The Use of Dried Blood Spots for Pharmacokinetic Monitoring of Vemurafenib Treatment in Melanoma Patients

Pharmacokinetic monitoring is increasingly becoming an important part of clinical care of tyrosine kinase inhibitor treatment. Vemurafenib is an oral tyrosine kinase inhibitor that inhibits mutated serine/threonine protein kinase B‐Raf (BRAF) and is approved for the treatment of adult patients with...

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Bibliographic Details
Published in:Journal of clinical pharmacology 2016-10, Vol.56 (10), p.1307-1312
Main Authors: Nijenhuis, Cynthia M., Huitema, Alwin D.R., Marchetti, Serena, Blank, Christian, Haanen, John B.A.G., van Thienen, Johannes V., Rosing, Hilde, Schellens, Jan H.M., Beijnen, Jos H.
Format: Article
Language:English
Subjects:
Antineoplastic Agents - blood
Antineoplastic Agents - pharmacokinetics
Antineoplastic Agents - therapeutic use
bioanalysis
Chromatography, High Pressure Liquid
Cohort Studies
dried blood spot
Dried Blood Spot Testing - methods
Drug Monitoring
Hematocrit
Humans
Indoles - blood
Indoles - pharmacokinetics
Indoles - therapeutic use
Melanoma - blood
Melanoma - drug therapy
Melanoma - metabolism
pharmacokinetics
Sulfonamides - blood
Sulfonamides - pharmacokinetics
Sulfonamides - therapeutic use
Tandem Mass Spectrometry
therapeutic drug monitoring
vemurafenib
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Summary:Pharmacokinetic monitoring is increasingly becoming an important part of clinical care of tyrosine kinase inhibitor treatment. Vemurafenib is an oral tyrosine kinase inhibitor that inhibits mutated serine/threonine protein kinase B‐Raf (BRAF) and is approved for the treatment of adult patients with BRAF V600 mutation‐positive unresectable or metastatic melanoma. The aim of this study was to establish the relationship between dried blood spot (DBS) and plasma concentrations of vemurafenib to enable the use of DBS sampling, which is a minimally invasive form of sample collection. In total, 43 paired plasma and DBS samples (in duplicate) were obtained from 8 melanoma patients on vemurafenib therapy and were analyzed using high‐performance liquid chromatography–tandem mass spectrometry. Plasma concentrations were predicted from the DBS concentrations using 2 methods: (1) individual hematocrit correction and blood cell‐to‐plasma partitioning and (2) the calculated slope explaining the relationship between DBS and plasma concentrations (without individual hematocrit correction). Vemurafenib DBS concentrations and plasma concentrations showed a strong correlation (r = 0.964), and the relationship could be described by ([vemurafenib]plasma = [vemurafenib]DBS/0.64). The predicted plasma concentrations were within ±20% of the analyzed plasma concentrations in 97% and 100% of the samples for the methods with and without hematocrit correction, respectively. In conclusion, DBS concentrations and plasma concentrations of vemurafenib are highly correlated. Plasma concentrations can be predicted from DBS concentration using the blood cell‐to‐plasma partition and the average hematocrit value of this cohort (0.40 L/L). DBS sampling for pharmacokinetic monitoring of vemurafenib treatment can be used in clinical practice.
ISSN:0091-2700
1552-4604
DOI:10.1002/jcph.728