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Clinical Pharmacokinetics

, Volume 55, Issue 1, pp 33–45 | Cite as

Clinical Pharmacokinetic and Pharmacodynamic Profile of Idelalisib

  • Srinivasan RamanathanEmail author
  • Feng Jin
  • Shringi Sharma
  • Brian P. Kearney
Review Article

Abstract

Idelalisib is a potent and selective phosphatidylinositol 3-kinase-δ inhibitor, which is a first-in-class agent to be approved for the treatment of relapsed chronic lymphocytic leukaemia, follicular B cell non-Hodgkin’s lymphoma and small lymphocytic lymphoma. In dose-ranging studies, idelalisib exposure increased in a less than dose-proportional manner, likely because of solubility-limited absorption. The approved starting dose of 150 mg twice daily was supported by extensive exposure–response evaluations, with dose reduction to 100 mg twice daily being allowed for specific toxicities. Idelalisib may be administered without regard to food on the basis of the absence of clinically relevant food effects, and was accordingly dosed in primary efficacy/safety studies. Idelalisib is metabolized primarily via aldehyde oxidase (AO) and, to a lesser extent, via cytochrome P450 (CYP) 3A. Coadministration with the strong CYP3A inhibitor ketoconazole 400 mg once daily resulted in a ~79 % increase in the idelalisib area under the plasma concentration–time curve (AUC). Administration with the potent inducer rifampin resulted in a 75 % decrease in idelalisib exposure (AUC) and, as such, coadministration with strong inducers should be avoided. GS-563117 is an inactive primary circulating metabolite of idelalisib formed mainly via AO. Unlike idelalisib, GS-563117 is a mechanism-based inhibitor of CYP3A. Accordingly, idelalisib 150 mg twice-daily dosing increases the midazolam AUC 5.4-fold. Clinically, idelalisib is not an inhibitor of the transporters P-glycoprotein, breast cancer resistance protein, organic anion–transporting polypeptide (OATP) 1B1 or OAPT1B3. In a population pharmacokinetic model, no meaningful impact on idelalisib pharmacokinetics was noted for any of the covariates tested. Idelalisib exposure was ~60 % higher with moderate/severe hepatic impairment; no relevant changes were observed with severe renal impairment. This article reviews a comprehensive pharmacology programme, including drug–drug interaction studies and mechanistic and special population studies, which has allowed a thorough understanding of idelalisib clinical pharmacokinetics and their impact on clinical safety and efficacy.

Keywords

Chronic Lymphocytic Leukaemia Rosuvastatin Breast Cancer Resistance Protein Bendamustine Chronic Lymphocytic Leukaemia Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with Ethical Standards

Srinivasan Ramanathan, Feng Jin, Shringi Sharma and Brian P. Kearney are employees of Gilead Sciences, Inc. (Foster City, CA, USA), contributed significantly to the design, conduct, analyses and interpretation of data, and were involved in the preparation, review and approval of this article. Gilead Sciences, Inc., provided funding for the research presented in this article. The idelalisib project team and individual study team members contributed towards the conduct and management of clinical trials described here.

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Srinivasan Ramanathan
    • 1
    Email author
  • Feng Jin
    • 1
  • Shringi Sharma
    • 1
  • Brian P. Kearney
    • 1
  1. 1.Gilead Sciences, Inc.Foster CityUSA

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