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评估口服血管内皮生长因子受体酪氨酸激酶抑制剂帕唑帕尼(pazopanib)与先进固体肿瘤患者的改良库伯斯敦 5+1 鸡尾酒药物相互作用的潜力。

An evaluation of the drug interaction potential of pazopanib, an oral vascular endothelial growth factor receptor tyrosine kinase inhibitor, using a modified Cooperstown 5+1 cocktail in patients with advanced solid tumors.

机构信息

Section of Clinical Pharmacology, Department of Hematology-Oncology, National University Hospital, Singapore, Singapore.

出版信息

Clin Pharmacol Ther. 2010 Nov;88(5):652-9. doi: 10.1038/clpt.2010.158. Epub 2010 Sep 29.

Abstract

Pazopanib, an oral inhibitor of vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and c-kit kinases, inhibits multiple cytochrome P450 (CYP450) enzymes in vitro. This study in patients with advanced cancer evaluated the effect of pazopanib on CYP450 function by comparing the pharmacokinetics of CYP-specific probe drugs in the presence and absence of pazopanib. The probes used included midazolam (CYP3A specific), warfarin (CYP2C9 specific), omeprazole (CYP2C19 specific), caffeine (CYP1A2 specific), and dextromethorphan (CYP2D6 specific). The estimated ratios of the geometric means (90% confidence interval (CI)) for the area under the curve to the last measurable point (AUC(0-t)) for these probe drugs with/without pazopanib were as follows: midazolam, 1.35 (1.18-1.54); omeprazole, 0.81 (0.59-1.12); caffeine, 1.00 (0.77-1.30); and S-warfarin, 0.93 (0.84-1.03). The geometric least-squares (LS) mean ratio of urine dextromethorphan:dextrorphan ranged from 1.33 (0-4-h interval) to 1.64 (4-8-h interval). The data suggest that pazopanib is a weak inhibitor of CYP3A4 and CYP2D6 and has no effect on CYP1A2, CYP2C9, and CYP2C19 in patients with advanced cancer.

摘要

帕唑帕尼是一种口服的血管内皮生长因子受体、血小板衍生生长因子受体和 c-kit 激酶抑制剂,在体外能抑制多种细胞色素 P450(CYP450)酶。这项针对晚期癌症患者的研究通过比较存在和不存在帕唑帕尼时 CYP 特异性探针药物的药代动力学,评估了帕唑帕尼对 CYP450 功能的影响。所用的探针包括咪达唑仑(CYP3A 特异性)、华法林(CYP2C9 特异性)、奥美拉唑(CYP2C19 特异性)、咖啡因(CYP1A2 特异性)和右美沙芬(CYP2D6 特异性)。这些探针药物与/无帕唑帕尼时 AUC(0-t)的曲线下面积到最后可测量点(AUC(0-t))的几何均值(90%置信区间(CI))比值估计值如下:咪达唑仑,1.35(1.18-1.54);奥美拉唑,0.81(0.59-1.12);咖啡因,1.00(0.77-1.30);S-华法林,0.93(0.84-1.03)。尿右美沙芬/右啡烷的最小二乘(LS)均值比值范围为 1.33(0-4 小时间隔)至 1.64(4-8 小时间隔)。数据表明,帕唑帕尼是 CYP3A4 和 CYP2D6 的弱抑制剂,对晚期癌症患者的 CYP1A2、CYP2C9 和 CYP2C19 没有影响。

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