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Impact of bariatric surgery on oral anticancer drugs: an analysis of real-world data. 减肥手术对口服抗癌药物的影响:真实世界数据分析。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-01 DOI: 10.1007/s00280-024-04640-0
Cedric Lau, Ma Ida Mohmaed Ali, Lishi Lin, Dorieke E M van Balen, Bart A W Jacobs, Bastiaan Nuijen, Robert M Smeenk, Neeltje Steeghs, Alwin D R Huitema

Purpose: The number of patients with bariatric surgery who receive oral anticancer drugs is rising. Bariatric surgery may affect the absorption of oral anticancer drugs. Strikingly, no specific drug dosing recommendations are available. We aim to provide practical recommendations on the application of oral anticancer drugs in patients who underwent bariatric surgery.

Methods: Patients with any kind of bariatric surgery were extracted retrospectively in a comprehensive cancer center. In addition, a flowchart was proposed to assess the risk of inadequate exposure to oral anticancer drugs in patients who underwent bariatric surgery. Subsequently, the flowchart was evaluated retrospectively using routine Therapeutic drug monitoring (TDM) samples.

Results: In our analysis, 571 cancer patients (0.4% of 140.000 treated or referred patients) had previous bariatric surgery. Of these patients, 78 unique patients received 152 oral anticancer drugs equaling an overall number of 30 unique drugs. The 30 different prescribed oral anticancer drugs were categorized as low risk (13%), medium risk (67%), and high risk (20%) of underdosing. TDM plasma samples of 25 patients (82 samples) were available, of which 21 samples post-bariatric surgery (25%) were below the target value.

Conclusions: The proposed flowchart can support optimizing the treatment with orally administered anticancer drugs in patients who underwent bariatric surgery. We recommend performing TDM in drugs that belong to BCS classes II, III, or IV. If more risk factors are present in BCS classes II or IV, a priori switches to other drugs may be advised. In specific cases, higher dosages can be provided from the start (e.g., tamoxifen).

目的:接受减肥手术并口服抗癌药物的患者人数正在增加。减肥手术可能会影响口服抗癌药物的吸收。令人吃惊的是,目前还没有具体的药物剂量建议。我们旨在为减肥手术患者应用口服抗癌药物提供实用建议:方法:我们在一家综合癌症中心对接受过各种减肥手术的患者进行了回顾性提取。此外,还提出了一个流程图,用于评估减肥手术患者口服抗癌药物暴露不足的风险。随后,利用常规治疗药物监测(TDM)样本对流程图进行了回顾性评估:在我们的分析中,571 名癌症患者(占 14 万名接受治疗或转诊患者的 0.4%)曾接受过减肥手术。在这些患者中,有 78 名患者接受了 152 种口服抗癌药物治疗,共计 30 种药物。这 30 种不同的处方口服抗癌药被分为用药不足的低风险(13%)、中风险(67%)和高风险(20%)。25 名患者(82 份样本)的 TDM 血浆样本可用,其中减肥手术后的 21 份样本(25%)低于目标值:建议的流程图有助于优化接受减肥手术患者的口服抗癌药物治疗。我们建议对属于 BCS II、III 或 IV 级的药物进行 TDM。如果 BCS II 级或 IV 级药物中存在更多的风险因素,则建议事先改用其他药物。在特殊情况下,可以从一开始就提供较大剂量的药物(如他莫昔芬)。
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引用次数: 0
Predictive performance of population pharmacokinetic models of imatinib in chronic myeloid leukemia patients. 慢性骨髓性白血病患者服用伊马替尼的群体药代动力学模型的预测性能。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-05 DOI: 10.1007/s00280-024-04644-w
Jaya Shree Dilli Batcha, Vikram Gota, Saikumar Matcha, Arun Prasath Raju, Mahadev Rao, Karthik S Udupa, Surulivelrajan Mallayasamy

Background and aim: Chronic myeloid leukemia is a myeloproliferative neoplasm associated with the specific chromosomal translocation known as the Philadelphia chromosome. Imatinib is a potent BCR-ABL tyrosine kinase inhibitor, which is approved as the first line therapy for CML patients. There are various population pharmacokinetic studies available in the literature for this population. However, their use in other populations outside of their cohort for the model development has not been evaluated. This study was aimed to perform the predictive performance of the published population pharmacokinetic models for imatinib in CML population and propose a dosing nomogram.

Methods: A systematic review was conducted through PubMed, and WoS databases to identify PopPK models. Clinical data collected in adult CML patients treated with imatinib was used for evaluation of these models. Various prediction-based metrics were used for assessing the bias and precision of PopPK models using individual predictions.

Results: Eight imatinib PopPK model were selected for evaluating the model performance. A total of 145 plasma imatinib samples were collected from 43 adult patients diagnosed with CML and treated with imatinib. The PopPK model reported by Menon et al. had better performance than all other PopPK models.

Conclusion: Menon et al. model was able to predict well for our clinical data where it had the relative mean prediction error percentage ≤ 20%, relative median absolute prediction error ≤ 30% and relative root mean square error close to zero. Based on this final model, we proposed a dosing nomogram for various weight groups, which could potentially help to maintain the trough concentrations in the therapeutic range.

背景和目的:慢性髓性白血病是一种与特定染色体易位(即费城染色体)相关的骨髓增生性肿瘤。伊马替尼是一种强效的 BCR-ABL 酪氨酸激酶抑制剂,已被批准作为慢性骨髓性白血病患者的一线疗法。文献中有各种针对这一人群的药代动力学研究。然而,这些研究在其队列之外的其他人群中用于模型开发的情况尚未得到评估。本研究旨在对已发表的伊马替尼群体药代动力学模型在 CML 群体中的预测性能进行评估,并提出剂量提名图:方法:通过PubMed和WoS数据库进行了系统回顾,以确定PopPK模型。收集的伊马替尼治疗的成年 CML 患者的临床数据用于评估这些模型。使用各种基于预测的指标来评估PopPK模型的偏差和精确度:结果:选择了 8 个伊马替尼 PopPK 模型来评估模型的性能。从43名确诊为慢性骨髓性白血病并接受伊马替尼治疗的成人患者身上共收集了145份伊马替尼血浆样本。Menon等人报告的PopPK模型的性能优于其他所有PopPK模型:Menon等人的模型能够很好地预测我们的临床数据,其相对平均预测误差百分比≤20%,相对中位绝对预测误差≤30%,相对均方根误差接近于零。根据这一最终模型,我们提出了针对不同体重组的剂量提名图,这可能有助于将谷浓度维持在治疗范围内。
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引用次数: 0
Phase I pharmacokinetic, safety, and preliminary efficacy study of tiragolumab in combination with atezolizumab in Chinese patients with advanced solid tumors. 替拉戈单抗联合阿特珠单抗治疗中国晚期实体瘤患者的药代动力学、安全性和初步疗效的 I 期研究。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-07 DOI: 10.1007/s00280-024-04650-y
Colby S Shemesh, Yongsheng Wang, Andrew An, Hao Ding, Phyllis Chan, Qi Liu, Yih-Wen Chen, Benjamin Wu, Qiong Wu, Xian Wang

Purpose: Tiragolumab is an immunoglobulin G1 monoclonal antibody targeting the immune checkpoint T cell immunoreceptor with immunoglobulin and immunoreceptor ITIM domains. Targeting multiple immune pathways may improve anti-tumor responses. The phase I YP42514 study assessed the pharmacokinetics (PK), safety, and preliminary efficacy of tiragolumab plus atezolizumab in Chinese patients with advanced solid tumors.

Methods: Adult patients from mainland China with Eastern Cooperative Oncology Group performance score 0/1, life expectancy of ≥ 12 weeks, and adequate hematologic/end organ function were eligible. Patients received tiragolumab 600 mg and atezolizumab 1200 mg intravenous every 3 weeks. Key endpoints were PK (serum concentrations of tiragolumab and atezolizumab) and safety. Results from this study were compared with the global phase I study, GO30103 (NCT02794571).

Results: In this study, 20 patients received a median of five doses of tiragolumab plus atezolizumab. Median age was 57.5 years, 85.0% of patients were male and the most common tumor type was non-small cell lung cancer. Exposures in Chinese patients were comparable to the global GO30103 population: geometric mean ratio was 1.07 for Cycle 1 tiragolumab area under the concentration-time curve0-21 and 0.92 and 0.93 for Cycle 1 peak and trough atezolizumab exposure, respectively. Treatment-related adverse events were consistent across the Chinese and global populations. Two patients (10.0%) in this study achieved a partial response.

Conclusion: In this study, tiragolumab plus atezolizumab was tolerable and demonstrated preliminary anti-tumor activity. There were no meaningful differences in the PK or safety of tiragolumab plus atezolizumab between the Chinese and global populations.

Clinical trial registration number: China Clinical Trial Registry Identifier CTR20210219/YP42514. Date of registration 16 March 2021.

目的:Tiragolumab 是一种免疫球蛋白 G1 单克隆抗体,靶向具有免疫球蛋白和免疫受体 ITIM 结构域的免疫检查点 T 细胞免疫受体。靶向多种免疫途径可改善抗肿瘤反应。YP42514 I期研究评估了替拉戈单抗联合阿特珠单抗在中国晚期实体瘤患者中的药代动力学(PK)、安全性和初步疗效:方法: 符合条件的中国大陆成人患者均为东部合作肿瘤学组(Eastern Cooperative Oncology Group)表现评分为0/1分、预期寿命≥12周且血液学/内脏器官功能正常。患者每3周接受一次tiragolumab 600毫克和atezolizumab 1200毫克静脉注射。主要终点是PK(替拉戈单抗和阿特珠单抗的血清浓度)和安全性。这项研究的结果与全球 I 期研究 GO30103(NCT02794571)的结果进行了比较:在这项研究中,20 名患者接受了中位数为 5 个剂量的替拉戈单抗和阿特珠单抗治疗。中位年龄为57.5岁,85.0%的患者为男性,最常见的肿瘤类型为非小细胞肺癌。中国患者的暴露量与全球GO30103人群相当:第1周期替拉单抗浓度-时间曲线下面积的几何平均比值为1.07,0-21;第1周期阿特珠单抗暴露峰值和谷值的几何平均比值分别为0.92和0.93。在中国和全球人群中,治疗相关不良事件的发生率一致。本研究中有两名患者(10.0%)获得了部分应答:结论:在这项研究中,替拉戈单抗联合阿特佐利珠单抗具有耐受性,并显示出初步的抗肿瘤活性。在中国和全球人群中,替拉戈单抗联合阿特珠单抗的PK和安全性没有明显差异:中国临床试验注册编号:CTR20210219/YP42514。注册日期:2021年3月16日。
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引用次数: 0
Phase I study of the anti-TIGIT antibody tiragolumab in combination with atezolizumab in Japanese patients with advanced or metastatic solid tumors. 抗 TIGIT 抗体 tiragolumab 联合 atezolizumab 治疗日本晚期或转移性实体瘤患者的 I 期研究。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-01-11 DOI: 10.1007/s00280-023-04627-3
Noboru Yamamoto, Takafumi Koyama, Jun Sato, Tatsuya Yoshida, Kazuki Sudo, Satoru Iwasa, Shunsuke Kondo, Kan Yonemori, Atsuko Kawasaki, Kyoko Satake, Shoyo Shibata, Toshio Shimizu

Purpose: Tiragolumab is a monoclonal antibody that binds to the inhibitory immune checkpoint TIGIT (T-cell immunoreceptor with Ig and ITIM domains). In early phase clinical trials, tiragolumab in combination with the programmed death-ligand 1-inhibitor atezolizumab was well tolerated and has demonstrated preliminary anti-tumor activity in patients with advanced/metastatic solid tumors. We report the results of a phase I study of tiragolumab plus atezolizumab in Japanese patients (jRCT2080224926).

Methods: Japanese patients ≥ 20 years old received tiragolumab (600 mg) and atezolizumab (1200 mg) intravenously every 21 days until unacceptable toxicity or disease progression. Primary endpoints were safety and pharmacokinetic (PK) parameters of tiragolumab plus atezolizumab. Secondary endpoints were anti-tumor activity.

Results: Three patients were enrolled with diagnoses of non-small cell lung cancer, pancreatic cancer, and cholangiocarcinoma. No dose-limiting toxicities were observed. Two patients experienced treatment-related adverse events (AEs) of any grade. There were no grade ≥ 3 AEs, serious AEs, AEs leading to discontinuation, modification or withdrawal of any study drug, or AEs leading to death. At cycle 1, mean PK parameters of tiragolumab were as follows: Cmax 217 μg/mL; Cmin 54.9 μg/mL; area under the concentration-time curve from 0 to the last measurable concentration, 2000 μg·day/mL; t1/2, 17.6 days. Best overall response was stable disease in two patients.

Conclusion: Tiragolumab plus atezolizumab was well tolerated in Japanese patients with advanced/metastatic solid tumors, and no differences in tiragolumab PK characteristics were noted between Japanese patients enrolled in this study, and non-Japanese patients enrolled in a global phase Ia/Ib study. These results may support the inclusion of Japanese patients in ongoing global phase III clinical trials.

Trial registration number: jRCT2080224926.

目的:Tiragolumab 是一种与抑制性免疫检查点 TIGIT(具有 Ig 和 ITIM 结构域的 T 细胞免疫受体)结合的单克隆抗体。在早期临床试验中,tiragolumab与程序性死亡配体1抑制剂atezolizumab联合治疗晚期/转移性实体瘤患者的耐受性良好,并显示出初步的抗肿瘤活性。我们报告了在日本患者中开展的替拉戈单抗联合阿特佐利珠单抗 I 期研究(jRCT2080224926)的结果:方法:年龄≥20岁的日本患者接受替拉戈单抗(600毫克)和阿替佐利单抗(1200毫克)静脉注射,每21天一次,直至出现不可接受的毒性或疾病进展。主要终点是替拉戈单抗和阿特佐利珠单抗的安全性和药代动力学(PK)参数。次要终点为抗肿瘤活性:3名患者入组,诊断为非小细胞肺癌、胰腺癌和胆管癌。未观察到限制剂量的毒性反应。两名患者出现了任何级别的治疗相关不良事件(AE)。没有≥3级的不良反应、严重不良反应、导致停药、改药或撤药的不良反应或导致死亡的不良反应。在第一周期,替拉戈单抗的平均 PK 参数如下Cmax为217微克/毫升;Cmin为54.9微克/毫升;从0到最后可测量浓度的浓度-时间曲线下面积为2000微克-天/毫升;t1/2为17.6天。两名患者的最佳总体反应是病情稳定:结论:日本晚期/转移性实体瘤患者对替拉戈单抗联合阿特珠单抗的耐受性良好,参加本研究的日本患者与参加全球III期研究的非日本患者在替拉戈单抗PK特征方面没有差异。这些结果可能支持将日本患者纳入正在进行的全球III期临床试验。
{"title":"Phase I study of the anti-TIGIT antibody tiragolumab in combination with atezolizumab in Japanese patients with advanced or metastatic solid tumors.","authors":"Noboru Yamamoto, Takafumi Koyama, Jun Sato, Tatsuya Yoshida, Kazuki Sudo, Satoru Iwasa, Shunsuke Kondo, Kan Yonemori, Atsuko Kawasaki, Kyoko Satake, Shoyo Shibata, Toshio Shimizu","doi":"10.1007/s00280-023-04627-3","DOIUrl":"10.1007/s00280-023-04627-3","url":null,"abstract":"<p><strong>Purpose: </strong>Tiragolumab is a monoclonal antibody that binds to the inhibitory immune checkpoint TIGIT (T-cell immunoreceptor with Ig and ITIM domains). In early phase clinical trials, tiragolumab in combination with the programmed death-ligand 1-inhibitor atezolizumab was well tolerated and has demonstrated preliminary anti-tumor activity in patients with advanced/metastatic solid tumors. We report the results of a phase I study of tiragolumab plus atezolizumab in Japanese patients (jRCT2080224926).</p><p><strong>Methods: </strong>Japanese patients ≥ 20 years old received tiragolumab (600 mg) and atezolizumab (1200 mg) intravenously every 21 days until unacceptable toxicity or disease progression. Primary endpoints were safety and pharmacokinetic (PK) parameters of tiragolumab plus atezolizumab. Secondary endpoints were anti-tumor activity.</p><p><strong>Results: </strong>Three patients were enrolled with diagnoses of non-small cell lung cancer, pancreatic cancer, and cholangiocarcinoma. No dose-limiting toxicities were observed. Two patients experienced treatment-related adverse events (AEs) of any grade. There were no grade ≥ 3 AEs, serious AEs, AEs leading to discontinuation, modification or withdrawal of any study drug, or AEs leading to death. At cycle 1, mean PK parameters of tiragolumab were as follows: C<sub>max</sub> 217 μg/mL; C<sub>min</sub> 54.9 μg/mL; area under the concentration-time curve from 0 to the last measurable concentration, 2000 μg·day/mL; t<sub>1/2</sub>, 17.6 days. Best overall response was stable disease in two patients.</p><p><strong>Conclusion: </strong>Tiragolumab plus atezolizumab was well tolerated in Japanese patients with advanced/metastatic solid tumors, and no differences in tiragolumab PK characteristics were noted between Japanese patients enrolled in this study, and non-Japanese patients enrolled in a global phase Ia/Ib study. These results may support the inclusion of Japanese patients in ongoing global phase III clinical trials.</p><p><strong>Trial registration number: </strong>jRCT2080224926.</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/PMC11258096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416455","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
Vitamin D suppresses CD133+/CD44 + cancer stem cell stemness by inhibiting NF-κB signaling and reducing NLRP3 expression in triple-negative breast cancer. 维生素D通过抑制三阴性乳腺癌中的NF-κB信号传导和减少NLRP3表达,抑制CD133+/CD44+癌症干细胞的干性。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-08 DOI: 10.1007/s00280-024-04660-w
Wei Zheng, Wei Peng, Fuyong Qian, Mingshuai Zhang, Bofeng Duan, Zhifeng Fan, Yi Xie, Xiaoying Fu

Background and objective: This study aims to investigate the role of Vitamin D (VD) in regulating the stemness and survival of CD133+/CD44 + breast cancer stem cells, and to explore the role of NLRP3 in this process.

Methods: Breast cancer tissues were collected for RXRα and VDR expression analysis. A triple-negative breast cancer cell line was cultured and stem-like cells (CD133 + CD44+) isolated using flow cytometry. These cells were treated with VD, analyzing their stem-like properties, apoptosis and proliferation, as well as P65 nuclear expression and NLRP3 expression. After NLRP3 inflammasome activator treatment, the parameters were reassessed. RXRα and VDR interaction was confirmed using co-immunoprecipitation (CoIP). Finally, a subcutaneous xenograft model of triple-negative breast cancer was treated with VD and subsequently analyzed for stem-like properties, proliferation, apoptosis, and NLRP3 expression levels.

Results: CD133+/CD44 + stem cells expressed high levels of SOX2 and OCT4. VD treatment resulted in a significant decrease in SOX2 and OCT4 expression, fewer sphere-forming colonies, lower proliferation ability, and more apoptosis. Additionally, VD treatment inhibited NF-κB signaling and reduced NLRP3 expression. The NLRP3 activator BMS-986,299 counteracted the effects of VD in vitro. In vivo, VD inhibited the growth of breast cancer stem cells, reducing both tumor volume and weight, and decreased NLRP3, SOX2, and OCT4 expression within tumor tissues.

Conclusion: Findings elucidate that VD mediates the modulation of stemness in CD133+/CD44 + breast cancer stem cells through the regulation of NLRP3 expression. The research represents novel insights on the implications for the application of VD in cancer therapies.

背景和目的:本研究旨在探讨维生素D(VD)在调控CD133+/CD44+乳腺癌干细胞的干性和存活中的作用,并探索NLRP3在这一过程中的作用:方法:采集乳腺癌组织进行RXRα和VDR表达分析。培养三阴性乳腺癌细胞系,使用流式细胞术分离干样细胞(CD133 + CD44+)。用 VD 处理这些细胞,分析它们的干样特性、凋亡和增殖,以及 P65 核表达和 NLRP3 表达。经 NLRP3 炎性体激活剂处理后,重新评估了这些参数。通过共免疫沉淀(CoIP)确认了RXRα和VDR的相互作用。最后,用 VD 处理了三阴性乳腺癌皮下异种移植模型,随后分析了干样特性、增殖、凋亡和 NLRP3 表达水平:结果:CD133+/CD44+干细胞表达高水平的SOX2和OCT4。VD处理后,SOX2和OCT4的表达明显减少,球形集落减少,增殖能力降低,凋亡增多。此外,VD 处理还抑制了 NF-κB 信号传导,减少了 NLRP3 的表达。NLRP3 激活剂 BMS-986,299 抵消了 VD 在体外的作用。在体内,VD抑制了乳腺癌干细胞的生长,减少了肿瘤体积和重量,并降低了肿瘤组织中NLRP3、SOX2和OCT4的表达:研究结果阐明,VD通过调节NLRP3的表达介导CD133+/CD44+乳腺癌干细胞干性的调节。这项研究为VD在癌症疗法中的应用提供了新的见解。
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引用次数: 0
Impact of loperamide on the pharmacokinetics and tissue disposition of ritonavir-boosted oral docetaxel therapy; a preclinical assessment. 洛哌丁胺对利托那韦口服多西他赛的药代动力学和组织处置的影响;临床前评估。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-08 DOI: 10.1007/s00280-024-04662-8
Nancy H C Loos, Viët Bui, Daniëlle H de Jong, Maria C Lebre, Hilde Rosing, Jos H Beijnen, Alfred H Schinkel

Purpose: An oral docetaxel formulation boosted by the Cytochrome P450 (CYP) 3 A inhibitor ritonavir, ModraDoc006/r, is currently under clinical investigation. Based on clinical data, the incidence of grade 1-2 diarrhea is increased with this oral docetaxel formulation compared to the conventional intravenous administration. Loperamide, a frequently used diarrhea inhibitor, could be added to the regimen as symptomatic treatment. However, loperamide is also a substrate of the CYP3A enzyme, which could result in competition between ritonavir and loperamide for this protein. Therefore, we were interested in the impact of coadministered loperamide on the pharmacokinetics of ritonavir-boosted oral docetaxel.

Methods: We administered loperamide simultaneously or with an 8-hour delay to humanized CYP3A4 mice (with expression in liver and intestine) receiving oral ritonavir and docetaxel. Concentrations of docetaxel, ritonavir, loperamide and two of its active metabolites were measured.

Results: The plasma exposure (AUC and Cmax) of docetaxel was not altered during loperamide treatment, nor were the ritonavir plasma pharmacokinetics. However, the hepatic and intestinal dispositions of ritonavir were somewhat changed in the simultaneous, but not 8-hour loperamide treatment groups, possibly due to loperamide-induced delayed drug absorption. The pharmacokinetics of loperamide itself did not seem to be influenced by ritonavir.

Conclusion: These results suggest that delayed loperamide administration can be added to ritonavir-boosted oral docetaxel treatment, without affecting the overall systemic exposure of docetaxel.

目的:一种由细胞色素 P450(CYP)3 A 抑制剂利托那韦增强的口服多西他赛制剂 ModraDoc006/r 目前正在接受临床研究。根据临床数据,与传统的静脉给药相比,这种口服多西他赛制剂会增加 1-2 级腹泻的发生率。洛哌丁胺是一种常用的腹泻抑制剂,可添加到治疗方案中作为对症治疗。然而,洛哌丁胺也是CYP3A酶的底物,这可能会导致利托那韦和洛哌丁胺竞争这种蛋白质。因此,我们想知道同时服用洛哌丁胺对利托那韦口服多西他赛药代动力学的影响:方法:我们给接受利托那韦和多西他赛口服药的人源化 CYP3A4 小鼠(在肝脏和肠道中表达)同时或延迟 8 小时服用洛哌丁胺。测定了多西他赛、利托那韦、洛哌丁胺及其两种活性代谢物的浓度:结果:在洛哌丁胺治疗期间,多西他赛的血浆暴露量(AUC 和 Cmax)没有变化,利托那韦的血浆药代动力学也没有变化。然而,利托那韦的肝脏和肠道处置在同时服用洛哌丁胺组发生了一些变化,而在8小时服用洛哌丁胺组没有发生变化,这可能是由于洛哌丁胺引起的药物吸收延迟所致。洛哌丁胺本身的药代动力学似乎不受利托那韦的影响:这些结果表明,在利托那韦口服多西他赛治疗中可以加入延迟服用洛哌丁胺,而不会影响多西他赛的总体全身暴露。
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引用次数: 0
Role of renin angiotensin system inhibitors and metformin in Glioblastoma Therapy: a review. 肾素血管紧张素系统抑制剂和二甲双胍在胶质母细胞瘤治疗中的作用:综述。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-25 DOI: 10.1007/s00280-024-04686-0
Sashana Dixon, Ann Tenneil O'connor, Chloe Brooks-Noreiga, Michelle A Clark, Arkene Levy, Ana M Castejon

Glioblastoma multiforme (GBM) is a highly aggressive and incurable disease accounting for about 10,000 deaths in the USA each year. Despite the current treatment approach which includes surgery with chemotherapy and radiation therapy, there remains a high prevalence of recurrence. Notable improvements have been observed in persons receiving concurrent antihypertensive drugs such as renin angiotensin inhibitors (RAS) or the antidiabetic drug metformin with standard therapy. Anti-tumoral effects of RAS inhibitors and metformin have been observed in in vitro and in vivo studies. Although clinical trials have shown mixed results, the potential for the use of RAS inhibitors and metformin as adjuvant GBM therapy remains promising. Nevertheless, evidence suggest that these drugs exert multimodal antitumor actions; by particularly targeting several cancer hallmarks. In this review, we highlight the results of clinical studies using multidrug cocktails containing RAS inhibitors and or metformin added to standard therapy for GBM. In addition, we highlight the possible molecular mechanisms by which these repurposed drugs with an excellent safety profile might elicit their anti-tumoral effects. RAS inhibition elicits anti-inflammatory, anti-angiogenic, and immune sensitivity effects in GBM. However, metformin promotes anti-migratory, anti-proliferative and pro-apoptotic effects mainly through the activation of AMP-activated protein kinase. Also, we discussed metformin's potential in targeting both GBM cells as well as GBM associated-stem cells. Finally, we summarize a few drug interactions that may cause an additive or antagonistic effect that may lead to adverse effects and influence treatment outcome.

多形性胶质母细胞瘤(GBM)是一种侵袭性极强的不治之症,美国每年约有 10,000 人死于这种疾病。尽管目前的治疗方法包括手术、化疗和放疗,但复发率仍然很高。在接受标准治疗的同时,同时服用肾素血管紧张素抑制剂(RAS)等抗高血压药物或二甲双胍等抗糖尿病药物的患者病情明显好转。在体外和体内研究中已观察到 RAS 抑制剂和二甲双胍的抗肿瘤作用。虽然临床试验结果不一,但使用 RAS 抑制剂和二甲双胍作为 GBM 辅助治疗的潜力仍然很好。然而,有证据表明这些药物具有多模式抗肿瘤作用,尤其是针对几种癌症标志物。在这篇综述中,我们重点介绍了在 GBM 标准疗法中添加 RAS 抑制剂和二甲双胍的多药鸡尾酒的临床研究结果。此外,我们还强调了这些安全性极佳的再利用药物可能产生抗肿瘤作用的分子机制。抑制 RAS 可在 GBM 中产生抗炎、抗血管生成和免疫敏感效应。然而,二甲双胍主要通过激活AMP激活蛋白激酶来促进抗迁移、抗增殖和促凋亡作用。此外,我们还讨论了二甲双胍在靶向 GBM 细胞以及 GBM 相关干细胞方面的潜力。最后,我们总结了一些药物相互作用,这些相互作用可能会产生相加或拮抗作用,从而导致不良反应并影响治疗效果。
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引用次数: 0
Life-threatening toxicities upon Pembrolizumab intake: could pharmacokinetics be the bad guy? 服用派姆单抗后会产生危及生命的毒性:药代动力学会是坏家伙吗?
IF 3 4区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2023-11-13 DOI: 10.1007/s00280-023-04611-x
Mourad Hamimed, Raynier Devillier, Pierre-Jean Weiller, Clémence Marin, Jean-Marc Schiano, Nawel Belmecheri, Marie-Christine Etienne-Grimaldi, Joseph Ciccolini, Samia Harbi

Purpose: We report the case of an adult patient diagnosed with Hodgkin's lymphoma who was scheduled for Pembrolizumab after failure of standard therapy. After three well-tolerated courses of Pembrolizumab, a PET scan showed a favorable outcome and a fourth course of Pembrolizumab was started. Unexpectedly, extremely severe toxicities (i.e., autoimmune peripheral hypothyroidism, rhabdomyolysis and severe acute renal failure) occurred after this last course, requiring transfer to the intensive care unit.

Methods: Therapeutic drug monitoring was performed to measure residual Pembrolizumab levels at intervals from the last dose (i.e., 120 and then 170 days), as well as pharmacogenetics investigations on the FCγR gene.

Results: Pembrolizumab plasma concentrations that were still pharmacologically active months after the last administration, suggesting impaired elimination of Pembrolizumab in this patient. Further pharmacokinetic modeling based on the population approach showed that both half-life (47.8 days) and clearance (0.12 L/day) values were significantly different from the standard values usually reported in patients. Further in silico simulations showed that pharmacologically active concentrations of Pembrolizumab were maintained for up to 136 days after the last dose. The search for possible polymorphisms affecting the genes coding for FCγR (i.e., rs1801274 on FCGR2A and rs396991 on FCGR3A gene) was negative. Further TDM showed that Pembrolizumab could be detected up to 263 days after the last administration.

Conclusion: This case report suggests that persistent overexposure in plasma could lead to life-threatening toxicities with Pembrolizumab.

目的:我们报告了一例诊断为霍奇金淋巴瘤的成年患者,在标准治疗失败后计划使用派姆单抗。在三个耐受良好的Pembrolizumab疗程后,PET扫描显示有利的结果,并开始了第四个疗程的Pembrolizumab。出乎意料的是,在最后一个疗程后发生了极其严重的毒性(即自身免疫性外周甲状腺功能减退、横纹肌溶解和严重急性肾功能衰竭),需要转移到重症监护室。方法:进行治疗药物监测,从最后一次给药(即120天和170天)开始,每隔一段时间测量残余派姆单抗水平,并对FCγR基因进行药物遗传学研究。结果:Pembrolizumab血浆浓度在最后一次给药后几个月仍具有药理活性,表明该患者的Pembrolizumab消除受损。基于群体方法的进一步药代动力学建模显示,半衰期(47.8天)和清除率(0.12 L/天)值与通常报道的患者标准值均有显著差异。进一步的计算机模拟显示,Pembrolizumab的药理学活性浓度在最后一次给药后维持了136天。对FCγR编码基因(即FCGR2A基因上的rs1801274和FCGR3A基因上的rs396991)可能多态性的搜索结果为阴性。进一步的TDM显示,Pembrolizumab可以在最后一次给药后263天检测到。结论:本病例报告表明,血浆中持续过量暴露可能导致Pembrolizumab危及生命的毒性。
{"title":"Life-threatening toxicities upon Pembrolizumab intake: could pharmacokinetics be the bad guy?","authors":"Mourad Hamimed, Raynier Devillier, Pierre-Jean Weiller, Clémence Marin, Jean-Marc Schiano, Nawel Belmecheri, Marie-Christine Etienne-Grimaldi, Joseph Ciccolini, Samia Harbi","doi":"10.1007/s00280-023-04611-x","DOIUrl":"10.1007/s00280-023-04611-x","url":null,"abstract":"<p><strong>Purpose: </strong>We report the case of an adult patient diagnosed with Hodgkin's lymphoma who was scheduled for Pembrolizumab after failure of standard therapy. After three well-tolerated courses of Pembrolizumab, a PET scan showed a favorable outcome and a fourth course of Pembrolizumab was started. Unexpectedly, extremely severe toxicities (i.e., autoimmune peripheral hypothyroidism, rhabdomyolysis and severe acute renal failure) occurred after this last course, requiring transfer to the intensive care unit.</p><p><strong>Methods: </strong>Therapeutic drug monitoring was performed to measure residual Pembrolizumab levels at intervals from the last dose (i.e., 120 and then 170 days), as well as pharmacogenetics investigations on the FCγR gene.</p><p><strong>Results: </strong>Pembrolizumab plasma concentrations that were still pharmacologically active months after the last administration, suggesting impaired elimination of Pembrolizumab in this patient. Further pharmacokinetic modeling based on the population approach showed that both half-life (47.8 days) and clearance (0.12 L/day) values were significantly different from the standard values usually reported in patients. Further in silico simulations showed that pharmacologically active concentrations of Pembrolizumab were maintained for up to 136 days after the last dose. The search for possible polymorphisms affecting the genes coding for FCγR (i.e., rs1801274 on FCGR2A and rs396991 on FCGR3A gene) was negative. Further TDM showed that Pembrolizumab could be detected up to 263 days after the last administration.</p><p><strong>Conclusion: </strong>This case report suggests that persistent overexposure in plasma could lead to life-threatening toxicities with Pembrolizumab.</p>","PeriodicalId":9556,"journal":{"name":"Cancer Chemotherapy and Pharmacology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92152754","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
Ommaya reservoir use in pediatric ALL and NHL: a review at St. Jude Children's Research Hospital. Ommaya 储库在小儿 ALL 和 NHL 中的应用:圣裘德儿童研究医院的综述。
IF 2.7 4区 医学 Q3 ONCOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-28 DOI: 10.1007/s00280-024-04653-9
Alyssa Gaietto, John C Panetta, Jennifer L Pauley, Mary V Relling, Raul Ribeiro, Matthew J Ehrhardt, Ching-Hon Pui, Hiroto Inaba, Hope D Swanson

Purpose: The intraventricular route of chemotherapy administration, via an Ommaya Reservoir (OmR) improves drug distribution in the central nervous system (CNS) compared to the more commonly used intrathecal administration. We retrospectively reviewed our experience with intraventricular chemotherapy, focused on methotrexate, in patients with Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin Lymphoma (NHL).

Methods: Twenty-four patients (aged 7 days - 22.2 years) with 26 OmR placements were identified for a total of 25,009 OmR days between 1990 and 2019. Methotrexate cerebrospinal fluid (CSF) concentrations (n = 124) were analyzed from 59 courses of OmR therapy in 15 patients. Twenty-one courses involved methotrexate dosing on day 0 only, whereas 38 courses involved booster dosing on days 1, 2, or both. We simulated the time CSF methotrexate concentrations remained > 1 µM for 3 days given various dosing regimens.

Results: CSF methotrexate exposure was higher in those who concurrently received systemic methotrexate than via OmR alone (p < 10- 7). Our simulations showed that current intraventricular methotrexate boosting strategy for patients ≥ 3 years of age maintained CSF methotrexate concentrations ≥ 1 µM for 72 h 40% of the time. Alternatively, other boosting strategies were predicted to achieve CSF methotrexate concentrations ≥ 1 µM for 72 h between 46 and 72% of the time.

Conclusions: OmR were able to be safely placed and administer intraventricular methotrexate with and without boost doses in patients from 7 days to 22 years old. Boosting strategies are predicted to increase CSF methotrexate concentrations ≥ 1 µM for 72 h.

目的:与更常用的鞘内给药相比,通过 Ommaya Reservoir(OmR)进行的静脉内化疗途径可改善药物在中枢神经系统(CNS)中的分布。我们回顾总结了急性淋巴细胞白血病(ALL)和非霍奇金淋巴瘤(NHL)患者的静脉内化疗经验,重点是甲氨蝶呤:在1990年至2019年期间,共对24名患者(年龄在7天至22.2岁之间)进行了26次OmR治疗,总计25009个OmR日。分析了 15 名患者 59 个 OmR 治疗疗程的甲氨蝶呤脑脊液(CSF)浓度(n = 124)。其中 21 个疗程仅在第 0 天服用甲氨蝶呤,38 个疗程在第 1 天、第 2 天或第 2 天同时服用甲氨蝶呤。我们模拟了不同给药方案下 CSF 甲氨蝶呤浓度在 3 天内保持 > 1 µM 的时间:结果:同时接受全身甲氨蝶呤治疗的患者的脑脊液甲氨蝶呤暴露量高于单独接受 OmR 治疗的患者(p - 7)。我们的模拟结果表明,对于年龄≥ 3 岁的患者,目前的脑室内甲氨蝶呤升压策略可在 40% 的时间内使脑脊液甲氨蝶呤浓度在 72 小时内保持≥ 1 µM。另外,根据预测,其他升压策略可在 46% 到 72% 的时间内使 CSF 甲氨蝶呤浓度在 72 小时内≥ 1 µM:对于 7 天至 22 岁的患者,OmR 可以安全放置,并在使用或不使用增强剂量的情况下进行静脉注射甲氨蝶呤。预计增量策略可在 72 小时内使 CSF 甲氨蝶呤浓度≥ 1 µM。
{"title":"Ommaya reservoir use in pediatric ALL and NHL: a review at St. Jude Children's Research Hospital.","authors":"Alyssa Gaietto, John C Panetta, Jennifer L Pauley, Mary V Relling, Raul Ribeiro, Matthew J Ehrhardt, Ching-Hon Pui, Hiroto Inaba, Hope D Swanson","doi":"10.1007/s00280-024-04653-9","DOIUrl":"10.1007/s00280-024-04653-9","url":null,"abstract":"<p><strong>Purpose: </strong>The intraventricular route of chemotherapy administration, via an Ommaya Reservoir (OmR) improves drug distribution in the central nervous system (CNS) compared to the more commonly used intrathecal administration. We retrospectively reviewed our experience with intraventricular chemotherapy, focused on methotrexate, in patients with Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin Lymphoma (NHL).</p><p><strong>Methods: </strong>Twenty-four patients (aged 7 days - 22.2 years) with 26 OmR placements were identified for a total of 25,009 OmR days between 1990 and 2019. Methotrexate cerebrospinal fluid (CSF) concentrations (n = 124) were analyzed from 59 courses of OmR therapy in 15 patients. Twenty-one courses involved methotrexate dosing on day 0 only, whereas 38 courses involved booster dosing on days 1, 2, or both. We simulated the time CSF methotrexate concentrations remained > 1 µM for 3 days given various dosing regimens.</p><p><strong>Results: </strong>CSF methotrexate exposure was higher in those who concurrently received systemic methotrexate than via OmR alone (p < 10<sup>- 7</sup>). Our simulations showed that current intraventricular methotrexate boosting strategy for patients ≥ 3 years of age maintained CSF methotrexate concentrations ≥ 1 µM for 72 h 40% of the time. Alternatively, other boosting strategies were predicted to achieve CSF methotrexate concentrations ≥ 1 µM for 72 h between 46 and 72% of the time.</p><p><strong>Conclusions: </strong>OmR were able to be safely placed and administer intraventricular methotrexate with and without boost doses in patients from 7 days to 22 years old. Boosting strategies are predicted to increase CSF methotrexate concentrations ≥ 1 µM for 72 h.</p>","PeriodicalId":9556,"journal":{"name":"Cancer Chemotherapy and Pharmacology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11376002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982440","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
Evaluation of mycophenolic acid exposure in a patient with immune-related hepatotoxicity caused by nivolumab and ipilimumab therapy for malignant melanoma: a case report. 评估一名因接受尼妥珠单抗和伊匹单抗治疗恶性黑色素瘤而出现免疫相关肝毒性的患者暴露于霉酚酸的情况:病例报告。
IF 3 4区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2023-12-26 DOI: 10.1007/s00280-023-04628-2
Yoshiharu Suzuki, Shingo Ishiguro, Hirokazu Shimada, Masahiro Ohgami, Mika Suzuki

Background: Guidelines such as the National Comprehensive Cancer Network recommend mycophenolate mofetil (MMF) for the treatment of severe steroid-refractory immune-related hepatotoxicity. Mycophenolic acid (MPA) is an active form of MMF that suppresses T- and B-lymphocyte proliferation and immune-related adverse events caused by immune checkpoint inhibitors. MPA has a narrow therapeutic range (37-70 µg·h/mL) and overexposure increases the risk of leukopenia in transplantation. However, the optimal use of MMF in oncology has not yet been established; thus, monitoring plasma MPA concentrations is necessary to avoid excessive immunosuppression in oncology practice.

Case presentation: We evaluated plasma MPA concentration in a 75-year-old man with immune-related hepatotoxicity following nivolumab and ipilimumab combination therapy for malignant melanoma. The patient developed severe hepatotoxicity after immunotherapy, and immunosuppressant therapy with corticosteroids was initiated. The patient then developed steroid-refractory immune-related hepatotoxicity; therefore, MMF (1,000 mg twice daily) was co-administered. Seven days after the administration of MMF, the plasma MPA concentration was measured using an enzyme multiplied immunoassay technique. The area under the plasma concentration-time curve for MPA from 0 to 12 h was 41.0 µg·h/mL, and the same dose of MMF was continued. Grade 2 lymphocytopenia, which could be attributed to MMF, was observed during the administration period. Unfortunately, the patient was infected with SARS-CoV-2 and died from respiratory failure.

Conclusion: Our patient did not exceed the upper limit of MPA levels as an index of the onset of side effects of kidney transplantation and achieved rapid improvement in liver function. Prompt initiation of MMF after assessment of the steroid effect leads to adequate MPA exposure. Therapeutic drug monitoring should be considered when MMF is administered, to avoid overexposure.

背景:美国国家综合癌症网络等指南推荐使用霉酚酸酯(MMF)治疗严重的类固醇难治性免疫相关肝毒性。霉酚酸(MPA)是MMF的一种活性形式,可抑制T淋巴细胞和B淋巴细胞增殖以及免疫检查点抑制剂引起的免疫相关不良反应。MPA 的治疗范围较窄(37-70 µg-h/mL),过度暴露会增加移植中白细胞减少的风险。然而,MMF在肿瘤学中的最佳使用方法尚未确定;因此,有必要监测血浆MPA浓度,以避免在肿瘤学实践中出现过度免疫抑制:我们评估了一名 75 岁男性患者的血浆 MPA 浓度,该患者在接受尼妥珠单抗和伊匹单抗联合治疗恶性黑色素瘤后出现了免疫相关肝毒性。患者在接受免疫治疗后出现了严重的肝毒性,并开始使用皮质类固醇进行免疫抑制治疗。随后,患者出现了类固醇难治性免疫相关肝毒性;因此,患者同时服用了 MMF(1000 毫克,每天两次)。服用 MMF 七天后,使用酶乘免疫测定技术测定了血浆中的 MPA 浓度。从 0 到 12 小时,MPA 的血浆浓度-时间曲线下面积为 41.0 µg-h/mL,因此继续服用相同剂量的 MMF。在用药期间,观察到 2 级淋巴细胞减少,这可能是 MMF 引起的。不幸的是,患者感染了 SARS-CoV-2,死于呼吸衰竭:结论:我们的患者没有超过作为肾移植副作用发病指标的 MPA 水平上限,肝功能也得到了迅速改善。在评估类固醇效果后及时开始使用 MMF,可获得足够的 MPA 暴露。使用 MMF 时应考虑进行治疗药物监测,以避免过度暴露。
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引用次数: 0
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Cancer Chemotherapy and Pharmacology
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