Clinical Pharmacokinetics of Anaplastic Lymphoma Kinase Inhibitors in Non-Small-Cell Lung Cancer

AbstractThe identification of anaplastic lymphoma kinase rearrangements in 2 –5% of patients with non-small-cell lung cancer led to rapid advances in the clinical development of oral tyrosine kinase inhibitors. Anaplastic lymphoma kinase inhibitors are an effective treatment in preclinical models and patients with anaplastic lymphoma kinase-translocated cancers. Four anapl astic lymphoma kinase inhibitors (crizotinib, ceritinib, alectinib, and brigatinib) have recently been approved. Post-marketing studies provided additional pharmacokinetic information on their pharmacokinetic parameters. The pharmacokinetic properties of approved anaplastic lymphoma kinase inhibitor s have been reviewed herein. Findings from additional studies on the effects of drug-metabolizing enzymes, drug transporters, and drug–drug interactions have been incorporated. Crizotinib, ceritinib, and alectinib reach their maximum plasma concentrations after approximately 6 h and brigatinib af ter 1–4 h. These drugs are primarily metabolized by cytochrome P450 3A with other cytochrome P450 enzymes. They are mainly excreted in the feces, with only a minor fraction being eliminated in urine. Crizotinib, ceritinib, and brigatinib are substrates for the adenosine triphosphate binding-casse tte transporter B1, whereas alectinib is not. The different substrate specificities of the transporters play a key role in superior blood–brain barrier penetration by alectinib than by crizotinib and ceritinib. Althou...

Source: Clinical Pharmacokinetics - June 19, 2018 Category: Drugs & Pharmacology Source Type: research