Pharmacokinetics and safety of rucaparib in patients with advanced solid tumors and hepatic impairment

• Published in: Cancer chemotherapy and pharmacology 2021-08, Vol.88 (2), p.259-270
• Main Authors: Grechko, Nikolay, Skarbova, Viera, Tomaszewska-Kiecana, Monika, Ramlau, Rodryg, Centkowski, Piotr, Drew, Yvette, Dziadziuszko, Rafal, Zemanova, Milada, Beltman, Jeri, Nash, Eileen, Habeck, Jenn, Liao, Mingxiang, Xiao, Jim
• Format: Article
• Language: English
• Subjects: Adverse events; Cancer Research; Castration; Impairment; Liver; Medicine; Medicine & Public Health; Metabolites; Metastases; Oncology; Original; Original Article; Pharmacokinetics; Pharmacology; Pharmacology/Toxicology; Poly(ADP-ribose); Poly(ADP-ribose) polymerase; Prostate cancer; Ribose; Safety; Solid tumors; Tumors
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-021-04278-2

Purpose The poly(ADP-ribose) polymerase inhibitor rucaparib is approved for the treatment of patients with recurrent ovarian and metastatic castration-resistant prostate cancer; however, limited data are available on its use in patients with hepatic dysfunction. This study investigated whether hepatic impairment affects the pharmacokinetics, safety, and tolerability of rucaparib in patients with advanced solid tumors. Methods Patients with normal hepatic function or moderate hepatic impairment according to the National Cancer Institute Organ Dysfunction Working Group (NCI-ODWG) criteria were enrolled and received a single oral dose of rucaparib 600 mg. Concentrations of rucaparib and its metabolite M324 in plasma and urine were measured. Pharmacokinetic parameters were compared between hepatic function groups, and safety and tolerability were assessed. Results Sixteen patients were enrolled ( n  = 8 per group). Rucaparib maximum concentration ( C max ) was similar, while the area under the concentration–time curve from time 0 to infinity (AUC 0–inf ) was mildly higher in the moderate hepatic impairment group than in the normal control group (geometric mean ratio, 1.446 [90% CI 0.668–3.131]); similar trends were observed for M324. Eight (50%) patients experienced ≥ 1 treatment-emergent adverse event (TEAE); 2 had normal hepatic function and 6 had moderate hepatic impairment. Conclusion Patients with moderate hepatic impairment showed mildly increased AUC 0–inf for rucaparib compared to patients with normal hepatic function. Although more patients with moderate hepatic impairment experienced TEAEs, only 2 TEAEs were considered treatment related. These results suggest no starting dose adjustment is necessary for patients with moderate hepatic impairment; however, close safety monitoring is warranted.