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Current Drug Metabolism


ISSN (Print): 1389-2002
ISSN (Online): 1875-5453

Drug Interaction Potential of Trastuzumab Emtansine (T-DM1) Combined with Pertuzumab in Patients With HER2-Positive Metastatic Breast Cancer

Author(s): Dan Lu, Howard A. Burris III, Bei Wang, E. Claire Dees, Javier Cortes, Amita Joshi, Manish Gupta, Joo-Hee Yi, Yu-Waye Chu, Ted Shih, Liang Fang and Sandhya Girish

Volume 13, Issue 7, 2012

Page: [911 - 922] Pages: 12

DOI: 10.2174/138920012802138688

Price: $65


Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate comprised of trastuzumab and the cytotoxic agent DM1 (derivative of maytansine) linked by a stable linker N-succinimidyl 4-(N-maleimidomethyl) cyclohexane-1-carboxylate (SMCC). T-DM1 targets an epitope located at subdomain IV of human epidermal growth factor receptor 2 (HER2). Pertuzumab is a monoclonal antibody that targets an epitope located at subdomain II of HER2, distinct from the epitope recognized by T-DM1. The pharmacokinetics (PK), safety, and efficacy of T-DM1 combined with pertuzumab were studied in a phase 1b/2 trial in 67 patients with HER2-positive, locally advanced or metastatic breast cancer (MBC). The therapeutic protein-drug interaction (TP-DI) potential of T-DM1 plus pertuzumab was evaluated. The PK of T-DM1–related analytes and pertuzumab were compared with historical PK data. The results show that the exposure of T-DM1 and DM1, as estimated by noncompartmental analyses, was comparable with that reported by historical single-agent studies in patients with HER2-positive MBC. T-DM1 clearance and volume of distribution in the central compartment, as estimated by population PK analysis, were also comparable between this study and historical single-agent studies in patients with HER2-positive MBC. Summary statistics of pertuzumab trough and maximal exposure (concentrations at predose and 15–30 minutes after the end of infusion at cycle 1 and at steady state) were similar with those observed in a representative historical single-agent study with the same dosing regimen. The visual predictive check plot by population simulation further confirmed that T-DM1 did not alter pertuzumab PK. Based on these data and the PK and pharmacodynamic properties of T-DM1 and pertuzumab, the risk of TP-DI appears to be low when T-DM1 and pertuzumab are given together.

Keywords: HER2, metastatic breast cancer, pertuzumab, pharmacokinetics, therapeutic protein-drug interactions, trastuzumab emtansine, Interaction, cytotoxic agent, PK analysis, T-DM1, noncompartmental analyses.

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