Original Article

Cancer Chemotherapy and Pharmacology

, Volume 74, Issue 2, pp 399-410

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Population pharmacokinetics of trastuzumab emtansine (T-DM1), a HER2-targeted antibody–drug conjugate, in patients with HER2-positive metastatic breast cancer: clinical implications of the effect of covariates

  • Dan LuAffiliated withDepartment of Clinical Pharmacology, Genentech, Inc. Email author 
  • , Sandhya GirishAffiliated withDepartment of Clinical Pharmacology, Genentech, Inc.
  • , Yuying GaoAffiliated withDrug Development Consulting Services, Quantitative Solutions
  • , Bei WangAffiliated withDepartment of Clinical Pharmacology, Genentech, Inc.
  • , Joo-Hee YiAffiliated withBioAnalytical Sciences, Genentech, Inc.
  • , Ellie GuardinoAffiliated withDepartment of Clinical Pharmacology, Genentech, Inc.
  • , Meghna SamantAffiliated withBiostatistics, Genentech, Inc.
  • , Melody CobleighAffiliated withDepartment of Internal Medicine, Rush University Medical Center
  • , Mothaffar RimawiAffiliated withLester and Sue Smith Breast Center, Baylor College of Medicine
    • , Pierfranco ConteAffiliated withDepartment of Surgery, Oncology and Gastroenterology, University of Padua
    • , Jin Yan JinAffiliated withDepartment of Clinical Pharmacology, Genentech, Inc.

Abstract

Purpose

Trastuzumab emtansine (T-DM1) is an antibody–drug conjugate comprising the humanized monoclonal antibody trastuzumab linked to DM1, a highly potent cytotoxic agent. A population pharmacokinetic (PK) analysis was performed to estimate typical values and interindividual variability of T-DM1 PK parameters and the effects of clinically relevant covariates.

Methods

Serum samples were collected from 671 patients with human epidermal growth factor receptor 2-positive locally advanced or metastatic breast cancer (MBC) who received single-agent T-DM1 in five phase I to phase III studies. Nonlinear mixed-effects modeling with the first-order conditional estimation method was used.

Results

A linear two-compartment model with first-order elimination from the central compartment described T-DM1 PKs in the clinical dose range. T-DM1 elimination clearance was 0.676 L/day, volume of distribution in the central compartment (V c) was 3.127 L, and terminal elimination half-life was 3.94 days. Age, race, region, and renal function did not influence T-DM1 PK. Given the low-to-moderate effect of all statistically significant covariates on T-DM1 exposure, none of these covariates is expected to result in a clinically meaningful change in T-DM1 exposure.

Conclusions

T-DM1 PK properties are consistent and predictable in patients. A further refinement of dose based on baseline covariates other than body weight for the current 3.6 mg/kg regimen would not yield clinically meaningful reductions in interindividual PK variability in patients with MBC.

Keywords

Ado-trastuzumab emtansine T-DM1 HER2 Pharmacokinetics Metastatic breast cancer