ge and gender
The population pharmacokinetic analysis in patients aged 28 to 87 years, of whom 11% were ≥75 years suggests that age had no clinically meaningful effect on the exposure to irinotecan and SN-38.
The population pharmacokinetic analysis in 196 male and 157 female patients suggests that gender had no clinically meaningful effect on the exposure to irinotecan and SN-38 after adjusting for body surface area (BSA).
Ethnicity
The population pharmacokinetic analysis suggest that Asians have 56% lower total irinotecan average steady state concentration (3.93 [95%CI: 3.68-4.2] and 1.74 [95%CI: 1.58-1.93] mg/l, respectively) and 8% higher total SN-38 average steady state concentration (0.97 [95%CI: 0.92-1.03] and 1.05 [95%CI: 0.98-1.11] ng/ml, respectively) than Caucasians.
Pharmacokinetic/pharmacodynamic relationship
In a pooled analysis from 353 patients, higher plasma SN-38 Cmax was associated with increased likelihood of experiencing neutropenia, and higher plasma total irinotecan Cmax was associated with increased likelihood of experiencing diarrhoea.
In the clinical trial demonstrating effectiveness of ONIVYDE, higher plasma exposures of total irinotecan and SN-38 for patients in the ONIVYDE+5-FU/LV treatment arm were associated with longer OS and PFS as well as with higher ORR (objective response rate).
5.3 Preclinical safety data
In single and repeated dose toxicity studies in mice, rats and dogs, the target organs of toxicity were the gastrointestinal tract and the hematologic system. The severity of effects was dose-related and reversible. The no-observed-adverse-effect level (NOAEL) in rats and dogs following 90 min intravenous infusion of ONIVYDE once every 3 weeks for 18 weeks was at least 180 mg/m2.
In safety pharmacology studies in dogs, ONIVYDE had no effect on cardiovascular, hemodynamic, electrocardiographic, or respiratory parameters at doses up to 21 mg/kg (420 mg/m2). No findings indicative of CNS related toxicity were observed in the repeated dose toxicity studies in rats.
Genotoxic and carcinogenic potential
No genotoxicity studies have been performed with ONIVYDE. Non-liposomal irinotecan and SN-38 were genotoxic in vitro in the chromosomal aberration test on CHO-cells as well as in the in vivo micronucleus test in mice. However, in other studies with irinotecan they have been shown to be devoid of any mutagenic potential in the Ames test.
No carcinogenicity studies have been performed with ONIVYDE. For non-liposomal irinotecan, in rats treated once a week during 13 weeks at the maximum dose of 150 mg/m2, no treatment related tumours were reported 91 weeks after the end of treatment. Under these conditions, there was a significant linear trend with dose for the incidence of combined uterine horn endometrial stromal polyps and endometrial stromal sarcomas. Due to its mechanism of action, irinotecan is considered a potential carcinogen.
Reproduction toxicity
No reproductive and developmental toxicity studies have been performed with ONIVYDE.
Non-liposomal irinotecan was teratogenic in rats and rabbits at doses below the human therapeutic dose. In rats, pups born from treated animals and having external abnormalities showed a decrease in fertility. This was not seen in morphologically normal pups. In pregnant rats there was a decrease in placental weight and in the offspring a decrease in foetal viability and increase in behavioural abnormalities.
Non-liposomal irinotecan caused atroph |
