Setting the Dose of Checkpoint Inhibitors: The Role of Clinical Pharmacology

Clin Pharmacokinet. 2020 Mar;59(3):287-296. doi: 10.1007/s40262-019-00837-2.

Abstract

Cancer immunotherapy is based on checkpoint inhibitors (CPIs) that significantly improve the clinical outcome of several malignant diseases. These inhibitors are monoclonal antibodies (mAbs) directed at cytotoxic T lymphocyte-associated protein 4 (CTLA-4), programmed cell death 1 (PD-1), or programmed death-ligand 1 (PD-L1), sharing most of the clinical pharmacokinetic characteristics of mAb targeted therapies, all of which differ from those of cytotoxics and small molecules. Establishing the labeled dose of mAbs, and particularly of the CPIs, represents a true challenge. This review therefore examines the main criteria used for dose selection, along with their limits. The relationships between CPI pharmacokinetic parameters and treatment outcome (efficacy and/or toxicity) differ somewhat among the various drugs, but general features can be identified. Nevertheless, the interpretation of these relationships remains quite controversial. A first interpretation asserts that inter-individual pharmacokinetic variability in clearance has an impact on outcome and should be taken into consideration for dosing individualization. The second considers that higher clearance values observed in some patients result from characteristics associated with poor predictive factors of efficacy. Finally, the schedule, and particularly its frequency of administration, merits rethinking.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / pharmacokinetics*
  • Antibodies, Monoclonal / therapeutic use
  • Antineoplastic Agents, Immunological / pharmacokinetics*
  • Antineoplastic Agents, Immunological / therapeutic use
  • B7-H1 Antigen / drug effects
  • B7-H1 Antigen / immunology
  • Biological Variation, Population
  • CTLA-4 Antigen / drug effects
  • CTLA-4 Antigen / immunology
  • Drug Administration Schedule
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects
  • Immune Checkpoint Inhibitors / pharmacokinetics*
  • Immune Checkpoint Inhibitors / therapeutic use
  • Immunotherapy / methods*
  • Neoplasms / drug therapy*
  • Pharmacogenetics
  • Pharmacology, Clinical
  • Predictive Value of Tests
  • Programmed Cell Death 1 Receptor / drug effects
  • Programmed Cell Death 1 Receptor / immunology
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Antineoplastic Agents, Immunological
  • B7-H1 Antigen
  • CTLA-4 Antigen
  • CTLA4 protein, human
  • Immune Checkpoint Inhibitors
  • PDCD1 protein, human
  • Programmed Cell Death 1 Receptor