Wulkersdorfer Beatrix, Zeitlinger Markus, Schmid Monika
Department of Clinical Pharmacology, Medical University of Vienna, Währinger-Gürtel 18-20, 1090, Vienna, Austria.
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Clin Pharmacokinet. 2016 Jan;55(1):47-77. doi: 10.1007/s40262-015-0302-2.
Scientists have identified the impact of angiogenesis on tumor growth and survival. Among other efficient drugs, several small-molecule tyrosine kinase inhibitors (TKIs) targeting the vascular endothelial growth factor receptor (VEGFR) have been developed and have already been integrated into the treatment of various advanced malignancies. This review provides a compilation of current knowledge on the pharmacokinetic aspects of all VEGFR-TKIs already approved by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) and of those still under investigation. Additional information on substance metabolism, potential for drug-drug interactions (DDIs), and the need for dose adaptation in patients with predominant renal and/or hepatic impairment has been included. All TKIs introduced in this review were administered orally, allowing for easy drug handling for healthcare professionals and patients. For almost all substances, the maximum plasma concentrations were reached within a short period of time. The majority of the substances showed a high plasma protein binding and their excretion occurred via the feces and, to a lesser extent, via the urine. In most cases, dose adaptation in patients with mild to moderate renal or hepatic impairment is not recommended. Cytochrome P450 (CYP) 3A4 was found to play a crucial role in the drug metabolic processes of many compounds. In order to prevent unwanted DDIs, co-administration of VEGFR TKIs together with CYP3A4 inhibitors or inducers should be avoided. Throughout all TKIs, the data indicate high inter-individual variability. The causes of this are still unclear and require further research to allow for individualization of treatment regimens.
科学家们已经确定了血管生成对肿瘤生长和存活的影响。在其他有效药物中,几种靶向血管内皮生长因子受体(VEGFR)的小分子酪氨酸激酶抑制剂(TKIs)已被开发出来,并已被纳入各种晚期恶性肿瘤的治疗中。本综述汇编了美国食品药品监督管理局(FDA)和欧洲药品管理局(EMA)已批准的以及仍在研究中的所有VEGFR-TKIs的药代动力学方面的现有知识。还包括了关于药物代谢、药物相互作用(DDIs)潜力以及主要有肾和/或肝损伤患者剂量调整需求的额外信息。本综述中介绍的所有TKIs均通过口服给药,这便于医护人员和患者进行药物处理。几乎所有物质在短时间内即可达到血浆最大浓度。大多数物质显示出高血浆蛋白结合率,其排泄途径为粪便,少量通过尿液。在大多数情况下,不建议对轻度至中度肾或肝损伤患者进行剂量调整。发现细胞色素P450(CYP)3A4在许多化合物的药物代谢过程中起关键作用。为避免不必要的药物相互作用,应避免将VEGFR TKIs与CYP3A4抑制剂或诱导剂联合使用。在所有TKIs中,数据表明个体间存在很大差异。其原因尚不清楚,需要进一步研究以实现治疗方案的个体化。