A Physiologically-Based Pharmacokinetic Modeling Approach To Predict Drug–Drug Interactions of Sonidegib (LDE225) with Perpetrators of CYP3A in Cancer Patients

Abstract

Sonidegib (Odomzo) is an orally available Smoothened inhibitor for the treatment of advanced basal cell carcinoma. Sonidegib was found to be metabolized primarily by cytochrome P450 (CYP)3A in vitro. The effect of multiple doses of the strong CYP3A perpetrators, ketoconazole (KTZ) and rifampin (RIF), on sonidegib pharmacokinetics (PK) after a single 800 mg dose in healthy subjects was therefore assessed. These data were used to verify a physiologically-based pharmacokinetic (PBPK) model developed to 1) bridge the clinical drugdrug interaction (DDI) study of sonidegib with KTZ and RIF in healthy subjects to the marketed dose (200 mg) in patients 2) predict acute (14 days) versus long-term dosing of the perpetrators with sonidegib at steady state and 3) predict the effect of moderate CYP3A perpetrators on sonidegib exposure in patients. Treatment of healthy subjects with KTZ resulted in an increased sonidegib exposure of 2.25- and 1.49-fold (area under the curve and maximal concentration respectively), and RIF decreased exposure by 72% and 54%, respectively. The model simulated the single- and/or multiple-dose PK of sonidegib (healthy subjects and patients) within ∼50% of observed values. The effect of KTZ and RIF on sonidegib in healthy subjects was also simulated well, and the predicted DDI in patients was slightly less and independent of sonidegib dose. At steady state, sonidegib was predicted to have a higher DDI magnitude with strong or moderate CYP3A perpetrators compared with a single dose. Different dosing regimens of sondigeb with the perpetrators were also simulated and provided guidance to the current dosing recommendations incorporated in the product label.

A Drug‐Drug Interaction Study to Evaluate the Effect of TAS‐303 on CYP3A Activity in the Small Intestine and Liver

“…Thus, there is a marked discrepancy between the estimated and actual values for the AUC ratio. We suggest some possible reasons for this discrepancy: uncertainties in key input parameters, such as the K deg of CYP3A, K i , and K inact of TAS‐303, may be alienated from in vivo data; the differential equations for intestinal inhibition implemented in the DDI simulator provide a static rather than dynamic model, and not accounting for the intestinal tissue binding of TAS‐303 in this model (the unbound fraction was assumed to be unity) may lead to an overestimation of unbound TAS‐303 concentration in enterocytes and its inhibitory effect on intestinal CYP3A activity . To reasonably describe the observed DDI between TAS‐303 and simvastatin, the current PBPK model of TAS‐303 needs to be further refined based on emerging preclinical and clinical findings through the future development of TAS‐303.…”

Oral oncolytic and antiretroviral therapy administration: dose adjustments, drug interactions, and other considerations for clinical use

“…Sonidegib is metabolized predominantly by CYP3A4 and does not inhibit or induce any other CYP3A4 enzyme systems to any great extent. Clinical studies included in the package labeling demonstrate co-administration with moderate or strong CYP3A4 inhibitor increased sonidegib AUC by 1.8- and 2.2-fold, respectively 79,81. Therefore, concomitant use with PIs or cobicistat should be avoided.…”

The effect of sonidegib (LDE225) on the pharmacokinetics of bupropion and warfarin in patients with advanced solid tumours

“…Ketoconazole, a potent CYP3A4 inhibitor, increased sonidegib AUC 0‐240h 2.25‐fold (90% CI: 1.78–2.86) and C max 1.49‐fold (90% CI: 1.11–1.99). In contrast, rifampicin, a CYP3A4 inducer, decreased 800 mg PO QD sonidegib AUC 0‐240h exposure by 72% (ratio 0.28, 90% CI: 0.22–0.35) and C max by 54% (ratio 0.46, 90% CI 0.35–0.61) 10 . Thus, the FDA‐approved product labelling indicates that concomitant administration of sonidegib with moderate–strong CYP3A inhibitors and moderate–strong CYP3A inducers should be avoided 8 .…”

“…Based on population pharmacokinetic (PK) modelling the elimination half‐life of sonidegib was 28 days. Little or no parent sonidegib was found in the urine as it is primarily cleared from the body in humans by hepatic metabolism, predominantly via CYP3A 8,10,11 . Sonidegib treatment of human liver microsomes showed inhibition of CYP2B6 (IC 50 ~ 0.5 μmol L −1 ; inhibitor constant [K i ] 0.045 μmol L −1 , substrate bupropion) and CYP2C9 (IC 50 ~ 5 μmol L −1 ; K i 1.7 μmol L −1 , substrate diclofenac).…”