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Published in: Cancer Chemotherapy and Pharmacology 2/2012

Open Access 01-02-2012 | Original Article

Effect of trabectedin on the QT interval in patients with advanced solid tumor malignancies

Authors: R. Thertulien, G. M. Manikhas, L. Y. Dirix, J. B. Vermorken, K. Park, M. M. Jain, J. J. Jiao, J. Natarajan, T. Parekh, P. Zannikos, A. P. Staddon

Published in: Cancer Chemotherapy and Pharmacology | Issue 2/2012

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Abstract

Purpose

The primary objective of this study was to access the potential effects of trabectedin on the QT/QTc interval in patients with locally advanced or metastatic solid tumors.

Methods

Patients (n = 75) who had received ≤3 previous lines of chemotherapy and had either relapsed or had progressive disease were enrolled. Patients were administered 3-h intravenous infusions of placebo (saline) on day 1 and trabectedin (1.3 mg/m2) on day 2. Time-matched serial triplicate ECG recordings and pharmacokinetic blood samples were collected over 24 h on both days. Heart rate corrected mean QT intervals and changes from predose baseline in QTc (ΔQTc) were assessed. The difference in ΔQTc between trabectedin and placebo was calculated at each time point (ΔΔQTc).

Results

The upper limits of the 90% confidence interval for ΔΔQTcF and ΔΔQTcB at all time points were less than the prespecified noninferiority margin of 10 ms (≤6.65 ms). No patient had a QTc > 500 ms or a time-matched increase from baseline in QTc > 60 ms at any time point. Regression analyses indicated ΔΔQTc was poorly correlated with trabectedin concentration. No adverse events suggestive of proarrhythmic potential were reported.

Conclusion

Trabectedin did not prolong the QTc interval. Safety and pharmacokinetic profiles of trabectedin were similar to that observed in other ovarian and breast cancer studies.
Literature
1.
go back to reference Boudou L, Baconnier M, Blay J-Y, Lombard-Bohas C, Cassier PA (2009) Trabectedin for the management of soft-tissue sarcoma. Expert Rev Anticancer Ther 9:727–737PubMedCrossRef Boudou L, Baconnier M, Blay J-Y, Lombard-Bohas C, Cassier PA (2009) Trabectedin for the management of soft-tissue sarcoma. Expert Rev Anticancer Ther 9:727–737PubMedCrossRef
2.
go back to reference Carter NJ, Keam SJ (2007) Trabectedin: a review of its use in the management of soft tissue sarcoma and ovarian cancer. Drugs 67:2257–2276PubMedCrossRef Carter NJ, Keam SJ (2007) Trabectedin: a review of its use in the management of soft tissue sarcoma and ovarian cancer. Drugs 67:2257–2276PubMedCrossRef
4.
go back to reference Perez-Ruixo JJ, Zannikos P, Hirankarn S, Stuyckens K, Ludwig EA, Soto-Matos A, Lopez-Lazaro L, Owen JS (2007) Population pharmacokinetic meta-analysis of trabectedin (ET-743, Yondelis) in cancer patients. Clin Pharmacokinet 46:867–884PubMedCrossRef Perez-Ruixo JJ, Zannikos P, Hirankarn S, Stuyckens K, Ludwig EA, Soto-Matos A, Lopez-Lazaro L, Owen JS (2007) Population pharmacokinetic meta-analysis of trabectedin (ET-743, Yondelis) in cancer patients. Clin Pharmacokinet 46:867–884PubMedCrossRef
5.
go back to reference Beumer JH, Lopez-Lazaro L, Schellens JH, Beijnen JH, van Tellingen O (2009) Evaluation of human plasma protein binding of trabectedin (Yondelis, ET-743). Curr Clin Pharmacol 4:38–42PubMedCrossRef Beumer JH, Lopez-Lazaro L, Schellens JH, Beijnen JH, van Tellingen O (2009) Evaluation of human plasma protein binding of trabectedin (Yondelis, ET-743). Curr Clin Pharmacol 4:38–42PubMedCrossRef
6.
go back to reference Vermeir M, Hemeryck A, Cuyckens F, Francesch A, Bockx M, Van Houdt J, Steemans K, Mannens G, Aviles P, De Coster R (2009) In vitro studies on the metabolism of trabectedin (YONDELIS) in monkey and man, including human CYP reaction phenotyping. Biochem Pharmacol 77:1642–1654PubMedCrossRef Vermeir M, Hemeryck A, Cuyckens F, Francesch A, Bockx M, Van Houdt J, Steemans K, Mannens G, Aviles P, De Coster R (2009) In vitro studies on the metabolism of trabectedin (YONDELIS) in monkey and man, including human CYP reaction phenotyping. Biochem Pharmacol 77:1642–1654PubMedCrossRef
7.
go back to reference Gussak I, Litwin J, Kleiman R, Grisanti S, Morganroth J (2004) Drug-induced cardiac toxicity: emphasizing the role of electrocardiography in clinical research and drug development. J Electrocardiol 37:19–24PubMedCrossRef Gussak I, Litwin J, Kleiman R, Grisanti S, Morganroth J (2004) Drug-induced cardiac toxicity: emphasizing the role of electrocardiography in clinical research and drug development. J Electrocardiol 37:19–24PubMedCrossRef
9.
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
10.
go back to reference Darpo B, Nebout T, Sager PT (2006) Clinical evaluation of QT/QTc prolongation and proarrhythmic potential for nonantiarrhythmic drugs: the international conference on harmonization of technical requirements for registration of pharmaceuticals for human use E14 guideline. J Clin Pharmacol 46:498–507PubMedCrossRef Darpo B, Nebout T, Sager PT (2006) Clinical evaluation of QT/QTc prolongation and proarrhythmic potential for nonantiarrhythmic drugs: the international conference on harmonization of technical requirements for registration of pharmaceuticals for human use E14 guideline. J Clin Pharmacol 46:498–507PubMedCrossRef
11.
go back to reference Cassier PA, Dufresne A, Blay JY, Fayette J (2008) Trabectedin and its potential in the treatment of soft tissue sarcoma. Ther Clin Risk Manag 4:109–116PubMed Cassier PA, Dufresne A, Blay JY, Fayette J (2008) Trabectedin and its potential in the treatment of soft tissue sarcoma. Ther Clin Risk Manag 4:109–116PubMed
12.
go back to reference Sessa C, De Braud F, Perotti A, Bauer J, Curigliano G, Noberasco C, Zanaboni F, Gianni L, Marsoni S, Jimeno J, D’Incalci M, Dall’o E, Colombo N (2005) Trabectedin for women with ovarian carcinoma after treatment with platinum and taxanes fails. J Clin Oncol 23:1867–1874PubMedCrossRef Sessa C, De Braud F, Perotti A, Bauer J, Curigliano G, Noberasco C, Zanaboni F, Gianni L, Marsoni S, Jimeno J, D’Incalci M, Dall’o E, Colombo N (2005) Trabectedin for women with ovarian carcinoma after treatment with platinum and taxanes fails. J Clin Oncol 23:1867–1874PubMedCrossRef
13.
go back to reference Demetri GD, Chawla SP, von Mehren M, Ritch P, Baker LH, Blay JY, Hande KR, Keohan ML, Samuels BL, Schuetze S, Lebedinsky C, Elsayed YA, Izquierdo MA, Gomez J, Park YC, Le Cesne A (2009) Efficacy and safety of trabectedin in patients with advanced or metastatic liposarcoma or leiomyosarcoma after failure of prior anthracyclines and ifosfamide: results of a randomized phase II study of two different schedules. J Clin Oncol 27:4188–4196PubMedCrossRef Demetri GD, Chawla SP, von Mehren M, Ritch P, Baker LH, Blay JY, Hande KR, Keohan ML, Samuels BL, Schuetze S, Lebedinsky C, Elsayed YA, Izquierdo MA, Gomez J, Park YC, Le Cesne A (2009) Efficacy and safety of trabectedin in patients with advanced or metastatic liposarcoma or leiomyosarcoma after failure of prior anthracyclines and ifosfamide: results of a randomized phase II study of two different schedules. J Clin Oncol 27:4188–4196PubMedCrossRef
14.
go back to reference Gurtler S, Goldstein L, Delprete S (2005) Trabectedin in third line breast cancer: a multicenter, randomized, phase II study comparing two administration. J Clin Oncol 23:625 Gurtler S, Goldstein L, Delprete S (2005) Trabectedin in third line breast cancer: a multicenter, randomized, phase II study comparing two administration. J Clin Oncol 23:625
15.
go back to reference Monk BJ, Herzog TJ, Kaye SB, Krasner CN, Vermorken JB, Muggia FM, Pujade-Lauraine E, Lisyanskaya AS, Makhson AN, Rolski J, Gorbounova VA, Ghatage P, Bidzinski M, Shen K, Ngan HY, Vergote IB, Nam JH, Park YC, Lebedinsky CA, Poveda AM (2010) Trabectedin plus pegylated liposomal doxorubicin in recurrent ovarian cancer. J Clin Oncol 28:3107–3114PubMedCrossRef Monk BJ, Herzog TJ, Kaye SB, Krasner CN, Vermorken JB, Muggia FM, Pujade-Lauraine E, Lisyanskaya AS, Makhson AN, Rolski J, Gorbounova VA, Ghatage P, Bidzinski M, Shen K, Ngan HY, Vergote IB, Nam JH, Park YC, Lebedinsky CA, Poveda AM (2010) Trabectedin plus pegylated liposomal doxorubicin in recurrent ovarian cancer. J Clin Oncol 28:3107–3114PubMedCrossRef
16.
go back to reference Puchalski TA, Ryan DP, Garcia-Carbonero R, Demetri GD, Butkiewicz L, Harmon D, Seiden MV, Maki RG, Lopez-Lazaro L, Jimeno J, Guzman C, Supko JG (2002) Pharmacokinetics of ecteinascidin 743 administered as a 24 h continuous intravenous infusion to adult patients with soft tissue sarcomas: associations with clinical characteristics, pathophysiological variables and toxicity. Cancer Chemother Pharmacol 50:309–319PubMedCrossRef Puchalski TA, Ryan DP, Garcia-Carbonero R, Demetri GD, Butkiewicz L, Harmon D, Seiden MV, Maki RG, Lopez-Lazaro L, Jimeno J, Guzman C, Supko JG (2002) Pharmacokinetics of ecteinascidin 743 administered as a 24 h continuous intravenous infusion to adult patients with soft tissue sarcomas: associations with clinical characteristics, pathophysiological variables and toxicity. Cancer Chemother Pharmacol 50:309–319PubMedCrossRef
17.
go back to reference International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (2005) The clinical evaluation of QT/QTc interval prolongation and proarrhythmic potential for non-antiarrhythmic drugs: E14. Geneva, Switzerland (updated 12 May 2005). Available from: http://www.ich.org/LOB/media/MEDIA1476.pdf International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (2005) The clinical evaluation of QT/QTc interval prolongation and proarrhythmic potential for non-antiarrhythmic drugs: E14. Geneva, Switzerland (updated 12 May 2005). Available from: http://​www.​ich.​org/​LOB/​media/​MEDIA1476.​pdf
18.
go back to reference Bloomfield DM, Kost JT, Ghosh K, Hreniuk D, Hickey LA, Guitierrez MJ, Gottesdiener K, Wagner JA (2008) The effect of moxifloxacin on QTc and implications for the design of thorough QT studies. Clin Pharmacol Ther 84:475–480PubMedCrossRef Bloomfield DM, Kost JT, Ghosh K, Hreniuk D, Hickey LA, Guitierrez MJ, Gottesdiener K, Wagner JA (2008) The effect of moxifloxacin on QTc and implications for the design of thorough QT studies. Clin Pharmacol Ther 84:475–480PubMedCrossRef
19.
go back to reference Malik M, Hnatkova K, Schmidt A, Smetana P (2009) Electrocardiographic QTc changes due to moxifloxacin infusion. J Clin Pharmacol 49:674–683PubMedCrossRef Malik M, Hnatkova K, Schmidt A, Smetana P (2009) Electrocardiographic QTc changes due to moxifloxacin infusion. J Clin Pharmacol 49:674–683PubMedCrossRef
20.
go back to reference Iwamoto M, Kost JT, Mistry GC, Wenning LA, Breidinger SA, Marbury TC, Stone JA, Gottesdiener KM, Bloomfield DM, Wagner JA (2008) Raltegravir thorough QT/QTc study: a single supratherapeutic dose of raltegravir does not prolong the QTcF interval. J Clin Pharmacol 48:726–733PubMedCrossRef Iwamoto M, Kost JT, Mistry GC, Wenning LA, Breidinger SA, Marbury TC, Stone JA, Gottesdiener KM, Bloomfield DM, Wagner JA (2008) Raltegravir thorough QT/QTc study: a single supratherapeutic dose of raltegravir does not prolong the QTcF interval. J Clin Pharmacol 48:726–733PubMedCrossRef
21.
go back to reference Hulhoven R, Rosillon D, Letiexhe M, Meeus MA, Daoust A, Stockis A (2007) Levocetirizine does not prolong the QT/QTc interval in healthy subjects: results from a thorough QT study. Eur J Clin Pharmacol 63:1011–1017PubMedCrossRef Hulhoven R, Rosillon D, Letiexhe M, Meeus MA, Daoust A, Stockis A (2007) Levocetirizine does not prolong the QT/QTc interval in healthy subjects: results from a thorough QT study. Eur J Clin Pharmacol 63:1011–1017PubMedCrossRef
22.
go back to reference Bloomfield DM, Krishna R, Hreniuk D, Hickey L, Ghosh K, Bergman AJ, Miller J, Gutierrez MJ, Stoltz R, Gottesdiener KM, Herman GA, Wagner JA (2009) A thorough QTc study to assess the effect of sitagliptin, a DPP4 inhibitor, on ventricular repolarization in healthy subjects. J Clin Pharmacol 49:937–946PubMedCrossRef Bloomfield DM, Krishna R, Hreniuk D, Hickey L, Ghosh K, Bergman AJ, Miller J, Gutierrez MJ, Stoltz R, Gottesdiener KM, Herman GA, Wagner JA (2009) A thorough QTc study to assess the effect of sitagliptin, a DPP4 inhibitor, on ventricular repolarization in healthy subjects. J Clin Pharmacol 49:937–946PubMedCrossRef
23.
go back to reference Zhang X, Silkey M, Schumacher M, Wang L, Raval H, Caulfield JP (2009) Period correction of the QTc of moxifloxacin with multiple predose baseline ECGs is the least variable of 4 methods tested. J Clin Pharmacol 49:534–539PubMedCrossRef Zhang X, Silkey M, Schumacher M, Wang L, Raval H, Caulfield JP (2009) Period correction of the QTc of moxifloxacin with multiple predose baseline ECGs is the least variable of 4 methods tested. J Clin Pharmacol 49:534–539PubMedCrossRef
Metadata
Title
Effect of trabectedin on the QT interval in patients with advanced solid tumor malignancies
Authors
R. Thertulien
G. M. Manikhas
L. Y. Dirix
J. B. Vermorken
K. Park
M. M. Jain
J. J. Jiao
J. Natarajan
T. Parekh
P. Zannikos
A. P. Staddon
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
Cancer Chemotherapy and Pharmacology / Issue 2/2012
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-011-1697-6

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