Population pharmacokinetic and covariate analyses of intravenous trastuzumab (Herceptin®), a HER2-targeted monoclonal antibody, in patients with a variety of solid tumors

• Published in: Cancer chemotherapy and pharmacology 2019-02, Vol.83 (2), p.329-340
• Main Authors: Quartino, Angelica L., Li, Hanbin, Kirschbrown, Whitney P., Mangat, Ranvir, Wada, D. Russell, Garg, Amit, Jin, Jin Y., Lum, Bert
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Antineoplastic Agents, Immunological - administration & dosage; Antineoplastic Agents, Immunological - pharmacokinetics; Aspartate aminotransferase; Body weight; Breast cancer; Cancer; Cancer Research; Case-Control Studies; Clinical trials; Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Computer simulation; ErbB-2 protein; Female; Follow-Up Studies; Gastric cancer; Humans; Immunoglobulin G; Immunotherapy; Incidence; Intravenous administration; Liver; Male; Medicine; Medicine & Public Health; Metastases; Middle Aged; Models, Statistical; Monoclonal antibodies; Neoplasms - drug therapy; Neoplasms - epidemiology; Neoplasms - pathology; Nonlinear analysis; Oncology; Original; Original Article; Patients; Pharmacokinetics; Pharmacology; Pharmacology/Toxicology; Prognosis; Receptor, ErbB-2 - antagonists & inhibitors; Receptor, ErbB-2 - immunology; San Francisco - epidemiology; Solid tumors; Targeted cancer therapy; Tissue Distribution; Trastuzumab; Trastuzumab - administration & dosage; Trastuzumab - pharmacokinetics; Tumors
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-018-3728-z

Purpose The aim of the study was to characterize the population pharmacokinetics (PK) of the intravenous formulation of trastuzumab, assess the impact of patient and pathological covariates on trastuzumab PK, and perform simulations to support dosing recommendations in special situations. Methods Serum trastuzumab concentrations were obtained from 1582 patients with metastatic breast cancer (MBC), early breast cancer (EBC), advanced gastric cancer (AGC), or other tumor types/healthy volunteers in 18 phase I, II, and III trials and analyzed by nonlinear mixed-effects modeling. Results A two-compartment model with parallel linear and nonlinear elimination best described the data. During treatment, linear clearance (CL) dominated, resulting in a total CL of 0.173–0.337 L/day, which is similar to other IgG1 monoclonal antibodies. Covariates influencing CL were baseline body weight, aspartate aminotransferase, albumin, gastric cancer, and the presence of liver metastases. MBC and EBC had similar PK parameters, while CL was higher in AGC. Simulations indicated that at least 95% of patients with BC reach concentrations  1 week would take approximately 6 weeks to get back within steady-state exposure range. Conclusions Trastuzumab PK for the intravenous formulation was well-described across cancer types, disease status, and regimens. No dose adjustment is required for any of the identified patient covariates. A 7-month serum washout period for trastuzumab is recommended. A reloading dose is required if a maintenance dose is missed by > 1 week.