Skip to main content
Top
Published in: Clinical Pharmacokinetics 2/2021

Open Access 01-02-2021 | NSCLC | Original Research Article

Population Pharmacokinetics of Brigatinib in Healthy Volunteers and Patients With Cancer

Authors: Neeraj Gupta, Xiaohui Wang, Elliot Offman, Marita Prohn, Narayana Narasimhan, David Kerstein, Michael J. Hanley, Karthik Venkatakrishnan

Published in: Clinical Pharmacokinetics | Issue 2/2021

Login to get access

Abstract

Background and objectives

Brigatinib is an oral tyrosine kinase inhibitor approved in multiple countries for the treatment of patients with anaplastic lymphoma kinase-positive metastatic non-small cell lung cancer who have progressed on or are intolerant to crizotinib. We report a population pharmacokinetic model-based analysis for brigatinib.

Methods

Plasma concentration–time data were collected from 442 participants (105 healthy volunteers and 337 patients with cancer) who received single or multiple doses of oral brigatinib in one of five trials. Data were analyzed using non-linear mixed-effects modeling (NONMEM software version 7.3).

Results

Brigatinib plasma concentrations were best described by a three-compartment model with a transit compartment input (number of transit compartments = 2.35; mean transit time = 0.9 h). The final model included albumin as a covariate on apparent clearance. None of the additional covariates examined, including sex, age, race, body weight, mild or moderate renal impairment, total bilirubin, aspartate aminotransferase, and alanine aminotransferase, were found to meaningfully explain variability in apparent clearance, suggesting that no dose adjustment is required based on these covariates.

Conclusions

Results from these population pharmacokinetic analyses informed the prescribing guidance for patients with mild or moderate renal impairment in the US Prescribing Information and the European Summary of Product Characteristics for brigatinib.
Appendix
Available only for authorised users
Literature
1.
go back to reference Katayama R, Khan TM, Benes C, et al. Therapeutic strategies to overcome crizotinib resistance in non-small cell lung cancers harboring the fusion oncogene EML4-ALK. Proc Natl Acad Sci USA. 2011;108:7535–40.CrossRef Katayama R, Khan TM, Benes C, et al. Therapeutic strategies to overcome crizotinib resistance in non-small cell lung cancers harboring the fusion oncogene EML4-ALK. Proc Natl Acad Sci USA. 2011;108:7535–40.CrossRef
2.
go back to reference Huang WS, Liu S, Zou D, et al. Discovery of brigatinib (AP26113), a phosphine oxide-containing, potent, orally active inhibitor of anaplastic lymphoma kinase. J Med Chem. 2016;59:4948–64.CrossRef Huang WS, Liu S, Zou D, et al. Discovery of brigatinib (AP26113), a phosphine oxide-containing, potent, orally active inhibitor of anaplastic lymphoma kinase. J Med Chem. 2016;59:4948–64.CrossRef
3.
go back to reference Gettinger SN, Bazhenova LA, Langer CJ, et al. Activity and safety of brigatinib in ALK-rearranged non-small-cell lung cancer and other malignancies: a single-arm, open-label, phase 1/2 trial. Lancet Oncol. 2016;17:1683–96.CrossRef Gettinger SN, Bazhenova LA, Langer CJ, et al. Activity and safety of brigatinib in ALK-rearranged non-small-cell lung cancer and other malignancies: a single-arm, open-label, phase 1/2 trial. Lancet Oncol. 2016;17:1683–96.CrossRef
4.
go back to reference Kim DW, Tiseo M, Ahn MJ, et al. Brigatinib in patients with crizotinib-refractory anaplastic lymphoma kinase-positive non-small-cell lung cancer: a randomized, multicenter phase II trial. J Clin Oncol. 2017;35:2490–8.CrossRef Kim DW, Tiseo M, Ahn MJ, et al. Brigatinib in patients with crizotinib-refractory anaplastic lymphoma kinase-positive non-small-cell lung cancer: a randomized, multicenter phase II trial. J Clin Oncol. 2017;35:2490–8.CrossRef
5.
go back to reference Huber RM, Hansen KH, Rodríguez LP, et al. Brigatinib in crizotinib-refractory ALK + NSCLC: 2-year follow-up on systemic and intracranial outcomes in the phase 2 ALTA trial. J Thorac Oncol. 2020;15:404–15.CrossRef Huber RM, Hansen KH, Rodríguez LP, et al. Brigatinib in crizotinib-refractory ALK + NSCLC: 2-year follow-up on systemic and intracranial outcomes in the phase 2 ALTA trial. J Thorac Oncol. 2020;15:404–15.CrossRef
6.
go back to reference Camidge DR, Kim DW, Tiseo M, et al. Exploratory analysis of brigatinib activity in patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer and brain metastases in two clinical trials. J Clin Oncol. 2018;36:2693–701.CrossRef Camidge DR, Kim DW, Tiseo M, et al. Exploratory analysis of brigatinib activity in patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer and brain metastases in two clinical trials. J Clin Oncol. 2018;36:2693–701.CrossRef
7.
go back to reference Ng TL, Narasimhan N, Gupta N, Venkatakrishnan K, Kerstein D, Camidge DR. Early-onset pulmonary events associated with brigatinib use in advanced NSCLC. J Thorac Oncol. 2020;15:1190–9.CrossRef Ng TL, Narasimhan N, Gupta N, Venkatakrishnan K, Kerstein D, Camidge DR. Early-onset pulmonary events associated with brigatinib use in advanced NSCLC. J Thorac Oncol. 2020;15:1190–9.CrossRef
8.
go back to reference Camidge DR, Kim HR, Ahn MJ, et al. Brigatinib versus crizotinib in ALK-positive non-small-cell lung cancer. N Engl J Med. 2018;379:2027–39.CrossRef Camidge DR, Kim HR, Ahn MJ, et al. Brigatinib versus crizotinib in ALK-positive non-small-cell lung cancer. N Engl J Med. 2018;379:2027–39.CrossRef
9.
go back to reference Alunbrig [package insert]. Cambridge (MA): Takeda Pharmaceutical Company Limited; 2020. Alunbrig [package insert]. Cambridge (MA): Takeda Pharmaceutical Company Limited; 2020.
10.
go back to reference Tugnait M, Gupta N, Hanley MJ, et al. The effect of a high-fat meal on the pharmacokinetics of brigatinib, an oral anaplastic lymphoma kinase inhibitor, in healthy volunteers. Clin Pharmacol Drug Dev. 2019;8:734–41.CrossRef Tugnait M, Gupta N, Hanley MJ, et al. The effect of a high-fat meal on the pharmacokinetics of brigatinib, an oral anaplastic lymphoma kinase inhibitor, in healthy volunteers. Clin Pharmacol Drug Dev. 2019;8:734–41.CrossRef
11.
go back to reference Tugnait M, Gupta N, Hanley MJ, et al. Effects of strong CYP2C8 or CYP3A inhibition and CYP3A induction on the pharmacokinetics of brigatinib, an oral anaplastic lymphoma kinase inhibitor, in healthy volunteers. Clin Pharmacol Drug Dev. 2020;9:214–23.CrossRef Tugnait M, Gupta N, Hanley MJ, et al. Effects of strong CYP2C8 or CYP3A inhibition and CYP3A induction on the pharmacokinetics of brigatinib, an oral anaplastic lymphoma kinase inhibitor, in healthy volunteers. Clin Pharmacol Drug Dev. 2020;9:214–23.CrossRef
12.
go back to reference Bauer RJ. NONMEM users guide: introduction to NONMEM 7.3.0. Gaithersburg (MD): ICON Development Solutions; 2015. Bauer RJ. NONMEM users guide: introduction to NONMEM 7.3.0. Gaithersburg (MD): ICON Development Solutions; 2015.
13.
go back to reference R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2013. R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2013.
14.
go back to reference Savic RM, Jonker DM, Kerbusch T, Karlsson MO. Implementation of a transit compartment model for describing drug absorption in pharmacokinetic studies. J Pharmacokinet Pharmacodyn. 2007;34:711–26.CrossRef Savic RM, Jonker DM, Kerbusch T, Karlsson MO. Implementation of a transit compartment model for describing drug absorption in pharmacokinetic studies. J Pharmacokinet Pharmacodyn. 2007;34:711–26.CrossRef
15.
go back to reference Duffull SB, Wright DF, Winter HR. Interpreting population pharmacokinetic-pharmacodynamic analyses: a clinical viewpoint. Br J Clin Pharmacol. 2011;71:807–14.CrossRef Duffull SB, Wright DF, Winter HR. Interpreting population pharmacokinetic-pharmacodynamic analyses: a clinical viewpoint. Br J Clin Pharmacol. 2011;71:807–14.CrossRef
16.
go back to reference Jonsson EN, Karlsson MO. Automated covariate model building within NONMEM. Pharm Res. 1998;15:1463–8.CrossRef Jonsson EN, Karlsson MO. Automated covariate model building within NONMEM. Pharm Res. 1998;15:1463–8.CrossRef
17.
go back to reference Karlsson MO, Savic RM. Diagnosing model diagnostics. Clin Pharmacol Ther. 2007;82:17–20.CrossRef Karlsson MO, Savic RM. Diagnosing model diagnostics. Clin Pharmacol Ther. 2007;82:17–20.CrossRef
18.
go back to reference Savic RM, Karlsson MO. Importance of shrinkage in empirical Bayes estimates for diagnostics: problems and solutions. AAPS J. 2009;11:558–69.CrossRef Savic RM, Karlsson MO. Importance of shrinkage in empirical Bayes estimates for diagnostics: problems and solutions. AAPS J. 2009;11:558–69.CrossRef
19.
go back to reference Nguyen TH, Mouksassi MS, Holford N, et al. Model evaluation of continuous data pharmacometric models: metrics and graphics. CPT Pharmacometr Syst Pharmacol. 2017;6:87–109.CrossRef Nguyen TH, Mouksassi MS, Holford N, et al. Model evaluation of continuous data pharmacometric models: metrics and graphics. CPT Pharmacometr Syst Pharmacol. 2017;6:87–109.CrossRef
20.
go back to reference Bergstrand M, Hooker AC, Wallin JE, Karlsson MO. Prediction-corrected visual predictive checks for diagnosing nonlinear mixed-effects models. AAPS J. 2011;13:143–51.CrossRef Bergstrand M, Hooker AC, Wallin JE, Karlsson MO. Prediction-corrected visual predictive checks for diagnosing nonlinear mixed-effects models. AAPS J. 2011;13:143–51.CrossRef
21.
go back to reference Venkatakrishnan K, Friberg LE, Ouellet D, et al. Optimizing oncology therapeutics through quantitative translational and clinical pharmacology: challenges and opportunities. Clin Pharmacol Ther. 2015;97:37–54.CrossRef Venkatakrishnan K, Friberg LE, Ouellet D, et al. Optimizing oncology therapeutics through quantitative translational and clinical pharmacology: challenges and opportunities. Clin Pharmacol Ther. 2015;97:37–54.CrossRef
22.
go back to reference Faucette S, Wagh S, Trivedi A, Venkatakrishnan K, Gupta N. Reverse translation of US Food and Drug Administration reviews of oncology new molecular entities approved in 2011–2017: lessons learned for anticancer drug development. Clin Transl Sci. 2018;11:123–46.CrossRef Faucette S, Wagh S, Trivedi A, Venkatakrishnan K, Gupta N. Reverse translation of US Food and Drug Administration reviews of oncology new molecular entities approved in 2011–2017: lessons learned for anticancer drug development. Clin Transl Sci. 2018;11:123–46.CrossRef
23.
go back to reference Gupta N, Hanley MJ, Diderichsen PM, et al. Model-informed drug development for ixazomib, an oral proteasome inhibitor. Clin Pharmacol Ther. 2019;105:376–87.CrossRef Gupta N, Hanley MJ, Diderichsen PM, et al. Model-informed drug development for ixazomib, an oral proteasome inhibitor. Clin Pharmacol Ther. 2019;105:376–87.CrossRef
24.
go back to reference Gupta N, Zhao Y, Hui AM, Esseltine DL, Venkatakrishnan K. Switching from body surface area-based to fixed dosing for the investigational proteasome inhibitor ixazomib: a population pharmacokinetic analysis. Br J Clin Pharmacol. 2015;79:789–800.CrossRef Gupta N, Zhao Y, Hui AM, Esseltine DL, Venkatakrishnan K. Switching from body surface area-based to fixed dosing for the investigational proteasome inhibitor ixazomib: a population pharmacokinetic analysis. Br J Clin Pharmacol. 2015;79:789–800.CrossRef
25.
go back to reference Mathijssen RH, de Jong FA, Loos WJ, van der Bol JM, Verweij J, Sparreboom A. Flat-fixed dosing versus body surface area based dosing of anticancer drugs in adults: does it make a difference? Oncologist. 2007;12:913–23.CrossRef Mathijssen RH, de Jong FA, Loos WJ, van der Bol JM, Verweij J, Sparreboom A. Flat-fixed dosing versus body surface area based dosing of anticancer drugs in adults: does it make a difference? Oncologist. 2007;12:913–23.CrossRef
26.
go back to reference Venkatakrishnan K, Burgess C, Gupta N, et al. Toward optimum benefit-risk and reduced access lag for cancer drugs in Asia: a global development framework guided by clinical pharmacology principles. Clin Transl Sci. 2016;9:9–22.CrossRef Venkatakrishnan K, Burgess C, Gupta N, et al. Toward optimum benefit-risk and reduced access lag for cancer drugs in Asia: a global development framework guided by clinical pharmacology principles. Clin Transl Sci. 2016;9:9–22.CrossRef
28.
go back to reference Perazella MA. Onco-nephrology: renal toxicities of chemotherapeutic agents. Clin J Am Soc Nephrol. 2012;7:1713–21.CrossRef Perazella MA. Onco-nephrology: renal toxicities of chemotherapeutic agents. Clin J Am Soc Nephrol. 2012;7:1713–21.CrossRef
29.
go back to reference de Castria TB, da Silva EM, Gois AF, Riera R. Cisplatin versus carboplatin in combination with third-generation drugs for advanced non-small cell lung cancer. Cochrane Database Syst Rev. 2013;(1):CD009256. de Castria TB, da Silva EM, Gois AF, Riera R. Cisplatin versus carboplatin in combination with third-generation drugs for advanced non-small cell lung cancer. Cochrane Database Syst Rev. 2013;(1):CD009256.
30.
go back to reference Alunbrig [summary of product characteristics]. Taastrup: Takeda Pharmaceuticals, Inc.; 2020. Alunbrig [summary of product characteristics]. Taastrup: Takeda Pharmaceuticals, Inc.; 2020.
31.
go back to reference Zhang S, Anjum R, Squillace R, et al. The potent ALK inhibitor brigatinib (AP26113) overcomes mechanisms of resistance to first- and second-generation ALK inhibitors in preclinical models. Clin Cancer Res. 2016;22:5527–38.CrossRef Zhang S, Anjum R, Squillace R, et al. The potent ALK inhibitor brigatinib (AP26113) overcomes mechanisms of resistance to first- and second-generation ALK inhibitors in preclinical models. Clin Cancer Res. 2016;22:5527–38.CrossRef
32.
go back to reference Gainor JF, Dardaei L, Yoda S, et al. Molecular mechanisms of resistance to first- and second-generation ALK inhibitors in ALK-rearranged lung cancer. Cancer Discov. 2016;6:1118–33.CrossRef Gainor JF, Dardaei L, Yoda S, et al. Molecular mechanisms of resistance to first- and second-generation ALK inhibitors in ALK-rearranged lung cancer. Cancer Discov. 2016;6:1118–33.CrossRef
Metadata
Title
Population Pharmacokinetics of Brigatinib in Healthy Volunteers and Patients With Cancer
Authors
Neeraj Gupta
Xiaohui Wang
Elliot Offman
Marita Prohn
Narayana Narasimhan
David Kerstein
Michael J. Hanley
Karthik Venkatakrishnan
Publication date
01-02-2021
Publisher
Springer International Publishing
Published in
Clinical Pharmacokinetics / Issue 2/2021
Print ISSN: 0312-5963
Electronic ISSN: 1179-1926
DOI
https://doi.org/10.1007/s40262-020-00929-4

Other articles of this Issue 2/2021

Clinical Pharmacokinetics 2/2021 Go to the issue