Background: Lenvatinib is currently available as the first-line treatment for advanced unresectable hepatocellular carcinoma. We evaluated the relationship between its relative dose intensity (RDI) and response in clinical settings. Methods: From March 2018 to May 2019, 93 patients were administered lenvatinib at the Nagasaki University Hospital and its related facilities. Among these, 81 patients (66 men, 15 women, median age 72.0) who received lenvatinib were analyzed retrospectively. Results: Fourteen patients were Child–Pugh grade B, and 15 had received other systemic therapy. According to Response Evaluation Criteria in Solid Tumors (RECIST), the objective response (OR) rate was 17.3%. The overall survival (OS) was significantly better in the OR group (p = 0.011). There was a significant difference in RDI between the OR and non-OR groups (p < 0.05). The area under the receiver operating characteristics curve for OR prediction by the 4, 8, 12, and 16-week RDI were 0.666, 0.747, 0.731, and 0.704, respectively. In the 8-week RDI ≥67.0% group, OS was significantly better than in the 8-week RDI <67.0% group (p = 0.003). Conclusions: Because a sufficient RDI is required to achieve an OR, it is strongly recommended that lenvatinib should be administered to patients with good hepatic function and status.

Preparation of hard palm midfractions (PMF) and its use as a cocoa butter equivalent ingredient were studied. Hard PMF is obtained by multistep fractionation of palm oil involving dry fractionation (DF) and/or solvent fractionation (SF), usually using hexane or acetone. From our experience, in acetone, a polar solvent, symmetrical 1,3-disaturated triacylglycerols tend to selectively crystallize more than nonsymmetrical 1,2-or 2,3-disaturated triacylglycerols, making it suitable for obtaining the solid midfraction. Unfortunately, triacylglycerols are very soluble in hexane, and temperatures at least 15 degrees lower than those required for acetone must be used for equivalent crystal yields. On the other hand, DF is a less expensive and safer process. Thus, multistep fractionation combining DF and SF using acetone was developed to achieve sufficient removal of high-melting components, and further enrichment of 1,3-dipalmitoyl-2-oleoylglycerol and the hard PMF was obtained by triple-step fractionation of palm olein or double-step fractionation of soft PMF. Compared to conventional hard PMF, this hard PMF had a steeper melting curve and better snapping and sharp-melting qualities when used in chocolate. Heat resistance of the hard PMF chocolate was similar to the conventional hard PMF chocolate, and its bloom resistance could be improved by adding polyglycerol fatty acid esters. Paper no. J9713 in JAOCS 78, 455-460 (May 2001). Hard palm midfractions (PMF) used as an ingredient of cocoa butter equivalents (CBE) are obtained by multistep fractionation of palm oil (1). Palm oil is abundant, inexpensive, and a good source of CBE. For example, palm oil [iodine value (IV) = 51-53] can be fractionated into palm stearin (IV = 32-40) and palm olein (PO; IV = 56-58), and the PO can then be fractionated into soft PMF (sPMF; IV = 44-50) and palm super-olein (IV = 63-65). A hard PMF (IV = 34-36) can finally be obtained by fractionation of the sPMF by separation from the PO fraction (IV = 64-70) (all IV values depend on fractionating conditions).Hard PMF is rich in 1,3-dipalmitoyl-2-oleoylglycerol (POP) and is characterized by its hardness at room temperature and sharp melting property at around 30-35°C, like cocoa butter. However, the content of a few percent of highermelting trisaturated triacylglycerols (SSS) and of diacylglycerols (DG) in hard PMF has an adverse effect on these properties, and is best removed completely to achieve more rapid and complete melting in the mouth. From our experience, acetone, a polar solvent, is suitable for obtaining the solid midfraction, because symmetrical 1,3-disaturated triacylglycerols (SUS) in acetone tend to selectively crystallize more than nonsymmetrical 1,2-or 2,3-disaturated triacylglycerols (SSU), while in nonpolar hexane, both symmetrical and nonsymmetrical disaturated triacylglycerols (S 2 U) tend to be nonselectively crystallized. Triacylglycerols are very soluble in hexane, but this means that temperatures at least 15°C lower than those required for acetone must be used for equiv...

Pharmacokinetic exposures to fexofenadine (FEX) are reduced by apple juice (AJ); however, the relationship between the AJ volume and the degree of AJ‐FEX interaction has not been understood. In this crossover study, 10 healthy subjects received single doses of FEX 60 mg with different volumes (150, 300, and 600 mL) of AJ or water (control). To identify an AJ volume lacking clinically meaningful interaction, we tested a hypothesis that the 90% confidence interval (CI) for geometric mean ratio (GMR) of FEX AUCAJ/AUCwater is contained within a biocomparability bound of 0.5–2.0, with at least one tested volume of AJ. GMR (90% CI) of AUCAJ 150mL/AUCwater, AUCAJ 300mL/AUCwater, and AUCAJ 600mL/AUCwater were 0.903 (0.752–1.085), 0.593 (0.494–0.712), and 0.385 (0.321–0.462), respectively. While a moderate to large AJ‐FEX interaction is caused by a larger volumes of AJ (e.g., 300 to 600 mL), the effect of a small volume (e.g., 150 mL) appears to be not meaningful.

BackgroundCombination therapy of linezolid (LZD) and rifampicin (RFP) may be more effective than monotherapy for treating gram-positive bacterial infections, but several studies have suggested that RFP decreases LZD exposures, thereby increasing the risk of therapeutic failure and emergence of LZD-resistant strains. However, the mechanism of the drug-drug interaction between LZD and RFP is unknown.MethodsWe conducted a prospective, open-label, uncontrolled clinical study in Japanese patients receiving LZD and RFP to evaluate the effect of coadministered RFP on the concentration of LZD. In animal study in rats, the influence of coadministered RFP on the pharmacokinetics of LZD administered intravenously or orally was examined. Intestinal permeability was investigated with an Ussing chamber to assess whether coadministered RFP alters the absorption process of LZD in the intestine.ResultsOur clinical study indicated that multiple doses of RFP reduced the dose-normalized trough concentration of LZD at the first assessment day by an average of 65%. In an animal study, we found that multiple doses of RFP significantly decreased the area under the concentration-time curve, the maximum concentration and the bioavailability of orally administered LZD by 48%, 54% and 48%, respectively. In contrast, the pharmacokinetics of intravenously administered LZD was unaffected by the RFP pretreatment. However, investigation of the intestinal permeability of LZD revealed no difference in absorptive or secretory transport of LZD in the upper, middle and lower intestinal tissues between RFP-pretreated and control rats, even though RFP induced gene expression of multidrug resistance protein 1a and multidrug resistance-associated protein 2.ConclusionsTherapeutic drug monitoring may be important for avoiding subtherapeutic levels of LZD in the combination therapy. The drug-drug interaction between LZD and RFP may occur only after oral administration of LZD, but is not due to any change of intestinal permeability of LZD.Trial registrationUMIN, UMIN000004322. Registered 4 October 2010.