Abstract
This was an open-label, multicenter, phase-1 study to evaluate the drug interaction between steady-state ibrutinib and moderate (erythromycin) and strong (voriconazole) CYP3A inhibitors in patients with B-cell malignancies and to confirm dosing recommendations. During cycle 1, patients received oral ibrutinib 560 mg qd alone (Days 1-4 and 14-18), and ibrutinib 140 mg (Days 5-13; 19-27) plus erythromycin 500 mg tid (Days 5-11) and voriconazole 200 mg bid (Days 19-25). Twenty-six patients (median [range] age: 64.5 [50-88] years) were enrolled. Geometric mean ratio (90% confidence intervals) after co-administration of ibrutinib 140 mg with erythromycin and voriconazole was 74.7 (53.97-103.51) and 143.3 (107.77-190.42), respectively, versus ibrutinib 560 mg alone. The most common (≥20%) adverse events were diarrhea (27%) and neutropenia (23%). The results demonstrate that ibrutinib 140 mg with voriconazole or erythromycin provides exposure within the clinical range for patients with B-cell malignancies.
Keywords:
CYP3A; Erythromycin; ibrutinib; pharmacokinetics; voriconazole.
Publication types
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Clinical Trial, Phase I
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Multicenter Study
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Research Support, Non-U.S. Gov't
MeSH terms
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Adenine / analogs & derivatives
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Administration, Oral
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Aged
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Aged, 80 and over
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Antineoplastic Combined Chemotherapy Protocols / pharmacology*
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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B-Lymphocytes / pathology*
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Cytochrome P-450 CYP2C19 / genetics
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Cytochrome P-450 CYP3A / genetics
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Cytochrome P-450 CYP3A Inhibitors / pharmacology*
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Cytochrome P-450 CYP3A Inhibitors / therapeutic use
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Diarrhea / chemically induced
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Diarrhea / epidemiology
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Dose-Response Relationship, Drug
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Drug Administration Schedule
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Drug Interactions
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Erythromycin / pharmacology
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Erythromycin / therapeutic use
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Female
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Hematologic Neoplasms / drug therapy*
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Hematologic Neoplasms / genetics
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Hematologic Neoplasms / pathology
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Humans
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Male
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Middle Aged
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Neutropenia / chemically induced
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Neutropenia / epidemiology
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Piperidines
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Polymorphism, Single Nucleotide
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Pyrazoles / pharmacology*
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Pyrazoles / therapeutic use
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Pyrimidines / pharmacology*
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Pyrimidines / therapeutic use
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Voriconazole / pharmacology
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Voriconazole / therapeutic use
Substances
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Cytochrome P-450 CYP3A Inhibitors
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Piperidines
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Pyrazoles
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Pyrimidines
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ibrutinib
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Erythromycin
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CYP2C19 protein, human
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CYP3A5 protein, human
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Cytochrome P-450 CYP2C19
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Cytochrome P-450 CYP3A
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CYP3A4 protein, human
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Adenine
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Voriconazole