Clinical Trial Report

Cancer Chemotherapy and Pharmacology

, Volume 69, Issue 2, pp 563-571

First online:

The effect of bexarotene on atorvastatin pharmacokinetics: results from a phase I trial of bexarotene plus chemotherapy in patients with advanced non-small cell lung cancer

  • Heather A. WakeleeAffiliated withDivision of Oncology, Department of Medicine, Stanford University and Stanford Cancer Institute Email author 
  • , Chris H. TakimotoAffiliated withInstitute for Drug Development, Cancer Therapy and Research Center at The University of Texas Health Science CenterOrtho Biotech Oncology R&D/Johnson & Johnson
  • , Arturo Lopez-AnayaAffiliated withEisai, Inc.Forest Laboratories, Inc.
  • , Quincy ChuAffiliated withInstitute for Drug Development, Cancer Therapy and Research Center at The University of Texas Health Science CenterCross Cancer Institute, University of Alberta
  • , Gary MiddletonAffiliated withSt. Luke’s Cancer Centre, Royal Surrey County Hospital
  • , David DunlopAffiliated withBeatson West of Scotland Cancer Centre
  • , Rodryg RamlauAffiliated withPoznan University of Medical Sciences
  • , Natasha LeighlAffiliated withPrincess Margaret Hospital
  • , Eric K. RowinskyAffiliated withInstitute for Drug Development, Cancer Therapy and Research Center at The University of Texas Health Science CenterOncodrugs Consulting
    • , Desiree HaoAffiliated withTom Baker Cancer Centre
    • , Petr ZatloukalAffiliated withThird Faculty of Medicine, Faculty Hospital Bulovka and Postgraduate Medical Institute, Charles University
    • , Charlotte D. JacobsAffiliated withDivision of Oncology, Department of Medicine, Stanford University and Stanford Cancer Institute
    • , Jordi RodonAffiliated withInstitute for Drug Development, Cancer Therapy and Research Center at The University of Texas Health Science CenterVall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology

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Abstract

Purpose

Bexarotene (Targretin® capsules) is a retinoid-X-receptor agonist and an inducer of CYP3A4-mediated metabolism. This phase I trial evaluated the pharmacokinetic (PK) and drug–drug interactions of bexarotene with chemotherapy and a lipid-lowering agent (atorvastatin or fenofibrate). This trial was run in parallel with phase III trials of the combinations to determine whether repeated doses of bexarotene capsules affect the pharmacokinetics (PK) of the chemotherapeutic or the lipid-lowering agents.

Methods

Patients (n = 48) with advanced non-small cell lung cancer were treated with repetitive cycles of either paclitaxel/carboplatin or cisplatin/vinorelbine chemotherapy, bexarotene (400 mg/m2/day) administered continuously starting on day 4 of chemotherapy, and a lipid-lowering drug, either atorvastatin or fenofibrate, starting at least 5 days before chemotherapy due to hypertriglyceridemia induced by bexarotene. Extensive plasma sampling to characterize the PK profiles of the lipid-lowering drugs, relevant chemotherapy agents was performed on day 1 (without bexarotene) and during chemotherapy cycles 2 or 3 (with bexarotene).

Results

Here, we report the drug–drug interactions between the lipid-lowering agents and bexarotene. Mean atorvastatin clearance and dose-corrected AUC values were reduced by nearly 50% with the addition of concomitant bexarotene. As fenofibrate was less effective at controlling hypertriglyceridemia, too few patients received this agent to make any meaningful conclusions about drug–drug interactions.

Conclusions

A drug–drug interaction was seen in this trial with bexarotene co-administration leading to a significant reduction in the AUC of atorvastatin. The likely mechanism for this interaction is through induction of CYP3A4 by bexarotene given the role of this enzyme in the metabolism of atorvastatin. Knowledge of this interaction is important for optimizing lipid management with atorvastatin for patients receiving bexarotene.

Keywords

Bexarotene Atorvastatin Pharmacokinetics Non-small cell lung cancer