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ASCEND-8: A Randomized Phase 1 Study of Ceritinib, 450 mg or 600 mg, Taken with a Low-Fat Meal versus 750 mg in Fasted State in Patients with Anaplastic Lymphoma Kinase (ALK)-Rearranged Metastatic Non-Small Cell Lung Cancer (NSCLC)

 Byoung Chul Cho  ;  Dong-Wan Kim  ;  Alessandra Bearz  ;  Scott A. Laurie  ;  Mark McKeage  ;  Gloria Borra  ;  Keunchil Park  ;  Sang-We Kim  ;  Marwan Ghosn  ;  Andrea Ardizzoni  ;  Evaristo Maiello  ;  Alastair Greystoke  ;  Richard Yu  ;  Karen Osborne  ;  Wen Gu  ;  Jeffrey W. Scott  ;  Vanessa Q. Passos  ;  Yvonne Y. Lau  ;  Anna Wron 
 JOURNAL OF THORACIC ONCOLOGY, Vol.12(9) : 1357-1367, 2017 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Carcinoma, Non-Small-Cell Lung/pathology ; Fasting ; Humans ; Lung Neoplasms/drug therapy* ; Lung Neoplasms/pathology ; Middle Aged ; Pyrimidines/administration & dosage ; Pyrimidines/pharmacology ; Pyrimidines/therapeutic use* ; Receptor Protein-Tyrosine Kinases/drug effects* ; Sulfones/administration & dosage ; Sulfones/pharmacology ; Sulfones/therapeutic use*
Anaplastic lymphoma kinase ; Ceritinib ; Food-effect study ; NSCLC
INTRODUCTION: Ceritinib, 750 mg fasted, is approved for treatment of patients with ALK receptor tyrosine kinase gene (ALK)-rearranged (ALK-positive) NSCLC previously treated with crizotinib. Part 1 of the ASCEND-8 study determined whether administering ceritinib, 450 mg or 600 mg, with a low-fat meal may enhance gastrointestinal (GI) tolerability versus 750 mg fasted in patients with ALK-positive NSCLC while maintaining similar exposure.

METHODS: ASCEND-8 is a multicenter, randomized, open-label, phase 1 study. Part 1 investigated the steady-state pharmacokinetics (PK) and safety of ceritinib, 450 mg or 600 mg, taken with a low-fat meal versus 750 mg fasted in patients with advanced ALK-positive NSCLC who were either treatment naive or pretreated with chemotherapy and/or crizotinib. Part 2 will assess efficacy and safety of ceritinib in treatment-naive patients.

RESULTS: As of June 16, 2016, 137 patients were randomized (450 mg fed [n = 44], 600 mg fed [n = 47], and 750 mg fasted [n = 46]); 135 patients received ceritinib. Median follow-up duration was 4.14 months. At steady state, relative to 750 mg fasted, 450 mg with food demonstrated comparable PK as assessed by maximum (peak) concentration of drug in plasma and area under the plasma concentration-time curve from time zero to 24 hours, whereas 600 mg with food demonstrated approximately 25% higher PK. Relative to 750 mg fasted, 450 mg with food was associated with a lower proportion of patients with GI toxicities, mostly grade 1 (diarrhea [43.2%], nausea [29.5%], and vomiting [18.2%]); there were no grade 3 or 4 events, study drug discontinuations, or serious AEs due to GI toxicities.

CONCLUSION: Ceritinib, 450 mg with food, had similar exposure and a more favorable GI safety profile than ceritinib, 750 mg in fasted patients with ALK-positive NSCLC.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Cho, Byoung Chul(조병철) ORCID logo https://orcid.org/0000-0002-5562-270X
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