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The effects of liver impairment on the pharmacokinetics of brivanib, a dual inhibitor of fibroblast growth factor receptor and vascular endothelial growth factor receptor tyrosine kinases

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Abstract

Purpose

Hepatic impairment may impede tyrosine kinase inhibitor metabolism. This phase I study compared the pharmacokinetics of brivanib in patients with hepatocellular carcinoma (HCC) and varying levels of hepatic impairment with those with non-HCC malignancies and normal liver function.

Methods

Patients were assigned to the following groups: Groups A, B, and C (HCC plus mild, moderate, or severe hepatic impairment, respectively) and Group D (non-HCC malignancy and normal hepatic function). Brivanib alaninate (brivanib prodrug) doses were 400 mg in Groups A, B, and D and 200 mg in Group C. Brivanib exposure was determined on day 1 (single dose) and day 28 (multiple doses).

Results

Twenty-four patients participated in the study. After a single brivanib alaninate dose, brivanib exposure was comparable between Groups A, B, and D. Area under the concentration–time curve was 50 % higher in Group C versus Group D. There were not enough data to draw conclusions on multiple doses. Safety profile in Groups A, B, and D was consistent with previous brivanib monotherapy experience. Tolerability could not be assessed in Group C because of dose interruptions and discontinuations, generally due to the disease natural history.

Conclusions

Brivanib exposure was similar in patients with HCC and mild or moderate hepatic impairment (Child-Pugh [CP] A or B status) and those with non-HCC malignancies and normal hepatic function, suggesting dose adjustment is unnecessary with CP A or B status. Experience with HCC and severe hepatic impairment (CP C status) is insufficient to recommend brivanib use in this population.

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Acknowledgments

This research was funded by Bristol-Myers Squibb. Editorial and writing assistance was provided by StemScientific, funded by Bristol-Myers Squibb. Supported by research funding from Bristol-Myers Squibb (Study No. CA182015). This trial is registered at www.clinicaltrials.gov as NCT00437424.

Conflict of interest

A. El-Khoueiry disclosures: consultant, Bristol-Myers Squibb; J.A. Posey disclosures: consultant, Novartis; funding, Genomic Health and Pfizer; J.R. Castillo Ferrando disclosures: NONE; S.S. Krishnamurthi disclosures: funding, Bristol-Myers Squibb; S. Syed disclosures: previous employee (during study research and manuscript development), Bristol-Myers Squibb; G. Kollia, I. Walters, B.S. Fischer, E. Masson disclosures: employee, stock ownership, Bristol-Myers Squibb.

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Authors and Affiliations

  1. USC Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 3440, Los Angeles, CA, 90033, USA

    Anthony El-Khoueiry

  2. University of Alabama at Birmingham, Birmingham, AL, USA

    James A. Posey

  3. Clinical Assay Unit Phase I–II, Virgen del Rocío University Hospital, Seville University, Seville, Spain

    Juan Ramón Castillo Ferrando

  4. Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH, USA

    Smitha S. Krishnamurthi

  5. Piscataway, New Jersey, USA

    Shariq Syed

  6. Bristol-Myers Squibb, Princeton, NJ, USA

    Georgia Kollia, Ian Walters, Bruce S. Fischer & Eric Masson

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  1. Anthony El-Khoueiry
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Correspondence to Anthony El-Khoueiry.

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El-Khoueiry, A., Posey, J.A., Castillo Ferrando, J.R. et al. The effects of liver impairment on the pharmacokinetics of brivanib, a dual inhibitor of fibroblast growth factor receptor and vascular endothelial growth factor receptor tyrosine kinases. Cancer Chemother Pharmacol 72, 53–64 (2013). https://doi.org/10.1007/s00280-013-2168-z

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  • DOI: https://doi.org/10.1007/s00280-013-2168-z

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