43 research outputs found
Towards a pharmacologically guided individualization of imatinib and sunitnib therapy
The approval of imatinib mesylate (Gleeve) in 2001 has added a new class of drugs to
the systemic treatment of cancer: that of the tyrosine kinase inhibitors (TKIs). Imatinib
inhibits autophosphorylation of specific proteins involved in oncogenesis such as the
BCR-ABL fusion protein (expressed in Philadelphia chromosome positive chronic myeloid
leukemia), c-KIT (expressed in gastrointestinal stromal tumors; GIST) and the plateletderived
growth factor receptor (PDGFR; i.e. expressed in GIST and several sarcomas).
After a decade of therapeutic use, imatinib has proven to be a highly effective targeted
agent with a median overall survival in advanced GIST patients close to 5 years
Tamoxifen use and potential effects on liver parenchyma:A long-term prospective transient elastographic evaluation
Tamoxifen is a commonly prescribed drug in both early and metastatic breast cancer. Prospective studies in Asian populations demonstrated that tamoxifenârelated liver steatosis occurred in more than 30% of the patients within 2âyears after start of treatment. No wellâdesigned prospective studies on potential tamoxifenârelated liver steatosis have been conducted in Caucasian patients so far. Therefore, our prospective study aimed to assess the incidence of tamoxifenârelated liver steatosis for a period of 2âyears in a population of Caucasian breast cancer patients treated with tamoxifen. Patients with an indication for adjuvant treatment with tamoxifen were included in this study. Data were collected at 3 months (T1) and at 2âyears (T2) after start of tamoxifen treatment (followâup period of 21âmonths). For the quantification of liver steatosis, patients underwent liver stiffness measurement by transient elastography with simultaneous controlled attenuation parameter (CAP) determination using the FibroScan. A total of 95 Caucasian breast cancer patients were included in this evaluation. Liver steatosis was observed in 46 of 95 (48%) and 48 of 95 (51%) of the patients at T1 and T2, respectively. No clinically relevant increase in liver steatosis was observed during the treatment period of 2âyears with tamoxifen (median CAP = 243â±â49âdB/m (T1) and 253â±â55âdB/m (T2), respectively; p = 0.038). Conclusion: In this prospective longitudinal study in Caucasian breast cancer patients, no clinically relevant alterations in liver steatosis in terms of CAP values and liver/lipid parameters were observed after 2âyears of tamoxifen treatment. This study therefore demonstrates an absence of tamoxifenârelated adverse events such as steatosis and (early) development of fibrosis or cirrhosis during a treatment period of at least 2âyears
Prospective Analysis in GIST Patients on the Role of Alpha-1 Acid Glycoprotein in Imatinib Exposure
Background: For imatinib, a relationship between systemic exposure and clinical outcome has been suggested. Importantly, imatinib concentrations are not stable and decrease over time, for which several mechanisms have been suggested. In this study, we investigated if a decrease in alpha-1 acid glycoprotein (AGP) is the main cause of the lowering in imatinib exposure over time. Methods: We prospectively measured imatinib trough concentration (Cmin) values in 28 patients with gastrointestinal stromal tumours, at 1, 3 and 12 months after the start of imatinib treatment. At the same time points, AGP levels were measured. Results: Overall, imatinib Cmin and AGP levels were correlated (r2 = 0.656; P < 0.001). However, AGP levels did not fluctuate significantly over time, nor did the change in AGP levels correlate with the change in the imatinib Cmin. Conclusion: We showed that systemic AGP levels are not likely to be a key player in the decrease in systemic imatinib exposure over time. As long as intra-individual changes in imatinib exposure remain unexplained, researchers should standardize the sampling times for imatinib in order to be able to assess the clinical applicability of therapeutic drug monitoring
Tumor Volume as an Alternative Response Measurement for Imatinib Treated GIST Patients
Background: Assessment of tumor size changes is crucial in clinical trials and patient care. We compared imatinib-induced volume changes of liver metastases (LM) from gastro-intestinal stromal tumors (GIST) to RECIST and Choi criteria and their association with overall survival (OS). Methods: LM from 84 GIST p
Influence of probenecid on the pharmacokinetics and pharmacodynamics of sorafenib
Prior studies have demonstrated an organic anion transporter 6 (OAT6)-mediated accumulation of sorafenib in keratinocytes. The OAT6 inhibitor probenecid decreases sorafenib uptake in skin and might, therefore, decrease sorafenib-induced cutaneous adverse events. Here, the influence of probenecid on sorafenib pharmacokinetics and toxicity was investigated. Pharmacokinetic sampling was performed in 16 patients on steady-state sorafenib treatment at days 1 and 15 of the study. Patients received sorafenib (200â800 mg daily) in combination with probenecid (500 mg two times daily (b.i.d.)) on days 2â15. This study was designed to determine bioequivalence with geometric mean Area under the curve from zero to twelve hours (AUC0â12 h) as primary endpoint. During concomitant probenecid, s