, Milojkovic-Kerklaan B, van den Broek D, Beijnen J, Boogerd W, Schellens J, Rhun EL, Brandsma D. CMET-12. TUMOR CELL DETECTION BY IMMUNOFLOW CYTOMETRY AND BRAF MUTATION ANALYSIS IN CEREBROSPINAL FLUID OF MELANOMA PATIENTS WITH SUSPECTED LEPTOMENINGEAL METASTASES. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
25
|
Gorelova V, De Lepeleire J, Van Daele J, Pluim D, Meï C, Cuypers A, Leroux O, Rébeillé F, Schellens JHM, Blancquaert D, Stove CP, Van Der Straeten D. Dihydrofolate Reductase/Thymidylate Synthase Fine-Tunes the Folate Status and Controls Redox Homeostasis in Plants. Plant Cell 2017; 29:2831-2853. [PMID: 28939595 PMCID: PMC5728131 DOI: 10.1105/tpc.17.00433] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/10/2017] [Accepted: 09/18/2017] [Indexed: 05/08/2023]
Abstract
Folates (B9 vitamins) are essential cofactors in one-carbon metabolism. Since C1 transfer reactions are involved in synthesis of nucleic acids, proteins, lipids, and other biomolecules, as well as in epigenetic control, folates are vital for all living organisms. This work presents a complete study of a plant DHFR-TS (dihydrofolate reductase-thymidylate synthase) gene family that implements the penultimate step in folate biosynthesis. We demonstrate that one of the DHFR-TS isoforms (DHFR-TS3) operates as an inhibitor of its two homologs, thus regulating DHFR and TS activities and, as a consequence, folate abundance. In addition, a novel function of folate metabolism in plants is proposed, i.e., maintenance of the redox balance by contributing to NADPH production through the reaction catalyzed by methylenetetrahydrofolate dehydrogenase, thus allowing plants to cope with oxidative stress.
Collapse
Affiliation(s)
- Vera Gorelova
- Department of Biology, Laboratory of Functional Plant Biology, Ghent University, 9000 Gent, Belgium
| | - Jolien De Lepeleire
- Department of Biology, Laboratory of Functional Plant Biology, Ghent University, 9000 Gent, Belgium
| | | | - Dick Pluim
- Laboratory of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Coline Meï
- Laboratoire de Physiologie Cellulaire Vegetale, UMR168 CNRS-CEA-INRA-Universite Joseph Fourier Grenoble I, Bioscience and Biotechnologies Institute of Grenoble, CEA-Grenoble, 38054 Grenoble Cedex 9, France
| | - Ann Cuypers
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Olivier Leroux
- Department of Biology, Ghent University, 9000 Gent, Belgium
| | - Fabrice Rébeillé
- Laboratoire de Physiologie Cellulaire Vegetale, UMR168 CNRS-CEA-INRA-Universite Joseph Fourier Grenoble I, Bioscience and Biotechnologies Institute of Grenoble, CEA-Grenoble, 38054 Grenoble Cedex 9, France
| | - Jan H M Schellens
- Laboratory of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Dieter Blancquaert
- Department of Biology, Laboratory of Functional Plant Biology, Ghent University, 9000 Gent, Belgium
| | | | | |
Collapse
|
26
|
Leijen S, van Geel RMJM, Sonke GS, de Jong D, Rosenberg EH, Marchetti S, Pluim D, van Werkhoven E, Rose S, Lee MA, Freshwater T, Beijnen JH, Schellens JHM. Phase II Study of WEE1 Inhibitor AZD1775 Plus Carboplatin in Patients With TP53-Mutated Ovarian Cancer Refractory or Resistant to First-Line Therapy Within 3 Months. J Clin Oncol 2016; 34:4354-4361. [PMID: 27998224 DOI: 10.1200/jco.2016.67.5942] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose AZD1775 is a first-in-class, potent, and selective inhibitor of WEE1 with proof of chemopotentiation in p53-deficient tumors in preclinical models. In a phase I study, the maximum tolerated dose of AZD1775 in combination with carboplatin demonstrated target engagement. We conducted a proof-of-principle phase II study in patients with p53 tumor suppressor gene ( TP53)-mutated ovarian cancer refractory or resistant (< 3 months) to first-line platinum-based therapy to determine overall response rate, progression-free and overall survival, pharmacokinetics, and modulation of phosphorylated cyclin-dependent kinase (CDK1) in skin biopsies. Patients and Methods Patients were treated with carboplatin (area under the curve, 5 mg/mL⋅min) combined with AZD1775 225 mg orally twice daily over 2.5 days every 21-day cycle until disease progression. Results AZD1775 plus carboplatin demonstrated manageable toxicity; fatigue (87%), nausea (78%), thrombocytopenia (70%), diarrhea (70%), and vomiting (48%) were the most common adverse events. The most frequent grade 3 or 4 adverse events were thrombocytopenia (48%) and neutropenia (37%). Of 24 patients enrolled, 21 patients were evaluable for efficacy end points. The overall response rate was 43% (95% CI, 22% to 66%), including one patient (5%) with a prolonged complete response. Median progression-free and overall survival times were 5.3 months (95% CI, 2.3 to 9.0 months) and 12.6 months (95% CI, 4.9 to 19.7), respectively, with two patients with ongoing response for more than 31 and 42 months at data cutoff. Conclusion To our knowledge, this is the first report providing clinical proof that AZD1775 enhances carboplatin efficacy in TP53-mutated tumors. The encouraging antitumor activity observed in patients with TP53-mutated ovarian cancer who were refractory or resistant (< 3 months) to first-line therapy warrants further development.
Collapse
Affiliation(s)
- Suzanne Leijen
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Robin M J M van Geel
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Gabe S Sonke
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Daphne de Jong
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Efraim H Rosenberg
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Serena Marchetti
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Dick Pluim
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Erik van Werkhoven
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Shelonitda Rose
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Mark A Lee
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Tomoko Freshwater
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Jos H Beijnen
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Jan H M Schellens
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| |
Collapse
|
27
|
Lassen U, Mau-Sørensen M, Hald Buhl U, Madsen MW, Balslev E, Pluim D, Schellens JHM, Knudsen S, Jensen PB. Abstract CT154: Phase I dose-escalating PoC study to evaluate the safety and tolerability of LiPlaCis (liposomal cisplatin formulation) in patients with advanced or refractory tumors. Clin Trials 2016. [DOI: 10.1158/1538-7445.am2016-ct154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
28
|
Jacobs BAW, Deenen MJ, Pluim D, van Hasselt JGC, Krähenbühl MD, van Geel RMJM, de Vries N, Rosing H, Meulendijks D, Burylo AM, Cats A, Beijnen JH, Huitema ADR, Schellens JHM. Pronounced between-subject and circadian variability in thymidylate synthase and dihydropyrimidine dehydrogenase enzyme activity in human volunteers. Br J Clin Pharmacol 2016; 82:706-16. [PMID: 27161955 DOI: 10.1111/bcp.13007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/25/2016] [Accepted: 05/08/2016] [Indexed: 01/04/2023] Open
Abstract
AIMS The enzymatic activity of dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) are important for the tolerability and efficacy of the fluoropyrimidine drugs. In the present study, we explored between-subject variability (BSV) and circadian rhythmicity in DPD and TS activity in human volunteers. METHODS The BSVs in DPD activity (n = 20) in peripheral blood mononuclear cells (PBMCs) and in plasma, measured by means of the dihydrouracil (DHU) and uracil (U) plasma levels and DHU : U ratio (n = 40), and TS activity in PBMCs (n = 19), were examined. Samples were collected every 4 h throughout 1 day for assessment of circadian rhythmicity in DPD and TS activity in PBMCs (n = 12) and DHU : U plasma ratios (n = 23). In addition, the effects of genetic polymorphisms and gene expression on DPD and TS activity were explored. RESULTS Population mean (± standard deviation) DPD activity in PBMCs and DHU : U plasma ratio were 9.2 (±2.1) nmol mg(-1) h(-1) and 10.6 (±2.4), respectively. Individual TS activity in PBMCs ranged from 0.024 nmol mg(-1) h(-1) to 0.596 nmol mg(-1) h(-1) . Circadian rhythmicity was demonstrated for all phenotype markers. Between 00:30 h and 02:00 h, DPD activity in PBMCs peaked, while the DHU : U plasma ratio and TS activity in PBMCs showed trough activity. Peak-to-trough ratios for DPD and TS activity in PBMCs were 1.69 and 1.62, respectively. For the DHU : U plasma ratio, the peak-to-trough ratio was 1.43. CONCLUSIONS BSV and circadian variability in DPD and TS activity were demonstrated. Circadian rhythmicity in DPD might be tissue dependent. The results suggested an influence of circadian rhythms on phenotype-guided fluoropyrimidine dosing and supported implications for chronotherapy with high-dose fluoropyrimidine administration during the night.
Collapse
Affiliation(s)
- Bart A W Jacobs
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten J Deenen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dick Pluim
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J G Coen van Hasselt
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Martin D Krähenbühl
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Robin M J M van Geel
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Niels de Vries
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Didier Meulendijks
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Artur M Burylo
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemieke Cats
- Department of Gastroenterology & Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan H M Schellens
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
29
|
Jacobs BAW, Meulenaar J, Rosing H, Pluim D, Tibben MM, de Vries N, Nuijen B, Huitema ADR, Beijnen JH, Schellens JHM, Marchetti S. A phase 0 clinical trial of novel candidate extended-release formulations of capecitabine. Cancer Chemother Pharmacol 2016; 77:1201-7. [PMID: 27103124 DOI: 10.1007/s00280-016-3035-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/12/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the pharmacokinetic (PK) profile of several candidate extended-release (ER) formulations of capecitabine in patients. METHODS In a phase 0 clinical study, PK profiles of several oral candidate ER formulations of capecitabine were compared to the PK profile of capecitabine after administration of the commercially available immediate-release (IR) tablet. A single dose of 1000 mg IR formulation (two 500 mg tablets) was administered on day 1, and a single dose of a 1000 mg candidate ER formulation of capecitabine (two 500 mg tablets) was administered on day 2. Candidate ER formulations of capecitabine differed with regard to the amount of the ER excipient (Kollidon(®) SR) in tablet matrix (0-5 % w/w) and coating (0-12 mg/cm(2)). RESULTS PK profiles of nine different candidate ER formulations were examined. The tablet coating seemed the main determinant for ER of capecitabine and tablet integrity. Average (±standard deviation) AUC0-2h, relative to AUC0-2h after oral administration of the IR tablet, were 43.3 % (±34.9 %) and 1.2 % (±1.2 %) for candidate ER formulations coated with 3 and 6 mg/cm(2), respectively. Corresponding AUC0-last were 93.6 % (±40.2 %) and 44.0 % (±5.4 %). CONCLUSION Modulation of capecitabine release in patients can be accomplished by varying tablet coating content. Proof of principle was demonstrated for candidate ER formulations with coating content of 3 mg/cm(2).
Collapse
Affiliation(s)
- Bart A W Jacobs
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.
| | - Jelte Meulenaar
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands
| | - Dick Pluim
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Matthijs M Tibben
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands
| | - Niels de Vries
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands
| | - Bastiaan Nuijen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.,Division of Pharmaco-epidemiology and Clinical Pharmacology, Science Faculty, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Jan H M Schellens
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Division of Pharmaco-epidemiology and Clinical Pharmacology, Science Faculty, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Serena Marchetti
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Meulendijks D, de Groot JWB, Los M, Boers JE, Beerepoot LV, Polee MB, Beeker A, Portielje JEA, Goey SH, de Jong RS, Vanhoutvin SALW, Kuiper M, Sikorska K, Pluim D, Beijnen JH, Schellens JHM, Grootscholten C, Tesselaar MET, Cats A. Bevacizumab combined with docetaxel, oxaliplatin, and capecitabine, followed by maintenance with capecitabine and bevacizumab, as first-line treatment of patients with advanced HER2-negative gastric cancer: A multicenter phase 2 study. Cancer 2016; 122:1434-43. [PMID: 26970343 DOI: 10.1002/cncr.29864] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The current study was a multicenter, single-arm, phase 2 study performed to investigate the feasibility and efficacy of bevacizumab combined with docetaxel, oxaliplatin, and capecitabine (B-DOC) in patients with advanced human epidermal growth factor receptor 2 (HER2)-negative, previously untreated, gastric or gastroesophageal adenocarcinoma. METHODS Tumor HER2 status was determined centrally. Patients received 6 cycles of bevacizumab at a dose of 7.5 mg/kg, docetaxel at a dose of 50 mg/m(2) , and oxaliplatin at a dose of 100 mg/m(2) (all on day 1) combined with capecitabine at a dose of 850 mg/m(2) twice daily (days 1-14) every 3 weeks followed by maintenance with capecitabine and bevacizumab in patients with disease control. The primary objective was to demonstrate a progression-free survival (PFS) of >6.5 months, according to the 95% confidence interval (95% CI). Secondary endpoints included safety, objective response rate, overall survival (OS), analyses of circulating tumor cells (CTCs), and pharmacogenetic analyses. RESULTS Sixty eligible patients were enrolled. The median PFS was 8.3 months (95% CI, 7.2-10.9 months). The objective response rate was 70% (95% CI, 55%-83%) and the disease control rate was 96% (95% CI, 85%-99%). The median OS was 12.0 months (95% CI, 10.2-16.1 months). According to CTC-AE v4.0, the most common treatment-related grade ≥3 adverse events were neutropenia (20%), leukocytopenia (18%), diarrhea (15%), and nausea/vomiting (15%). The presence of CTCs at baseline was strongly predictive of PFS (hazard ratio [HR], 3.8; P =.007) and OS (HR, 3.4; P =.014). The methylenetetrahydrofolate reductase (MTHFR) 677C>T genotype was strongly associated with PFS (HR, 4.7 for TT vs CC or CT; P =.0007) and OS (HR, 5.9; P =.0001). CONCLUSIONS The B-DOC regimen plus maintenance was feasible and active. CTCs were found to be prognostic in patients treated with B-DOC. Docetaxel-based triplet chemotherapy as a backbone for targeted therapies is feasible and deserves further study. Cancer 2016;122:1434-1443. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Didier Meulendijks
- Division of Medical Oncology, Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Maartje Los
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - James E Boers
- Department of Pathology, Isala, Zwolle, The Netherlands
| | | | - Marco B Polee
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Aart Beeker
- Department of Internal Medicine, Spaarne Hospital, Hoofddorp, The Netherlands
| | | | - Swan H Goey
- Department of Internal Medicine, Tweesteden Hospital, Tilburg, The Netherlands
| | - Robert S de Jong
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Steven A L W Vanhoutvin
- Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maria Kuiper
- Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dick Pluim
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan H M Schellens
- Division of Medical Oncology, Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Cecile Grootscholten
- Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Margot E T Tesselaar
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemieke Cats
- Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
31
|
Milojkovic Kerklaan B, Pluim D, Bol M, Hofland I, Westerga J, van Tinteren H, Beijnen JH, Boogerd W, Schellens JHM, Brandsma D. EpCAM-based flow cytometry in cerebrospinal fluid greatly improves diagnostic accuracy of leptomeningeal metastases from epithelial tumors. Neuro Oncol 2015; 18:855-62. [PMID: 26566655 DOI: 10.1093/neuonc/nov273] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/06/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Moderate diagnostic accuracy of MRI and initial cerebrospinal fluid (CSF) cytology analysis results in at least 10%-15% false negative diagnoses of leptomeningeal metastases (LM) of solid tumors, thus postponing start of therapy. The aim of this prospective clinical study was to determine the diagnostic value of epithelial cell adhesion molecule (EpCAM)-based flow cytometry versus cytology in CSF for the diagnosis of LM in patients with epithelial tumors. METHODS Patients with a clinical suspicion of LM but a negative or inconclusive MRI in whom a diagnostic lumbar puncture has to be performed were included. At least 5 mL of CSF for cytology, 5 mL for flow cytometry, 2 mL for cell count and biochemistry, and 8 mL whole blood samples for circulating tumor cells measurements and biochemistry were drawn. Tumor cells in CSF and whole blood were detected by multiparameter flow cytometry using EpCAM antibody. RESULTS In total 29 eligible patients were enrolled in the study. Thirteen patients were ultimately diagnosed with LM. The flow cytometry assay showed 100% sensitivity and 100% specificity for diagnosing LM, while sensitivity of CSF cytology was only 61.5%. Cell count or biochemical parameters in CSF were abnormal in 100% of patients with LM. CONCLUSIONS Our results suggest that the EpCAM-based flow cytometry assay is superior to CSF cytology for the diagnosis of LM in patients with an epithelial tumor, a clinical suspicion of LM, and a nonconclusive MRI. Confirmation of these data is needed in a larger dataset to recommend dual CSF diagnostics for LM. CLINICALTRIALSGOV IDENTIFIER NCT01713699.
Collapse
Affiliation(s)
- Bojana Milojkovic Kerklaan
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Dick Pluim
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Mijke Bol
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Ingrid Hofland
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Johan Westerga
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Harm van Tinteren
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Jos H Beijnen
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Willem Boogerd
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Jan H M Schellens
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Dieta Brandsma
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| |
Collapse
|
32
|
Meulendijks D, Jacobs BAW, Aliev A, Pluim D, van Werkhoven E, Deenen MJ, Beijnen JH, Cats A, Schellens JHM. Increased risk of severe fluoropyrimidine-associated toxicity in patients carrying a G to C substitution in the first 28-bp tandem repeat of the thymidylate synthase 2R allele. Int J Cancer 2015; 138:245-53. [PMID: 26189437 DOI: 10.1002/ijc.29694] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/02/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023]
Abstract
The fluoropyrimidines act by inhibiting thymidylate synthase (TS). Recent studies have shown that patients' risk of severe fluoropyrimidine-associated toxicity is affected by polymorphisms in the 5'-untranslated region of TYMS, the gene encoding TS. A G>C substitution in the promoter enhancer region of TYMS, rs183205964 (known as the 2RC allele), markedly reduces TS activity in vitro, but its clinical relevance is unknown. We determined rs183205964 in 1605 patients previously enrolled in a prospective multicenter study. Associations between putative low TS expression genotypes (3RC/2RC, 2RG/2RC, and 2RC/2RC) and severe toxicity were investigated using univariable and multivariable logistic regression. Activity of TS and TYMS gene expression were determined in peripheral blood mononuclear cells (PBMCs) of a patient carrying genotype 2RC/2RC and of a control group of healthy individuals. Among 1,605 patients, 28 patients (1.7%) carried the 2RC allele. Twenty patients (1.2%) carried a risk-associated genotype (2RG/2RC, n=13; 3RC/2RC, n=6; and 2RC/2RC, n=1), the eight remaining patients had genotype 3RG/2RC. Early severe toxicity and toxicity-related hospitalization were significantly more frequent in risk-associated genotype carriers (OR 3.0, 95%CI 1.04-8.93, p=0.043 and OR 3.8, 95%CI 1.19-11.9, p=0.024, respectively, in multivariable analysis). The patient with genotype 2RC/2RC was hospitalized twice and had severe febrile neutropenia, diarrhea, and hand-foot syndrome. Baseline TS activity and gene expression in PBMCs of this patient, and a healthy individual with the 2RC allele, were found to be within the normal range. Our study suggests that patients carrying rs183205964 are at strongly increased risk of severe, potentially life-threatening, toxicity when treated with fluoropyrimidines.
Collapse
Affiliation(s)
- Didier Meulendijks
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bart A W Jacobs
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abidin Aliev
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dick Pluim
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten J Deenen
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Annemieke Cats
- Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan H M Schellens
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
33
|
Haan RD, Pluim D, Van Triest B, Verheij M, Schellens J, Vens C. 351 Sensitive pharmacodynamic assessment of PARP inhibitors for individualized treatment in clinic. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Leijen S, van Geel R, Sonke GS, de Jong D, Rosenberg EH, Marchetti S, Pluim D, van Werkhoven ED, Rose S, Lee MA, Beijnen JH, Schellens JHM. Phase II study with Wee1 inhibitor AZD1775 plus carboplatin in patients with p53 mutated ovarian cancer refractory or resistant (<3 months) to standard first line therapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Suzanne Leijen
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Robin van Geel
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Gabe S. Sonke
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Daphne de Jong
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Dick Pluim
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - Jos H. Beijnen
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | |
Collapse
|
35
|
Leijen S, Burgers SA, Baas P, Pluim D, Tibben M, van Werkhoven E, Alessio E, Sava G, Beijnen JH, Schellens JHM. Phase I/II study with ruthenium compound NAMI-A and gemcitabine in patients with non-small cell lung cancer after first line therapy. Invest New Drugs 2014; 33:201-14. [PMID: 25344453 DOI: 10.1007/s10637-014-0179-1] [Citation(s) in RCA: 298] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND This phase I/II study determined the maximal tolerable dose, dose limiting toxicities, antitumor activity, the pharmacokinetics and pharmacodynamics of ruthenium compound NAMI-A in combination with gemcitabine in Non-Small Cell Lung Cancer patients after first line treatment. METHODS Initial dose escalation of NAMI-A was performed in a 28 day cycle: NAMI-A as a 3 h infusion through a port-a-cath at a starting dose of 300 mg/m(2) at day 1, 8 and 15, in combination with gemcitabine 1,000 mg/m(2) at days 2, 9 and 16. Subsequently, dose escalation of NAMI-A in a 21 day schedule was explored. At the maximal tolerable dose level of this schedule an expansion group was enrolled of which 15 patients were evaluable for response. RESULTS Due to frequent neutropenic dose interruptions in the third week, the 28 day schedule was amended into a 21 day schedule. The maximal tolerable dose was 300 and 450 mg/m(2) of NAMI-A (21 day schedule). Main adverse events consisted of neutropenia, anemia, elevated liver enzymes, transient creatinine elevation, nausea, vomiting, constipation, diarrhea, fatigue, and renal toxicity. CONCLUSION NAMI-A administered in combination with gemcitabine is only moderately tolerated and less active in NSCLC patients after first line treatment than gemcitabine alone.
Collapse
Affiliation(s)
- Suzanne Leijen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Marchetti S, Pluim D, van Eijndhoven M, van Tellingen O, Mazzanti R, Beijnen JH, Schellens JHM. Effect of the drug transporters ABCG2, Abcg2, ABCB1 and ABCC2 on the disposition, brain accumulation and myelotoxicity of the aurora kinase B inhibitor barasertib and its more active form barasertib-hydroxy-QPA. Invest New Drugs 2013; 31:1125-35. [DOI: 10.1007/s10637-013-9923-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/01/2013] [Indexed: 01/18/2023]
|
37
|
Marchetti S, Pluim D, van Eijndhoven M, van Tellingen O, Mazzanti R, Beijnen JH, Schellens JHM. Erratum to: Effect of the drug transporters ABCG2, Abcg2, ABCB1 and ABCC2 on the disposition, brain accumulation and myelotoxicity of the aurora kinase B inhibitor barasertib and its more active form barasertib-hydroxy-QPA. Invest New Drugs 2013. [DOI: 10.1007/s10637-013-9955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
38
|
Marchetti S, Pluim D, van Eijndhoven M, van Tellingen O, Mazzanti R, Beijnen J, Schellens JHM. Abstract 966: Effect of ABC drug transporters (BCRP, MDR1, MRP2) on the disposition, brain accumulation and myelotoxicity of the aurora kinase B inhibitor barasertib and its more active form barasertib-hydroxy-QPA . Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In our studies we explore whether barasertib (AZD1152), a novel Aurora B kinase inhibitor, and its more active form barasertib-hQPA, is a substrate drug for the main ABC transporter pumps in vitro and in vivo. We tested this in vitro by using barasertib and barasertib-hQPA in cell survival, drug transport, and competition experiments using MDCKII (wild type, and overexpressing -MDR1, -BCRP, and -MRP2) and LLCPK (wild type and overexpressing -MDR1) cells and monolayers, and Sf9-BCRP membrane vesicles. In vivo, we tested whether P-gp and BCRP affect the oral pharmacokinetics, tissue distribution, and myelotoxicity of barasertib in wild type mice and in the combined P-glycoprotein (Pgp) and Bcrp1 negative mice (Bcrp1−/−/Mdr1a/1b−/−), which model was developed at our institute.
In cell survival experiments expression of BCRP and MDR1 resulted in significant resistance to barasertib. Compared with parental ones, MDCKII-Bcrp1 cells were 57-fold and 97-fold resistant to barasertib and barasertib-hQPA, respectively, whereas MDCKII-MDR1 cells were 7.8- and 12.5-fold resistant to barasertib and barasertib-hQPA, respectively.
In transwell experiments, barasertib-hQPA was transported by BCRP and MDR1 efficiently and transport could be inhibited by the BCRP blockers elacridar (5 μM) or pantoprazole (500 μM) and by the P-gp inhibitor zosuquidar, respectively. In Sf9-BCRP membrane vesicles, both barasertib and barasertib-hQPA significantly inhibited the BCRP-mediated transport of methotrexate in a concentration dependent manner. In contrast, no active transport of barasertib by MRP2 was observed, and overexpression of MRP2 did not affect cytotoxicity of barasertib.
In vivo, area under the curve (AUC) of barasertib-hQPA after oral dosing (10 mg/kg) in Bcrp1−/−/Mdr1a/1b−/− was 27-fold higher than in wild type mice (p<0.001). The maximal plasma concentration in Bcrp1−/−/Mdr1a/1b−/− was 22-fold higher than in wild type mice (p<0.001). Intraperitoneal pharmacokinetics were not significantly different in Bcrp1−/−/Mdr1a/1b−/− and wild type mice. Moreover, brain penetration, kidney and liver distribution as well as myelotoxicity of barasertib-hQPA were statistically significantly increased in Bcrp1/Mdr1a/1b−/− compared with wild type mice (p<0.001).
Our results suggest that barasertib is transported efficiently by P-gp and BCRP/Bcrp1 in vitro. In vivo, genetic deletion of P-gp and BCRP in mice significantly affected pharmacokinetics, tissue distribution and myelotoxicity of barasertib-hQPA. Possible clinical consequences for the observed affinity of barasertib for P-gp and BCRP should be considered.
Citation Format: Serena Marchetti, Dick Pluim, Monique van Eijndhoven, Olaf van Tellingen, Roberto Mazzanti, Jos Beijnen, Jan HM Schellens. Effect of ABC drug transporters (BCRP, MDR1, MRP2) on the disposition, brain accumulation and myelotoxicity of the aurora kinase B inhibitor barasertib and its more active form barasertib-hydroxy-QPA . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 966. doi:10.1158/1538-7445.AM2013-966
Collapse
Affiliation(s)
| | - Dick Pluim
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | | | | |
Collapse
|
39
|
Lin F, Marchetti S, Pluim D, Iusuf D, Mazzanti R, Schellens JHM, Beijnen JH, van Tellingen O. Abcc4 together with abcb1 and abcg2 form a robust cooperative drug efflux system that restricts the brain entry of camptothecin analogues. Clin Cancer Res 2013; 19:2084-95. [PMID: 23461902 DOI: 10.1158/1078-0432.ccr-12-3105] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Multidrug resistance-associated protein 4 (ABCC4) shares many features with P-glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2), including broad substrate affinity and expression at the blood-brain barrier (BBB). However, the pharmacologic relevance of ABCC4 at the BBB is difficult to evaluate, as most drugs are also substrates of ABCB1 and/or ABCG2. EXPERIMENTAL DESIGN We have created a mouse strain in which all these alleles are inactivated to assess their impact on brain delivery of camptothecin analogues, an important class of antineoplastic agents and substrates of these transporters. Wild-type (WT), Abcg2(-/-), Abcb1a/b(-/-), Abcc4(-/-), Abcb1a/b;Abcg2(-/-), Abcg2;Abcc4(-/-), and Abcb1a/b;Abcg2;Abcc4(-/-) mice received i.v. topotecan, irinotecan, SN-38, or gimatecan alone or with concomitant oral elacridar. Drug levels were analyzed by high-performance liquid chromatography (HPLC). RESULTS We found that additional deficiency of Abcc4 in Abcb1a/b;Abcg2(-/-) mice significantly increased the brain concentration of all camptothecin analogues by 1.2-fold (gimatecan) to 5.8-fold (SN-38). The presence of Abcb1a/b or Abcc4 alone was sufficient to reduce the brain concentration of SN-38 to the level in WT mice. Strikingly, the brain distribution of gimatecan in brain of WT mice was more than 220- and 40-fold higher than that of SN-38 and topotecan, respectively. CONCLUSION Abcc4 limits the brain penetration of camptothecin analogues and teams up with Abcb1a/b and Abcg2 to form a robust cooperative drug efflux system. This concerted action limits the usefulness of selective ABC transport inhibitors to enhance drug entry for treatment of intracranial diseases. Our results also suggest that gimatecan might be a better candidate than irinotecan for clinical evaluation against intracranial tumors.
Collapse
Affiliation(s)
- Fan Lin
- Department of Clinical Chemistry/Preclinical Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, EC Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Pluim D, Jacobs BAW, Krähenbühl MD, Ruijter AEM, Beijnen JH, Schellens JHM. Correction of peripheral blood mononuclear cell cytosolic protein for hemoglobin contamination. Anal Bioanal Chem 2013; 405:2391-5. [PMID: 23318760 DOI: 10.1007/s00216-012-6614-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/22/2012] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
Abstract
Pharmacodynamic (PD) analysis requires accurate and precise quantification of enzyme activity targeted by anticancer agents in surrogate cells like peripheral blood mononuclear cells (PBMCs). Enzyme activity is normally reported per mass unit of protein input. However, high and fluctuating hemoglobin (Hb) contamination strongly influences the protein content of PBMC cytosolic lysate. We present the development and validation of a spectrophotometrical Hb quantification method to correct for this contamination. The applicability of Hb correction was demonstrated by determination of the dihydropyrimidine dehydrogenase enzyme activity in PBMC cytosolic lysates.
Collapse
Affiliation(s)
- Dick Pluim
- Division of Molecular Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
41
|
Pluim D, Devriese LA, Beijnen JH, Schellens JHM. Validation of a multiparameter flow cytometry method for the determination of phosphorylated extracellular-signal-regulated kinase and DNA in circulating tumor cells. Cytometry A 2012; 81:664-71. [PMID: 22499242 DOI: 10.1002/cyto.a.22049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 03/02/2012] [Accepted: 03/12/2012] [Indexed: 02/02/2023]
Abstract
A simple, selective, and sensitive multiparameter fluorescence activated cell sorting method utilizing density gradient centrifugation and magnetic antibody cell sorting was developed and validated for the determination of phosphorylated extracellular-signal-regulated kinase (pERK) and DNA in circulating tumor cells (CTCs). Cell preparation tubes (CPT) were used for peripheral blood collection and density gradient centrifugation, followed by phosphorylation of ERK with epidermal growth factor (EGF). After fixation with formaldehyde and methanol, magnetic anti epithelial cell adhesion molecule (EpCAM) micro-beads were used for the selective isolation of CTCs from the background, consisting of peripheral blood mononuclear cells and platelets. Subsequently, samples were stained with Hoechst 33342, and fluorescent antibodies against EpCAM, CD45, and pERK. Flow cytometry was used for identification and enumeration of CTCs and determination of their pERK and DNA content. The validation parameters included specificity, recovery, linearity, precision, sensitivity, and stability. The lower limit of quantification was two CTCs per 8 ml peripheral blood. Samples were stable for 4 months in storage at -80°C. The applicability of the method was demonstrated by successful enumeration of CTCs, and the determination of DNA, and pERK before and after stimulation with EGF in 8 ml peripheral blood samples from patients with metastatic cancer.
Collapse
Affiliation(s)
- Dick Pluim
- Division of Experimental Therapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
42
|
Boss DS, Siegel-Lakhai WS, van Egmond-Schoemaker NE, Pluim D, Rosing H, Ten Bokkel Huinink WW, Beijnen JH, Schellens JHM. Phase I pharmacokinetic and pharmacodynamic study of Carboplatin and topotecan administered intravenously every 28 days to patients with malignant solid tumors. Clin Cancer Res 2009; 15:4475-83. [PMID: 19531625 DOI: 10.1158/1078-0432.ccr-08-3144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Preclinical studies have shown that the combination of topotecan and carboplatin is synergistic. To evaluate the schedule dependency of this interaction, the following phase I trial was designed to determine the safety and maximum tolerated dose (MTD), pharmacokinetics, and pharmacodynamics of carboplatin and topotecan in patients with malignant solid tumors. EXPERIMENTAL DESIGN In part 1, patients received carboplatin on day 1 and topotecan on days 1, 2, and 3 (C-->T schedule). In part 2, topotecan was administered on days 1, 2, and 3, followed by carboplatin on day 3 (T-->C schedule). Pharmacokinetics were determined in plasma and DNA topoisomerase I catalytic activity and Pt-DNA adducts in WBC and tumor tissue. RESULTS Forty-one patients were included. Dose-limiting toxicities during the C-->T schedule were grade 4 thrombocytopenia and febrile neutropenia (MTD: carboplatin target area under the free carboplatin plasma concentration versus time curve, 4 min mg/mL; topotecan, 0.5 mg/m(2)/d). Dose-limiting toxicities during the T-->C schedule included grade 4 neutropenia, thrombocytopenia, neutropenic fever, and grade 4 nausea and vomiting (MTD: carboplatin target area under the free carboplatin plasma concentration versus time curve, 6 min mg/mL; topotecan, 0.9 mg/m(2)/d). One complete response and five partial responses were observed. The clearance of and exposure to carboplatin and topotecan did not depend on the sequence of drug administration. No schedule-dependent effects were seen in Pt-DNA levels and DNA topoisomerase I catalytic activity in WBC and tumor tissue. However, myelotoxicity was clearly more evident in the C-->T schedule. CONCLUSION The T-->C schedule was better tolerated because both hematologic and nonhematologic toxicities were milder. Other pharmacodynamic factors than the ones investigated must explain the schedule-dependent differences in toxicities.
Collapse
Affiliation(s)
- David S Boss
- Division of Clinical Pharmacology, The Netherlands Cancer Institute, Slotervaart Hospital, Amsterdam, the Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Boss DS, Siegel-Lakhai WS, Schoemaker-van Egmond NE, Pluim D, Rosing H, Ten Bokkel-Huinink WW, Beijnen JH, Schellens JH. Phase I, pharmacokinetic, and pharmacodynamic study of carboplatin and topotecan administered in two different schedules. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2561 Background: Preclinical studies showed sequence dependent synergy of the combination of topoisomerase I inhibitors and platinum agents. This trial was designed to determine the safety and maximum tolerated dose (MTD), pharmacokinetics (PK) and pharmacodynamics (PD) of carboplatin (carbo) and topotecan (topo) in patients (pts) with solid malignancies in two different schedules. Methods: In part 1, pts received carbo as a 60 min IV infusion on day 1 and topo as a 30 min IV infusion on days 1, 2 and 3 (C→T). The sequence of drug administration was reversed in part 2 of the study (T→C): topo on days 1, 2, and 3, followed by carbo on day 3. In both schedules, the PK was determined of each agent in plasma and the TopI catalytic activity and Pt-DNA adducts in white blood cells (WBC) and tumor tissue. Results: 41 pts were included in this trial. Dose-limiting toxicities (DLTs) during C→T included grade (G) 4 thrombocytopenia and febrile neutropenia. The MTD was reached at carbo target AUC 4 min.mg/mL and topo 0.5 mg/m2/day. DLTs during T→C included G4 neutropenia, thrombocytopenia and neutropenic fever, G3 nausea and G4 vomiting. Carbo target AUC 6 min.mg/mL and topo 0.9 mg/m2/day was the MTD in this schedule. No schedule dependent differences in PK were found (clearance (Cl) of unbound carbo: 0.6 vs 0.7 mL/min, p=0.14; Cl of total topo: 24.1 vs 29.6 L/h, p=0.08; Cl of topo lactone: 84.5 vs 83.7 L/h, p=0.96). WBC and tumor samples were collected from 30 and 27 pts, respectively. Pt-DNA levels were not schedule dependent in WBC (range C→T = 0.44–4.13, and T→C = 0.22–6.07 fmol*h/μg DNA) and in tumor tissue (range C→T = 0.20–0.96, and T→C = 0.62–1.8 fmol/μg DNA). Also, no schedule dependent effects were seen in TopI catalytic activity in WBC and tumor tissue. However, myelotoxicity was clearly more evident in the C→T schedule. One pt with ovarian cancer had a complete response (T→C schedule), 2 pts with ovarian cancer (C→T schedule) and 3 pts treated in the T→C schedule (ovarian, SCLC and gastric cancer) had a partial response. Conclusions: T→C was better tolerated as both hematological and non-hematological toxicities were milder. Other than the investigated PD factors must explain the schedule dependent differences in toxicities. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- D. S. Boss
- Netherlands Cancer Institute, Amsterdam, Netherlands; Slotervaart Hospital, Amsterdam, Netherlands
| | - W. S. Siegel-Lakhai
- Netherlands Cancer Institute, Amsterdam, Netherlands; Slotervaart Hospital, Amsterdam, Netherlands
| | | | - D. Pluim
- Netherlands Cancer Institute, Amsterdam, Netherlands; Slotervaart Hospital, Amsterdam, Netherlands
| | - H. Rosing
- Netherlands Cancer Institute, Amsterdam, Netherlands; Slotervaart Hospital, Amsterdam, Netherlands
| | - W. W. Ten Bokkel-Huinink
- Netherlands Cancer Institute, Amsterdam, Netherlands; Slotervaart Hospital, Amsterdam, Netherlands
| | - J. H. Beijnen
- Netherlands Cancer Institute, Amsterdam, Netherlands; Slotervaart Hospital, Amsterdam, Netherlands
| | - J. H. Schellens
- Netherlands Cancer Institute, Amsterdam, Netherlands; Slotervaart Hospital, Amsterdam, Netherlands
| |
Collapse
|
44
|
Veltkamp SA, Pluim D, van Eijndhoven MAJ, Bolijn MJ, Ong FHG, Govindarajan R, Unadkat JD, Beijnen JH, Schellens JHM. New insights into the pharmacology and cytotoxicity of gemcitabine and 2',2'-difluorodeoxyuridine. Mol Cancer Ther 2008; 7:2415-25. [PMID: 18723487 DOI: 10.1158/1535-7163.mct-08-0137] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a clinical study with oral gemcitabine (2',2'-difluorodeoxycytidine, dFdC), 2',2'-difluorodeoxyuridine (dFdU) was extensively formed and accumulated after multiple oral dosing. Here, we have investigated the in vitro cytotoxicity, cellular uptake, efflux, biotransformation, and nucleic acid incorporation of dFdC and dFdU. Short-term and long-term cytotoxicity assays were used to assess the cytotoxicity of dFdC and dFdU in human hepatocellular carcinoma HepG2, human lung carcinoma A549, and Madin-Darby canine kidney cell lines transfected with the human concentrative or equilibrative nucleoside transporter 1 (hCNT1 or hENT1), or empty vector. Radiolabeled dFdC and dFdU were used to determine cellular uptake, efflux, biotransformation, and incorporation into DNA and RNA. The compounds dFdC, dFdU, and their phosphorylated metabolites were quantified by high-performance liquid chromatography with UV and radioisotope detection. dFdU monophosphate, diphosphate, and triphosphate (dFdU-TP) were formed from dFdC and dFdU. dFdU-TP was incorporated into DNA and RNA. The area under the intracellular concentration-time curve of dFdC-TP and dFdU-TP and their extent of incorporation into DNA and RNA inversely correlated with the IC(50) of dFdC and dFdU, respectively. The cellular uptake and cytotoxicity of dFdU were significantly enhanced by hCNT1. dFdU inhibited cell cycle progression and its cytotoxicity significantly increased with longer duration of exposure. dFdU is taken up into cells with high affinity by hCNT1 and phosphorylated to its dFdU-TP metabolite. dFdU-TP is incorporated into DNA and RNA, which correlated with dFdU cytotoxicity. These data provide strong evidence that dFdU can significantly contribute to the cytotoxicity of dFdC.
Collapse
Affiliation(s)
- Stephan A Veltkamp
- Division of Experimental Therapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Veltkamp SA, Jansen RS, Callies S, Pluim D, Visseren-Grul CM, Rosing H, Kloeker-Rhoades S, Andre VAM, Beijnen JH, Slapak CA, Schellens JHM. Oral administration of gemcitabine in patients with refractory tumors: a clinical and pharmacologic study. Clin Cancer Res 2008; 14:3477-86. [PMID: 18519780 DOI: 10.1158/1078-0432.ccr-07-4521] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the toxicity, tolerability, pharmacokinetics, pharmacodynamics, and preliminary antitumor activity of oral gemcitabine (2',2'-difluorodeoxycytidine; dFdC) in patients with cancer. EXPERIMENTAL DESIGN Patients with advanced or metastatic cancer refractory to standard therapy were eligible. Gemcitabine was administered p.o. starting at 1 mg once daily using dose escalation with three patients per dose level. Patients received one of two dosing schemes: (a) once daily dosing for 14 days of a 21-day cycle or (b) every other day dosing for 21 days of a 28-day cycle. Pharmacokinetics were assessed by measuring concentrations of dFdC and 2',2'-difluorodeoxyuridine (dFdU) in plasma and gemcitabine triphosphate in peripheral blood mononuclear cells, and pharmacodynamics by measuring the effect on T-cell proliferation. RESULTS Thirty patients entered the study. Oral gemcitabine was generally well-tolerated. The maximum tolerated dose was not reached. Mainly moderate gastrointestinal toxicities occurred except for one patient who died after experiencing grade 4 hepatic failure during cycle two. One patient with a leiomyosarcoma had stable disease during 2 years and 7 months. Systemic exposure to dFdC was low with an estimated bioavailability of 10%. dFdC was highly converted to dFdU, probably via first pass metabolism and dFdU had a long terminal half-life ( approximately 89 h). Concentrations of dFdCTP in peripheral blood mononuclear cells were low, but high levels of gemcitabine triphosphate, the phosphorylated metabolite of dFdU, were detected. CONCLUSIONS Systemic exposure to oral gemcitabine was low due to extensive first-pass metabolism to dFdU. Moderate toxicity combined with hints of activity warrant further investigation of the concept of prolonged exposure to gemcitabine.
Collapse
Affiliation(s)
- Stephan A Veltkamp
- Division of Experimental Therapy, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Veltkamp SA, Pluim D, van Tellingen O, Beijnen JH, Schellens JHM. Extensive metabolism and hepatic accumulation of gemcitabine after multiple oral and intravenous administration in mice. Drug Metab Dispos 2008; 36:1606-15. [PMID: 18490432 DOI: 10.1124/dmd.108.021048] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In a clinical study with oral gemcitabine (2',2'-difluorodeoxycytidine, dFdC), we found that gemcitabine was hepatotoxic and extensively metabolized to 2',2'-difluorodeoxyuridine (dFdU) after continuous oral dosing. The main metabolite dFdU had a long terminal half-life after oral administration. Our hypothesis was that dFdU and/or phosphorylated metabolites of gemcitabine accumulated in the liver after multiple oral dosing. In this study, mice were treated with oral or i.v. dFdC at a single dose (1qdx1d) or at multiple doses once daily for 7 days (1qdx7d) or seven times daily (7qdx1d). Blood, liver, kidneys, and lungs were collected at several time points. Urine samples were collected after i.v. dFdC, and peripheral blood mononuclear cells were collected 7qdx1d dosing of dFdC. The nucleosides dFdC and dFdU as well as the nucleotides gemcitabine monophosphate (dFdC-MP), diphosphate, and triphosphate (dFdC-TP) and dFdU monophosphate, diphosphate (dFdU-DP), and triphosphate (dFdU-TP) were simultaneously quantified by high-performance liquid chromatography with ultraviolet and radioisotope detection. We demonstrate that phosphorylated metabolites of both dFdC and dFdU are formed in mice, primarily consisting of dFdC-MP, dFdC-TP, and dFdU-TP. Multiple dosing of dFdC leads to substantial hepatic and renal accumulation of dFdC-TP and dFdU-TP, which have a more pronounced liver accumulation after oral than after i.v. dosing. The presence of dFdC-MP, dFdC-TP, and dFdU-TP in plasma and urine suggests efflux of these potentially toxic metabolites. Our results show that dFdU, dFdC-TP, and dFdU-TP accumulate in the liver after multiple dosing of dFdC in mice and might be associated with hepatotoxicity of oral dFdC in patients.
Collapse
Affiliation(s)
- Stephan A Veltkamp
- Division of Experimental Therapy, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
47
|
Brouwers EEM, Tibben MM, Pluim D, Rosing H, Boot H, Cats A, Schellens JHM, Beijnen JH. Inductively coupled plasma mass spectrometric analysis of the total amount of platinum in DNA extracts from peripheral blood mononuclear cells and tissue from patients treated with cisplatin. Anal Bioanal Chem 2008; 391:577-85. [DOI: 10.1007/s00216-008-2034-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 02/26/2008] [Accepted: 02/28/2008] [Indexed: 11/28/2022]
|
48
|
Marchetti S, Oostendorp RL, Pluim D, van Eijndhoven M, van Tellingen O, Schinkel AH, Versace R, Beijnen JH, Mazzanti R, Schellens JH. In vitro transport of gimatecan (7-t-butoxyiminomethylcamptothecin) by breast cancer resistance protein, P-glycoprotein, and multidrug resistance protein 2. Mol Cancer Ther 2008; 6:3307-13. [PMID: 18089724 DOI: 10.1158/1535-7163.mct-07-0461] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lipophilic camptothecin derivatives are considered to have negligible affinity for breast cancer resistance protein (BCRP; ABCG2). Gimatecan, a new orally available 7-t-butoxyiminomethyl-substituted lipophilic camptothecin derivative, has been previously reported to be not a substrate for BCRP. Using a panel of in vitro models, we tested whether gimatecan is a substrate for BCRP as well as for P-glycoprotein (MDR1) or multidrug resistance protein 2 (MRP2; ABCC2), ATP-binding cassette drug efflux transporters involved in anticancer drug resistance, and able to affect the pharmacokinetics of substrate drugs. Cell survival, drug transport, accumulation, and efflux were studied in IGROV1 and (human BCRP overexpressing) T8 cells, Madin-Darby canine kidney II (MDCKII-WT, MDCKII-Bcrp1, MDCKII-MDR1, and MDCKII-MRP2), and LLCPK (LLCPK-WT and LLCPK-MDR1) cells. Competition with methotrexate uptake was studied in Sf9-BCRP membrane vesicles. In vitro, expression of BCRP resulted in 8- to 10-fold resistance to gimatecan. In Transwell experiments, gimatecan was transported by Bcrp1 and transport was inhibited by the BCRP/P-glycoprotein inhibitors elacridar and pantoprazole. Efflux of gimatecan from MDCKII-Bcrp1 cells was faster than in WT cells. In Sf9-BCRP membrane vesicles, gimatecan significantly inhibited BCRP-mediated transport of methotrexate. In contrast, gimatecan was not transported by MDR1 or MRP2. Gimatecan is transported by BCRP/Bcrp1 in vitro, although to a lesser extent than the camptothecin analogue topotecan. Implications of BCRP expression in the gut for the oral development of gimatecan and the interaction between gimatecan and other BCRP substrate drugs and/or inhibitors warrant further clinical investigation.
Collapse
Affiliation(s)
- Serena Marchetti
- Department of Experimental Therapy and Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Hoebers FJP, Pluim D, Hart AAM, Verheij M, Balm AJM, Fons G, Rasch CRN, Schellens JHM, Stalpers LJA, Bartelink H, Begg AC. Cisplatin-DNA adduct formation in patients treated with cisplatin-based chemoradiation: lack of correlation between normal tissues and primary tumor. Cancer Chemother Pharmacol 2007; 61:1075-81. [PMID: 17639394 PMCID: PMC2270367 DOI: 10.1007/s00280-007-0545-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 06/08/2007] [Indexed: 11/24/2022]
Abstract
Purpose In this study, the formation of cisplatin-DNA adducts after concurrent cisplatin-radiation and the relationship between adduct-formation in primary tumor tissue and normal tissue were investigated. Methods Three intravenous cisplatin-regimens, given concurrently with radiation, were studied: daily low-dose (6 mg/m2) cisplatin, weekly 40 mg/m2, three-weekly 100 mg/m2. A 32P-postlabeling technique was used to quantify adducts in normal tissue [white blood cells (WBC) and buccal cells] and tumor. Results Normal tissue samples for adduct determination were obtained from 63 patients and tumor biopsies from 23 of these patients. Linear relationships and high correlations were observed between the levels of two guanosine- and adenosine–guanosine-adducts in normal and tumor tissue. Adduct levels in tumors were two to five times higher than those in WBC (P < 0.001). No significant correlations were found between adduct levels in normal tissues and primary tumor biopsies, nor between WBC and buccal cells. Conclusions In concurrent chemoradiotherapy schedules, cisplatin adduct levels in tumors were significantly higher than in normal tissues (WBC). No evidence of a correlation was found between adduct levels in normal tissues and primary tumor biopsies. This lack of correlation may, to some extent, explain the inconsistencies in the literature regarding whether or not cisplatin-DNA adducts can be used as a predictive test in anticancer platinum therapy.
Collapse
Affiliation(s)
- F J P Hoebers
- Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Breedveld P, Pluim D, Cipriani G, Dahlhaus F, van Eijndhoven MAJ, de Wolf CJF, Kuil A, Beijnen JH, Scheffer GL, Jansen G, Borst P, Schellens JHM. The effect of low pH on breast cancer resistance protein (ABCG2)-mediated transport of methotrexate, 7-hydroxymethotrexate, methotrexate diglutamate, folic acid, mitoxantrone, topotecan, and resveratrol in in vitro drug transport models. Mol Pharmacol 2006; 71:240-9. [PMID: 17032904 DOI: 10.1124/mol.106.028167] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Some cellular uptake systems for (anti)folates function optimally at acidic pH. We have tested whether this also applies to efflux from cells by breast cancer resistance protein (BCRP; ABCG2), which has been reported to transport folic acid, methotrexate, and methotrexate di- and triglutamate at physiological pH. Using Spodoptera frugiperda-BCRP membrane vesicles, we showed that the ATP-dependent vesicular transport of 1 muM methotrexate by BCRP is 5-fold higher at pH 5.5 than at physiological pH. The transport of methotrexate was saturable at pH 5.5, with apparent Km and Vmax values of 1.3 +/- 0.2 mM and 44 +/- 2.5 nmol/mg of protein/min, respectively, but was linear with drug concentration at pH 7.3 up to 6 mM methotrexate. In contrast to recent reports, we did not detect transport of methotrexate diglutamate at physiological pH, but we did find transport at pH 5.5. We also found that 7-hydroxy-methotrexate, the major metabolite of methotrexate, is transported by BCRP both at physiological pH and (more efficiently) at low pH. The pH effect was also observed in intact BCRP-overexpressing cells: we found a 3-fold higher level of resistance to both methotrexate and the prototypical BCRP substrate mitoxantrone at pH 6.5 as at physiological pH. Furthermore, with MDCKII-BCRP monolayers, we found that resveratrol, which is a neutral compound at pH < or = 7.4, is efficiently transported by BCRP at pH 6.0, whereas we did not detect active transport at pH 7.4. We conclude that BCRP transports substrate drugs more efficiently at low pH, independent of the dissociation status of the substrate.
Collapse
Affiliation(s)
- Pauline Breedveld
- Department of Experimental Therapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|