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癌症人群中抑酸剂(ARA)的患病率以及临床开发中分子靶向药物的ARA药物相互作用潜力。

Prevalence of acid-reducing agents (ARA) in cancer populations and ARA drug-drug interaction potential for molecular targeted agents in clinical development.

作者信息

Smelick Gillian S, Heffron Timothy P, Chu Laura, Dean Brian, West David A, Duvall Scott L, Lum Bert L, Budha Nageshwar, Holden Scott N, Benet Leslie Z, Frymoyer Adam, Dresser Mark J, Ware Joseph A

机构信息

Clinical Pharmacology, Genentech Research and Early Development , 1 DNA Way, South San Francisco, California 94080, United States.

出版信息

Mol Pharm. 2013 Nov 4;10(11):4055-62. doi: 10.1021/mp400403s. Epub 2013 Oct 24.

Abstract

Acid-reducing agents (ARAs) are the most commonly prescribed medications in North America and Western Europe. There are currently no data describing the prevalence of their use among cancer patients. However, this is a paramount question due to the potential for significant drug-drug interactions (DDIs) between ARAs, most commonly proton pump inhibitors (PPIs), and orally administered cancer therapeutics that display pH-dependent solubility, which may lead to decreased drug absorption and decreased therapeutic benefit. Of recently approved orally administered cancer therapeutics, >50% are characterized as having pH-dependent solubility, but there are currently no data describing the potential for this ARA-DDI liability among targeted agents currently in clinical development. The objectives of this study were to (1) determine the prevalence of ARA use among different cancer populations and (2) investigate the prevalence of orally administered cancer therapeutics currently in development that may be liable for an ARA-DDI. To address the question of ARA use among cancer patients, a retrospective cross-sectional analysis was performed using two large healthcare databases: Thomson Reuters MarketScan (N = 1,776,443) and the U.S. Department of Veterans Affairs (VA, N = 1,171,833). Among all cancer patients, the total prevalence proportion of ARA use (no. of cancer patients receiving an ARA/total no. of cancer patients) was 20% and 33% for the MarketScan and VA databases, respectively. PPIs were the most commonly prescribed agent, comprising 79% and 65% of all cancer patients receiving a prescription for an ARA (no. of cancer patients receiving a PPI /no. of cancer patients receiving an ARA) for the MarketScan and VA databases, respectively. To estimate the ARA-DDI liability of orally administered molecular targeted cancer therapeutics currently in development, two publicly available databases, (1) Kinase SARfari and (2) canSAR, were examined. For those orally administered clinical candidates that had available structures, the pKa's and corresponding relative solubilities were calculated for a normal fasting pH of 1.2 and an "ARA-hypochlorhydric" pH of 4. Taking calculated pKa's and relative solubilities into consideration, clinical candidates were classified based on their risk for an ARA-DDI. More than one-quarter (28%) of the molecules investigated are at high risk for an ARA-DDI, and of those high risk molecules, nearly three-quarters (73%) are being clinically evaluated for at least one of five cancer types with the highest prevalence of ARA use (gastrointestinal, pancreatic, lung, glioblastoma multiforme, gastrointestinal stromal tumor (GIST)). These data strongly suggest that with the clinical development of ARA-DDI-susceptible cancer therapeutics will come continued challenges for drug-development scientists, oncologists, and regulatory agencies in ensuring that patients achieve safe and efficacious exposures of their cancer therapeutics and thus optimal patient outcomes.

摘要

抑酸剂(ARAs)是北美和西欧最常用的处方药。目前尚无关于其在癌症患者中使用 prevalence 的数据。然而,这是一个至关重要的问题,因为 ARAs(最常见的是质子泵抑制剂(PPIs))与口服癌症治疗药物之间可能存在显著的药物相互作用(DDIs),这些口服癌症治疗药物具有pH依赖性溶解性,这可能导致药物吸收减少和治疗益处降低。在最近批准的口服癌症治疗药物中,超过50%的药物具有pH依赖性溶解性,但目前尚无数据描述目前处于临床开发阶段的靶向药物中这种ARA-DDI风险的可能性。本研究的目的是:(1)确定不同癌症人群中ARA的使用 prevalence;(2)调查目前正在开发的可能存在ARA-DDI风险的口服癌症治疗药物的 prevalence。为了解决癌症患者中ARA使用的问题,使用了两个大型医疗保健数据库进行回顾性横断面分析:汤森路透市场扫描数据库(N = 1,776,443)和美国退伍军人事务部(VA,N = 1,171,833)。在所有癌症患者中,市场扫描数据库和VA数据库中ARA使用的总 prevalence 比例(接受ARA的癌症患者数量/癌症患者总数)分别为20%和33%。PPIs是最常用的药物,在市场扫描数据库和VA数据库中,分别占接受ARA处方的所有癌症患者的79%和65%(接受PPI的癌症患者数量/接受ARA的癌症患者数量)。为了估计目前正在开发的口服分子靶向癌症治疗药物的ARA-DDI风险,研究了两个公开可用的数据库:(1)激酶SARfari和(2)canSAR。对于那些具有可用结构的口服临床候选药物,计算了正常空腹pH值为1.2和“ARA低胃酸”pH值为4时的pKa值和相应的相对溶解度。考虑到计算出的pKa值和相对溶解度,根据临床候选药物的ARA-DDI风险对其进行分类。超过四分之一(28%)的研究分子具有较高的ARA-DDI风险,在这些高风险分子中,近四分之三(73%)正在针对ARA使用 prevalence最高的五种癌症类型(胃肠道、胰腺、肺、多形性胶质母细胞瘤、胃肠道间质瘤(GIST))中的至少一种进行临床评估。这些数据强烈表明随着对ARA-DDI敏感的癌症治疗药物的临床开发,药物开发科学家、肿瘤学家和监管机构在确保患者安全有效地接触其癌症治疗药物并从而实现最佳患者预后方面将面临持续的挑战。

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