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      A phase 1, open-label, drug–drug interaction study of rucaparib with rosuvastatin and oral contraceptives in patients with advanced solid tumors

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          Abstract

          Purpose

          This study aimed at evaluating the effect of rucaparib on the pharmacokinetics of rosuvastatin and oral contraceptives in patients with advanced solid tumors and the safety of rucaparib with and without coadministration of rosuvastatin or oral contraceptives.

          Methods

          Patients received single doses of oral rosuvastatin 20 mg (Arm A) or oral contraceptives ethinylestradiol 30 µg + levonorgestrel 150 µg (Arm B) on days 1 and 19 and continuous doses of rucaparib 600 mg BID from day 5 to 23. Serial blood samples were collected with and without rucaparib for pharmacokinetic analysis.

          Results

          Thirty-six patients ( n = 18 each arm) were enrolled and received at least 1 dose of study drug. In the drug–drug interaction analysis ( n = 15 each arm), the geometric mean ratio (GMR) of maximum concentration ( C max) with and without rucaparib was 1.29 for rosuvastatin, 1.09 for ethinylestradiol, and 1.19 for levonorgestrel. GMR of area under the concentration–time curve from time zero to last quantifiable measurement (AUC 0–last) was 1.34 for rosuvastatin, 1.43 for ethinylestradiol, and 1.56 for levonorgestrel. There was no increase in frequency of treatment-emergent adverse events (TEAEs) when rucaparib was given with either of the probe drugs. In both arms, most TEAEs were mild in severity and considered unrelated to study treatment.

          Conclusion

          Rucaparib 600 mg BID weakly increased the plasma exposure to rosuvastatin or oral contraceptives. Rucaparib safety profile when coadministered with rosuvastatin or oral contraceptives was consistent with that of rucaparib monotherapy. Dose adjustments of rosuvastatin and oral contraceptives are not necessary when coadministered with rucaparib.

          ClinicalTrials.gov NCT03954366; Date of registration May 17, 2019.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00280-021-04338-7.

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          Most cited references21

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          New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).

          Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics: both tumour shrinkage (objective response) and disease progression are useful endpoints in clinical trials. Since RECIST was published in 2000, many investigators, cooperative groups, industry and government authorities have adopted these criteria in the assessment of treatment outcomes. However, a number of questions and issues have arisen which have led to the development of a revised RECIST guideline (version 1.1). Evidence for changes, summarised in separate papers in this special issue, has come from assessment of a large data warehouse (>6500 patients), simulation studies and literature reviews. HIGHLIGHTS OF REVISED RECIST 1.1: Major changes include: Number of lesions to be assessed: based on evidence from numerous trial databases merged into a data warehouse for analysis purposes, the number of lesions required to assess tumour burden for response determination has been reduced from a maximum of 10 to a maximum of five total (and from five to two per organ, maximum). Assessment of pathological lymph nodes is now incorporated: nodes with a short axis of 15 mm are considered measurable and assessable as target lesions. The short axis measurement should be included in the sum of lesions in calculation of tumour response. Nodes that shrink to <10mm short axis are considered normal. Confirmation of response is required for trials with response primary endpoint but is no longer required in randomised studies since the control arm serves as appropriate means of interpretation of data. Disease progression is clarified in several aspects: in addition to the previous definition of progression in target disease of 20% increase in sum, a 5mm absolute increase is now required as well to guard against over calling PD when the total sum is very small. Furthermore, there is guidance offered on what constitutes 'unequivocal progression' of non-measurable/non-target disease, a source of confusion in the original RECIST guideline. Finally, a section on detection of new lesions, including the interpretation of FDG-PET scan assessment is included. Imaging guidance: the revised RECIST includes a new imaging appendix with updated recommendations on the optimal anatomical assessment of lesions. A key question considered by the RECIST Working Group in developing RECIST 1.1 was whether it was appropriate to move from anatomic unidimensional assessment of tumour burden to either volumetric anatomical assessment or to functional assessment with PET or MRI. It was concluded that, at present, there is not sufficient standardisation or evidence to abandon anatomical assessment of tumour burden. The only exception to this is in the use of FDG-PET imaging as an adjunct to determination of progression. As is detailed in the final paper in this special issue, the use of these promising newer approaches requires appropriate clinical validation studies.
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            Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial

            Rucaparib, a poly(ADP-ribose) polymerase inhibitor, has anticancer activity in recurrent ovarian carcinoma harbouring a BRCA mutation or high percentage of genome-wide loss of heterozygosity. In this trial we assessed rucaparib versus placebo after response to second-line or later platinum-based chemotherapy in patients with high-grade, recurrent, platinum-sensitive ovarian carcinoma.
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              Rucaparib in relapsed, platinum-sensitive high-grade ovarian carcinoma (ARIEL2 Part 1): an international, multicentre, open-label, phase 2 trial

              Poly(ADP-ribose) polymerase (PARP) inhibitors have activity in ovarian carcinomas with homologous recombination deficiency. Along with BRCA1 and BRCA2 (BRCA) mutations genomic loss of heterozygosity (LOH) might also represent homologous recombination deficiency. In ARIEL2, we assessed the ability of tumour genomic LOH, quantified with a next-generation sequencing assay, to predict response to rucaparib, an oral PARP inhibitor.
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                Author and article information

                Contributors
                jxiao@clovisoncology.com
                Journal
                Cancer Chemother Pharmacol
                Cancer Chemother Pharmacol
                Cancer Chemotherapy and Pharmacology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0344-5704
                1432-0843
                9 August 2021
                9 August 2021
                2021
                : 88
                : 5
                : 887-897
                Affiliations
                [1 ]GRID grid.428464.8, ISNI 0000 0004 0493 2614, Clinical Pharmacology, , Clovis Oncology, Inc 5500 Flatrion Pkwy, ; Boulder, CO 80301 USA
                [2 ]GRID grid.460480.e, Department of Gerontology, Public Health and Didactics, , National Institute of Geriatrics, Rheumatology and Rehabilitation, ; Warsaw, Poland
                [3 ]GRID grid.418165.f, ISNI 0000 0004 0540 2543, Maria Skłodowska-Curie National Research Institute of Oncology, ; Warsaw, Poland
                [4 ]GRID grid.476876.c, BioVirtus Research Site Sp. Z.O.O., , BioVirtus Medical Centre, ; Józefów, Poland
                [5 ]Oncology Unit, Istenhegy Private Health Center, Budapest, Hungary
                [6 ]GRID grid.418165.f, ISNI 0000 0004 0540 2543, Gynecological Oncology Clinic, Centre of Oncology, , Maria Skłodowska-Curie Memorial Institute, ; Krakow, Poland
                [7 ]Pleiades Medical Centre, Krakow, Poland
                [8 ]Department of Internal Medicine and Clinical Pharmacology, Summit Clinical Research, Bratislava, Slovakia
                [9 ]Department of Oncology and Hematology, Provincial Specialist Hospital, Biala Podlaska, Poland
                [10 ]GRID grid.22254.33, ISNI 0000 0001 2205 0971, Department of Oncology, , Poznan University of Medical Sciences, ; Poznań, Poland
                [11 ]Department of Chemotherapy, ATTIS Centre, Warsaw, Poland
                [12 ]GRID grid.476183.f, ISNI 0000 0004 0495 2551, Regulatory Affairs, , Clovis Oncology UK, Ltd., ; Cambridge, UK
                [13 ]GRID grid.476183.f, ISNI 0000 0004 0495 2551, Medical Affairs, , Clovis Oncology UK, Ltd., ; Cambridge, UK
                [14 ]GRID grid.428464.8, ISNI 0000 0004 0493 2614, Biostatistics, , Clovis Oncology, Inc., ; Boulder, CO USA
                [15 ]GRID grid.428464.8, ISNI 0000 0004 0493 2614, Clinical Operations, , Clovis Oncology, Inc., ; Boulder, CO USA
                [16 ]GRID grid.476183.f, ISNI 0000 0004 0495 2551, Clinical Science, , Clovis Oncology UK, Ltd., ; Cambridge, UK
                Author information
                http://orcid.org/0000-0003-3632-2012
                Article
                4338
                10.1007/s00280-021-04338-7
                8484168
                34370076
                0124291e-ed3b-4e28-9fd9-8224b1b9507d
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 4 May 2021
                : 23 July 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100014487, Clovis Oncology;
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                Oncology & Radiotherapy
                bcrp,drug–drug interaction,oncology,oral contraceptives,rucaparib
                Oncology & Radiotherapy
                bcrp, drug–drug interaction, oncology, oral contraceptives, rucaparib

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