生理药代动力学模型在EGFR-TKI精准治疗中的应用进展
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篇名: 生理药代动力学模型在EGFR-TKI精准治疗中的应用进展
TITLE: Advances in the application of physiologically-based pharmacokinetic model in EGFR-TKI precision therapy
摘要: 表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)是一类小分子肿瘤靶向治疗药物,是EGFR突变晚期非小细胞肺癌(NSCLC)的一线治疗药物,代表药物有吉非替尼、达可替尼、奥希替尼等。临床治疗中,肿瘤患者若存在药物联用、肝肾损伤等特殊情况,可能需调整EGFR-TKI的剂量。生理药代动力学(PBPK)模型可以预测药物在人体内的药代动力学(PK)过程,是临床剂量调整的重要工具。本文梳理了PBPK模型的建模方法、流程以及常用建模软件,总结了截至2024年6月30日PBPK模型在EGFR-TKI精准用药中的应用现状,发现PBPK模型的建模方法常用“自下而上”法和中间法,流程包括收集参数、房室选择、模型验证、模型应用4个步骤,常用软件有Simcyp、GastroPlus及开源软件PK-Sim等。PBPK模型可用于预测EGFR-TKI与代谢酶诱导剂或抑制剂、抑酸药、中西药联用时的药物-药物相互作用,结合基因组学调整药物剂量,预测特殊人群(肝肾功能不全患者、儿童患者)PK过程,评价药物的疗效和安全性,以及从动物模型外推预测人体PK等。
ABSTRACT: Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) represent a class of small-molecule targeted therapeutics for oncology treatment, and serve as first-line therapy for advanced non-small cell lung cancer (NSCLC) with EGFR- sensitive mutations, with representative agents including gefitinib, dacomitinib, and osimertinib. In clinical practice, dose adjustment of EGFR-TKI may be required for cancer patients under special circumstances such as drug combinations or hepatic/ renal impairment. Physiologically-based pharmacokinetic (PBPK) model, capable of predicting pharmacokinetic (PK) processes in humans, has emerged as a vital tool for clinical dose optimization. This article sorts the modeling methodologies, workflows, and commonly used software tools for PBPK model, and summarizes the current applications of PBPK model in EGFR-TKI precision therapy as of June 30, 2024. Findings demonstrate that PBPK modeling methods commonly employ the “bottom-up” approach and the middle-out approach. The process typically involves four steps: parameter collection, compartment selection, model validation, and model application. Commonly used software for modeling includes Simcyp, GastroPlus, and open-source software such as PK- Sim. PBPK model can be utilized for predicting drug-drug interactions of EGFR-TKI co-administered with metabolic enzyme inducers or inhibitors, acid-suppressive drugs, or traditional Chinese and Western medicines. It can also adjust dosages in conjunction with genomics, predict PK processes in special populations (such as patients with liver or kidney dysfunction, pediatric patients), evaluate the efficacy and safety of drugs, and extrapolate PK predictions from animal models to humans.
期刊: 2025年第36卷第08期
作者: 杨莹莹;邵佳琪;向秋林;李国兴;余娴
AUTHORS: YANG Yingying,SHAO Jiaqi,XIANG Qiulin,LI Guoxing,YU Xian
关键字: 生理药代动力学模型;EGFR-TKI;精准治疗;药物相互作用;非小细胞肺癌
KEYWORDS: physiologically-based pharmacokinetic model; EGFR-TKI; precision treatment; drug interaction; non-small cell
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