Yifei Xue

and 10 more

Objective:Population pharmacokinetics analysis explored the pharmacokinetics of anlotinib in children with soft tissue sarcomas (STS) and identified the optimal dose for children across various age brackets. Method:From 2021 to 2023, a single dose of anlotinib (4.62 mg/m2) was orally administered in 16 children with advanced STS in 8 days. Anlotinib plasma concentration was evaluated by LC-MS/MS. Pharmacokinetic models were developed using nonlinear mixed-effects modelling. The effect of predefined covariates on pharmacokinetic parameters was assessed. Results:Totally 128 samples from 16 children (aged 5-14) were collected for pop-PK analysis. The two-compartment model was most consistent with the data of oral anlotinib in pediatrics with advanced STS, and the relevant parameters were: Ka (h-1) 0.419; Vc/F (L) 760; Q (L∙h-1) 21.2; Vp/F (L) 547. Covariate screening showed that the clearance of anlotinib gradually increased with age in a sigmoidal relationship, the maximum CL/F was 15.7L∙h-1, and age of median clearance (Age50) was 6.84 years; the Vc/F increased linearly with BSA. Dose of 8 mg anlotinib for children aged 5-7, and 10 mg or 12 mg for children aged 8-10 would be expected to lead to a similar exposure of anlotinib compared with an adult patient receiving 12 mg. Conclusion:The population pharmacokinetics of orally administrated anlotinib were evaluated in pediatric advanced STS patients. BSA and age were significant physiologic factors on PK. A simulation of 8 mg anlotinib in children aged 5-7, 10 mg or 12 mg in 8-10 and 12 mg for children over 11 would get similar exposure of adults receiving 12mg.

Yifei Xue

and 3 more

Background: Existing research focuses primarily on common adverse events (AEs) in adults using Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI), systematic reports from real-world settings and safety research on off-label use in children are lacking. Therefore, we aimed to investigate the safety profiles of VEGFR-TKIs via the FAERS. Method: Data regarding VEGFR-TKIs were extracted from the FAERS between 2004Q1 to 2022Q2. Reporting odds ratio (ROR) was performed to identify risk signals associations of VEGFR-TKIs with AEs. A reported AE would be defined as a potential risk signal if it simultaneously met the report cases ≥ 3, ROR ≥ 2, the lower limit of 95% CI ≥1, and χ2 ≥ 4. and categorized by the MedDRA terms. Results: A total of 51,841 reports containing 536 children were identified from May 18, 2005, to June 30, 2022. Despite some differences, 7 VEGFR-TKIs had similar safety profiles in the general population. The most significant ROR was PPES and the most frequent SOC was gastrointestinal disorders. In pediatrics, results varied in these agents, and the most frequent AE with significant ROR were PPES, followed by pneumothorax. Furthermore, blood and lymphatic system disorders and investigation abnormalities were both the most common SOCs. Conclusion: Disproportionality analysis based on the FAERS database is an effective path to recognize VEGFR-TKI-related AEs. Findings of the general population were largely consistent with real-world setting studies, and the widely recorded data in FAERS also made it possible to retrieve the safety of these agents in pediatrics.