Zhou X, et al. – The effect of gastric acid reducing agents and strong inducers/inhibitors of CYP3A4 on the pharmacokinetics of alisertib, an investigational Aurora A kinase inhibitor, in patients with advanced malignancies, was analyzed. In view of the outcomes, experts suggested avoiding the use of gastric acid reducing agents, strong CYP3A inhibitors or strong metabolic enzyme inducers in patients receiving alisertib.

Methods

• Patients received single doses of alisertib (50 mg) in the presence and absence of either esomeprazole (40 mg once daily [QD]) or rifampin (600 mg QD), in Study 1.
• Patients received single doses of alisertib (30 mg) in the presence and absence of itraconazole (200 mg QD), in Study 2.
• Researchers gathered blood samples for alisertib and 2 major metabolites up to 72 h (Study 1) and 96 h (Study 2) postdose.
• They calculated area under the curve from time zero extrapolated to infinity (AUC0-inf) and maximum concentrations (Cmax) and compared it using analysis of variance to estimate least squares (LS) mean ratios and 90% confidence intervals (CIs).

Results

• As per the observations, the LS mean ratios (90% CIs) for alisertib AUC0-inf and Cmax in the presence compared to the absence of esomeprazole were 1.28 (1.07, 1.53) and 1.14 (0.97, 1.35), respectively.
• As compared to the absence of rifampin, the LS mean ratios (90% CIs) for alisertib AUC0-inf and Cmax in the presence of rifampin were 0.53 (0.41, 0.70) and 1.03 (0.84, 1.26), respectively.
• Furthermore, the LS mean ratios (90% CIs) for alisertib AUC0-inf and Cmax in the presence compared to the absence of itraconazole were 1.39 (0.99, 1.95) and 0.98 (0.82, 1.19), respectively.