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Cheung SYA, Hay JL, Lin YW, de Greef R, Bullock J. Pediatric oncology drug development and dosage optimization. Front Oncol 2024; 13:1235947. [PMID: 38348118 PMCID: PMC10860405 DOI: 10.3389/fonc.2023.1235947] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/29/2023] [Indexed: 02/15/2024] Open
Abstract
Oncology drug discovery and development has always been an area facing many challenges. Phase 1 oncology studies are typically small, open-label, sequential studies enrolling a small sample of adult patients (i.e., 3-6 patients/cohort) in dose escalation. Pediatric evaluations typically lag behind the adult development program. The pediatric starting dose is traditionally referenced on the recommended phase 2 dose in adults with the incorporation of body size scaling. The size of the study is also small and dependent upon the prevalence of the disease in the pediatric population. Similar to adult development, the dose is escalated or de-escalated until reaching the maximum tolerated dose (MTD) that also provides desired biological activities or efficacy. The escalation steps and identification of MTD are often rule-based and do not incorporate all the available information, such as pharmacokinetic (PK), pharmacodynamic (PD), tolerability and efficacy data. Therefore, it is doubtful if the MTD approach is optimal to determine the dosage. Hence, it is important to evaluate whether there is an optimal dosage below the MTD, especially considering the emerging complexity of combination therapies and the long-term tolerability and safety of the treatments. Identification of an optimal dosage is also vital not only for adult patients but for pediatric populations as well. Dosage-finding is much more challenging for pediatric populations due to the limited patient population and differences among the pediatric age range in terms of maturation and ontogeny that could impact PK. Many sponsors defer the pediatric strategy as they are often perplexed by the challenges presented by pediatric oncology drug development (model of action relevancy to pediatric population, budget, timeline and regulatory requirements). This leads to a limited number of approved drugs for pediatric oncology patients. This review article provides the current regulatory landscape, incentives and how they impact pediatric drug discovery and development. We also consider different pediatric cancers and potential clinical trial challenges/opportunities when designing pediatric clinical trials. An outline of how quantitative methods such as pharmacometrics/modelling & simulation can support the dosage-finding and justification is also included. Finally, we provide some reflections that we consider helpful to accelerate pediatric drug discovery and development.
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Sebastien B, Cheung SYA, Corriol-Rohou S, Gamalo-Siebers M, Jreich R, Krishna R, Liu J. Use of pharmacodynamic modeling for Bayesian information borrowing in pediatric clinical trials. J Biopharm Stat 2023; 33:726-736. [PMID: 36524777 DOI: 10.1080/10543406.2022.2149772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
The use of Bayesian methodology to design and analyze pediatric efficacy trials is one of the possible options to reduce their sample size. This reduction of the sample size results from the use of an informative prior for the parameters of interest. In most of the applications, the principle of 'information borrowing' from adults' trials is applied, which means that the informative prior is constructed using efficacy results in adult of the drug under investigation. This implicitly assumes similarity in efficacy between the selected pediatric dose and the efficacious dose in adults. The goal of this article is to propose a method to construct prior distribution for the parameter of interest, not directly constructed from the efficacy results of the efficacious dose in adult patients but using pharmacodynamic modeling of a bridging biomarker using early phase pediatric data. When combined with a model bridging the biomarker with the clinical endpoints, the prior is constructed using a variational method after simulation of the parameters of interest. A use case application illustrates how the method can be used to construct a realistic informative prior.
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Affiliation(s)
| | - S Y Amy Cheung
- Integrated Drug Development, Certara USA Inc, Princeton, NJ, USA
| | - Solange Corriol-Rohou
- Regulatory Affairs and Policy, AstraZeneca, Global Regulatory Policy, R&D, Paris, France
| | | | - Rana Jreich
- Data and Data Science, Sanofi, R&D, Chilly-Mazarin, France
| | - Rajesh Krishna
- Clinical Pharmacology, Certara USA Inc, Princeton, NJ, USA
| | - Jing Liu
- Clinical Pharmacology, Pfizer Inc, Groton, CT, USA
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Cheung SYA, Barrett JS. Supporting Prospective Pregnancy Trials via Modeling and Simulation: Lessons From the Past and Recommendations for the Future. J Clin Pharmacol 2023; 63 Suppl 1:S51-S61. [PMID: 37317497 DOI: 10.1002/jcph.2284] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/09/2023] [Indexed: 06/16/2023]
Abstract
Despite the increasing awareness and guidance to support drug research and development in the pregnant population, there is still a high unmet medical need and off-label use in the pregnant population for mainstream, acute, chronic, rare disease, and vaccination/prophylactic use. There are many obstacles to enrolling the pregnant population in a study, ranging from ethical considerations, the complexity of the pregnancy stages, postpartum, fetus-mother interaction, and drug transfer to breast milk during lactation and impacts on neonates. This review will outline the common challenges of incorporating physiological differences in the pregnant population and historical but noninformative practice in a past clinical trial in pregnant women that led to labeling difficulties. The recommendations of different modeling approaches, such as a population pharmacokinetic model, physiologically based pharmacokinetic modeling, model-based meta-analysis, and quantitative system pharmacology modeling, are presented with some examples. Finally, we outline the gaps in the medical need for the pregnant population by classifying various types of diseases and some considerations that exist to support the use of medicines in this area. Ideas on the potential framework to support clinical trials and collaboration examples are also presented that could also accelerate understanding of drug research and medicine/prophylactics/vaccines in the pregnant population.
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Musuamba FT, Cheung SYA, Colin P, Davies EH, Barret JS, Pappalardo F, Chappell M, Dogne JM, Ceci A, Della Pasqua O, Rusten IS. Moving Toward a Question-Centric Approach for Regulatory Decision Making in the Context of Drug Assessment. Clin Pharmacol Ther 2023. [PMID: 36708100 DOI: 10.1002/cpt.2856] [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] [Received: 10/31/2022] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Abstract
The most intuitive question for market access for medicinal products is the benefit/risk (B/R) balance. The B/R assessment can conceptually be divided into subquestions related to establishing efficacy and safety. There are additional layers to the B/R ratio for medical products, including questions related to dose selection, clinical and nonclinical pharmacology, and drug quality. Explicitly stating the actual questions and how they contribute to the overall B/R provides a structure that fosters better informed cross-domain discussions. There is currently no systematic approach in the regulatory setting to assess and establish the acceptability of alternative methods and data sources. In most cases, the medicinal product sponsors tend to prioritize traditional data types and methods, which are well accepted by regulators for inclusion in regulatory submissions. This, in addition to the absence of rigor in the use and validation of new data types and methods, and the limited training of assessors in related fields can lead to increased regulatory skepticism toward new data types and methods. A data-knowledge backbone is needed to mitigate the uncertainty in efficacy and safety characterization. This white paper discusses the value of explicitly redefining and restructuring the regulatory scientific decision making around the scientific question to be addressed. The ecosystem proposed is based on three pillars: (i) a repository connecting questions, data, and methods; (ii) the development and validation of high-quality standards for data and methods; and (iii) credibility assessment. The ecosystem is applied to four use cases for illustration. The need for training and regulatory guidance is also discussed.
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Affiliation(s)
- Flora T Musuamba
- University of Namur, Namur Research Institute for Life Sciences, Namur, Belgium.,Belgian Federal Agency for Medicines and Health Products, Brussels, Belgium
| | | | - Pieter Colin
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Francesco Pappalardo
- Department of Drug and Health Science, University of Catania, Catania, Italy.,Menzies Health Institute, Griffith University, Queensland, Australia.,Computer Science Department, Metropolitan College, Boston University, Boston, Massachusetts, USA
| | | | - Jean-Michel Dogne
- University of Namur, Namur Research Institute for Life Sciences, Namur, Belgium
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi, Valenzano, Italy
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Zhao J, Zhu X, Tan S, Chen C, Kaddoumi A, Guo XL, Lin YW, Cheung SYA. Editorial: Model-informed drug development and evidence-based translational pharmacology. Front Pharmacol 2022; 13:1086551. [PMID: 36578539 PMCID: PMC9791580 DOI: 10.3389/fphar.2022.1086551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jinxin Zhao
- Biomedicine Discovery Institute, Infection and Immunity Program and Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Xiao Zhu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Songwen Tan
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China,*Correspondence: Songwen Tan, ; Chuanpin Chen, ; Amal Kaddoumi, ; Xiu-Li Guo, ; Yu-Wei Lin, ; S. Y. Amy Cheung,
| | - Chuanpin Chen
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China,*Correspondence: Songwen Tan, ; Chuanpin Chen, ; Amal Kaddoumi, ; Xiu-Li Guo, ; Yu-Wei Lin, ; S. Y. Amy Cheung,
| | - Amal Kaddoumi
- Department of Drug Discovery and Development, Harrison College of Pharmacy, Auburn University, Auburn, AL, United States,*Correspondence: Songwen Tan, ; Chuanpin Chen, ; Amal Kaddoumi, ; Xiu-Li Guo, ; Yu-Wei Lin, ; S. Y. Amy Cheung,
| | - Xiu-Li Guo
- Department of Pharmacology, School of Pharmaceutical Science, Shandong University, Jinan, China,*Correspondence: Songwen Tan, ; Chuanpin Chen, ; Amal Kaddoumi, ; Xiu-Li Guo, ; Yu-Wei Lin, ; S. Y. Amy Cheung,
| | - Yu-Wei Lin
- Biomedicine Discovery Institute, Infection and Immunity Program and Department of Microbiology, Monash University, Melbourne, VIC, Australia,Malaya Translational and Clinical Pharmacometrics Group, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia,Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia,Integrated Drug Development, Certara, NJ, United States,*Correspondence: Songwen Tan, ; Chuanpin Chen, ; Amal Kaddoumi, ; Xiu-Li Guo, ; Yu-Wei Lin, ; S. Y. Amy Cheung,
| | - S. Y. Amy Cheung
- Integrated Drug Development, Certara, NJ, United States,*Correspondence: Songwen Tan, ; Chuanpin Chen, ; Amal Kaddoumi, ; Xiu-Li Guo, ; Yu-Wei Lin, ; S. Y. Amy Cheung,
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Lim AH, Abdul Rahim N, Zhao J, Cheung SYA, Lin YW. Cost effectiveness analyses of pharmacological treatments in heart failure. Front Pharmacol 2022; 13:919974. [PMID: 36133814 PMCID: PMC9483981 DOI: 10.3389/fphar.2022.919974] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/19/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
In a rapidly growing and aging population, heart failure (HF) has become recognised as a public health concern that imposes high economic and societal costs worldwide. HF management stems from the use of highly cost-effective angiotensin converting enzyme inhibitors (ACEi) and β-blockers to the use of newer drugs such as sodium-glucose cotransporter-2 inhibitors (SGLT2i), ivabradine, and vericiguat. Modelling studies of pharmacological treatments that report on cost effectiveness in HF is important in order to guide clinical decision making. Multiple cost-effectiveness analysis of dapagliflozin for heart failure with reduced ejection fraction (HFrEF) suggests that it is not only cost-effective and has the potential to improve long-term clinical outcomes, but is also likely to meet conventional cost-effectiveness thresholds in many countries. Similar promising results have also been shown for vericiguat while a cost effectiveness analysis (CEA) of empagliflozin has shown cost effectiveness in HF patients with Type 2 diabetes. Despite the recent FDA approval of dapagliflozin and empagliflozin in HF, it might take time for these SGLT2i to be widely used in real-world practice. A recent economic evaluation of vericiguat found it to be cost effective at a higher cost per QALY threshold than SGLT2i. However, there is a lack of clinical or real-world data regarding whether vericiguat would be prescribed on top of newer treatments or in lieu of them. Sacubitril/valsartan has been commonly compared to enalapril in cost effectiveness analysis and has been found to be similar to that of SGLT2i but was not considered a cost-effective treatment for heart failure with reduced ejection fraction in Thailand and Singapore with the current economic evaluation evidences. In order for more precise analysis on cost effectiveness analysis, it is necessary to take into account the income level of various countries as it is certainly easier to allocate more financial resources for the intervention, with greater effectiveness, in high- and middle-income countries than in low-income countries. This review aims to evaluate evidence and cost effectiveness studies in more recent HF drugs i.e., SGLT2i, ARNi, ivabradine, vericiguat and omecamtiv, and gaps in current literature on pharmacoeconomic studies in HF.
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Affiliation(s)
- Audrey Huili Lim
- Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
- *Correspondence: Audrey Huili Lim,
| | - Nusaibah Abdul Rahim
- Malaya Translational and Clinical Pharmacometrics Group, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia
| | - Jinxin Zhao
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | | | - Yu-Wei Lin
- Malaya Translational and Clinical Pharmacometrics Group, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
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Kania SP, Silva JMF, Charles OJ, Booth J, Cheung SYA, Yates JWT, Worth A, Breuer J, Klein N, Amrolia PJ, Veys P, Standing JF. Epstein-Barr Virus Reactivation After Paediatric Haematopoietic Stem Cell Transplantation: Risk Factors and Sensitivity Analysis of Mathematical Model. Front Immunol 2022; 13:903063. [PMID: 35903096 PMCID: PMC9314642 DOI: 10.3389/fimmu.2022.903063] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022] Open
Abstract
Epstein-Barr virus (EBV) establishes a lifelong latent infection in healthy humans, kept under immune control by cytotoxic T cells (CTLs). Following paediatric haematopoetic stem cell transplantation (HSCT), a loss of immune surveillance leads to opportunistic outgrowth of EBV-infected cells, resulting in EBV reactivation, which can ultimately progress to post-transplant lymphoproliferative disorder (PTLD). The aims of this study were to identify risk factors for EBV reactivation in children in the first 100 days post-HSCT and to assess the suitability of a previously reported mathematical model to mechanistically model EBV reactivation kinetics in this cohort. Retrospective electronic data were collected from 56 children who underwent HSCT at Great Ormond Street Hospital (GOSH) between 2005 and 2016. Using EBV viral load (VL) measurements from weekly quantitative PCR (qPCR) monitoring post-HSCT, a multivariable Cox proportional hazards (Cox-PH) model was developed to assess time to first EBV reactivation event in the first 100 days post-HSCT. Sensitivity analysis of a previously reported mathematical model was performed to identify key parameters affecting EBV VL. Cox-PH modelling revealed EBV seropositivity of the HSCT recipient and administration of anti-thymocyte globulin (ATG) pre-HSCT to be significantly associated with an increased risk of EBV reactivation in the first 100 days post-HSCT (adjusted hazard ratio (AHR) = 2.32, P = 0.02; AHR = 2.55, P = 0.04). Five parameters were found to affect EBV VL in sensitivity analysis of the previously reported mathematical model. In conclusion, we have assessed the effect of multiple covariates on EBV reactivation in the first 100 days post-HSCT in children and have identified key parameters in a previously reported mechanistic mathematical model that affect EBV VL. Future work will aim to fit this model to patient EBV VLs, develop the model to account for interindividual variability and model the effect of clinically relevant covariates such as rituximab therapy and ATG on EBV VL.
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Affiliation(s)
- Soumya P Kania
- Infection, Immunity and Inflammation Research & Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Juliana M F Silva
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Oscar J Charles
- Infection, Immunity and Inflammation Research & Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - John Booth
- Digital Research, Informatics and Virtual Environment Unit, National Institute for Health and Care Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - S Y Amy Cheung
- Integrated Drug Development, Certara, Princeton, NJ, United States
| | - James W T Yates
- Drug Metabolism and Pharmacokinetics (DMPK) Modelling, In-Vitro In-Vivo Translation, GlaxoSmithKline, Stevenage, United Kingdom
| | - Austen Worth
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Judith Breuer
- Infection, Immunity and Inflammation Research & Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Nigel Klein
- Infection, Immunity and Inflammation Research & Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Persis J Amrolia
- Infection, Immunity and Inflammation Research & Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Paul Veys
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Joseph F Standing
- Infection, Immunity and Inflammation Research & Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Department of Pharmacy, Great Ormond Street Hospital for Children, London, United Kingdom
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Largajolli A, Plock N, Kandala B, Chawla A, Robey SH, Watson K, Thatavarti R, Dubey S, Amy Cheung SY, de Greef R, Sachs JR. 1010. Cross-Species Translation of Correlates of Protection for COVID-19 Vaccine Candidates Using Quantitative Tools. Open Forum Infect Dis 2021. [PMCID: PMC8690825 DOI: 10.1093/ofid/ofab466.1204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Several COVID-19 vaccines have been authorized, and the need for rapid, further modification is anticipated. This work uses a Model-Based Meta-Analysis (MBMA) to relate, across species, immunogenicity to peak viral load (VL) after challenge and to clinical efficacy. Together with non-clinical and/or early clinical immunogenicity data (ECID), this enables prediction of a candidate vaccine’s clinical efficacy. The goal of this work was to enable the accelerated development of vaccine candidates by supporting Go/No-Go and study design decisions, and the resulting MBMA can be instrumental in decisions not to progress candidates to late stage development. Methods A literature review with pre-specified inclusion/exclusion criteria enabled creation of a database including nonclinical serum neutralizing titers (SN), peak VL after challenge with SARS-CoV-2 (VL), along with data from several clinical vaccine candidates. Rhesus Macaque (RM) and golden hamster (GH) were selected (due to availability and consistency of data) for MBMA modeling. For both RM and GH, peak post-challenge VL in lung and nasal tissues were used as surrogates for clinical disease and were related to pre-challenge SN via the MBMA. The VL predictions from the RM MBMA were scaled to incidence rates in humans, with a scaling factor between RM and human SN estimated using early Phase 3 efficacy data. This enabled clinical efficacy predictions based on ECID. To qualify the model’s predictive power, efficacies of COVID-19 vaccine candidates were compared to those predicted from the MBMA and their respective Ph1/2 SN data. More recently available clinical data enable building a clinical MBMA; comparing this to the RM MBMA further supports SN as predictive. Results The MBMA analyses identified a sigmoidal decrease in VL (increasing protection) with increase in SN in all three species, with more SN needed (in both RM and GH) for protection in nasal swabs than in BAL (see figure). The comparison between predicted and reported clinical efficacies demonstrated the model’s predictive power across vaccine platforms. RM and GH MBMA Protection Models and Translational Prediction with Observed Efficacies ![]()
Sizes of circles indicate relative weight of the data in the respective quantitative model. Model and data visualizations have been harmonized (across tissue-types) separately for each of RM and GH using VACHER (Lommerse, et al., CPT:PSP, in press). Conclusion By quantifying adjustments needed between species and assays, translational MBMA can inform development decisions by using nonclinical SN and VL, and ECID to predict protection from COVID-19. Disclosures Anna Largajolli, PhD, Certara (Employee) Nele Plock, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Bhargava Kandala, PhD, Merck & Co., Inc. (Employee, Shareholder) Akshita Chawla, PhD, Merck & Co., Inc. (Employee, Shareholder) Seth H. Robey, PhD, Merck & Co., Inc. (Employee, Shareholder) Kenny Watson, PhD, Certara (Employee, Shareholder) Raj Thatavarti, MS, Certara (Employee, Shareholder) Sheri Dubey, PhD, Merck & Co., Inc. (Employee, Shareholder) S. Y. Amy Cheung, PhD, Certara (Employee, Shareholder) Rik de Greef, MSc, Certara (Employee, Shareholder) Jeffrey R. Sachs, PhD, Merck & Co., Inc. (Employee, Shareholder)
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Plock N, Lommerse J, Maas BM, Chen J, Bellanti F, Qin L, Witjes H, Pierrillas P, Railkar R, Aliprantis AO, Vora KA, Gao W, Caro L, Amy Cheung SY, Sachs JR. 1013. Predicting RSV Efficacy for MK-1654 in Temperate and Tropical Climates using MBMA and Clinical Trial Simulation to Account for Seasonal Differences in RSV Force-of-Infection. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.1207] [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: 11/14/2022] Open
Abstract
Abstract
Background
MK-1654 is a respiratory syncytial virus (RSV) F glycoprotein neutralizing monoclonal antibody under development to prevent RSV infection in infants. A model-based meta-analysis (MBMA) describing the relationship between RSV serum neutralizing activity (SNA) and clinically relevant endpoints (e.g. incidence rates) in humans, including lower respiratory tract infection (LRI) in infants, was presented previously. This model accounted for variable exposure to RSV over the course of the season through a force-of-infection (FOI) function modulating the overall risk of RSV infection over time. The objective of the current work was to determine whether variations in regional seasonality would impact the efficacy of a clinical trial evaluating MK-1654.
Methods
A FOI function to describe the degree of RSV exposure as a function of time was created by fitting epidemiological data to a Gaussian function added to a constant baseline value. Clinical trial simulations were conducted using the MBMA to predict seasonal incidence rates (IR) of RSV medically attended lower-respiratory tract infection (MALRI) and efficacies for a range of MK-1654 doses in both temperate and tropical regions.
Results
Epidemiological data was well captured by the FOI function. Clinical trial simulations indicated that seasonal IRs of RSV were sensitive to differences in the FOI represented by temperate and tropical regions; however, there was no substantial impact on efficacies across MK-1654 dose levels. Consistent with predictions for a temperate climate, MK-1654, when administered at the start of the RSV season in a region with a tropical climate, was also predicted to maintain high efficacy ( > 75%) for the prevention of RSV MALRI for 150 days.
Conclusion
Simulations indicated that while FOI is a substantial driver of overall RSV incidence rates, MK-1654 efficacy in a late-stage clinical trial is likely to be high, regardless of regional variations in RSV.
Disclosures
Nele Plock, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Jos Lommerse, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Brian M. Maas, PharmD, Merck & Co., Inc. (Employee, Shareholder) Jingxian Chen, PhD, Merck & Co., Inc. (Employee, Shareholder) Francesco Bellanti, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Li Qin, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Han Witjes, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Philippe Pierrillas, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Radha Railkar, PhD, Merck & Co., Inc. (Employee, Shareholder) Antonios O. Aliprantis, MD, PhD, Merck & Co., Inc. (Employee, Shareholder) Kalpit A. Vora, PhD, Merck & Co., Inc. (Employee, Shareholder) Wei Gao, PhD, Merck & Co., Inc. (Employee, Shareholder) Luzelena Caro, PhD, Merck & Co., Inc. (Employee, Shareholder) S. Y. Amy Cheung, PhD, Certara (Employee, Shareholder) Jeffrey R. Sachs, PhD, Merck & Co., Inc. (Employee, Shareholder)
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Affiliation(s)
| | | | | | | | | | - Li Qin
- Certara, Princeton, New Jersey
| | | | | | | | | | | | - Wei Gao
- Merck & Co., Inc., Kenilworth, New Jersey
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Maas BM, Lommerse J, Plock N, Railkar R, Amy Cheung SY, Caro L, Chen J, Liu W, Zhang Y, Huang Q, Gao W, Qin L, Meng J, Witjes H, Schindler E, Guiastrennec B, Bellanti F, Spellman D, Roadcap B, Kalinova M, Fok-Seang J, Catchpole AP, Espeseth A, Aubrey Stoch S, Lai E, Vora KA, Aliprantis AO, Sachs JR. 998. Forward and Reverse Translational Approaches to Predict Efficacy of the Neutralizing Respiratory Syncytial Virus (RSV) Antibody MK-1654. Open Forum Infect Dis 2021. [PMCID: PMC8644347 DOI: 10.1093/ofid/ofab466.1192] [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: 12/01/2022] Open
Abstract
Background MK-1654 is a respiratory syncytial virus (RSV) F glycoprotein neutralizing monoclonal antibody (mAb) with an extended half-life in late development to prevent RSV infection in infants. Neutralizing mAbs, like MK-1654, have great potential for prophylaxis against viral infection. However, well-validated approaches for clinical dose and efficacy predictions are lacking. Methods Summary-level literature data from RSV prevention studies were used in a model-based meta-analysis (MBMA) to describe the relationship between RSV incidence rates and serum neutralizing antibody (SNA) titer. The model was validated using viral challenge experiments in cotton rats and phase 3 RSV-A efficacy results in infants for an anti-RSV F mAb, REGN-2222. A phase 2b human RSV challenge study (HCS) in adults was also conducted with MK-1654. Participants (N=70) received 100, 200, 300, or 900 mg of MK-1564 or placebo and were challenged intranasally with RSV 29 days later. RSV viral load and symptomatic infection were monitored. Data from the HCS were compared to model predictions. The MBMA was used to predict efficacy of MK-1654 in a virtual population of pre- and full- term infants. Results The relationship between SNA titer and RSV incidence rate defined using the viral load data from the cotton rat approximated the relationship identified for infants from the clinical MBMA. The MBMA was quantitatively consistent with the phase 3 efficacy results against RSV A for REGN-2222. In the HCS, RSV nasal viral load measured by RT-qPCR and quantitative culture as well as symptomatic infections were decreased in MK-1654 recipients compared to placebo. Incidence rates of RSV infection in the HCS were also consistent with MBMA predictions. The model-based clinical trial simulations for MK-1654 indicated a high probability of substantial efficacy against RSV-associated medically attended lower respiratory tract infection ( >75% for 5 months) for doses ≥75 mg. Conclusion Our MBMA successfully quantified the relationship between RSV SNA and clinically relevant endpoints, including lower respiratory tract infection in infants. MBMA-based efficacy predictions support continued development of the MK-1654 antibody for the prevention of RSV in infants. Disclosures Brian M. Maas, PharmD, Merck & Co., Inc. (Employee, Shareholder) Jos Lommerse, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Nele Plock, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Radha Railkar, PhD, Merck & Co., Inc. (Employee, Shareholder) S. Y. Amy Cheung, PhD, Certara (Employee, Shareholder) Luzelena Caro, PhD, Merck & Co., Inc. (Employee, Shareholder) Jingxian Chen, PhD, Merck & Co., Inc. (Employee, Shareholder) Wen Liu, MPH, Merck & Co., Inc. (Employee, Shareholder) Ying Zhang, PhD, Merck & Co., Inc. (Employee, Shareholder) Qinlei Huang, MS, Merck & Co., Inc. (Employee, Shareholder) Wei Gao, PhD, Merck & Co., Inc. (Employee, Shareholder) Li Qin, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Jie Meng, MSc, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Han Witjes, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Emilie Schindler, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Benjamin Guiastrennec, PharmD, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Francesco Bellanti, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Daniel Spellman, PhD, Merck & Co., Inc. (Employee, Shareholder) Brad Roadcap, MS, Merck & Co., Inc. (Employee, Shareholder) Amy Espeseth, PhD, Merck & Co., Inc. (Employee, Shareholder) S. Aubrey Stoch, MD, Merck & Co., Inc. (Employee, Shareholder) Eseng Lai, MD, PhD, Merck & Co., Inc. (Employee, Shareholder) Kalpit A. Vora, PhD, Merck & Co., Inc. (Employee, Shareholder) Antonios O. Aliprantis, MD, PhD, Merck & Co., Inc. (Employee, Shareholder) Jeffrey R. Sachs, PhD, Merck & Co., Inc. (Employee, Shareholder)
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Affiliation(s)
| | | | | | | | | | | | | | - Wen Liu
- Merck & Co., Inc., Kenilworth, New Jersey
| | - Ying Zhang
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - Wei Gao
- Merck & Co., Inc., Kenilworth, New Jersey
| | - Li Qin
- Certara, Princeton, New Jersey
| | | | | | | | | | | | | | | | | | | | | | | | | | - Eseng Lai
- Merck & Co., Inc., Kenilworth, New Jersey
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11
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Maas BM, Lommerse J, Plock N, Railkar RA, Cheung SYA, Caro L, Chen J, Liu W, Zhang Y, Huang Q, Gao W, Qin L, Meng J, Witjes H, Schindler E, Guiastrennec B, Bellanti F, Spellman DS, Roadcap B, Kalinova M, Fok-Seang J, Catchpole AP, Espeseth AS, Stoch SA, Lai E, Vora KA, Aliprantis AO, Sachs JR. Forward and reverse translational approaches to predict efficacy of neutralizing respiratory syncytial virus (RSV) antibody prophylaxis. EBioMedicine 2021; 73:103651. [PMID: 34775220 PMCID: PMC8603022 DOI: 10.1016/j.ebiom.2021.103651] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Neutralizing mAbs can prevent communicable viral diseases. MK-1654 is a respiratory syncytial virus (RSV) F glycoprotein neutralizing monoclonal antibody (mAb) under development to prevent RSV infection in infants. Development and validation of methods to predict efficacious doses of neutralizing antibodies across patient populations exposed to a time-varying force of infection (i.e., seasonal variation) are necessary. METHODS Five decades of clinical trial literature were leveraged to build a model-based meta-analysis (MBMA) describing the relationship between RSV serum neutralizing activity (SNA) and clinical endpoints. The MBMA was validated by backward translation to animal challenge experiments and forward translation to predict results of a recent RSV mAb trial. MBMA predictions were evaluated against a human trial of 70 participants who received either placebo or one of four dose-levels of MK-1654 and were challenged with RSV [NCT04086472]. The MBMA was used to perform clinical trial simulations and predict efficacy of MK-1654 in the infant target population. FINDINGS The MBMA established a quantitative relationship between RSV SNA and clinical endpoints. This relationship was quantitatively consistent with animal model challenge experiments and results of a recently published clinical trial. Additionally, SNA elicited by increasing doses of MK-1654 in humans reduced RSV symptomatic infection rates with a quantitative relationship that approximated the MBMA. The MBMA indicated a high probability that a single dose of ≥ 75 mg of MK-1654 will result in prophylactic efficacy (> 75% for 5 months) in infants. INTERPRETATION An MBMA approach can predict efficacy of neutralizing antibodies against RSV and potentially other respiratory pathogens.
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Affiliation(s)
- Brian M Maas
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Jos Lommerse
- Certara, 100 Overlook Center STE 101, Princeton, NJ 08540, USA
| | - Nele Plock
- Certara, 100 Overlook Center STE 101, Princeton, NJ 08540, USA
| | - Radha A Railkar
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - S Y Amy Cheung
- Certara, 100 Overlook Center STE 101, Princeton, NJ 08540, USA
| | - Luzelena Caro
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Jingxian Chen
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Wen Liu
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Ying Zhang
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Qinlei Huang
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Wei Gao
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Li Qin
- Certara, 100 Overlook Center STE 101, Princeton, NJ 08540, USA
| | - Jie Meng
- Certara, 100 Overlook Center STE 101, Princeton, NJ 08540, USA
| | - Han Witjes
- Certara, 100 Overlook Center STE 101, Princeton, NJ 08540, USA
| | | | | | | | - Daniel S Spellman
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Brad Roadcap
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | | | | | | | - Amy S Espeseth
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - S Aubrey Stoch
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Eseng Lai
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Kalpit A Vora
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | | | - Jeffrey R Sachs
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
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12
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Voronova V, Cullberg M, Delff P, Parkinson J, Dota C, Schiavon G, Maroj B, Rekić D, Cheung SYA. Concentration-QT modeling shows no evidence of clinically significant QT interval prolongation with capivasertib at expected therapeutic concentrations. Br J Clin Pharmacol 2021; 88:858-864. [PMID: 34309049 PMCID: PMC9292875 DOI: 10.1111/bcp.15006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/15/2021] [Accepted: 07/03/2021] [Indexed: 12/04/2022] Open
Abstract
Pharmacokinetics‐matched digital electrocardiogram data (n = 503 measurements from 180 patients) collected in a first‐in‐human, multi‐part, dose‐escalation (from 80 to 800 mg) and dose expansion (at 480 mg) phase 1 study in patients with advanced solid malignancies, were used to assess potential risk of QT prolongation associated with the AKT inhibitor capivasertib. The relationship between plasma drug concentrations and baseline‐adjusted Fridericia‐corrected QT (ΔQTcF) values was estimated using a prespecified linear mixed‐effects model. The model provided an unbiased reproduction of the experimental data set, estimating a small but positive correlation between capivasertib concentration and ΔQTcF. At the expected therapeutic dose (400 mg twice daily) the predicted mean ΔQTcF at the steady state maximum concentration was 3.97 ms with an upper limit of the 90% CI of 5.07 ms; below the 10 ms limit proposed by ICH E14 guidance. This analysis suggests that capivasertib is not expected to present a clinically significant risk for QT prolongation that is associated with pro‐arrhythmic effects.
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Affiliation(s)
| | - Marie Cullberg
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Gothenburg, Sweden
| | - Philip Delff
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Boston, MA, USA.,Now at Vertex Pharmaceuticals, Boston, MA, USA
| | - Joanna Parkinson
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Gothenburg, Sweden
| | - Corina Dota
- Cardiovascular Safety Center of Excellence, Oncology R&D, AstraZeneca R&D, Gothenburg, Sweden
| | - Gaia Schiavon
- Late Development Oncology, Oncology R&D, AstraZeneca R&D, Cambridge, UK
| | - Brijesh Maroj
- Patient Safety Oncology, Global Medicines Development, AstraZeneca R&D, Cambridge, UK
| | - Dinko Rekić
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Gothenburg, Sweden
| | - S Y Amy Cheung
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca R&D, Cambridge, UK.,Now at Certara, Princeton, NJ, USA
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13
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Lommerse J, Plock N, Cheung SYA, Sachs JR. V 2 ACHER: Visualization of complex trial data in pharmacometric analyses with covariates. CPT Pharmacometrics Syst Pharmacol 2021; 10:1092-1106. [PMID: 34242494 PMCID: PMC8452296 DOI: 10.1002/psp4.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 11/06/2022]
Abstract
Pharmacometric models can enhance clinical decision making, with covariates exposing potential contributions to variability of subpopulation characteristics, for example, demographics or disease status. Intuitive visualization of models with multiple covariates is needed because sparsity of data in visualizations trellised by covariate values can raise concerns about the credibility of the underlying model. V2 ACHER, introduced here, is a stepwise transformation of data that can be applied to a variety of static (non-ordinary-differential-equation-based) pharmacometric analyses. This work uses four examples of increasing complexity to show how the transformation elucidates the relationship between observations and model results and how it can also be used in visual predictive checks to confirm the quality of a model. V2 ACHER facilitates consistent, intuitive, single-plot visualization of a multicovariate model with a complex data set, thereby enabling easier model communication for modelers and for cross-functional development teams and facilitating confident use in support of decisions.
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Affiliation(s)
- Jos Lommerse
- Certara Strategic Consulting, Princeton, NJ, USA
| | - Nele Plock
- Certara Strategic Consulting, Princeton, NJ, USA
| | | | - Jeffrey R Sachs
- Pharmacokinetics, Pharmacodynamics, and Drug Metabolism-Quantitative Pharmacology and Pharmacometrics, Research Laboratories of Merck & Co., Inc., Kenilworth, NJ, USA
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14
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Yates JWT, Cheung SYA. A meta-analysis of tumour response and relapse kinetics based on 34,881 patients: A question of cancer type, treatment and line of treatment. Eur J Cancer 2021; 150:42-52. [PMID: 33892406 DOI: 10.1016/j.ejca.2021.03.027] [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: 02/03/2021] [Revised: 03/05/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer disease burden is commonly assessed radiologically in solid tumours in support of response assessment via the RECIST criteria. These longitudinal data are amenable to mathematical modelling and these models characterise the initial tumour size, initial tumour shrinkage in responding patients and rate of regrowth as patient's disease progresses. Knowing how these parameters vary between patient populations and treatments would inform translational modelling approaches from non-clinical data as well as clinical trial design. EXPERIMENTAL DESIGN Here a meta-analysis of reported model parameter values is reported. Appropriate literature was identified via a PubMed search and the application of text-based clustering approaches. The resulting parameter estimates are examined graphically and with ANOVA. RESULTS Parameter values from a total of 80 treatment arms were identified based on 80 trial arms containing a total of 34,881 patients. Parameter estimates are generally consistent. It is found that a significant proportion of the variation in rates of tumour shrinkage and regrowth are explained by differing cancer and treatment: cancer type accounts for 66% of the variation in shrinkage rate and 71% of the variation in reported regrowth rates. Mean average parameter values by cancer and treatment are also reported. CONCLUSIONS Mathematical modelling of longitudinal data is most often reported on a per clinical trial basis. However, the results reported here suggest that a more integrative approach would benefit the development of new treatments as well as the further optimisation of those currently used.
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15
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Khong YM, Liu J, Cook J, Purohit V, Thompson K, Mehrotra S, Cheung SYA, Hay JL, Fletcher EP, Wang J, Sachs HC, Zhu H, Siddiqui A, Cunningham L, Selen A. Harnessing formulation and clinical pharmacology knowledge for efficient pediatric drug development: Overview and discussions from M-CERSI pediatric formulation workshop 2019. Eur J Pharm Biopharm 2021; 164:66-74. [PMID: 33878434 DOI: 10.1016/j.ejpb.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/11/2020] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
A pediatric formulation workshop entitled "Pediatric Formulations: Challenges of Today and Strategies for Tomorrow" was held to advance pediatric drug product development efforts in both pre-competitive and competitive environments. The workshop had four main sessions discussing key considerations of Formulation, Analytical, Clinical and Regulatory. This paper focuses on the clinical session of the workshop. It provides an overview of the discussion on the interconnection of pediatric formulation design and development, clinical development strategy and pediatric clinical pharmacology. The success of pediatric drug product development requires collaboration of multi-disciplinary teams across the pharmaceutical industry, consortiums, foundations, academia and global regulatory agencies. Early strategic planning is essential to ensure alignment among major stakeholders of different functional teams. Such an alignment is particularly critical in the collaboration between formulators and clinical pharmacology teams.
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Affiliation(s)
| | - Jing Liu
- Pfizer Inc, Groton, CT 06340, USA.
| | | | | | | | - Shailly Mehrotra
- Otsuka Pharmaceutical Development & Commercialization, Princeton, NJ 08540, USA
| | | | - Justin L Hay
- Medicines and Healthcare Products Regulatory Agency (MHRA), Canary Wharf, London E14 4PU, UK
| | | | - Jian Wang
- U.S. Food and Drug Administration (FDA), Silver Spring, MD 20993, USA
| | - Hari Cheryl Sachs
- U.S. Food and Drug Administration (FDA), Silver Spring, MD 20993, USA
| | - Hao Zhu
- U.S. Food and Drug Administration (FDA), Silver Spring, MD 20993, USA
| | - Akhtar Siddiqui
- U.S. Food and Drug Administration (FDA), Silver Spring, MD 20993, USA
| | - Lea Cunningham
- U.S. Food and Drug Administration (FDA), Silver Spring, MD 20993, USA
| | - Arzu Selen
- U.S. Food and Drug Administration (FDA), Silver Spring, MD 20993, USA
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16
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Severin T, Corriol-Rohou S, Bucci-Rechtweg C, An Haack K, Fuerst-Recktenwald S, Lepola P, Norjavaara E, Dehlinger-Kremer M, Haertter S, Cheung SYA. How is the Pharmaceutical Industry Structured to Optimize Pediatric Drug Development? Existing Pediatric Structure Models and Proposed Recommendations for Structural Enhancement. Ther Innov Regul Sci 2020; 54:1076-1084. [PMID: 32030690 PMCID: PMC7458895 DOI: 10.1007/s43441-020-00116-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/26/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pediatric regulations enacted in both Europe and the USA have disrupted the pharmaceutical industry, challenging business and drug development processes, and organizational structures. Over the last decade, with science and innovation evolving, industry has moved from a reactive to a proactive mode, investing in building appropriate structures and capabilities as part of their business strategy to better tackle the challenges and opportunities of pediatric drug development. METHODS The EFGCP Children's Medicines Working Party and the IQ Pediatric working group have joined their efforts to survey their member company representatives to understand how pharmaceutical companies are organized to fulfill their regulatory obligations and optimize their pediatric drug development programs. RESULTS Key success factors and recommendations for a fit-for-purpose Pediatric Expert Group (PEG) were identified. CONCLUSION Pediatric structures and expert groups were shown to be important to support optimization of the development of pediatric medicines.
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Affiliation(s)
- Thomas Severin
- Global Drug Development, Novartis Pharma AG, Novartis Campus, 4002, Basel, Switzerland.
| | | | - Christina Bucci-Rechtweg
- Global Health Policy, Regulatory Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Kristina An Haack
- R&D/Clinical Development Rare Diseases, Sanofi/Genzyme, Chilly-Mazarin, France
| | | | - Pirkko Lepola
- Department of Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Sebastian Haertter
- Translational Medicine & Clinical Pharmacology, Boehringer-Ingelheim, Ingelheim, Germany
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17
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Angehrn Z, Haldna L, Zandvliet AS, Gil Berglund E, Zeeuw J, Amzal B, Cheung SYA, Polasek TM, Pfister M, Kerbusch T, Heckman NM. Artificial Intelligence and Machine Learning Applied at the Point of Care. Front Pharmacol 2020; 11:759. [PMID: 32625083 PMCID: PMC7314939 DOI: 10.3389/fphar.2020.00759] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/06/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction The increasing availability of healthcare data and rapid development of big data analytic methods has opened new avenues for use of Artificial Intelligence (AI)- and Machine Learning (ML)-based technology in medical practice. However, applications at the point of care are still scarce. Objective Review and discuss case studies to understand current capabilities for applying AI/ML in the healthcare setting, and regulatory requirements in the US, Europe and China. Methods A targeted narrative literature review of AI/ML based digital tools was performed. Scientific publications (identified in PubMed) and grey literature (identified on the websites of regulatory agencies) were reviewed and analyzed. Results From the regulatory perspective, AI/ML-based solutions can be considered medical devices (i.e., Software as Medical Device, SaMD). A case series of SaMD is presented. First, tools for monitoring and remote management of chronic diseases are presented. Second, imaging applications for diagnostic support are discussed. Finally, clinical decision support tools to facilitate the choice of treatment and precision dosing are reviewed. While tested and validated algorithms for precision dosing exist, their implementation at the point of care is limited, and their regulatory and commercialization pathway is not clear. Regulatory requirements depend on the level of risk associated with the use of the device in medical practice, and can be classified into administrative (manufacturing and quality control), software-related (design, specification, hazard analysis, architecture, traceability, software risk analysis, cybersecurity, etc.), clinical evidence (including patient perspectives in some cases), non-clinical evidence (dosing validation and biocompatibility/toxicology) and other, such as e.g. benefit-to-risk determination, risk assessment and mitigation. There generally is an alignment between the US and Europe. China additionally requires that the clinical evidence is applicable to the Chinese population and recommends that a third-party central laboratory evaluates the clinical trial results. Conclusions The number of promising AI/ML-based technologies is increasing, but few have been implemented widely at the point of care. The need for external validation, implementation logistics, and data exchange and privacy remain the main obstacles.
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Affiliation(s)
| | | | | | | | | | | | | | - Thomas M Polasek
- Certara, Princeton, NJ, United States.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre for Medicines Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Marc Pfister
- Certara, Princeton, NJ, United States.,Department of Pharmacology and Pharmacometrics, Children's University Hospital Basel, Basel, Switzerland
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Robertson JFR, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Cheung SYA, Cullberg M, de Bruin EC, Koulai L, Lindemann JPO, Pass M, Rugman P, Schiavon G, Deb R, Finlay P, Foxley A, Gee JMW. Proliferation and AKT Activity Biomarker Analyses after Capivasertib (AZD5363) Treatment of Patients with ER + Invasive Breast Cancer (STAKT). Clin Cancer Res 2020; 26:1574-1585. [PMID: 31836609 DOI: 10.1158/1078-0432.ccr-19-3053] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/22/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The STAKT study examined short-term exposure (4.5 days) to the oral selective pan-AKT inhibitor capivasertib (AZD5363) to determine if this drug can reach its therapeutic target in sufficient concentration to significantly modulate key biomarkers of the AKT pathway and tumor proliferation. PATIENTS AND METHODS STAKT was a two-stage, double-blind, randomized, placebo-controlled, "window-of-opportunity" study in patients with newly diagnosed ER+ invasive breast cancer. Stage 1 assessed capivasertib 480 mg b.i.d. (recommended monotherapy dose) and placebo, and stage 2 assessed capivasertib 360 and 240 mg b.i.d. Primary endpoints were changes from baseline in AKT pathway markers pPRAS40, pGSK3β, and proliferation protein Ki67. Pharmacologic and pharmacodynamic properties were analyzed from blood sampling, and tolerability by adverse-event monitoring. RESULTS After 4.5 days' exposure, capivasertib 480 mg b.i.d. (n = 17) produced significant decreases from baseline versus placebo (n = 11) in pGSK3β (H-score absolute change: -55.3, P = 0.006) and pPRAS40 (-83.8, P < 0.0001), and a decrease in Ki67 (absolute change in percentage positive nuclei: -9.6%, P = 0.031). Significant changes also occurred in secondary signaling biomarker pS6 (-42.3, P = 0.004), while pAKT (and nuclear FOXO3a) also increased in accordance with capivasertib's mechanism (pAKT: 81.3, P = 0.005). At doses of 360 mg b.i.d. (n = 5) and 240 mg b.i.d. (n = 6), changes in primary and secondary biomarkers were also observed, albeit of smaller magnitude. Biomarker modulation was dose and concentration dependent, and no new safety signals were evident. CONCLUSIONS Capivasertib 480 mg b.i.d. rapidly modulates key biomarkers of the AKT pathway and decreases proliferation marker Ki67, suggesting future potential as an effective therapy in AKT-dependent breast cancers.
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Affiliation(s)
| | | | | | | | | | - Anthony Skene
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Daniel Rea
- University of Birmingham, Birmingham, UK
| | | | - Ali Jahan
- King's Mill Hospital, Nottingham, UK
| | | | | | | | | | | | | | | | | | - Martin Pass
- IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Paul Rugman
- IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | | | - Rahul Deb
- Department of Histopathology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Barrett JS, Bucci-Rechtweg C, Amy Cheung SY, Gamalo-Siebers M, Haertter S, Karres J, Marquard J, Mulugeta Y, Ollivier C, Strougo A, Yanoff L, Yao L, Zeitler P. Pediatric Extrapolation in Type 2 Diabetes: Future Implications of a Workshop. Clin Pharmacol Ther 2020; 108:29-39. [PMID: 32017043 PMCID: PMC7383960 DOI: 10.1002/cpt.1805] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022]
Abstract
Extrapolation from adults to youth with type 2 diabetes (T2D) is challenged by differences in disease progression and manifestation. This manuscript presents the results of a mock-team workshop focused on examining the typical team-based decision process used to propose a pediatric development plan for T2D addressing the viability of extrapolation. The workshop was held at the American Society for Clinical Pharmacology and Therapeutics (ASCPT) in Orlando, Florida on March 21, 2018.
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Affiliation(s)
- Jeffrey S Barrett
- Quantitative Sciences, Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts, USA
| | - Christina Bucci-Rechtweg
- Pediatric & Maternal Health Policy, Regulatory Affairs, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | - Sebastian Haertter
- Translational Med & Clinical Pharmacology, Boehringer Ingelheim, Biberach, Germany
| | - Janina Karres
- Paediatric Medicines Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Jan Marquard
- Global Clinical Development CardioMetabolism, Boehringer Ingelheim, Ingelheim, Germany
| | - Yeruk Mulugeta
- Division of Pediatric and Maternal Health, Office of New Drugs, Center for Drug Evaluation and Research, Washington, DC, USA
| | | | - Ashley Strougo
- Translational Medicine, Pharmacokinetics, Dynamics and Metabolism, Sanofi, Frankfurt, Germany
| | - Lisa Yanoff
- Division of Metabolism and Endocrinology Products, Office of New Drugs, Center for Drug Evaluation and Research, Washington, DC, USA
| | - Lynne Yao
- Division of Pediatric and Maternal Health, Office of New Drugs, Center for Drug Evaluation and Research, Washington, DC, USA
| | - Philip Zeitler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Corriol-Rohou S, Cheung SYA. Industry Perspective on Using MIDD for Pediatric Studies Requiring Integration of Ontogeny. J Clin Pharmacol 2019; 59 Suppl 1:S112-S119. [PMID: 31502694 DOI: 10.1002/jcph.1495] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022]
Abstract
Joining the Food and Drug Administration/University of Maryland Center of Excellence in Regulatory Science and Innovation Workshop to discuss and identify solutions to optimize pediatric drug development and, in particular, to address the question as to whether we are ready to incorporate pediatric ontogeny into modeling was the opportunity to share learnings, confront ideas, and present examples of studies performed in industry and academia. This was not only the opportunity to reflect on the experience and the knowledge so far within the current regulatory framework but also to look at the future and explore new and future approaches as well as best practices with the use of modeling and simulation and extrapolation as part of pediatric development.
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21
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Turner NC, Alarcón E, Armstrong AC, Philco M, López Chuken YA, Sablin MP, Tamura K, Gómez Villanueva A, Pérez-Fidalgo JA, Cheung SYA, Corcoran C, Cullberg M, Davies BR, de Bruin EC, Foxley A, Lindemann JPO, Maudsley R, Moschetta M, Outhwaite E, Pass M, Rugman P, Schiavon G, Oliveira M. BEECH: a dose-finding run-in followed by a randomised phase II study assessing the efficacy of AKT inhibitor capivasertib (AZD5363) combined with paclitaxel in patients with estrogen receptor-positive advanced or metastatic breast cancer, and in a PIK3CA mutant sub-population. Ann Oncol 2019; 30:774-780. [PMID: 30860570 PMCID: PMC6551452 DOI: 10.1093/annonc/mdz086] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND BEECH investigated the efficacy of capivasertib (AZD5363), an oral inhibitor of AKT isoforms 1-3, in combination with the first-line weekly paclitaxel for advanced or metastatic estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer, and in a phosphoinositide 3-kinase, catalytic, alpha polypeptide mutation sub-population (PIK3CA+). PATIENTS AND METHODS BEECH consisted of an open-label, phase Ib safety run-in (part A) in 38 patients with advanced breast cancer, and a randomised, placebo-controlled, double-blind, phase II expansion (part B) in 110 women with ER+/HER2- metastatic breast cancer. In part A, patients received paclitaxel 90 mg/m2 (days 1, 8 and 15 of a 28-day cycle) with capivasertib taken twice daily (b.i.d.) at two intermittent ascending dosing schedules. In part B, patients were randomly assigned, stratified by PIK3CA mutation status, to receive paclitaxel with either capivasertib or placebo. The primary end point for part A was safety to recommend a dose and schedule for part B; primary end points for part B were progression-free survival (PFS) in the overall and PIK3CA+ sub-population. RESULTS Capivasertib was well tolerated, with a 400 mg b.i.d. 4 days on/3 days off treatment schedule selected in part A. In part B, median PFS in the overall population was 10.9 months with capivasertib versus 8.4 months with placebo [hazard ratio (HR) 0.80; P = 0.308]. In the PIK3CA+ sub-population, median PFS was 10.9 months with capivasertib versus 10.8 months with placebo (HR 1.11; P = 0.760). Based on the Common Terminology Criteria for Adverse Event v4.0, the most common grade ≥3 adverse events in the capivasertib group were diarrhoea, hyperglycaemia, neutropoenia and maculopapular rash. Dose intensity of paclitaxel was similar in both groups. CONCLUSIONS Capivasertib had no apparent impact on the tolerability and dose intensity of paclitaxel. Adding capivasertib to weekly paclitaxel did not prolong PFS in the overall population or PIK3CA+ sub-population of ER+/HER2- advanced/metastatic breast cancer patients.ClinicalTrials.gov: NCT01625286.
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Affiliation(s)
- N C Turner
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK; Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK.
| | - E Alarcón
- Clinical Oncology Department, British American Hospital, Lima, Peru
| | - A C Armstrong
- Department of Medical Oncology, Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M Philco
- Peruvian Institute of Oncology Radiotherapy, Lima, Peru
| | | | - M-P Sablin
- Department of Drug Development and Innovation (D3i), Curie Institute, Paris, France
| | - K Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - J A Pérez-Fidalgo
- Medical Oncology Unit, INCLIVA Biomedical Research Institute, University Clinical Hospital of Valencia, Valencia; CIBERONC, Health Institute Carlos III, Madrid, Spain
| | | | - C Corcoran
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge
| | - M Cullberg
- IMED Biotech Unit, AstraZeneca, Cambridge
| | - B R Davies
- IMED Biotech Unit, AstraZeneca, Cambridge
| | | | - A Foxley
- IMED Biotech Unit, AstraZeneca, Cambridge
| | | | - R Maudsley
- IMED Biotech Unit, AstraZeneca, Cambridge
| | | | | | - M Pass
- IMED Biotech Unit, AstraZeneca, Cambridge
| | - P Rugman
- IMED Biotech Unit, AstraZeneca, Cambridge
| | - G Schiavon
- IMED Biotech Unit, AstraZeneca, Cambridge
| | - M Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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22
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Cucurull-Sanchez L, Chappell MJ, Chelliah V, Amy Cheung SY, Derks G, Penney M, Phipps A, Malik-Sheriff RS, Timmis J, Tindall MJ, van der Graaf PH, Vicini P, Yates JWT. Best Practices to Maximize the Use and Reuse of Quantitative and Systems Pharmacology Models: Recommendations From the United Kingdom Quantitative and Systems Pharmacology Network. CPT Pharmacometrics Syst Pharmacol 2019; 8:259-272. [PMID: 30667172 PMCID: PMC6533407 DOI: 10.1002/psp4.12381] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/04/2018] [Accepted: 12/17/2018] [Indexed: 12/13/2022]
Abstract
The lack of standardization in the way that quantitative and systems pharmacology (QSP) models are developed, tested, and documented hinders their reproducibility, reusability, and expansion or reduction to alternative contexts. This in turn undermines the potential impact of QSP in academic, industrial, and regulatory frameworks. This article presents a minimum set of recommendations from the UK Quantitative and Systems Pharmacology Network (UK QSP Network) to guide QSP practitioners seeking to maximize their impact, and stakeholders considering the use of QSP models in their environment.
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Affiliation(s)
| | | | | | - S Y Amy Cheung
- Quantitative Clinical Pharmacology, Early Clinical Development, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Cambridge, UK.,Certara, Princeton, New Jersey, USA
| | - Gianne Derks
- Department of Mathematics, University of Surrey, Guildford, UK
| | - Mark Penney
- Union Chimique Belge-Celltech, Slough, Berkshire, UK
| | - Alex Phipps
- Pharmaceutical Sciences, Roche Pharmaceutical Research & Early Development, Roche Innovation Center, Welwyn Garden City, UK
| | - Rahuman S Malik-Sheriff
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, UK
| | - Jon Timmis
- Department of Electronic Engineering, University of York, York, UK
| | - Marcus J Tindall
- Department of Mathematics and Statistics, University of Reading, Reading, UK.,The Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, UK
| | - Piet H van der Graaf
- Certara QSP, Canterbury, UK.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Paolo Vicini
- Clinical Pharmacology, Pharmacometrics and Drug Metabolism and Pharmaco-Kinetics, MedImmune, Cambridge, UK.,Development Sciences, Kymab Ltd, Cambridge, UK
| | - James W T Yates
- Drug Metabolism and Pharmaco-Kinetics, Oncology, Innovative Medicines and Early Development, AstraZeneca, Chesterford Research Park, Cambridge, UK
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23
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Fornari C, O'Connor LO, Yates JWT, Cheung SYA, Jodrell DI, Mettetal JT, Collins TA. Understanding Hematological Toxicities Using Mathematical Modeling. Clin Pharmacol Ther 2018; 104:644-654. [PMID: 29604045 DOI: 10.1002/cpt.1080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/09/2018] [Accepted: 03/27/2018] [Indexed: 12/16/2022]
Abstract
Balancing antitumor efficacy with toxicity is a significant challenge, and drug-induced myelosuppression is a common dose-limiting toxicity of cancer treatments. Mathematical modeling has proven to be a powerful ally in this field, scaling results from animal models to humans, and designing optimized treatment regimens. Here we outline existing mathematical approaches for studying bone marrow toxicity, identify gaps in current understanding, and make future recommendations to advance this vital field of safety research further.
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Affiliation(s)
- Chiara Fornari
- Safety and ADME Translational Sciences, Drug Safety and Metabolism, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | | | - James W T Yates
- DMPK, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - S Y Amy Cheung
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, Cambridge, UK
| | - Duncan I Jodrell
- CRUK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - Jerome T Mettetal
- Safety and ADME Translational Sciences, Drug Safety and Metabolism, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts, USA
| | - Teresa A Collins
- Safety and ADME Translational Sciences, Drug Safety and Metabolism, IMED Biotech Unit, AstraZeneca, Cambridge, UK
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24
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Berges A, Cheung SYA, Pierce AJ, Dean E, Felicetti B, Standifer N, Smith S, Yates J, Lau A, Stephens C, Krebs M, Harrington K, Hollingsworth SJ. Abstract CT118: PK-Biomarker-Safety modelling aids choice of recommended Phase II dose and schedule for AZD6738 (ATR inhibitor). Clin Trials 2018. [DOI: 10.1158/1538-7445.am2018-ct118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Banerji U, Dean EJ, Pérez-Fidalgo JA, Batist G, Bedard PL, You B, Westin SN, Kabos P, Garrett MD, Tall M, Ambrose H, Barrett JC, Carr TH, Cheung SYA, Corcoran C, Cullberg M, Davies BR, de Bruin EC, Elvin P, Foxley A, Lawrence P, Lindemann JPO, Maudsley R, Pass M, Rowlands V, Rugman P, Schiavon G, Yates J, Schellens JHM. A Phase I Open-Label Study to Identify a Dosing Regimen of the Pan-AKT Inhibitor AZD5363 for Evaluation in Solid Tumors and in PIK3CA-Mutated Breast and Gynecologic Cancers. Clin Cancer Res 2018; 24:2050-2059. [PMID: 29066505 DOI: 10.1158/1078-0432.ccr-17-2260] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/07/2017] [Accepted: 10/19/2017] [Indexed: 11/16/2022]
Abstract
Purpose: This phase I, open-label study (Study 1, D3610C00001; NCT01226316) was the first-in-human evaluation of oral AZD5363, a selective pan-AKT inhibitor, in patients with advanced solid malignancies. The objectives were to investigate the safety, tolerability, and pharmacokinetics of AZD5363, define a recommended dosing schedule, and evaluate preliminary clinical activity.Experimental Design: Patients were aged ≥18 years with World Health Organization (WHO) performance status of 0 to 1. Dose escalation was conducted within separate continuous and intermittent [4 days/week (4/7) or 2 days/week (2/7)] schedules with safety, pharmacokinetic, and pharmacodynamic analyses. Expansion cohorts of approximately 20 patients each explored AZD5363 activity in PIK3CA-mutant breast and gynecologic cancers.Results: MTDs were 320, 480, and 640 mg for continuous (n = 47), 4/7 (n = 21), and 2/7 (n = 22) schedules, respectively. Dose-limiting toxicities were rash and diarrhea for continuous, hyperglycemia for 2/7, and none for 4/7. Common adverse events were diarrhea (78%) and nausea (49%) and, for Common Terminology Criteria for Adverse Events grade ≥3 events, hyperglycemia (20%). The recommended phase II dose (480 mg bid, 4/7 intermittent) was assessed in PIK3CA-mutant breast and gynecologic expansion cohorts: 46% and 56% of patients, respectively, showed a reduction in tumor size, with RECIST responses of 4% and 8%. These responses were less than the prespecified 20% response rate; therefore, the criteria to stop further recruitment to the PIK3CA-mutant cohort were met.Conclusions: At the recommended phase II dose, AZD5363 was well tolerated and achieved plasma levels and robust target modulation in tumors. Proof-of-concept responses were observed in patients with PIK3CA-mutant cancers treated with AZD5363. Clin Cancer Res; 24(9); 2050-9. ©2017 AACRSee related commentary by Costa and Bosch, p. 2029.
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Affiliation(s)
- Udai Banerji
- Clinical Pharmacology and Trials, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Emma J Dean
- Medical Oncology (Drug Development), University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Alejandro Pérez-Fidalgo
- Department of Oncology and Hematology, INCLIVA Biomedical Research Institute, Hospital Clínico Universitario de Valencia, CIBERONC, Valencia, Spain
| | - Gerald Batist
- Department of Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Canada
| | - Philippe L Bedard
- Department of Medical Oncology, The Princess Margaret Cancer Centre, Toronto, Canada
| | - Benoit You
- Medical Oncology Department, Institut de Cancérologie des Hospices Civils de Lyon, CITOHL, Université Lyon 1, Lyon, France
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Kabos
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | | | - Mathew Tall
- Clinical PD Biomarker Group, The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | | | | | | | | | | | | | - Paul Elvin
- IMED, AstraZeneca, Cambridge, United Kingdom
| | | | | | | | | | - Martin Pass
- IMED, AstraZeneca, Cambridge, United Kingdom
| | | | - Paul Rugman
- IMED, AstraZeneca, Cambridge, United Kingdom
| | | | - James Yates
- IMED, AstraZeneca, Cambridge, United Kingdom
| | - Jan H M Schellens
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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26
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Zhou W, Johnson TN, Bui KH, Cheung SYA, Li J, Xu H, Al-Huniti N, Zhou D. Predictive Performance of Physiologically Based Pharmacokinetic (PBPK) Modeling of Drugs Extensively Metabolized by Major Cytochrome P450s in Children. Clin Pharmacol Ther 2017; 104:188-200. [PMID: 29027194 DOI: 10.1002/cpt.905] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 12/20/2022]
Abstract
The accuracy of physiologically based pharmacokinetic (PBPK) model prediction in children, especially those younger than 2 years old, has not been systematically evaluated. The aim of this study was to characterize the pediatric predictive performance of the PBPK approach for 10 drugs extensively metabolized by CYP1A2 (theophylline), CYP2C8 (desloratidine, montelukast), CYP2C9 (diclofenac), CYP2C19 (esomeprazole, lansoprazole), CYP2D6 (tramadol), and CYP3A4 (itraconazole, ondansetron, sufentanil). Model performance in children was evaluated by comparing simulated plasma concentration-time profiles with observed clinical results for each drug and age group. PBPK models reasonably predicted the pharmacokinetics of desloratadine, diclofenac, itraconazole, lansoprazole, montelukast, ondansetron, sufentanil, theophylline, and tramadol across all age groups. Collectively, 58 out of 67 predictions were within 2-fold and 43 out of 67 predictions within 1.5-fold of observed values. Developed PBPK models can reasonably predict exposure in children age 1 month and older for an array of predominantly CYP metabolized drugs.
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Affiliation(s)
- Wangda Zhou
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, Massachusetts, USA
| | | | - Khanh H Bui
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, Massachusetts, USA
| | - S Y Amy Cheung
- Quantitative Clinical Pharmacology, AstraZeneca, Cambridge, UK
| | - Jianguo Li
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, Massachusetts, USA
| | - Hongmei Xu
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, Massachusetts, USA
| | - Nidal Al-Huniti
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, Massachusetts, USA
| | - Diansong Zhou
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, Massachusetts, USA
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Cheung SYA, Rodgers T, Aarons L, Gueorguieva I, Dickinson GL, Murby S, Brown C, Collins B, Rowland M. Whole body physiologically based modelling of β-blockers in the rat: events in tissues and plasma following an i.v. bolus dose. Br J Pharmacol 2017; 175:67-83. [PMID: 29053169 DOI: 10.1111/bph.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 09/29/2017] [Accepted: 10/05/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Whole body physiologically based pharmacokinetic (PBPK) models have been increasingly applied in drug development to describe kinetic events of therapeutic agents in animals and humans. The advantage of such modelling is the ability to incorporate vast amounts of physiological information, such as organ blood flow and volume, to ensure that the model is as close to reality as possible. EXPERIMENTAL APPROACH Previous PBPK model development of enantiomers of a series of seven racemic β-blockers, namely, acebutolol, betaxolol, bisoprolol, metoprolol, oxprenolol, pindolol and propranolol, together with S-timolol in rat was based on tissue and blood concentration data at steady state. Compounds were administered in several cassettes with the composition mix and blood and tissue sampling times determined using a D-optimal design. KEY RESULTS Closed-loop PBPK models were developed initially based on the application of open loop forcing function models to individual tissues and compounds. For the majority of compounds and tissues, distribution kinetics was adequately characterized by perfusion rate-limited models. For some compounds in the testes and gut, a permeability rate-limited distribution model was required to best fit the data. Parameter estimates of the tissue-to-blood partition coefficient through fitting of individual enantiomers and of racemic pair were generally in agreement and also concur with those from previous steady-state experiments. CONCLUSIONS AND IMPLICATIONS PBPK modelling is a very powerful tool to aid drug discovery and development of therapeutic agents in animals and humans. However, careful consideration of the assumptions made during the modelling exercise is essential.
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Affiliation(s)
- S Y A Cheung
- Quantitative Clinical Pharmacology, Early Clinical Development, iMED AstraZeneca, Cambridge, UK
| | - T Rodgers
- Icon Development Solutions, Manchester, UK
| | - L Aarons
- Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, University of Manchester, Manchester, UK
| | | | | | - S Murby
- Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - C Brown
- Redx Pharma, Macclesfield, UK
| | - B Collins
- Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - M Rowland
- Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, University of Manchester, Manchester, UK
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28
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Pierce A, Berges A, Cheung SYA, Standifer N, Ross G, Smith S, Hollingsworth SJ, Krebs M, Postel-Vinay S, Bang YJ, El-Khoueiry AB, Abida W, Sundar R, Carter L, Castanon-Alvarez E, Im SA, Lopez JS, Yap TA, Harrington K, Soria JC. Dose-exposure-response relationship between AZD6738 and peripheral monocytes. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e14063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
e14063 Background: AZD6738 is a potent, selective inhibitor of the ataxia telangiectasia and Rad3-related (ATR) serine/threonine-specific protein kinase with good selectivity against other phosphatidylinositol 3-kinase-related kinase (PIKK) family members. To support dose/schedule guidance through mathematical modelling of clinical pharmacokinetic/pharmacodynamic relationships, we sought to determine quantitative pharmacodynamic effects of AZD6738 in peripheral blood with respect to drug exposure. Methods: We assessed peripheral blood cell subpopulations in clinical studies of AZD6738 used either as a monotherapy, a combination with the PARP-1 inhibitor olaparib and in combination with the PD-L1 inhibitor durvalumab through both blood analyser and flow cytometry characterization. Peripheral pharmacokinetics of AZD6738 were also assessed. Results: Levels of peripheral monocytes were suppressed in a dose-dependent manner for the duration of AZD6738 dosing resulting in a decrease of up to 80% within the first 7 consecutive days of AZD6738 treatment; these results were consistent across studies. Upon cessation of an AZD6738 dosing interval monocyte levels return to baseline values within 14 days; in combination with durvalumab there is a trend for the rebound in monocyte counts to surpass baseline levels by up to 20%. Monocyte suppression is specific to AZD6738 and not found with either single agent olaparib or single agent durvalumab, possibly attributable to defective base excision repair in monocytes and lack of PARP-1. Monocytes were found to be the most sensitive cell type to AZD6738 treatment compared with neutrophils, platelets, haemoglobin or lymphocytes. Conclusions: This drug effect of AZD6738 is consistent with natural clearance of peripheral monocytes under suppression of monocyte precursor proliferation in the bone marrow, suggestive of a change in the equilibrium between production and elimination of peripheral monocytes. Used as a surrogate marker of target inhibition, a mathematical model of the AZD6738/monocyte dose-exposure-response relationship is described and has been used to inform AZD6738 Phase 2 dose and schedule.
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Affiliation(s)
| | | | - S Y Amy Cheung
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | | | | | | | | | - Matthew Krebs
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | | | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | | | - Wassim Abida
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Raghav Sundar
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Louise Carter
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Seock-Ah Im
- Seoul National University, Seoul, Republic of Korea
| | | | | | - Kevin Harrington
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
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Wilkins JJ, Chan PLS, Chard J, Smith G, Smith MK, Beer M, Dunn A, Flandorfer C, Franklin C, Gomeni R, Harnisch L, Kaye R, Moodie S, Sardu ML, Wang E, Watson E, Wolstencroft K, Cheung SYA. Thoughtflow: Standards and Tools for Provenance Capture and Workflow Definition to Support Model-Informed Drug Discovery and Development. CPT Pharmacometrics Syst Pharmacol 2017; 6:285-292. [PMID: 28504472 PMCID: PMC5445227 DOI: 10.1002/psp4.12171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 09/20/2016] [Revised: 12/21/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022] Open
Abstract
Pharmacometric analyses are complex and multifactorial. It is essential to check, track, and document the vast amounts of data and metadata that are generated during these analyses (and the relationships between them) in order to comply with regulations, support quality control, auditing, and reporting. It is, however, challenging, tedious, error-prone, and time-consuming, and diverts pharmacometricians from the more useful business of doing science. Automating this process would save time, reduce transcriptional errors, support the retention and transfer of knowledge, encourage good practice, and help ensure that pharmacometric analyses appropriately impact decisions. The ability to document, communicate, and reconstruct a complete pharmacometric analysis using an open standard would have considerable benefits. In this article, the Innovative Medicines Initiative (IMI) Drug Disease Model Resources (DDMoRe) consortium proposes a set of standards to facilitate the capture, storage, and reporting of knowledge (including assumptions and decisions) in the context of model-informed drug discovery and development (MID3), as well as to support reproducibility: "Thoughtflow." A prototype software implementation is provided.
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Affiliation(s)
| | - PLS Chan
- Pharmacometrics, Global Clinical PharmacologyPfizer, SandwichUK
| | - J Chard
- Mango SolutionsChippenhamWiltshireUK
| | - G Smith
- Scientific Computing Group, Cyprotex Discovery LimitedMacclesfieldCreweUK
| | - MK Smith
- Pharmacometrics, Global Clinical PharmacologyPfizer, SandwichUK
| | | | - A Dunn
- Mango SolutionsChippenhamWiltshireUK
| | | | - C Franklin
- GSK, Clinical Pharmacology Modelling & SimulationStockley ParkUK
| | - R Gomeni
- PharmacoMetricaLa FouilladeFrance
| | - L Harnisch
- Pharmacometrics, Global Clinical PharmacologyPfizer, SandwichUK
| | - R Kaye
- Mango SolutionsChippenhamWiltshireUK
| | | | - ML Sardu
- Merck Institute for Pharmacometrics, Merck Serono S.A.Switzerland
| | - E Wang
- Global PK/PD and Pharmacometrics, Eli Lilly and CompanyIndianapolisIndianaUSA
| | - E Watson
- Predictive Compound Safety & ADME, Drug Safety & MetabolismInnovative Medicines, AstraZenecaGothenburgSweden
| | - K Wolstencroft
- Leiden Institute of Advanced Computer Science (LIACS), Leiden UniversityLeidenThe Netherlands
| | - SYA Cheung
- Quantitative Clinical Pharmacology, Early Clinical Development, Innovative Medicine, AstraZenecaCambridgeUK
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30
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Marshall SF, Burghaus R, Cosson V, Cheung SYA, Chenel M, DellaPasqua O, Frey N, Hamrén B, Harnisch L, Ivanow F, Kerbusch T, Lippert J, Milligan PA, Rohou S, Staab A, Steimer JL, Tornøe C, Visser SAG. Good Practices in Model-Informed Drug Discovery and Development: Practice, Application, and Documentation. CPT Pharmacometrics Syst Pharmacol 2016; 5:93-122. [PMID: 27069774 PMCID: PMC4809625 DOI: 10.1002/psp4.12049] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022]
Abstract
This document was developed to enable greater consistency in the practice, application, and documentation of Model-Informed Drug Discovery and Development (MID3) across the pharmaceutical industry. A collection of "good practice" recommendations are assembled here in order to minimize the heterogeneity in both the quality and content of MID3 implementation and documentation. The three major objectives of this white paper are to: i) inform company decision makers how the strategic integration of MID3 can benefit R&D efficiency; ii) provide MID3 analysts with sufficient material to enhance the planning, rigor, and consistency of the application of MID3; and iii) provide regulatory authorities with substrate to develop MID3 related and/or MID3 enabled guidelines.
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Affiliation(s)
| | | | - R Burghaus
- Systems Pharmacology & Medicine Bayer Pharma AG Wuppertal Germany
| | - V Cosson
- Clinical Pharmacometrics F. Hoffmann-La Roche Ltd Basel Switzerland
| | - S Y A Cheung
- Quantitative Clinical Pharmacology AstraZeneca Cambridge UK
| | - M Chenel
- Institut de Recherches Internationales Servier Suresnes France
| | - O DellaPasqua
- Clinical Pharmacology Modelling & Simulation GlaxoSmithKline R&D Ltd Uxbridge UK
| | - N Frey
- Clinical Pharmacometrics F. Hoffmann-La Roche Ltd Basel Switzerland
| | - B Hamrén
- Quantitative Clinical Pharmacology AstraZeneca Gothenburg Sweden
| | | | - F Ivanow
- Global regulatory policy & Intelligence Janssen R&D High Wycombe UK
| | - T Kerbusch
- Quantitative Pharmacology & Pharmacometrics MSD Oss Netherlands
| | - J Lippert
- Systems Pharmacology & Medicine Bayer Pharma AG Wuppertal Germany
| | | | - S Rohou
- Global Regulatory Affairs & Policy AstraZeneca Paris France
| | - A Staab
- Translational Medicine & Clinical Pharmacology Boehringer Ingelheim Pharma GmbH & Co. KG Biberach Germany
| | | | - C Tornøe
- Clinical Reporting Novo Nordisk A/S Søborg Denmark
| | - S A G Visser
- Quantitative Pharmacology & Pharmacometrics Merck & Co Kenilworth USA
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31
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Elvin P, Palmer A, Womack C, Tall M, Swales KE, Garrett MD, Banerji U, Tamura K, Cheung SYA, Lawrence P, Lindemann J, Ambrose H, Stephens C, Davies B, Foxley A, Pass M, Harrington EA, Barrett JC. Pharmacodynamic activity of the AKT inhibitor AZD5363 in patients with advanced solid tumors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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)
- Paul Elvin
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | - Amy Palmer
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | - Chris Womack
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | - Matthew Tall
- The Institute of Cancer Research, Sutton, United Kingdom
| | - Karen E Swales
- The Institute of Cancer Research, Sutton, United Kingdom
| | | | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kenji Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - S Y Amy Cheung
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | - Peter Lawrence
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | - Justin Lindemann
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | - Helen Ambrose
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | | | - Barry Davies
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | - Andrew Foxley
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
| | - Martin Pass
- AstraZeneca Oncology Innovative Medicines, Macclesfield, United Kingdom
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32
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Abstract
The deterministic identifiability of models is only normally considered if a problem becomes apparent in the parameter identification stage of data analysis. If no problem is perceived then the analysis will continue. However, although the problem does not become apparent, the implications of ambiguities in what is inferred from the data should be considered. This paper reviews some fundamentals with respect to model indistinguishability and parameter identifiability.
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Affiliation(s)
- James W T Yates
- AstraZeneca R&D. Discovery DMPK, Alderley Park, Cheshire, UK.
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