Pharmacokinetics of Erlotinib for the Treatment of High‐Grade Glioma in a Pediatric Patient with Cystic Fibrosis: Case Report and Review of the Literature

• Published in: Pharmacotherapy 2009-07, Vol.29 (7), p.858-866
• Main Authors: Christiansen, Shannon R., Broniscer, Alberto, Panetta, J. Carl, Stewart, Clinton F.
• Format: Article
• Language: English
• Subjects: Antineoplastic agents; Biological and medical sciences; Biological Availability; Brain Neoplasms - complications; Brain Neoplasms - drug therapy; Brain Neoplasms - radiotherapy; Chemotherapy; Child; Combined Modality Therapy; cystic fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - drug therapy; erlotinib; Erlotinib Hydrochloride; Errors of metabolism; Exocrine Pancreatic Insufficiency - complications; Exocrine Pancreatic Insufficiency - drug therapy; Female; Glioma - complications; Glioma - drug therapy; Glioma - radiotherapy; high‐grade glioma; Humans; Malabsorption Syndromes - etiology; Malabsorption Syndromes - physiopathology; Medical sciences; Metabolic diseases; Miscellaneous hereditary metabolic disorders; Neurology; Pancrelipase - pharmacology; Pancrelipase - therapeutic use; pediatric patient; pharmacokinetics; Pharmacology. Drug treatments; Protein Kinase Inhibitors - pharmacokinetics; Protein Kinase Inhibitors - therapeutic use; Quinazolines - pharmacokinetics; Quinazolines - therapeutic use; Tumors of the nervous system. Phacomatoses
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.29.7.858

A 12‐year‐old girl with cystic fibrosis was diagnosed with a high‐grade glioma after radiographic and biopsy results confirmed the primary intracranial lesion. She was treated with single‐agent erlotinib during and after daily localized radiation therapy. Pharmacokinetic studies were conducted to assess the effect of pancreatic enzyme deficiency and intestinal malabsorption secondary to cystic fibrosis on the bioavailability of orally administered erlotinib, a lipophilic drug. Pharmacokinetic analysis of plasma samples from days 1 and 8 demonstrated that absorption of oral erlotinib was not affected by the patient's cystic fibrosis when the drug was given concomitantly with pancreatic enzyme replacement. When pediatric patients with cystic fibrosis are receiving erlotinib or other lipophilic oral drugs, continued supplementation of pancreatic enzymes is recommended, with therapeutic drug monitoring of plasma drug concentrations when feasible, and close observation for therapeutic responses and adverse effects.