Clinical Pharmacy, Saarland University, Saarbrücken, Germany.
Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.
CPT Pharmacometrics Syst Pharmacol. 2024 Jul;13(7):1144-1159. doi: 10.1002/psp4.13146. Epub 2024 May 1.
Dasatinib, a second-generation tyrosine kinase inhibitor, is approved for treating chronic myeloid and acute lymphoblastic leukemia. As a sensitive cytochrome P450 (CYP) 3A4 substrate and weak base with strong pH-sensitive solubility, dasatinib is susceptible to enzyme-mediated drug-drug interactions (DDIs) with CYP3A4 perpetrators and pH-dependent DDIs with acid-reducing agents. This work aimed to develop a whole-body physiologically-based pharmacokinetic (PBPK) model of dasatinib to describe and predict enzyme-mediated and pH-dependent DDIs, to evaluate the impact of strong and moderate CYP3A4 inhibitors and inducers on dasatinib exposure and to support optimized dasatinib dosing. Overall, 63 plasma profiles from perorally administered dasatinib in healthy volunteers and cancer patients were used for model development. The model accurately described and predicted plasma profiles with geometric mean fold errors (GMFEs) for area under the concentration-time curve from the first to the last timepoint of measurement (AUC) and maximum plasma concentration (C) of 1.27 and 1.29, respectively. Regarding the DDI studies used for model development, all (8/8) predicted AUC and C ratios were within twofold of observed ratios. Application of the PBPK model for dose adaptations within various DDIs revealed dasatinib dose reductions of 50%-80% for strong and 0%-70% for moderate CYP3A4 inhibitors and a 2.3-3.1-fold increase of the daily dasatinib dose for CYP3A4 inducers to match the exposure of dasatinib administered alone. The developed model can be further employed to personalize dasatinib therapy, thereby help coping with clinical challenges resulting from DDIs and patient-related factors, such as elevated gastric pH.
达沙替尼是一种第二代酪氨酸激酶抑制剂,获批用于治疗慢性髓性白血病和急性淋巴细胞白血病。作为一种敏感的细胞色素 P450(CYP)3A4 底物和具有强 pH 敏感性的弱碱,达沙替尼易受到 CYP3A4 介导的药物相互作用(DDI)和与酸还原剂的 pH 依赖性 DDI 的影响。本研究旨在建立达沙替尼的全身生理基于药代动力学(PBPK)模型,以描述和预测酶介导和 pH 依赖性 DDI,评估强和中度 CYP3A4 抑制剂和诱导剂对达沙替尼暴露的影响,并支持优化达沙替尼的给药方案。总体而言,使用了 63 例健康志愿者和癌症患者口服给予达沙替尼的血浆谱来进行模型开发。该模型准确地描述和预测了血浆谱,对于从第一个到最后一个测量时间点的浓度-时间曲线下面积(AUC)和最大血浆浓度(C)的几何平均误差(GMFE)分别为 1.27 和 1.29。关于用于模型开发的 DDI 研究,所有(8/8)预测的 AUC 和 C 比值均在观察比值的两倍以内。在各种 DDI 中应用 PBPK 模型进行剂量调整,结果显示对于强 CYP3A4 抑制剂,达沙替尼的剂量减少 50%-80%,对于中度 CYP3A4 抑制剂,剂量减少 0%-70%,对于 CYP3A4 诱导剂,达沙替尼的日剂量增加 2.3-3.1 倍,以匹配单独给予达沙替尼的暴露量。该模型可进一步用于个性化达沙替尼治疗,从而有助于应对由 DDI 和与患者相关的因素(如胃内 pH 值升高)引起的临床挑战。
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