丁珏芳, 钟大放. 小分子酪氨酸激酶抑制剂的临床药代动力学研究进展J. 药学学报, 2013,48(7): 1080-1090.
引用本文: 丁珏芳, 钟大放. 小分子酪氨酸激酶抑制剂的临床药代动力学研究进展J. 药学学报, 2013,48(7): 1080-1090.
DING Jue-fang, ZHONG Da-fang. Clinical pharmacokinetics of small molecule tyrosine kinase inhibitorsJ. 药学学报, 2013,48(7): 1080-1090.
Citation: DING Jue-fang, ZHONG Da-fang. Clinical pharmacokinetics of small molecule tyrosine kinase inhibitorsJ. 药学学报, 2013,48(7): 1080-1090.

小分子酪氨酸激酶抑制剂的临床药代动力学研究进展

Clinical pharmacokinetics of small molecule tyrosine kinase inhibitors

  • 摘要:

    酪氨酸激酶对肿瘤的发生和发展起重要作用, 已成为近年来抗肿瘤药物研发的新靶点。本文总结了 目前已在中国上市的8个小分子酪氨酸激酶抑制剂 (TKIs) 的药代动力学 (吸收、分布、代谢、排泄) 和药物相互作用方面的研究进展。总体上, 这些TKIs吸收快速, 体内分布广泛, 血浆蛋白结合率高 (大于90%), 主要由CYP3A4参与代谢, 药动学受CYP3A4抑制剂或诱导剂显著影响 (索拉非尼除外), 主要通过粪便排泄, 为外排转运体P-gpBCRP的底物。另外, 多个TKIs可以抑制多种CYP450酶、UGT酶和转运体。吉非替尼、厄洛替尼、达沙替尼和舒尼替尼可以代谢活化生成反应活性中间体而与生物大分子结合, 可能是化合物产生毒性的原因之一。

     

    Abstract:

    Human protein tyrosine kinases play an essential role in carcinogenesis and have been recognized as promising drug targets.  By the end of 2012, eight small molecule tyrosine kinase inhibitors (TKIs) have been approved by State Food and Drug Administration of China for cancer treatment.  In this paper, the pharmacokinetic characteristics (absorption, distribution, metabolism and excretion) and drug-drug interactions of the approved TKIs are reviewed.  Overall, these TKIs reach their peak plasma concentrations relatively fast; are extensively distributed and highly protein bound (>90%); are primarily metabolized by CYP3A4; most are heavily influenced by CYP3A4 inhibitors or inducers except for sorafenib; are mainly excreted with feces and only a minor fraction is eliminated with the urine; and are substrate of the efflux transporters ABCB1 (P-gp) and ABCG2 (BCRP).  Additionally, many of the TKIs can inhibit some CYP450 enzymes, UGT enzymes, and transporters. Gefitinib, erlotinib, dasatinib, and sunitinib are metabolized to form reactive metabolites capable of covalently binding to biomolecules.

     

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