The purpose of this international study was to assess the effect of varying degrees of impaired hepatic function compared to a normal hepatic function (Child-Pugh classification) on the pharmacokinetics and safety of midostaurin.
Midostaurin was developed for the treatment of patients with hematological and nonhematological malignancies. However, disease complications and various co-medications made it difficult to perform a hepatic impairment study in the targeted patient population. Metabolism and elimination of midostaurin predominantly occurs in the liver. Patients with impaired hepatic function may have a higher risk to have a decreased elimination or metabolism of midostaurin which may lead to increased systemic exposure or toxicity, hence understanding the impact of an impaired hepatic function on midostaurin PK is important. Cumulative safety data from over 900 subjects exposed to midostaurin showed that the drug was well tolerated in patients and in healthy subjects, thus, it was appropriate and justifiable to study midostaurin in subjects with varying degrees of hepatic impairment. Due to the difficulty in enrolling subjects with severe hepatic impairment, an interim analysis was performed when all mild and moderate hepatic impaired subjects, and the respective control subjects, had completed the trial, in order to obtain interim results on the PK and safety of midostaurin in patients with mild and moderate hepatic impairment. The protocol was amended in April 2018 to make the inclusion / exclusion criteria more fitting with enrolling the severe hepatic impairment group. The final study analysis was performed when all severe hepatic impaired subjects, and the matching controls, had completed the study.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
43
Midostaurin 25 mg soft gelatin capsules (2 capsules). The midostaurin capsules will be administered orally with 240 mL of non-carbonated water in the morning (between 8-10 AM), and in the evening (after a 12 hour break) from Day 1 to Day 6. On Day 7, midostaurin will be administered in the morning only (between 8-10 AM).
Midostaurin 25 mg soft gelatin capsules (2 capsules). The midostaurin capsules will be administered orally with 240 mL of non-carbonated water in the morning (between 8-10 AM) on Day 1 only.
American Research Corporation Inc
San Antonio, Texas, United States
Novartis Investigative Site
Brussels, Belgium
Novartis Investigative Site
Sofia, Bulgaria
Novartis Investigative Site
Berlin, Germany
Peak Plasma Concentrations (Cmax) for midostaurin and its metabolites, CGP52421 and CGP62221
In subjects with Child Pugh A, Child Pugh B (and matching healthy volunteers) Cmax will be measured at Day 1 and Day 7. In subjects with Child Pugh C (and matching healthy volunteers) Cmax will be measured at Day 1
Time frame: at different timepoints from Day 1 to Day 7
Incidence of treatment emergent adverse events (AEs)
Safety and tolerability of midostaurin measured by the number of treatment emergent adverse events in subjects with hepatic impairment (and matching healthy volunteers)
Time frame: During the study and until 28 days follow-up period
CYP3A4 induction by midostaurin in the hepatic impaired population
CYP3A4 induction will be measured by assessing endogenous biomarkers (6beta-hydroxycortisol to cortisol ratio) applicable to multiple dosing Child Pugh A and Child Pugh B subjects and matching healthy volunteers)
Time frame: At different timepoints from Day 3 to Day 11
Protein binding (free fraction) of midostaurin and it's metabolites
Free fraction of midostaurin and it's metabolites, CGP62221 and CGP52421, will be assessed by measuring their unbound concentration in plasma samples 3 hours post last dose on Day 1 (group 4 and 5) and Day 7 (group 1-3).
Time frame: Day 1 and Day 7
Apparent volume of distribution (Vz/F) of midostaurin
In subjects with Child Pugh A and Child Pugh B (and matching healthy volunteers), volume of distribution will be measured on Day 7. In subjects with Child Pugh C (and healthy volunteers), volume of distribution will be measured at Day 1.
Time frame: Day 1 and Day 7
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Novartis Investigative Site
Frankfurt, Germany
Novartis Investigative Site
Kaunas, LTU, Lithuania
Novartis Investigative Site
Cluj-Napoca, Napoca, Romania
Total body apparent clearance of drug (CL/F) of midostaurin
In subjects with Child Pugh A and Child Pugh B (and matching healthy volunteers), total body clearance will be measured on Day 7. In subjects with Child Pugh C (and healthy volunteers), total body clearance will be measured at Day 1.
Time frame: Day 1 and Day 7
Elimination half life (t½) of midostaurin and its metabolites, CGP52421 and CGP62221
In subjects with Child Pugh A and Child Pugh B (and matching healthy volunteers), elimination half life will be measured on Day 7. In subjects with Child Pugh C (and healthy volunteers), elimination half life will be measured at Day 1.
Time frame: Day 1 and Day 7
Time to maximum plasma concentration (tmax) for midostaurin and its metabolites, CGP52421 and CGP62221
In subjects with Child Pugh A and Child Pugh B (and matching healthy volunteers), tmax will be measured at Day 1 and Day 7. In subjects with Child Pugh C (and healthy volunteers), tmax will be measured at Day 1.
Time frame: Day 1 and Day 7
Area under the plasma concentration versus time curves (AUCs) for midostaurin and its metabolites, CGP52421 and CGP62221
In subjects with Child Pugh A and Child Pugh B (and matching healthy volunteers), AUC will be measured at Day 1 and Day 7. In subjects with Child Pugh C (and healthy volunteers), AUC will be measured at Day 1.
Time frame: Day 1 and Day 7