Skip to main content
Top
Published in: Cancer Chemotherapy and Pharmacology 6/2012

01-06-2012 | Original Article

A single-dose placebo- and moxifloxacin-controlled study of the effects of temsirolimus on cardiac repolarization in healthy adults

Authors: Joseph P. Boni, Cathie Leister, Bruce Hug, Jaime Burns, Daryl Sonnichsen

Published in: Cancer Chemotherapy and Pharmacology | Issue 6/2012

Login to get access

Abstract

Purpose

Temsirolimus, a selective inhibitor of mammalian target of rapamycin, is an approved treatment for patients with advanced renal cell carcinoma (RCC). This study assessed the effect of intravenous (i.v.) temsirolimus 25 mg, the recommended dose for patients with RCC, on the corrected QT (QTc) interval.

Methods

This 3-period crossover study enrolled healthy subjects. In periods 1 and 2, subjects received i.v. placebo either alone or with open-label oral moxifloxacin. In period 3, subjects received a single dose of temsirolimus 25 mg. The primary statistical objective was to estimate the effect of temsirolimus compared with placebo on change from time-matched baseline QTc at the end of infusion (0.5 h). Assay sensitivity was evaluated by the effect of moxifloxacin on change from time-matched baseline QTc compared with placebo.

Results

In total, 58 subjects were enrolled. Temsirolimus had no effect on QTc interval in the primary analysis. At 11 of 12 secondary time points, the upper bound for the temsirolimus QTc 90% confidence intervals for the time-matched change from baseline difference from placebo was <10 ms, with no evidence of QTc trends or relationship to concentrations of temsirolimus or its major metabolite, sirolimus. Moxifloxacin, the positive control, produced a significant increase in the QTc interval compared with placebo 0.5–4 h post-dose (P < 0.0001). No subject had a QTc interval exceeding 450 ms or a change from baseline of >30 ms.

Conclusions

Therapeutic exposure to temsirolimus is not associated with clinically significant changes in QTc intervals in healthy adults.
Literature
1.
go back to reference Farkas AS, Nattel S (2010) Minimizing repolarization-related proarrhythmic risk in drug development and clinical practice. Drugs 70:573–603PubMedCrossRef Farkas AS, Nattel S (2010) Minimizing repolarization-related proarrhythmic risk in drug development and clinical practice. Drugs 70:573–603PubMedCrossRef
2.
go back to reference Salvi V, Karnad DR, Panicker GK, Kothari S (2010) Update on the evaluation of a new drug for effects on cardiac repolarization in humans: issues in early drug development. Br J Pharmacol 159:34–48PubMedCrossRef Salvi V, Karnad DR, Panicker GK, Kothari S (2010) Update on the evaluation of a new drug for effects on cardiac repolarization in humans: issues in early drug development. Br J Pharmacol 159:34–48PubMedCrossRef
3.
go back to reference Shah RR (2002) The significance of QT interval in drug development. Br J Clin Pharmacol 54:188–202PubMedCrossRef Shah RR (2002) The significance of QT interval in drug development. Br J Clin Pharmacol 54:188–202PubMedCrossRef
4.
go back to reference Abraham RT, Gibbons JJ (2007) The mammalian target of rapamycin signaling pathway: twists and turns in the road to cancer therapy. Clin Cancer Res 13:3109–3114PubMedCrossRef Abraham RT, Gibbons JJ (2007) The mammalian target of rapamycin signaling pathway: twists and turns in the road to cancer therapy. Clin Cancer Res 13:3109–3114PubMedCrossRef
5.
go back to reference Boni JP, Hug B, Leister C, Sonichsen D (2009) Intravenous temsirolimus in cancer patients: clinical pharmacology and dosing considerations. Semin Oncol 36:S18–S25PubMedCrossRef Boni JP, Hug B, Leister C, Sonichsen D (2009) Intravenous temsirolimus in cancer patients: clinical pharmacology and dosing considerations. Semin Oncol 36:S18–S25PubMedCrossRef
6.
go back to reference Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, Staroslawska E, Sosman J, McDermott D, Bodrogi I, Kovacevic Z, Lesovoy V, Schmidt-Wolf I, Barbarash O, Gokmen E, O’Toole T, Lustgarten S, Moore L, Motzer R, Global ARCC Trial (2007) Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 356:2271–2281PubMedCrossRef Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, Staroslawska E, Sosman J, McDermott D, Bodrogi I, Kovacevic Z, Lesovoy V, Schmidt-Wolf I, Barbarash O, Gokmen E, O’Toole T, Lustgarten S, Moore L, Motzer R, Global ARCC Trial (2007) Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 356:2271–2281PubMedCrossRef
7.
go back to reference Food and Drug Administration (2005) International Conference on Harmonisation; guidance on E14 clinical evaluation of QT/QTc interval prolongation and proarrhythmic potential for non-antiarrhythmic drug. Fed Regist 70:61134–61135 Food and Drug Administration (2005) International Conference on Harmonisation; guidance on E14 clinical evaluation of QT/QTc interval prolongation and proarrhythmic potential for non-antiarrhythmic drug. Fed Regist 70:61134–61135
8.
go back to reference Hug B, Abbas R, Leister C, Burns J, Sonnichsen D (2010) A single-dose, crossover, placebo- and moxifloxacin-controlled study to assess the effects of neratinib (HKI-272) on cardiac repolarization in healthy adult subjects. Clin Cancer Res 16:4016–4023PubMedCrossRef Hug B, Abbas R, Leister C, Burns J, Sonnichsen D (2010) A single-dose, crossover, placebo- and moxifloxacin-controlled study to assess the effects of neratinib (HKI-272) on cardiac repolarization in healthy adult subjects. Clin Cancer Res 16:4016–4023PubMedCrossRef
9.
go back to reference Boni J, Leister C, Burns J, Cincotta M, Hug B, Moore L (2007) Pharmacokinetic profile of temsirolimus with concomitant administration of cytochrome P450-inducing medications. J Clin Pharmacol 47:1430–1439PubMedCrossRef Boni J, Leister C, Burns J, Cincotta M, Hug B, Moore L (2007) Pharmacokinetic profile of temsirolimus with concomitant administration of cytochrome P450-inducing medications. J Clin Pharmacol 47:1430–1439PubMedCrossRef
10.
go back to reference Boni J, Abbas R, Leister C, Burns J, Jordan R, Hoffmann M, DeMaio W, Hug B (2009) Disposition of desipramine, a sensitive cytochrome P450 2D6 substrate, when coadministered with intravenous temsirolimus. Cancer Chemother Pharmacol 64:263–270PubMedCrossRef Boni J, Abbas R, Leister C, Burns J, Jordan R, Hoffmann M, DeMaio W, Hug B (2009) Disposition of desipramine, a sensitive cytochrome P450 2D6 substrate, when coadministered with intravenous temsirolimus. Cancer Chemother Pharmacol 64:263–270PubMedCrossRef
11.
go back to reference Torisel [package insert] (2011) Pfizer Inc, Philadelphia Torisel [package insert] (2011) Pfizer Inc, Philadelphia
12.
go back to reference Avelox [package insert] (2008) Bayer HealthCare Pharmaceuticals, Wayne Avelox [package insert] (2008) Bayer HealthCare Pharmaceuticals, Wayne
13.
go back to reference Punt CJ, Boni J, Bruntsch U, Peters M, Thielert C (2003) Phase I and pharmacokinetic study of CCI-779, a novel cytostatic cell-cycle inhibitor, in combination with 5-fluorouracil and leucovorin in patients with advanced solid tumors. Ann Oncol 14:931–937PubMedCrossRef Punt CJ, Boni J, Bruntsch U, Peters M, Thielert C (2003) Phase I and pharmacokinetic study of CCI-779, a novel cytostatic cell-cycle inhibitor, in combination with 5-fluorouracil and leucovorin in patients with advanced solid tumors. Ann Oncol 14:931–937PubMedCrossRef
14.
go back to reference Evans WE, Schentag JJ, Jusko WJ (eds) (1992) Applied pharmacokinetics: principles of therapeutic drug monitoring. Lippincott Williams & Wilkins, New York Evans WE, Schentag JJ, Jusko WJ (eds) (1992) Applied pharmacokinetics: principles of therapeutic drug monitoring. Lippincott Williams & Wilkins, New York
15.
go back to reference Zareba W, Moss AJ, Rosero SZ, Hajj-Ali R, Konecki J, Andrews M (1997) Electrocardiographic findings in patients with diphenhydramine overdose. Am J Cardiol 80:1168–1173PubMedCrossRef Zareba W, Moss AJ, Rosero SZ, Hajj-Ali R, Konecki J, Andrews M (1997) Electrocardiographic findings in patients with diphenhydramine overdose. Am J Cardiol 80:1168–1173PubMedCrossRef
16.
go back to reference Atkins MB, Hidalgo M, Stadler WM, Logan TF, Dutcher JP, Hudes GR, Park Y, Liou SH, Marshall B, Boni JP, Dukart G, Sherman ML (2004) Randomized phase II study of multiple dose levels of CCI-779, a novel mammalian target of rapamycin kinase inhibitor, in patients with advanced refractory renal cell carcinoma. J Clin Oncol 22:909–918PubMedCrossRef Atkins MB, Hidalgo M, Stadler WM, Logan TF, Dutcher JP, Hudes GR, Park Y, Liou SH, Marshall B, Boni JP, Dukart G, Sherman ML (2004) Randomized phase II study of multiple dose levels of CCI-779, a novel mammalian target of rapamycin kinase inhibitor, in patients with advanced refractory renal cell carcinoma. J Clin Oncol 22:909–918PubMedCrossRef
17.
go back to reference Boni JP, Leister C, Burns J, Hug B (2008) Differential effects of ketoconazole on exposure to temsirolimus following intravenous infusion of temsirolimus. Br J Cancer 98:1797–1802PubMedCrossRef Boni JP, Leister C, Burns J, Hug B (2008) Differential effects of ketoconazole on exposure to temsirolimus following intravenous infusion of temsirolimus. Br J Cancer 98:1797–1802PubMedCrossRef
18.
go back to reference Hess G, Herbrecht R, Romaguera J, Verhoef G, Crump M, Gisselbrecht C, Laurell A, Offner F, Strahs A, Berkenblit A, Hanushevsky O, Clancy J, Hewes B, Moore L, Coiffier B (2009) Phase III study to evaluate temsirolimus compared with investigator’s choice therapy for the treatment of relapsed or refractory mantle cell lymphoma. J Clin Oncol 27:3822–3829PubMedCrossRef Hess G, Herbrecht R, Romaguera J, Verhoef G, Crump M, Gisselbrecht C, Laurell A, Offner F, Strahs A, Berkenblit A, Hanushevsky O, Clancy J, Hewes B, Moore L, Coiffier B (2009) Phase III study to evaluate temsirolimus compared with investigator’s choice therapy for the treatment of relapsed or refractory mantle cell lymphoma. J Clin Oncol 27:3822–3829PubMedCrossRef
19.
go back to reference Benton RE, Sale M, Flockhart DA, Woosley RL (2000) Greater quinidine-induced QTc interval prolongation in women. Clin Pharmacol Ther 67:413–418PubMedCrossRef Benton RE, Sale M, Flockhart DA, Woosley RL (2000) Greater quinidine-induced QTc interval prolongation in women. Clin Pharmacol Ther 67:413–418PubMedCrossRef
20.
go back to reference Boni JP, Leister C, Bender G, Fitzpatrick V, Twine N, Stover J, Dorner A, Immermann F, Burczynski ME (2005) Population pharmacokinetics of CCI-779: correlations to safety and pharmacogenomic responses in patients with advanced renal cancer. Clin Pharmacol Ther 77:76–89PubMedCrossRef Boni JP, Leister C, Bender G, Fitzpatrick V, Twine N, Stover J, Dorner A, Immermann F, Burczynski ME (2005) Population pharmacokinetics of CCI-779: correlations to safety and pharmacogenomic responses in patients with advanced renal cancer. Clin Pharmacol Ther 77:76–89PubMedCrossRef
21.
go back to reference Boni JP, Zhou S, Burns J, Smith K, Liao S (2006) Integrated population pharmacokinetic analysis of temsirolimus in cancer patients following weekly IV treatments [abstract 552]. Eur J Cancer Suppl 4:167CrossRef Boni JP, Zhou S, Burns J, Smith K, Liao S (2006) Integrated population pharmacokinetic analysis of temsirolimus in cancer patients following weekly IV treatments [abstract 552]. Eur J Cancer Suppl 4:167CrossRef
22.
go back to reference Schmidinger M, Zielinski CC, Vogl UM, Bojic A, Bojic M, Schukro C, Ruhsam M, Hejna M, Schmidinger H (2008) Cardiac toxicity of sunitinib and sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol 26:5204–5212PubMedCrossRef Schmidinger M, Zielinski CC, Vogl UM, Bojic A, Bojic M, Schukro C, Ruhsam M, Hejna M, Schmidinger H (2008) Cardiac toxicity of sunitinib and sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol 26:5204–5212PubMedCrossRef
23.
go back to reference Force T, Krause DS, Van Etten RA (2007) Molecular mechanisms of cardiotoxicity of tyrosine kinase inhibition. Nat Rev Cancer 7:332–344PubMedCrossRef Force T, Krause DS, Van Etten RA (2007) Molecular mechanisms of cardiotoxicity of tyrosine kinase inhibition. Nat Rev Cancer 7:332–344PubMedCrossRef
24.
go back to reference Girardi F, Franceschi E, Brandes AA (2010) Cardiovascular safety of VEGF-targeting therapies: current evidence and handling strategies. Oncologist 15:683–694PubMedCrossRef Girardi F, Franceschi E, Brandes AA (2010) Cardiovascular safety of VEGF-targeting therapies: current evidence and handling strategies. Oncologist 15:683–694PubMedCrossRef
25.
go back to reference Bello CL, Mulay M, Huang X, Patyna S, Dinolfo M, Levine S, Van VA, Toh M, Baum C, Rosen L (2009) Electrocardiographic characterization of the QTc interval in patients with advanced solid tumors: pharmacokinetic- pharmacodynamic evaluation of sunitinib. Clin Cancer Res 15:7045–7052PubMedCrossRef Bello CL, Mulay M, Huang X, Patyna S, Dinolfo M, Levine S, Van VA, Toh M, Baum C, Rosen L (2009) Electrocardiographic characterization of the QTc interval in patients with advanced solid tumors: pharmacokinetic- pharmacodynamic evaluation of sunitinib. Clin Cancer Res 15:7045–7052PubMedCrossRef
26.
go back to reference Keisner SV, Shah SR (2011) Pazopanib: the newest tyrosine kinase inhibitor for the treatment of advanced or metastatic renal cell carcinoma. Drugs 71:443–454PubMed Keisner SV, Shah SR (2011) Pazopanib: the newest tyrosine kinase inhibitor for the treatment of advanced or metastatic renal cell carcinoma. Drugs 71:443–454PubMed
27.
go back to reference Tolcher AW, Appleman LJ, Shapiro GI, Mita AC, Cihon F, Mazzu A, Sundaresan PR (2011) A phase I open-label study evaluating the cardiovascular safety of sorafenib in patients with advanced cancer. Cancer Chemother Pharmacol 67:751–764PubMedCrossRef Tolcher AW, Appleman LJ, Shapiro GI, Mita AC, Cihon F, Mazzu A, Sundaresan PR (2011) A phase I open-label study evaluating the cardiovascular safety of sorafenib in patients with advanced cancer. Cancer Chemother Pharmacol 67:751–764PubMedCrossRef
Metadata
Title
A single-dose placebo- and moxifloxacin-controlled study of the effects of temsirolimus on cardiac repolarization in healthy adults
Authors
Joseph P. Boni
Cathie Leister
Bruce Hug
Jaime Burns
Daryl Sonnichsen
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Cancer Chemotherapy and Pharmacology / Issue 6/2012
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-012-1845-7

Other articles of this Issue 6/2012

Cancer Chemotherapy and Pharmacology 6/2012 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine