Overcoming CYP1A1/1A2 Mediated Induction of Metabolism by Escalating Erlotinib Dose in Current Smokers

Andrew N. Hughes, Mary E. R. O'Brien, W. Jeffrey Petty, Jonathan B. Chick, Elaine Rankin, Penella J. Woll, David Dunlop, Marianne Nicolson, Ramesh Boinpally, Julie Wolf, Allan Price

    Research output: Contribution to journalArticle

    120 Citations (Scopus)

    Abstract

    Purpose

    Cigarette smoking induces CYP1A1/1A2 and is hypothesized to alter erlotinib pharmacokinetics. This study aimed to determine the maximum tolerated dose (MTD) of erlotinib in advanced non-small-cell lung cancer (NSCLC) patients who smoke and compare the pharmacokinetics of erlotinib at the MTD in current smokers with 150 mg.

    Patients and Methods

    Cohorts of NSCLC patients currently smoking >= 10 cigarettes per day for >= 1 year received escalating doses of erlotinib for 14 days until dose-limiting toxicity (DLT). A separate cohort of patients was then randomly assigned to erlotinib at either MTD or 150 mg daily with pharmacokinetics assessed at day 14. Erlotinib was continued until progression or intolerable toxicity.

    Results

    Four dose levels were evaluated in 22 patients: 200, 250, 300, and 350 mg. DLT was observed in one of six patients at 300 mg ( rash) and two of five patients at 350 mg (acneiform dermatitis and fatigue/ decreased Eastern Cooperative Oncology Group performance status). Thirty-five patients were randomly assigned to 150 mg or 300 mg. Common adverse events (all grades) were: skin toxicity (150 mg, 29%; 300 mg, 67%), diarrhea (150 mg, 18%; 300 mg, 50%), and fatigue (150 mg, 12%; 300 mg, 17%). Erlotinib exposure was dose-proportional within dose range tested. Median steady-state trough erlotinib plasma concentrations were 0.375 and 1.22 mu g/mL for 150 mg and 300 mg, respectively.

    Conclusion

    The MTD of erlotinib in NSCLC patients who smoke was 300 mg. Steady-state trough plasma concentrations and incidence of rash and diarrhea in smokers at 300 mg were similar to those in former or never smokers receiving 150 mg in previous studies. The potential benefit of higher erlotinib doses in current smokers warrants further evaluation.

    Original languageEnglish
    Pages (from-to)1220-1226
    Number of pages7
    JournalJournal of Clinical Oncology
    Volume27
    Issue number8
    DOIs
    Publication statusPublished - 10 Mar 2009

    Keywords

    • CELL LUNG-CANCER
    • FACTOR RECEPTOR EXPRESSION
    • GROUP-STUDY BR.21
    • SMOKING
    • PREDICTORS
    • INSTITUTE
    • SURVIVAL
    • THERAPY

    Cite this

    Hughes, A. N., O'Brien, M. E. R., Petty, W. J., Chick, J. B., Rankin, E., Woll, P. J., ... Price, A. (2009). Overcoming CYP1A1/1A2 Mediated Induction of Metabolism by Escalating Erlotinib Dose in Current Smokers. Journal of Clinical Oncology, 27(8), 1220-1226. https://doi.org/10.1200/JCO.2008.19.3995
    Hughes, Andrew N. ; O'Brien, Mary E. R. ; Petty, W. Jeffrey ; Chick, Jonathan B. ; Rankin, Elaine ; Woll, Penella J. ; Dunlop, David ; Nicolson, Marianne ; Boinpally, Ramesh ; Wolf, Julie ; Price, Allan. / Overcoming CYP1A1/1A2 Mediated Induction of Metabolism by Escalating Erlotinib Dose in Current Smokers. In: Journal of Clinical Oncology. 2009 ; Vol. 27, No. 8. pp. 1220-1226.
    @article{c053df4fa7924d839003f6610b2f255a,
    title = "Overcoming CYP1A1/1A2 Mediated Induction of Metabolism by Escalating Erlotinib Dose in Current Smokers",
    abstract = "PurposeCigarette smoking induces CYP1A1/1A2 and is hypothesized to alter erlotinib pharmacokinetics. This study aimed to determine the maximum tolerated dose (MTD) of erlotinib in advanced non-small-cell lung cancer (NSCLC) patients who smoke and compare the pharmacokinetics of erlotinib at the MTD in current smokers with 150 mg.Patients and MethodsCohorts of NSCLC patients currently smoking >= 10 cigarettes per day for >= 1 year received escalating doses of erlotinib for 14 days until dose-limiting toxicity (DLT). A separate cohort of patients was then randomly assigned to erlotinib at either MTD or 150 mg daily with pharmacokinetics assessed at day 14. Erlotinib was continued until progression or intolerable toxicity.ResultsFour dose levels were evaluated in 22 patients: 200, 250, 300, and 350 mg. DLT was observed in one of six patients at 300 mg ( rash) and two of five patients at 350 mg (acneiform dermatitis and fatigue/ decreased Eastern Cooperative Oncology Group performance status). Thirty-five patients were randomly assigned to 150 mg or 300 mg. Common adverse events (all grades) were: skin toxicity (150 mg, 29{\%}; 300 mg, 67{\%}), diarrhea (150 mg, 18{\%}; 300 mg, 50{\%}), and fatigue (150 mg, 12{\%}; 300 mg, 17{\%}). Erlotinib exposure was dose-proportional within dose range tested. Median steady-state trough erlotinib plasma concentrations were 0.375 and 1.22 mu g/mL for 150 mg and 300 mg, respectively.ConclusionThe MTD of erlotinib in NSCLC patients who smoke was 300 mg. Steady-state trough plasma concentrations and incidence of rash and diarrhea in smokers at 300 mg were similar to those in former or never smokers receiving 150 mg in previous studies. The potential benefit of higher erlotinib doses in current smokers warrants further evaluation.",
    keywords = "CELL LUNG-CANCER, FACTOR RECEPTOR EXPRESSION, GROUP-STUDY BR.21, SMOKING, PREDICTORS, INSTITUTE, SURVIVAL, THERAPY",
    author = "Hughes, {Andrew N.} and O'Brien, {Mary E. R.} and Petty, {W. Jeffrey} and Chick, {Jonathan B.} and Elaine Rankin and Woll, {Penella J.} and David Dunlop and Marianne Nicolson and Ramesh Boinpally and Julie Wolf and Allan Price",
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    month = "3",
    day = "10",
    doi = "10.1200/JCO.2008.19.3995",
    language = "English",
    volume = "27",
    pages = "1220--1226",
    journal = "Journal of Clinical Oncology",
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    }

    Hughes, AN, O'Brien, MER, Petty, WJ, Chick, JB, Rankin, E, Woll, PJ, Dunlop, D, Nicolson, M, Boinpally, R, Wolf, J & Price, A 2009, 'Overcoming CYP1A1/1A2 Mediated Induction of Metabolism by Escalating Erlotinib Dose in Current Smokers', Journal of Clinical Oncology, vol. 27, no. 8, pp. 1220-1226. https://doi.org/10.1200/JCO.2008.19.3995

    Overcoming CYP1A1/1A2 Mediated Induction of Metabolism by Escalating Erlotinib Dose in Current Smokers. / Hughes, Andrew N.; O'Brien, Mary E. R.; Petty, W. Jeffrey; Chick, Jonathan B.; Rankin, Elaine; Woll, Penella J.; Dunlop, David; Nicolson, Marianne; Boinpally, Ramesh; Wolf, Julie; Price, Allan.

    In: Journal of Clinical Oncology, Vol. 27, No. 8, 10.03.2009, p. 1220-1226.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Overcoming CYP1A1/1A2 Mediated Induction of Metabolism by Escalating Erlotinib Dose in Current Smokers

    AU - Hughes, Andrew N.

    AU - O'Brien, Mary E. R.

    AU - Petty, W. Jeffrey

    AU - Chick, Jonathan B.

    AU - Rankin, Elaine

    AU - Woll, Penella J.

    AU - Dunlop, David

    AU - Nicolson, Marianne

    AU - Boinpally, Ramesh

    AU - Wolf, Julie

    AU - Price, Allan

    PY - 2009/3/10

    Y1 - 2009/3/10

    N2 - PurposeCigarette smoking induces CYP1A1/1A2 and is hypothesized to alter erlotinib pharmacokinetics. This study aimed to determine the maximum tolerated dose (MTD) of erlotinib in advanced non-small-cell lung cancer (NSCLC) patients who smoke and compare the pharmacokinetics of erlotinib at the MTD in current smokers with 150 mg.Patients and MethodsCohorts of NSCLC patients currently smoking >= 10 cigarettes per day for >= 1 year received escalating doses of erlotinib for 14 days until dose-limiting toxicity (DLT). A separate cohort of patients was then randomly assigned to erlotinib at either MTD or 150 mg daily with pharmacokinetics assessed at day 14. Erlotinib was continued until progression or intolerable toxicity.ResultsFour dose levels were evaluated in 22 patients: 200, 250, 300, and 350 mg. DLT was observed in one of six patients at 300 mg ( rash) and two of five patients at 350 mg (acneiform dermatitis and fatigue/ decreased Eastern Cooperative Oncology Group performance status). Thirty-five patients were randomly assigned to 150 mg or 300 mg. Common adverse events (all grades) were: skin toxicity (150 mg, 29%; 300 mg, 67%), diarrhea (150 mg, 18%; 300 mg, 50%), and fatigue (150 mg, 12%; 300 mg, 17%). Erlotinib exposure was dose-proportional within dose range tested. Median steady-state trough erlotinib plasma concentrations were 0.375 and 1.22 mu g/mL for 150 mg and 300 mg, respectively.ConclusionThe MTD of erlotinib in NSCLC patients who smoke was 300 mg. Steady-state trough plasma concentrations and incidence of rash and diarrhea in smokers at 300 mg were similar to those in former or never smokers receiving 150 mg in previous studies. The potential benefit of higher erlotinib doses in current smokers warrants further evaluation.

    AB - PurposeCigarette smoking induces CYP1A1/1A2 and is hypothesized to alter erlotinib pharmacokinetics. This study aimed to determine the maximum tolerated dose (MTD) of erlotinib in advanced non-small-cell lung cancer (NSCLC) patients who smoke and compare the pharmacokinetics of erlotinib at the MTD in current smokers with 150 mg.Patients and MethodsCohorts of NSCLC patients currently smoking >= 10 cigarettes per day for >= 1 year received escalating doses of erlotinib for 14 days until dose-limiting toxicity (DLT). A separate cohort of patients was then randomly assigned to erlotinib at either MTD or 150 mg daily with pharmacokinetics assessed at day 14. Erlotinib was continued until progression or intolerable toxicity.ResultsFour dose levels were evaluated in 22 patients: 200, 250, 300, and 350 mg. DLT was observed in one of six patients at 300 mg ( rash) and two of five patients at 350 mg (acneiform dermatitis and fatigue/ decreased Eastern Cooperative Oncology Group performance status). Thirty-five patients were randomly assigned to 150 mg or 300 mg. Common adverse events (all grades) were: skin toxicity (150 mg, 29%; 300 mg, 67%), diarrhea (150 mg, 18%; 300 mg, 50%), and fatigue (150 mg, 12%; 300 mg, 17%). Erlotinib exposure was dose-proportional within dose range tested. Median steady-state trough erlotinib plasma concentrations were 0.375 and 1.22 mu g/mL for 150 mg and 300 mg, respectively.ConclusionThe MTD of erlotinib in NSCLC patients who smoke was 300 mg. Steady-state trough plasma concentrations and incidence of rash and diarrhea in smokers at 300 mg were similar to those in former or never smokers receiving 150 mg in previous studies. The potential benefit of higher erlotinib doses in current smokers warrants further evaluation.

    KW - CELL LUNG-CANCER

    KW - FACTOR RECEPTOR EXPRESSION

    KW - GROUP-STUDY BR.21

    KW - SMOKING

    KW - PREDICTORS

    KW - INSTITUTE

    KW - SURVIVAL

    KW - THERAPY

    U2 - 10.1200/JCO.2008.19.3995

    DO - 10.1200/JCO.2008.19.3995

    M3 - Article

    VL - 27

    SP - 1220

    EP - 1226

    JO - Journal of Clinical Oncology

    JF - Journal of Clinical Oncology

    SN - 0732-183X

    IS - 8

    ER -