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Erschienen in: Cancer Chemotherapy and Pharmacology 5/2023

31.07.2023 | Clinical Trial Report

Pharmacokinetics, safety, tolerability, and feasibility of apatinib in combination with gefitinib in stage IIIB-IV EGFR-mutated non-squamous NSCLC: a drug-drug interaction study

verfasst von: Yuxiang Ma, Qun Chen, Yang Zhang, Jinhui Xue, Qianwen Liu, Yuanyuan Zhao, Yunpeng Yang, Yan Huang, Wenfeng Fang, Zhiguo Hou, Shaorong Li, Jing Wang, Li Zhang, Hongyun Zhao

Erschienen in: Cancer Chemotherapy and Pharmacology | Ausgabe 5/2023

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Abstract

Purpose

Apatinib combined with gefitinib was proven to benefit advanced EGFR-mutant NSCLC patients in first-line treatment. This study aimed to evaluate the drug-drug interaction of gefitinib and apatinib when coadministered in EGFR-mutated NSCLC patients.

Methods

In this phase 1b, multi-center, open-label, fixed-sequence study, the drug-drug interaction of gefitinib and apatinib was evaluated when coadministered in EGFR-mutated NSCLC patients. Patients received single-agent apatinib 500 mg QD on days 1–4. Gefitinib 250 mg QD was given on days 5–15 and combined with apatinib 500 mg QD on days 12–15. Serial blood samples were drawn on days 4 and 15. The plasma concentrations and other pharmacokinetics parameters were measured for apatinib with and without gefitinib.

Results

The study enrolled 22 patients and 20 were analyzed for pharmacokinetics. There were no distinct differences in apatinib Cmax and AUC0−τ with versus without gefitinib (geometric LSM ratio, 0.96 [90% CI 0.84–1.10] for Cmax and 1.12 [90% CI 0.96–1.30] for AUC0−τ). Similar PFS and grade of treatment-emergent adverse events (TEAEs) were found between different Cmax and AUC0−τ of apatinib and gefitinib at 500 mg apatinib and 250 mg gefitinib dose levels.

Conclusions

Apatinib pharmacokinetics parameters were not significantly changed when coadministered with gefitinib. All TEAEs were manageable, and there was no need to change the dose level when combining apatinib and gefitinib (ClinicalTrials.gov identifier: NCT04390984, May 18, 2020).
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Literatur
1.
Zurück zum Zitat Hirata A et al (2002) ZD1839 (Iressa) induces antiangiogenic effects through inhibition of epidermal growth factor receptor tyrosine kinase. Can Res 62(9):2554–2560 Hirata A et al (2002) ZD1839 (Iressa) induces antiangiogenic effects through inhibition of epidermal growth factor receptor tyrosine kinase. Can Res 62(9):2554–2560
2.
Zurück zum Zitat Byers LA, Heymach JV (2007) Dual targeting of the vascular endothelial growth factor and epidermal growth factor receptor pathways: rationale and clinical applications for non-small-cell lung cancer. Clin Lung Cancer 8(Suppl 2):S79–S85CrossRefPubMed Byers LA, Heymach JV (2007) Dual targeting of the vascular endothelial growth factor and epidermal growth factor receptor pathways: rationale and clinical applications for non-small-cell lung cancer. Clin Lung Cancer 8(Suppl 2):S79–S85CrossRefPubMed
3.
Zurück zum Zitat Naumov GN et al (2009) Combined vascular endothelial growth factor receptor and epidermal growth factor receptor (EGFR) blockade inhibits tumor growth in xenograft models of EGFR inhibitor resistance. Clin Cancer Res 15(10):3484–3494CrossRefPubMedPubMedCentral Naumov GN et al (2009) Combined vascular endothelial growth factor receptor and epidermal growth factor receptor (EGFR) blockade inhibits tumor growth in xenograft models of EGFR inhibitor resistance. Clin Cancer Res 15(10):3484–3494CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Wu W et al (2007) Targeted therapy of orthotopic human lung cancer by combined vascular endothelial growth factor and epidermal growth factor receptor signaling blockade. Mol Cancer Ther 6(2):471–483CrossRefPubMed Wu W et al (2007) Targeted therapy of orthotopic human lung cancer by combined vascular endothelial growth factor and epidermal growth factor receptor signaling blockade. Mol Cancer Ther 6(2):471–483CrossRefPubMed
5.
Zurück zum Zitat Luwor RB et al (2005) The antiepidermal growth factor receptor monoclonal antibody cetuximab/C225 reduces hypoxia-inducible factor-1 alpha, leading to transcriptional inhibition of vascular endothelial growth factor expression. Oncogene 24(27):4433–4441CrossRefPubMed Luwor RB et al (2005) The antiepidermal growth factor receptor monoclonal antibody cetuximab/C225 reduces hypoxia-inducible factor-1 alpha, leading to transcriptional inhibition of vascular endothelial growth factor expression. Oncogene 24(27):4433–4441CrossRefPubMed
6.
Zurück zum Zitat Chen F et al (2020) Efficacy and safety of epidermal growth factor receptor (EGFR) inhibitors plus antiangiogenic agents as first-line treatments for patients with advanced EGFR-mutated non-small cell lung cancer: a meta-analysis. Front Oncol 10:904CrossRefPubMedPubMedCentral Chen F et al (2020) Efficacy and safety of epidermal growth factor receptor (EGFR) inhibitors plus antiangiogenic agents as first-line treatments for patients with advanced EGFR-mutated non-small cell lung cancer: a meta-analysis. Front Oncol 10:904CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Liu L et al (2021) Drug interaction of ningetinib and gefitinib involving CYP1A1 and efflux transporters in non-small cell lung cancer patients. Br J Clin Pharmacol 87(4):2098–2110CrossRefPubMed Liu L et al (2021) Drug interaction of ningetinib and gefitinib involving CYP1A1 and efflux transporters in non-small cell lung cancer patients. Br J Clin Pharmacol 87(4):2098–2110CrossRefPubMed
8.
Zurück zum Zitat Tian S et al (2011) YN968D1 is a novel and selective inhibitor of vascular endothelial growth factor receptor-2 tyrosine kinase with potent activity in vitro and in vivo. Cancer Sci 102(7):1374–1380CrossRefPubMed Tian S et al (2011) YN968D1 is a novel and selective inhibitor of vascular endothelial growth factor receptor-2 tyrosine kinase with potent activity in vitro and in vivo. Cancer Sci 102(7):1374–1380CrossRefPubMed
9.
Zurück zum Zitat Li F et al (2017) Apatinib enhances antitumour activity of EGFR-TKIs in non-small cell lung cancer with EGFR-TKI resistance. Eur J Cancer (Oxf Engl 1990) 84:184–192 Li F et al (2017) Apatinib enhances antitumour activity of EGFR-TKIs in non-small cell lung cancer with EGFR-TKI resistance. Eur J Cancer (Oxf Engl 1990) 84:184–192
10.
Zurück zum Zitat Zhao H et al (2021) Apatinib plus gefitinib as first-line treatment in advanced EGFR-mutant NSCLC: the phase III ACTIVE Study (CTONG1706). J Thorac Oncol 16(9):1533–1546CrossRefPubMed Zhao H et al (2021) Apatinib plus gefitinib as first-line treatment in advanced EGFR-mutant NSCLC: the phase III ACTIVE Study (CTONG1706). J Thorac Oncol 16(9):1533–1546CrossRefPubMed
11.
Zurück zum Zitat Ding J et al (2013) Metabolism and pharmacokinetics of novel selective vascular endothelial growth factor receptor-2 inhibitor apatinib in humans. Drug Metab Dispos Biol Fate Chem 41(6):1195–1210CrossRefPubMed Ding J et al (2013) Metabolism and pharmacokinetics of novel selective vascular endothelial growth factor receptor-2 inhibitor apatinib in humans. Drug Metab Dispos Biol Fate Chem 41(6):1195–1210CrossRefPubMed
12.
Zurück zum Zitat Baselga J, Averbuch SD (2000) ZD1839 ('Iressa') as an anticancer agent. Drugs 60(Suppl 1) Baselga J, Averbuch SD (2000) ZD1839 ('Iressa') as an anticancer agent. Drugs 60(Suppl 1)
13.
Zurück zum Zitat Swaisland H et al (2001) Pharmacokinetics and tolerability of the orally active selective epidermal growth factor receptor tyrosine kinase inhibitor ZD1839 in healthy volunteers. Clin Pharmacokinet 40(4):297–306CrossRefPubMed Swaisland H et al (2001) Pharmacokinetics and tolerability of the orally active selective epidermal growth factor receptor tyrosine kinase inhibitor ZD1839 in healthy volunteers. Clin Pharmacokinet 40(4):297–306CrossRefPubMed
14.
Zurück zum Zitat Scheffler M et al (2011) Clinical pharmacokinetics of tyrosine kinase inhibitors: focus on 4-anilinoquinazolines. Clin Pharmacokinet 50(6):371–403CrossRefPubMed Scheffler M et al (2011) Clinical pharmacokinetics of tyrosine kinase inhibitors: focus on 4-anilinoquinazolines. Clin Pharmacokinet 50(6):371–403CrossRefPubMed
15.
Zurück zum Zitat Liu X et al (2018) Pharmacokinetic drug interactions of apatinib with rifampin and itraconazole. J Clin Pharmacol 58(3):347–356CrossRefPubMed Liu X et al (2018) Pharmacokinetic drug interactions of apatinib with rifampin and itraconazole. J Clin Pharmacol 58(3):347–356CrossRefPubMed
16.
Zurück zum Zitat Ranson M et al (2002) ZD1839, a selective oral epidermal growth factor receptor-tyrosine kinase inhibitor, is well tolerated and active in patients with solid, malignant tumors: results of a phase I trial. J Clin Oncol 20(9):2240–2250CrossRefPubMed Ranson M et al (2002) ZD1839, a selective oral epidermal growth factor receptor-tyrosine kinase inhibitor, is well tolerated and active in patients with solid, malignant tumors: results of a phase I trial. J Clin Oncol 20(9):2240–2250CrossRefPubMed
17.
Zurück zum Zitat Nakagawa K et al (2003) Phase I pharmacokinetic trial of the selective oral epidermal growth factor receptor tyrosine kinase inhibitor gefitinib (“Iressa”, ZD1839) in Japanese patients with solid malignant tumors. Ann Oncol 14(6):922–930CrossRefPubMed Nakagawa K et al (2003) Phase I pharmacokinetic trial of the selective oral epidermal growth factor receptor tyrosine kinase inhibitor gefitinib (“Iressa”, ZD1839) in Japanese patients with solid malignant tumors. Ann Oncol 14(6):922–930CrossRefPubMed
18.
Zurück zum Zitat Motonaga M et al (2015) Phase I dose-finding and pharmacokinetic study of docetaxel and gefitinib in patients with advanced or metastatic non-small-cell lung cancer: evaluation of drug-drug interaction. Cancer Chemother Pharmacol 76(4):713–721CrossRefPubMed Motonaga M et al (2015) Phase I dose-finding and pharmacokinetic study of docetaxel and gefitinib in patients with advanced or metastatic non-small-cell lung cancer: evaluation of drug-drug interaction. Cancer Chemother Pharmacol 76(4):713–721CrossRefPubMed
19.
Zurück zum Zitat Milton DT et al (2007) Phase 1 trial of everolimus and gefitinib in patients with advanced nonsmall-cell lung cancer. Cancer 110(3):599–605CrossRefPubMed Milton DT et al (2007) Phase 1 trial of everolimus and gefitinib in patients with advanced nonsmall-cell lung cancer. Cancer 110(3):599–605CrossRefPubMed
20.
Zurück zum Zitat Adjei AA et al (2007) Phase I trial of sorafenib in combination with gefitinib in patients with refractory or recurrent non-small cell lung cancer. Clin Cancer Res 13(9):2684–2691CrossRefPubMed Adjei AA et al (2007) Phase I trial of sorafenib in combination with gefitinib in patients with refractory or recurrent non-small cell lung cancer. Clin Cancer Res 13(9):2684–2691CrossRefPubMed
21.
Zurück zum Zitat Zhang Z et al (2020) Dual blockade of EGFR and VEGFR pathways: results from a pilot study evaluating apatinib plus gefitinib as a first-line treatment for advanced EGFR-mutant non-small cell lung cancer. Clin Transl Med 10(2):e33CrossRefPubMedPubMedCentral Zhang Z et al (2020) Dual blockade of EGFR and VEGFR pathways: results from a pilot study evaluating apatinib plus gefitinib as a first-line treatment for advanced EGFR-mutant non-small cell lung cancer. Clin Transl Med 10(2):e33CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Wang C et al (2021) An investigation into possible interactions among four vascular epidermal growth factor receptor-tyrosine kinase inhibitors with gefitinib. Cancer Chemother Pharmacol 87(1):43–52CrossRefPubMed Wang C et al (2021) An investigation into possible interactions among four vascular epidermal growth factor receptor-tyrosine kinase inhibitors with gefitinib. Cancer Chemother Pharmacol 87(1):43–52CrossRefPubMed
23.
Zurück zum Zitat McKillop D et al (2005) Tumor penetration of gefitinib (Iressa), an epidermal growth factor receptor tyrosine kinase inhibitor. Mol Cancer Ther 4(4):641–649CrossRefPubMed McKillop D et al (2005) Tumor penetration of gefitinib (Iressa), an epidermal growth factor receptor tyrosine kinase inhibitor. Mol Cancer Ther 4(4):641–649CrossRefPubMed
24.
Zurück zum Zitat Zhu YT et al (2020) Effects of apatinib on the pharmacokinetics of nifedipine and warfarin in patients with advanced solid tumors. Drug Des Devel Ther 14:1963–1970CrossRefPubMedPubMedCentral Zhu YT et al (2020) Effects of apatinib on the pharmacokinetics of nifedipine and warfarin in patients with advanced solid tumors. Drug Des Devel Ther 14:1963–1970CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Li J et al (2007) Differential metabolism of gefitinib and erlotinib by human cytochrome P450 enzymes. Clin Cancer Res 13(12):3731–3737CrossRefPubMed Li J et al (2007) Differential metabolism of gefitinib and erlotinib by human cytochrome P450 enzymes. Clin Cancer Res 13(12):3731–3737CrossRefPubMed
26.
Zurück zum Zitat Swaisland HC et al (2005) Pharmacokinetic drug interactions of gefitinib with rifampicin, itraconazole and metoprolol. Clin Pharmacokinet 44(10):1067–1081CrossRefPubMed Swaisland HC et al (2005) Pharmacokinetic drug interactions of gefitinib with rifampicin, itraconazole and metoprolol. Clin Pharmacokinet 44(10):1067–1081CrossRefPubMed
27.
Zurück zum Zitat Kobayashi H et al (2015) Relationship among gefitinib exposure, polymorphisms of its metabolizing enzymes and transporters, and side effects in Japanese patients with non-small-cell lung cancer. Clin Lung Cancer 16(4):274–281CrossRefPubMed Kobayashi H et al (2015) Relationship among gefitinib exposure, polymorphisms of its metabolizing enzymes and transporters, and side effects in Japanese patients with non-small-cell lung cancer. Clin Lung Cancer 16(4):274–281CrossRefPubMed
28.
Zurück zum Zitat Wu F et al (2018) A Phase II clinical trial of apatinib in pretreated advanced non-squamous non-small-cell lung cancer. Clin Lung Cancer 19(6):e831–e842CrossRefPubMed Wu F et al (2018) A Phase II clinical trial of apatinib in pretreated advanced non-squamous non-small-cell lung cancer. Clin Lung Cancer 19(6):e831–e842CrossRefPubMed
29.
Zurück zum Zitat Wu Y-L et al (2017) Dacomitinib versus gefitinib as first-line treatment for patients with EGFR-mutation-positive non-small-cell lung cancer (ARCHER 1050): a randomised, open-label, phase 3 trial. Lancet Oncol 18(11):1454–1466CrossRefPubMed Wu Y-L et al (2017) Dacomitinib versus gefitinib as first-line treatment for patients with EGFR-mutation-positive non-small-cell lung cancer (ARCHER 1050): a randomised, open-label, phase 3 trial. Lancet Oncol 18(11):1454–1466CrossRefPubMed
30.
Zurück zum Zitat Ma Y et al (2019) The analysis of pharmacokinetic and pharmacogenomic impact on gefitinib efficacy in advanced non-small cell lung cancer patients: results from a prospective cohort study. Ann Transl Med 7(24):806CrossRefPubMedPubMedCentral Ma Y et al (2019) The analysis of pharmacokinetic and pharmacogenomic impact on gefitinib efficacy in advanced non-small cell lung cancer patients: results from a prospective cohort study. Ann Transl Med 7(24):806CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Okuda Y et al (2017) Low plasma concentration of gefitinib in patients with EGFR exon 21 L858R point mutations shortens progression-free survival. Cancer Chemother Pharmacol 79(5):1013–1020CrossRefPubMed Okuda Y et al (2017) Low plasma concentration of gefitinib in patients with EGFR exon 21 L858R point mutations shortens progression-free survival. Cancer Chemother Pharmacol 79(5):1013–1020CrossRefPubMed
32.
Zurück zum Zitat Mizoguchi K et al (2016) Pharmacokinetic parameters of gefitinib predict efficacy and toxicity in patients with advanced non-small cell lung cancer harboring EGFR mutations. Cancer Chemother Pharmacol 78(2):377–382CrossRefPubMed Mizoguchi K et al (2016) Pharmacokinetic parameters of gefitinib predict efficacy and toxicity in patients with advanced non-small cell lung cancer harboring EGFR mutations. Cancer Chemother Pharmacol 78(2):377–382CrossRefPubMed
33.
Zurück zum Zitat Nakamura Y et al (2010) Pharmacokinetics of gefitinib predicts antitumor activity for advanced non-small cell lung cancer. J Thorac Oncol 5(9):1404–1409CrossRefPubMed Nakamura Y et al (2010) Pharmacokinetics of gefitinib predicts antitumor activity for advanced non-small cell lung cancer. J Thorac Oncol 5(9):1404–1409CrossRefPubMed
Metadaten
Titel
Pharmacokinetics, safety, tolerability, and feasibility of apatinib in combination with gefitinib in stage IIIB-IV EGFR-mutated non-squamous NSCLC: a drug-drug interaction study
verfasst von
Yuxiang Ma
Qun Chen
Yang Zhang
Jinhui Xue
Qianwen Liu
Yuanyuan Zhao
Yunpeng Yang
Yan Huang
Wenfeng Fang
Zhiguo Hou
Shaorong Li
Jing Wang
Li Zhang
Hongyun Zhao
Publikationsdatum
31.07.2023
Verlag
Springer Berlin Heidelberg
Erschienen in
Cancer Chemotherapy and Pharmacology / Ausgabe 5/2023
Print ISSN: 0344-5704
Elektronische ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-023-04563-2

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