Clinical Therapeutics

Carboplatin Therapeutic Drug Monitoring in Intermittent Hemodialysis—A Case Report and Review of the Literature

We present the case of a 45-year-old female patient with hemodialysis-dependent renal failure due to FSGS who was diagnosed with FIGO IIIc ovarian cancer and treated with carboplatin/gemcitabine under hemodialysis. A carboplatin dose of 200 mg/m The measured AUC was 5.8 min*mg/mL. A dose reduction to 250 mg resulted in an AUC of 2.3 min*mg/mL. This is the first case of an ovarian cancer treated with a high-dose scheme of carboplatin under hemodialysis.

Cost-Effectiveness and Net Monetary Benefit of Olaparib Maintenance Therapy Versus No Maintenance Therapy After First-line Platinum-based Chemotherapy in Newly Diagnosed Advanced BRCA1/2-mutated Ovarian Cancer in the Italian National Health Service

The aim of this study was to evaluate the cost-effectiveness and net monetary benefit of olaparib maintenance therapy compared with no maintenance therapy after first-line platinum-based chemotherapy in newly diagnosed advanced BRCA1/2-mutated ovarian cancer from the Italian National Health Service (NHS) perspective. We developed a lifetime Markov model in which a cohort of patients with newly diagnosed advanced BRCA1/2-mutated ovarian cancer was assigned to receive either olaparib maintenance therapy or active surveillance (Italian standard of care) after first-line platinum-based chemotherapy to compare cost-effectiveness and net monetary benefit of the 2 strategies. Data on clinical outcomes were obtained from related clinical trial literature and extrapolated using parametric survival analyses. Data on costs were derived from Italian official sources and relevant real-world studies. The incremental cost-effectiveness ratio (ICER), incremental cost-utility ratio (ICUR), and incremental net monetary benefit (INMB) were computed and compared against an incremental cost per quality-adjusted life-year (QALY) gained of €16,372 willingness-to-pay (WTP) threshold. We used deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) to assess how uncertainty affects results; we also performed scenario analyses to compare results under different pricing settings. In the base-case scenario, during a 50-year time horizon, the total costs for patients treated with olaparib therapy and active surveillance were €124,359 and €97,043, respectively, and QALYs gained were 7.29 and 4.88, respectively, with an ICER of €9,515 per life-year gained, an ICUR of €11,345 per QALY gained, and an INMB of €12,104. In scenario analyses, considering maximum selling prices for all other drugs, ICUR decreased to €11,311 per QALY and €7,498 per QALY when a 10% and 20% discount, respectively, was applied to the olaparib official price, and the INMB increased to €12,186 and €21,366, respectively. DSA found that the model results were most sensitive to the proportion of patients with relapsing disease in response to platinum-based chemotherapy, time receiving olaparib first-line maintenance treatment, and subsequent treatments price. According to PSAresults, olaparib was associated with a probability of being cost-effective at a €16,372 per QALY WTP threshold ranging from 70% to 100% in the scenarios examined. Our analysis indicates that olaparib maintenance therapy may deliver a significant health benefit with a contained upfront cost during a 50-year time horizon, from the Italian NHS perspective, providing value in a setting with curative intent.

Peripheral Neuropathy in Patients With Ovarian Cancer Administrating Poly ADP-Ribose Polymerase Inhibitors: A Real-World Study Based on Bayesian Disproportionality Analysis of the US Food and Drug Administration Adverse Event Reporting System

The aim of this study was to analyze adverse events in terms of safety signals and conduct pairwise comparisons on the constituent ratios of the reporting rates, severity, and outcomes of peripheral neuropathy among poly ADP-ribose polymerase inhibitors in the treatment of epithelial ovarian cancer, fallopian tube cancer, and primary peritoneal cancer (collectively referred to as EOC) leveraging the US Food and Drug Administration Adverse Event Reporting System. Data on peripheral neuropathy reports related to EOC treatment submitted to the US Food and Drug Administration Adverse Event Reporting System from the first quarter of 2015 to the third quarter of 2024 were collected. Three poly ADP-ribose polymerase inhibitors are identified: olaparib, niraparib, and rucaparib. The primary composite end point of this study was the safety signals for peripheral neuropathy in patients with EOC receiving poly ADP-ribose polymerase inhibitors treatment, whereas the secondary end points included the safety signals for sensory neuropathy, autonomic neuropathy, and motor neuropathy. All analyses were conducted using Stata 18.0 MP software. A total of 300,810 eligible records were included, among which there were 70,332 reports of peripheral neuropathy. For the primary composite end point, a safety signal related to peripheral neuropathy was detected with niraparib (reporting odds ratio [ROR] = 1.47; information component [IC] For patients with EOC, prudent surveillance of peripheral neuropathy is warranted when administrating niraparib. Certainly, more large-scale and long-term follow-up period studies were entailed.

A Relative Bioavailability, Bioequivalence, and Food Effect Study of Niraparib Tablets in Patients with Advanced Solid Tumors

Niraparib Population Pharmacokinetics and Exposure-Response Relationships in Patients With Newly Diagnosed Advanced Ovarian Cancer

Niraparib is a poly(adenosine diphosphate [ADP]-ribose) polymerase inhibitor approved for the maintenance treatment of advanced ovarian cancer (OC). Niraparib was originally approved in recurrent OC at a fixed starting dose (FSD) of 300 mg once daily (QD). This analysis characterized the population pharmacokinetics (PK) of niraparib and evaluated the relationships between exposure, efficacy, and safety to support clinical use of an individualized dosing strategy, in which the starting dose of niraparib was adjusted based on patient characteristics to improve the benefit-risk profile. A population PK model was developed by pooling data from four niraparib clinical trials (PN001 [n = 104], QUADRA [n = 455], NOVA [n = 403], and PRIMA [n = 480]) in patients with solid tumors, including OC. Exposure-response analyses were conducted to explore the relationships of niraparib exposure with progression-free survival (PFS) and adverse events in the PRIMA study. A multivariate logistic regression model was also developed to estimate the probability of grade ≥3 thrombocytopenia, using data from patients enrolled in PRIMA and NOVA. The impact of an individualized starting dose (ISD) regimen (200 mg QD in patients with body weight [BW] <77 kg or platelet count [PLT] <150,000/µL, or 300 mg QD in patients with BW ≥77 kg and PLT ≥150,000/µL) on systemic exposure, efficacy, and safety was assessed. Niraparib disposition was best described by a 3-compartment model with linear elimination. Key covariates included baseline creatinine clearance, BW, albumin, and age, all of which had minor effects on niraparib exposure. Comparable model-predicted exposure up to the time of disease progression/death or censoring in the 300-mg FSD and 200-/300-mg ISD groups was consistent with the lower rate of dose reduction in the ISD groups. No consistent niraparib exposure-response relationship was observed for efficacy in all PRIMA patients (first-line OC), and no statistically significant difference was seen in PFS curves for patients receiving a niraparib dose of 200 mg versus 300 mg. In the multivariate regression model, performed using combined data from PRIMA and NOVA, higher niraparib exposure (area under the concentration-time curve at steady-state [AUC Population PK and exposure-response analyses support use of an ISD to improve the safety profile of niraparib, including reducing the rate of grade ≥3 thrombocytopenia, without compromising efficacy. ClinicalTrials.gov, NCT01847274 (NOVA), NCT00749502 (PN001), NCT02655016 (PRIMA), NCT02354586 (QUADRA), www. gov.

Genetic Polymorphisms as Treatment Biomarkers for Gynecological Malignancies Treated With Carboplatin and Paclitaxel: A Systematic Review

Gynecological tumors, which correspond to the group of neoplasms that affect the female reproductive system, have high incidence and mortality rates. This systematic review aimed to summarize the most recent advances in identifying pharmacogenetic variants associated with the clinical outcomes of carboplatin-paclitaxel chemotherapy in these patients. A comprehensive literature search was conducted across eight databases to identify studies published up to July 17, 2024. Two reviewers independently selected the studies and extracted the data; disagreements were resolved by two additional reviewers. Out of the 2375 records that were found, only 20 met the eligibility criteria. The main findings were: (1) The three most extensively investigated genes were ATP binding cassette subfamily C member 1 (ABCB1), cytochrome P450 2C8 (CYP2C8), and glutathione S-transferase P1 (GSTP1); (2) three variants, rs1128503 (ABCB1), rs10509681 and rs11572080 (CYPC28), appear to have a significant association with important adverse drug reactions (in particular, neutropenia, thrombocytopenia, and peripheral sensory neuropathy). Others, as is the case with rs1045642 (ABCB1) and rs1695 (GSTP1), have inconsistent results, and the extent to which these results can be extrapolated is still limited; and (c) most of the included studies concerned Asian or European patients. Therefore, future research should include more extensive analyses with more inclusive cohorts. As a limitation of the study, a meta-analysis was not possible due to the significant heterogeneity among the studies.