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Non-linear IV pharmacokinetics of the ATR inhibitor berzosertib (M6620) in mice. 小鼠体内 ATR 抑制剂 berzosertib(M6620)的非线性静脉药代动力学。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-05-14 DOI: 10.1007/s00280-024-04675-3
Joshua J Deppas, Brian F Kiesel, Jianxia Guo, Robert A Parise, D Andy Clump, David Z D'Argenio, Christopher J Bakkenist, Jan H Beumer

Background: The Ataxia Telangiectasia and Rad3-related (ATR) protein complex is an apical initiator of DNA damage response pathways. Several ATR inhibitors (ATRi) are in clinical development including berzosertib (formerly M6620, VX-970). Although clinical studies have examined plasma pharmacokinetics (PK) in humans, little is known regarding dose/exposure relationships and tissue distribution. To understand these concepts, we extensively characterized the PK of berzosertib in mouse plasma and tissues.

Methods: A highly sensitive LC-MS/MS method was utilized to quantitate berzosertib in plasma and tissues. Dose proportionality was assessed in female BALB/c mice following single IV doses (2, 6, 20 or 60 mg/kg). A more extensive PK study was conducted in tumor-bearing mice following a single IV dose of 20 mg/kg to evaluate distribution to tissues. PK parameters were calculated by non-compartmental analysis (NCA). A compartmental model was developed to describe the PK behavior of berzosertib. Plasma protein binding was determined in vitro.

Results: Increased doses of berzosertib were associated with less than proportional increases in early plasma concentrations and greater than proportional increase in tissue exposure, attributable to saturation of plasma protein binding. Berzosertib extensively distributed into bone marrow, tumor, thymus, and lymph nodes, however; brain and spinal cord exposure was less than plasma.

Conclusion: The nonlinear PK of berzosertib displayed here can be attributed to saturation of plasma protein binding and occurred at concentrations close to those observed in clinical trials. Our results will help to understand preclinical pharmacodynamic and toxicity data and to inform optimal dosing and deployment of berzosertib.

背景:共济失调性远端异位症和 Rad3 相关(ATR)蛋白复合物是 DNA 损伤反应通路的顶端启动器。目前有几种ATR抑制剂(ATRi)正在临床开发中,其中包括berzosertib(原名M6620,VX-970)。尽管临床研究已经检测了人体血浆药代动力学(PK),但对剂量/暴露关系和组织分布却知之甚少。为了理解这些概念,我们广泛研究了小鼠血浆和组织中贝唑色替布的药代动力学特征:方法:采用高灵敏度的 LC-MS/MS 方法对血浆和组织中的贝唑舍替进行定量。对雌性 BALB/c 小鼠单次静脉注射剂量(2、6、20 或 60 毫克/千克)后的剂量比例进行了评估。单次静脉注射 20 毫克/千克剂量后,在肿瘤小鼠体内进行了更广泛的 PK 研究,以评估药物在组织中的分布情况。PK 参数通过非室分析(NCA)计算。建立了一个区室模型来描述贝唑舍替的 PK 行为。在体外测定了血浆蛋白结合力:结果:由于血浆蛋白结合达到饱和,增加贝唑赛替的剂量与早期血浆浓度的增加不成比例,而与组织暴露的增加成正比。然而,Berzosertib广泛分布于骨髓、肿瘤、胸腺和淋巴结;脑和脊髓的暴露量低于血浆:结论:本文显示的贝唑舍替非线性 PK 可归因于血浆蛋白结合饱和,并且发生在接近临床试验观察到的浓度时。我们的研究结果将有助于理解临床前药效学和毒性数据,并为贝唑舍替的最佳剂量和部署提供依据。
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引用次数: 0
Combined treatment of All-trans retinoic acid with Tamoxifen suppresses ovarian cancer. 全反式维甲酸与他莫昔芬联合治疗可抑制卵巢癌。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-05-07 DOI: 10.1007/s00280-024-04671-7
Rui Xu, Xiaowen Yang, Bin Tang, Yifan Mao, Feiyun Jiang

Background: Ovarian cancer is a malignant tumor of the female reproductive system, and its mortality rate is as high as 70%. Estrogen receptor α (ERα)-positive ovarian cancer accounted for most of all ovarian cancer patients. ERα can promote the growth and proliferation of tumors.

Methods: The combined effect of All-trans retinoic acid (ATRA) and tamoxifen was obtained by the combination screening of tamoxifen and compound library by MTS. In addition, colony formation assay, flow cytometry analysis, immunofluorescence staining, quantitative real-time polymerase chain reaction (PCR), western blot, and tumor xenotransplantation models were used to further evaluate the efficacy of tamoxifen and ATRA in vitro and in vivo for ER-α-positive ovarian cancer.

Results: In our study, we found that All-trans retinoic acid (ATRA) can cooperate with tamoxifen to cause cell cycle arrest and apoptosis and inhibit ERα-positive ovarian cancer in vivo and in vitro. Further exploration of the mechanism found that ATRA can Inhibit genes related to the ERα signaling pathway, enhance the sensitivity of ERα-positive ovarian cancer cells to tamoxifen, and ascertain the effectiveness of tamoxifen and ATRA as treatments for ovarian cancer with an ERα-positive status.

Conclusion: Combination of ATRA and tamoxifen is a new way for the treatment of ERα-positive ovarian cancer.

背景:卵巢癌是女性生殖系统的恶性肿瘤,死亡率高达 70%:卵巢癌是女性生殖系统的恶性肿瘤,死亡率高达 70%。雌激素受体α(ERα)阳性的卵巢癌患者占所有卵巢癌患者的大多数。ERα可促进肿瘤的生长和增殖:方法:全反式维甲酸(ATRA)和他莫昔芬的联合作用是通过 MTS 对他莫昔芬和化合物库进行联合筛选得到的。此外,我们还采用了集落形成试验、流式细胞术分析、免疫荧光染色、实时定量聚合酶链反应(PCR)、Western blot和肿瘤异种移植模型等方法,进一步评估了他莫昔芬和ATRA在体外和体内对ER-α阳性卵巢癌的疗效:结果:我们的研究发现,全反式维甲酸(ATRA)可与他莫昔芬协同作用,导致细胞周期停滞和凋亡,抑制体内和体外ERα阳性卵巢癌。对其机制的进一步探讨发现,ATRA 可抑制 ERα 信号通路相关基因,提高 ERα 阳性卵巢癌细胞对他莫昔芬的敏感性,并确定他莫昔芬和 ATRA 作为 ERα 阳性卵巢癌治疗药物的有效性:结论:ATRA 和他莫昔芬联合应用是治疗 ERα 阳性卵巢癌的新方法。
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引用次数: 0
Physiologically-based pharmacokinetic models versus allometric scaling for prediction of tyrosine-kinase inhibitor exposure from adults to children. 在预测酪氨酸激酶抑制剂从成人到儿童的暴露量时,基于生理学的药代动力学模型与异计量比例。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-05-23 DOI: 10.1007/s00280-024-04678-0
Maddalena Centanni, Omar Zaher, David Elhad, Mats O Karlsson, Lena E Friberg

Purpose: Model-based methods can predict pediatric exposure and support initial dose selection. The aim of this study was to evaluate the performance of allometric scaling of population pharmacokinetic (popPK) versus physiologically based pharmacokinetic (PBPK) models in predicting the exposure of tyrosine kinase inhibitors (TKIs) for pediatric patients (≥ 2 years), based on adult data. The drugs imatinib, sunitinib and pazopanib were selected as case studies due to their complex PK profiles including high inter-patient variability, active metabolites, time-varying clearances and non-linear absorption.

Methods: Pediatric concentration measurements and adult popPK models were derived from the literature. Adult PBPK models were generated in PK-Sim® using available physicochemical properties, calibrated to adult data when needed. PBPK and popPK models for the pediatric populations were translated from the models for adults and were used to simulate concentration-time profiles that were compared to the observed values.

Results: Ten pediatric datasets were collected from the literature. While both types of models captured the concentration-time profiles of imatinib, its active metabolite, sunitinib and pazopanib, the PBPK models underestimated sunitinib metabolite concentrations. In contrast, allometrically scaled popPK simulations accurately predicted all concentration-time profiles. Trough concentration (Ctrough) predictions from the popPK model fell within a 2-fold range for all compounds, while 3 out of 5 PBPK predictions exceeded this range for the imatinib and sunitinib metabolite concentrations.

Conclusion: Based on the identified case studies it appears that allometric scaling of popPK models is better suited to predict exposure of TKIs in pediatric patients ≥ 2 years. This advantage may be attributed to the stable enzyme expression patterns from 2 years old onwards, which can be easily related to adult levels through allometric scaling. In some instances, both methods performed comparably. Understanding where discrepancies between the model methods arise, can further inform model development and ultimately support pediatric dose selection.

目的:基于模型的方法可以预测儿科用药暴露量并支持初始剂量选择。本研究的目的是以成人数据为基础,评估群体药代动力学(popPK)与生理药代动力学(PBPK)模型的异速缩放在预测酪氨酸激酶抑制剂(TKIs)对儿科患者(≥ 2 岁)的暴露量方面的性能。由于伊马替尼、舒尼替尼和帕唑帕尼等药物的PK谱复杂,包括患者间变异性大、有活性代谢物、清除率随时间变化和非线性吸收等,因此被选为案例研究对象:方法:儿科浓度测量值和成人 PBPK 模型均来自文献。成人 PBPK 模型是在 PK-Sim® 中利用现有理化特性生成的,必要时根据成人数据进行校准。儿科人群的 PBPK 和 popPK 模型由成人模型转化而来,用于模拟浓度-时间曲线,并与观察值进行比较:结果:从文献中收集了 10 个儿科数据集。虽然两种模型都能捕捉到伊马替尼、其活性代谢物、舒尼替尼和帕唑帕尼的浓度-时间曲线,但PBPK模型低估了舒尼替尼代谢物的浓度。与此相反,按等比例缩放的 popPK 模拟准确预测了所有浓度-时间曲线。popPK 模型对所有化合物的低谷浓度(Ctrough)预测均在 2 倍范围内,而对伊马替尼和舒尼替尼代谢物浓度的预测,5 个 PBPK 预测中有 3 个超出了这一范围:根据已确定的案例研究,popPK 模型的异计量比例似乎更适合预测 TKIs 在年龄≥ 2 岁的儿科患者中的暴露情况。这种优势可能是由于从 2 岁起酶的表达模式比较稳定,通过异速缩放可以很容易地将其与成人水平联系起来。在某些情况下,两种方法的表现不相上下。了解模型方法之间出现差异的原因,可以进一步为模型开发提供信息,并最终为儿科剂量选择提供支持。
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引用次数: 0
Overexposure to venetoclax is associated with prolonged-duration of neutropenia during venetoclax and azacitidine therapy in Japanese patients with acute myeloid leukemia. 日本急性髓性白血病患者在接受文尼他克和阿扎胞苷治疗期间,过度暴露于文尼他克与中性粒细胞减少症持续时间延长有关。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-05-23 DOI: 10.1007/s00280-024-04673-5
Takahiro Kobayashi, Honami Sato, Masatomo Miura, Yayoi Fukushi, Wataru Kuroki, Fumiko Ito, Kazuaki Teshima, Atsushi Watanabe, Naohito Fujishima, Isuzu Kobayashi, Yoshihiro Kameoka, Naoto Takahashi

Purpose: An observational study was conducted to evaluate the pharmacokinetics of venetoclax and its impact on the efficacy and safety for Japanese patients with acute myeloid leukemia (AML) treated with venetoclax and azacitidine therapy.

Methods: The association between the plasma concentration, after the first cycle of azacitidine and venetoclax therapy, and the efficacy and safety was evaluated in 33 patients with untreated or relapsed/refractory AML.

Results: Full dose of venetoclax was administered to all patients. Venetoclax treatment was 28 day long in 82% of patients; the relative dose intensity of azacitidine was 82%. Trough concentration was significantly higher among patients with complete remission (CR) and CR with incomplete hematologic recovery (CRi) than those with the morphologic leukemia-free state and partial remission, and no response groups (P = 0.01). Median duration of grade 3 neutropenia was 28 days (range 8-46 days). Area under the concentration-time curve (AUC0-24) was significantly higher among patients with protracted grade 3 neutropenia (≥ 28 days) than those with a shorter duration (< 28 days) (P = 0.03); multivariate analysis revealed that a higher AUC0-24 was a significant predictor of a longer duration of neutropenia (odds ratio 54.3, P = 0.007).

Conclusion: Plasma concentrations of venetoclax were variable in Japanese patients with AML. Higher plasma concentrations were associated with CR/CRi and protracted grade 3 neutropenia. Therefore, it is essential to adjust the duration of venetoclax administration based on individual pharmacokinetic data to limit total drug exposure, reduce severe neutropenia, and achieve higher efficacy.

目的:一项观察性研究旨在评估日本急性髓性白血病(AML)患者接受文替曲克和阿扎胞苷治疗后文替曲克的药代动力学及其对疗效和安全性的影响:方法:在33例未经治疗或复发/难治性AML患者中评估了阿扎胞苷和venetoclax治疗第一周期后血浆浓度与疗效和安全性之间的关系:所有患者均接受了全剂量的 Venetoclax 治疗。82%的患者接受了为期28天的 Venetoclax 治疗;阿扎胞苷的相对剂量强度为82%。完全缓解组(CR)和血液学不完全恢复组(CRi)患者的低浓度明显高于无形态白血病状态组、部分缓解组和无应答组(P = 0.01)。3 级中性粒细胞减少症的中位持续时间为 28 天(范围为 8-46 天)。3级中性粒细胞减少持续时间较长(≥28天)的患者血药浓度曲线下面积(AUC0-24)明显高于持续时间较短的患者(0-24是中性粒细胞减少持续时间较长的显著预测因子(几率比54.3,P = 0.007)):结论:日本急性髓细胞性白血病患者血浆中的 Venetoclax 浓度各不相同。结论:日本急性髓细胞性白血病患者的血浆浓度各不相同,较高的血浆浓度与CR/CRi和持续的3级中性粒细胞减少症相关。因此,必须根据个体药代动力学数据调整 Venetoclax 的给药时间,以限制药物总暴露量、减少严重中性粒细胞减少症并获得更高的疗效。
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引用次数: 0
Effect of food on the pharmacokinetics and safety profiles of a new PARP inhibitor fuzuloparib capsules in healthy volunteers. 食物对健康志愿者服用新型 PARP 抑制剂 fuzuloparib 胶囊的药代动力学和安全性的影响。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-05-04 DOI: 10.1007/s00280-024-04672-6
Pengfei Du, Yao Long, Minhui Wang, Yunzhe Huang, Yaqin Wang, Xinyan Chen, Yuhong Lin, Jianbang Wu, Jie Shen, Yuanwei Jia

Purpose: This study assessed effect of food on pharmacokinetics (PK) and safety of fuzuloparib capsules.

Methods: A randomized, open-label, two-cycle, two-sequence, crossover clinical trial was conducted. 20 subjects were randomly assigned to 2 groups at a 1:1 ratio. The first group subjects were orally administered 150 mg fuzuloparib capsules under fasting condition in first dosing cycle. The same dose of fuzuloparib capsules were taken under postprandial state after a 7-day washout period. The second group was reversed. 3 ml whole blood was collected at each blood collection point until 72 h post dose. PK parameters were calculated. Furthermore, safety assessment was performed.

Results: The time to maximum concentration (Tmax) was prolonged to 3 h and maximum concentration (Cmax) decreased by 18.6% on high-fat diets. 90% confidence intervals (CIs) of geometric mean ratios (GMRs) for Cmax, area under the concentration-time curve from time zero to time t (AUC0-t), and area under the concentration-time curve extrapolated to infinity (AUC0-∞) after high-fat meal were 71.6-92.6%, 81.7-102.7% and 81.6-102.5%, respectively. All treatment-emergent adverse events (TEAEs) were grade 1; No serious adverse events (SAEs), serious unexpected suspected adverse reaction (SUSAR) or deaths were reported.

Conclusion: Food decreased the absorption rate and slowed time to peak exposure of fuzuloparib capsules, without impact on absorption extent. Dosing with food was found to be safe for fuzuloparib capsules in this study.

Clinical trial registration: This study was registered with chinadrugtrials.org.cn (identifier: CTR20221498).

目的:本研究评估了食物对氟唑帕利胶囊药代动力学(PK)和安全性的影响:进行了一项随机、开放标签、两周期、两序列、交叉临床试验。20名受试者按1:1的比例随机分配到两组。第一组受试者在第一个给药周期中空腹口服150毫克福唑帕利胶囊。经过 7 天的冲洗期后,在餐后状态下服用相同剂量的 fuzuloparib 胶囊。第二组则相反。每个采血点采集 3 毫升全血,直至服药后 72 小时。计算 PK 参数。此外,还进行了安全性评估:结果:在高脂饮食中,达到最大浓度(Tmax)的时间延长至 3 小时,最大浓度(Cmax)降低了 18.6%。高脂餐后Cmax、从零时到t时的浓度时间曲线下面积(AUC0-t)和外推至无穷大的浓度时间曲线下面积(AUC0-∞)的几何平均比(GMR)的90%置信区间(CIs)分别为71.6%-92.6%、81.7%-102.7%和81.6%-102.5%。所有治疗突发不良事件(TEAEs)均为1级;无严重不良事件(SAEs)、严重意外疑似不良反应(SUSAR)或死亡报告:结论:食物降低了福唑帕利胶囊的吸收率,减缓了达到峰值暴露的时间,但对吸收程度没有影响。本研究发现,与食物一起服用福唑帕利胶囊是安全的:本研究已在chinadrugtrials.org.cn注册(标识符:CTR20221498)。
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引用次数: 0
A polo-like kinase 1 inhibitor enhances erastin sensitivity in head and neck squamous cell carcinoma cells in vitro. 一种多聚样激酶 1 抑制剂在体外增强了头颈部鳞状细胞癌细胞对厄拉斯汀的敏感性。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-03-27 DOI: 10.1007/s00280-024-04654-8
Xiangping Wu, Jing Wu

Background: Polo-like kinase 1 (PLK1) is a critical therapeutic target in the treatment of head and neck squamous cell carcinoma (HNSCC). The objective of this study was to investigate the therapeutic effect of the combination of BI 2536, a PLK1 inhibitor, and erastin, a ferroptosis inducer, in HNSCC.

Methods: The proliferation, invasion, and migration abilities of Tu177 and FaDu cells upon exposure to BI 2536 and erastin, used in combination or alone, were tested. Fe2+, glutathione (GSH), and malondialdehyde (MDA) detection kits were used to determine whether the addition of BI 2536 enhanced the accumulation of Fe2+ and MDA, along with the depletion of GSH. Quantitative real-time PCR, western blot analyses were performed to investigate whether BI 2536 further altered the mRNA and expression level of ferroptosis genes. Furthermore, si PLK1 was used to investigate whether targeting PLK1 gene promoted erastin-induced ferroptosis.

Results: The combination of BI 2536 and erastin exerted a stronger cytotoxicity than treatment with a single agent. Compared with erastin treatment alone, the combination of BI 2536 and erastin lowered the ability of tumor cells to self-clone, invade, and migrate. BI 2536 enhanced the accumulation of Fe2+ and MDA, and the depletion of GSH. BI 2536 increased erastin-induced changes in ferroptosis-related gene mRNA and expression. Importantly, targeting PKL1 enhanced the anti-cancer effect of erastin.

Conclusion: BI 2536 enhanced the sensitivity of HNSCC cells to erastin, which provides a new perspective for cancer treatment.

背景:Polo-like激酶1(PLK1)是治疗头颈部鳞状细胞癌(HNSCC)的关键治疗靶点。本研究的目的是探讨 PLK1 抑制剂 BI 2536 和铁变态反应诱导剂厄拉斯汀联合应用对 HNSCC 的治疗效果:方法:测试了Tu177和FaDu细胞在联合或单独使用BI 2536和厄拉斯汀后的增殖、侵袭和迁移能力。使用 Fe2+、谷胱甘肽(GSH)和丙二醛(MDA)检测试剂盒确定 BI 2536 的添加是否会增强 Fe2+ 和 MDA 的积累以及 GSH 的消耗。为了研究 BI 2536 是否进一步改变了铁突变基因的 mRNA 和表达水平,还进行了定量实时 PCR 和 Western 印迹分析。此外,还使用了 si PLK1 来研究靶向 PLK1 基因是否促进了麦拉宁诱导的铁变态反应:结果:BI 2536和厄拉斯汀联合用药比单药治疗具有更强的细胞毒性。与单用厄拉斯汀治疗相比,BI 2536 和厄拉斯汀联合用药可降低肿瘤细胞的自我克隆、侵袭和迁移能力。BI 2536能增强Fe2+和MDA的积累以及GSH的消耗。BI 2536 增加了厄拉斯汀诱导的铁突变相关基因 mRNA 和表达的变化。重要的是,以PKL1为靶点增强了厄拉斯汀的抗癌效果:BI 2536增强了HNSCC细胞对厄拉斯汀的敏感性,为癌症治疗提供了新的视角。
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引用次数: 0
Aclarubicin: contemporary insights into its mechanism of action, toxicity, pharmacokinetics, and clinical standing. 阿卡鲁宾:对其作用机制、毒性、药物动力学和临床地位的当代见解。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-04 DOI: 10.1007/s00280-024-04693-1
Aleksandra Murzyn, Justyna Orzeł, Natalia Obajtek, Anna Mróz, Dominika Miodowska, Patrycja Bojdo, Bartosz Gąsiorkiewicz, Paulina Koczurkiewicz-Adamczyk, Kamil Piska, Elżbieta Pękala

Aclarubicin (aclacinomycin A) is one of the anthracycline antineoplastic antibiotics with a multifaceted mechanism of antitumor activity. As a second-generation drug, it offers several advantages compared to standard anthracycline drugs such as doxorubicin or daunorubicin, which could position it as a potential blockbuster drug in antitumor therapy. Key mechanisms of action for aclarubicin include the inhibition of both types of topoisomerases, suppression of tumor invasion processes, generation of reactive oxygen species, inhibition of chymotrypsin-like activity, influence on cisplatin degradation, and inhibition of angiogenesis. Therefore, aclarubicin appears to be an ideal candidate for antitumor therapy. However, despite initial interest in its clinical applications, only a limited number of high-quality trials have been conducted thus far. Aclarubicin has primarily been evaluated as an induction therapy in acute myeloid and lymphoblastic leukemia. Studies have indicated that aclarubicin may hold significant promise for combination therapies with other anticancer drugs, although further research is needed to confirm its potential. This paper provides an in-depth exploration of aclarubicin's diverse mechanisms of action, its pharmacokinetics, potential toxicity, and the clinical trials in which it has been investigated.

阿克拉霉素(阿克拉霉素 A)是蒽环类抗肿瘤抗生素之一,具有多方面的抗肿瘤活性机制。作为第二代药物,它与标准蒽环类药物(如多柔比星或达乌诺比星)相比具有多项优势,因此有可能成为抗肿瘤治疗领域的 "大片 "药物。阿克拉比星的主要作用机制包括抑制两种拓扑异构酶、抑制肿瘤侵袭过程、产生活性氧、抑制糜蛋白酶样活性、影响顺铂降解以及抑制血管生成。因此,阿克拉比星似乎是抗肿瘤治疗的理想候选药物。然而,尽管人们对阿克拉比星的临床应用产生了初步兴趣,但迄今为止只进行了数量有限的高质量试验。阿克拉比星主要作为急性髓细胞和淋巴细胞白血病的诱导疗法进行评估。研究表明,阿克拉比星可能在与其他抗癌药物的联合疗法中大有可为,但还需要进一步的研究来证实其潜力。本文深入探讨了阿克拉比星的多种作用机制、药代动力学、潜在毒性以及对其进行研究的临床试验。
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引用次数: 0
Systematic review: genetic polymorphisms in the pharmacokinetics of high-dose methotrexate in pediatric acute lymphoblastic leukemia patients. 系统综述:儿科急性淋巴细胞白血病患者大剂量甲氨蝶呤药代动力学中的基因多态性。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-13 DOI: 10.1007/s00280-024-04694-0
Siti Utami Rahmayanti, Riezki Amalia, Taofik Rusdiana

Variations in pharmacokinetic responses to high-dose methotrexate are essential for the prognosis and management of toxicity in the treatment of pediatric acute lymphoblastic leukemia (ALL) patients. This systematic review aimed to identify and evaluate genetic polymorphisms that are significantly associated with the pharmacokinetic parameters of methotrexate during the consolidation phase of pediatric ALL treatment. Using the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, we systematically reviewed the literature from 2013 to 2023. The databases used were PubMed and Scopus. The outcomes of interest are the study design, patient characteristics, sample size, chemotherapy protocol utilized, pharmacokinetic parameters identified, and genetic polymorphisms implicated. We included 31 articles in the qualitative synthesis and found that the SLCO1B1, ABCB1, ABCC2, and MTHFR genes appear to play significant roles in MTX metabolism and clearance. Among these, variations in SLCO1B1 have the most significant and consistent impact on methotrexate clearance. These implicated variants may contribute to the precision and tailoring of HD-MTX treatment in pediatric ALL patients.

在治疗小儿急性淋巴细胞白血病(ALL)患者的过程中,大剂量甲氨蝶呤药代动力学反应的变化对预后和毒性管理至关重要。本系统综述旨在鉴定和评估与小儿急性淋巴细胞白血病巩固治疗阶段甲氨蝶呤药代动力学参数显著相关的基因多态性。采用系统综述首选报告项目(PRISMA)指南,我们系统地回顾了2013年至2023年的文献。使用的数据库为 PubMed 和 Scopus。我们关注的结果包括研究设计、患者特征、样本大小、采用的化疗方案、确定的药代动力学参数以及涉及的基因多态性。我们在定性综合中纳入了 31 篇文章,发现 SLCO1B1、ABCB1、ABCC2 和 MTHFR 基因似乎在 MTX 代谢和清除中起着重要作用。其中,SLCO1B1 基因变异对甲氨蝶呤清除率的影响最为显著和一致。这些基因变异可能有助于对小儿 ALL 患者进行精确的 HD-MTX 治疗。
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引用次数: 0
Phase 2 study of glucarpidase in patients with delayed methotrexate elimination after high-dose methotrexate therapy. 针对大剂量甲氨蝶呤治疗后甲氨蝶呤排出延迟患者的葡萄糖苷酶 2 期研究。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-13 DOI: 10.1007/s00280-024-04664-6
Atsushi Ogawa, Hiroshi Kawamoto, Junichi Hara, Atsushi Kikuta, Chitose Ogawa, Hiroaki Hiraga, Kenichi Yoshimura, Kazunari Miyairi, Reiko Omori, Tokihiro Ro, Yuna Kamei, Toshimi Kimura

Purpose: High-dose methotrexate therapy (HD-MTX) is a standard treatment for various malignant tumors, but approximately 1-10% of patients experience delayed MTX elimination (DME) that can induce organ damage. Glucarpidase can hydrolyze MTX and thereby lower the level of active MTX in the blood. A multicenter, open-label, phase II investigator-initiated trial (CPG2-PII study) was conducted to evaluate glucarpidase rescue therapy in Japanese patients who showed DME after HD-MTX treatment. To confirm the robustness of this therapy, further corporate-sponsored clinical trial (OP-07-001 study) was conducted.

Methods: The primary endpoint in the CPG2-PII study was to evaluate the proportion of patients of the percentage clinical important reduction (CIR) as an indicator of MTX concentration, which can be managed with leucovorin and supportive care. The primary endpoint of the OP-07-001 study was to evaluate the decreasing rate of plasma MTX concentration at 20 min after glucarpidase administration from the baseline for four patients. Glucarpidase was administered at a dose of 50 U/kg for 15 and 4 patients, respectively in the two studies, and safety was analyzed for each of them.

Results: The rate of CIR was 76.9% (95% confidence interval, 46.2-95.0%) in the CPG2-PII study. The median reduction rate of plasma MTX was 98.83% in the OP-07-001 study. Hypersensitivity, blood bilirubin increased, and headache for each patient were the only study drug-related events.

Conclusion: Glucarpidase showed an effect of reducing plasma MTX concentration in Japanese patients with DME as that observed in a previous US study, confirming its favorable safety and tolerability.

目的:大剂量甲氨蝶呤疗法(HD-MTX)是治疗各种恶性肿瘤的标准疗法,但约有 1-10% 的患者会出现 MTX 消解延迟(DME),从而诱发器官损伤。葡萄糖醛酸酶可以水解 MTX,从而降低血液中活性 MTX 的水平。一项由研究者发起的多中心、开放标签 II 期试验(CPG2-PII 研究)旨在评估葡萄糖醛酸酶对接受 HD-MTX 治疗后出现 DME 的日本患者的救治效果。为了证实这种疗法的稳健性,还进一步开展了由企业赞助的临床试验(OP-07-001 研究):CPG2-PII研究的主要终点是评估作为MTX浓度指标的临床重要降低百分比(CIR)的患者比例,该比例可通过利血平和支持性护理来控制。OP-07-001 研究的主要终点是评估四名患者在服用葡萄糖苷酶 20 分钟后血浆 MTX 浓度从基线开始的下降率。在两项研究中,分别为 15 名和 4 名患者注射了剂量为 50 U/kg的葡萄糖苷酶,并对每名患者的安全性进行了分析:CPG2-PII研究的CIR率为76.9%(95%置信区间,46.2-95.0%)。在 OP-07-001 研究中,血浆 MTX 的中位降低率为 98.83%。过敏、血胆红素升高和头痛是研究中唯一与药物相关的事件:结论:与之前在美国的一项研究中观察到的结果一样,葡萄糖苷酶在日本的 DME 患者中显示出降低血浆 MTX 浓度的效果,证实了其良好的安全性和耐受性。
{"title":"Phase 2 study of glucarpidase in patients with delayed methotrexate elimination after high-dose methotrexate therapy.","authors":"Atsushi Ogawa, Hiroshi Kawamoto, Junichi Hara, Atsushi Kikuta, Chitose Ogawa, Hiroaki Hiraga, Kenichi Yoshimura, Kazunari Miyairi, Reiko Omori, Tokihiro Ro, Yuna Kamei, Toshimi Kimura","doi":"10.1007/s00280-024-04664-6","DOIUrl":"10.1007/s00280-024-04664-6","url":null,"abstract":"<p><strong>Purpose: </strong>High-dose methotrexate therapy (HD-MTX) is a standard treatment for various malignant tumors, but approximately 1-10% of patients experience delayed MTX elimination (DME) that can induce organ damage. Glucarpidase can hydrolyze MTX and thereby lower the level of active MTX in the blood. A multicenter, open-label, phase II investigator-initiated trial (CPG2-PII study) was conducted to evaluate glucarpidase rescue therapy in Japanese patients who showed DME after HD-MTX treatment. To confirm the robustness of this therapy, further corporate-sponsored clinical trial (OP-07-001 study) was conducted.</p><p><strong>Methods: </strong>The primary endpoint in the CPG2-PII study was to evaluate the proportion of patients of the percentage clinical important reduction (CIR) as an indicator of MTX concentration, which can be managed with leucovorin and supportive care. The primary endpoint of the OP-07-001 study was to evaluate the decreasing rate of plasma MTX concentration at 20 min after glucarpidase administration from the baseline for four patients. Glucarpidase was administered at a dose of 50 U/kg for 15 and 4 patients, respectively in the two studies, and safety was analyzed for each of them.</p><p><strong>Results: </strong>The rate of CIR was 76.9% (95% confidence interval, 46.2-95.0%) in the CPG2-PII study. The median reduction rate of plasma MTX was 98.83% in the OP-07-001 study. Hypersensitivity, blood bilirubin increased, and headache for each patient were the only study drug-related events.</p><p><strong>Conclusion: </strong>Glucarpidase showed an effect of reducing plasma MTX concentration in Japanese patients with DME as that observed in a previous US study, confirming its favorable safety and tolerability.</p>","PeriodicalId":9556,"journal":{"name":"Cancer Chemotherapy and Pharmacology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11258064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of VEGFA and CCL4L2 polymorphisms with hand-foot skin reaction and survival of regorafenib in Japanese patients with colorectal cancer. 日本结直肠癌患者的 VEGFA 和 CCL4L2 多态性与手足皮肤反应和瑞戈非尼生存期的关系
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-08 DOI: 10.1007/s00280-024-04649-5
Koutaro Ono, Remi Murase, Natsumi Matsumoto, Yutaro Kubota, Hiroo Ishida, Ken-Ichi Fujita

Purpose: Treatment with regorafenib, which inhibits vascular endothelial growth factor (VEGF) receptor, frequently results in hand-foot skin reaction (HFSR), requiring treatment discontinuation or dose reduction. In our prospective study of regorafenib on patients with metastatic colorectal cancer, 17% of patients developed grade 3 HFSR. Herein, we retrospectively examined genetic polymorphisms associated with regorafenib-induced severe HFSR.

Methods: To identify associated polymorphisms, exploratory whole-exome sequencing focusing on factors related to VEGF-mediated signaling pathways was first performed in seven patients each, with grade 3 HFSR and without HFSR. The identified HFSR-associated polymorphisms were analyzed in all the 40 patients.

Results: The genotype frequency of rs3025009 G/A or A/A in the gene encoding VEGF-A (VEGFA) in patients with ≥ grade 2 HFSR was significantly higher than in other patients (P = 0.0257, Pc = 0.0771 [Bonferroni correction]). The frequency of C-C motif of chemokine ligand 4-like 2 (CCL4L2) rs3744596 A/T or T/T in patients with grade 3 HFSR was significantly lower than in others (P = 0.00894, Pc = 0.0268). The combination of the risk genotypes VEGFA rs3025009 G/A or A/A and CCL4L2 rs3744596 A/A was significantly associated with a higher incidence of grade 3 (P = 0.000614, Pc = 0.00246) and a longer median progression-free survival (P = 0.0234) than others.

Conclusions: These VEGF-related polymorphisms were found to be associated with HFSR and the survival benefits of regorafenib treatment.

Trial registration number and date: UMIN000013939, registered on May 12, 2014, when 6 months after the approval by the Institutional Review Board of Showa University.

目的:瑞戈非尼抑制血管内皮生长因子(VEGF)受体,其治疗经常导致手足皮肤反应(HFSR),需要停止治疗或减少剂量。在我们对转移性结直肠癌患者进行的瑞戈非尼前瞻性研究中,17%的患者出现了 3 级 HFSR。在此,我们回顾性地研究了与瑞戈非尼引起的严重HFSR相关的基因多态性:为了确定相关的多态性,我们首先对3级HFSR和无HFSR的7名患者各进行了探索性全外显子组测序,重点研究了与血管内皮生长因子介导的信号通路相关的因素。对所有 40 例患者中已确定的 HFSR 相关多态性进行了分析:结果:在≥2级HFSR患者中,编码VEGF-A(VEGFA)基因的rs3025009 G/A或A/A的基因型频率明显高于其他患者(P = 0.0257,Pc = 0.0771 [Bonferroni校正])。在 3 级 HFSR 患者中,趋化因子配体 4-like 2(CCL4L2)rs3744596 的 C-C motif A/T 或 T/T 频率明显低于其他患者(P = 0.00894,Pc = 0.0268)。风险基因型VEGFA rs3025009 G/A或A/A和CCL4L2 rs3744596 A/A的组合与3级发病率较高(P = 0.000614,Pc = 0.00246)和中位无进展生存期较长(P = 0.0234)明显相关:这些VEGF相关多态性被发现与HFSR和瑞戈非尼治疗的生存获益相关。试验注册号和日期:UMIN000013939,注册时间为2014年5月12日,即昭和大学机构审查委员会批准后6个月。
{"title":"Association of VEGFA and CCL4L2 polymorphisms with hand-foot skin reaction and survival of regorafenib in Japanese patients with colorectal cancer.","authors":"Koutaro Ono, Remi Murase, Natsumi Matsumoto, Yutaro Kubota, Hiroo Ishida, Ken-Ichi Fujita","doi":"10.1007/s00280-024-04649-5","DOIUrl":"10.1007/s00280-024-04649-5","url":null,"abstract":"<p><strong>Purpose: </strong>Treatment with regorafenib, which inhibits vascular endothelial growth factor (VEGF) receptor, frequently results in hand-foot skin reaction (HFSR), requiring treatment discontinuation or dose reduction. In our prospective study of regorafenib on patients with metastatic colorectal cancer, 17% of patients developed grade 3 HFSR. Herein, we retrospectively examined genetic polymorphisms associated with regorafenib-induced severe HFSR.</p><p><strong>Methods: </strong>To identify associated polymorphisms, exploratory whole-exome sequencing focusing on factors related to VEGF-mediated signaling pathways was first performed in seven patients each, with grade 3 HFSR and without HFSR. The identified HFSR-associated polymorphisms were analyzed in all the 40 patients.</p><p><strong>Results: </strong>The genotype frequency of rs3025009 G/A or A/A in the gene encoding VEGF-A (VEGFA) in patients with ≥ grade 2 HFSR was significantly higher than in other patients (P = 0.0257, Pc = 0.0771 [Bonferroni correction]). The frequency of C-C motif of chemokine ligand 4-like 2 (CCL4L2) rs3744596 A/T or T/T in patients with grade 3 HFSR was significantly lower than in others (P = 0.00894, Pc = 0.0268). The combination of the risk genotypes VEGFA rs3025009 G/A or A/A and CCL4L2 rs3744596 A/A was significantly associated with a higher incidence of grade 3 (P = 0.000614, Pc = 0.00246) and a longer median progression-free survival (P = 0.0234) than others.</p><p><strong>Conclusions: </strong>These VEGF-related polymorphisms were found to be associated with HFSR and the survival benefits of regorafenib treatment.</p><p><strong>Trial registration number and date: </strong>UMIN000013939, registered on May 12, 2014, when 6 months after the approval by the Institutional Review Board of Showa University.</p>","PeriodicalId":9556,"journal":{"name":"Cancer Chemotherapy and Pharmacology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140064968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Cancer Chemotherapy and Pharmacology
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