Cancer Therapy: Clinical Evaluation of Food Effect on Pharmacokinetics of Vismodegib in Advanced Solid Tumor Patients

Purpose: Vismodegib, an orally bioavailable small-molecule Smoothened inhibitor, is approved for treatment of advancedbasal cell carcinoma (BCC).We conducted apharmacokinetic study of vismodegib in patients with advanced solid tumors to explore the effects of food on drug exposure. Experimental Design: In part I, patients were randomized to fasting overnight (FO), a high fat meal (HF), or a low fat meal (LF) before a single dose of vismodegib 150 mg. Plasma concentrations of vismodegib were determined by a validated liquid chromatography-tandem mass spectrometry assay. Primary endpoints were Cmax and area under the curve (AUC0–168). In part II, patients randomized to FO or HF in part I took vismodegib 150 mg daily after fasting; those randomized to LF took it after a meal. Primary endpoints after two weeks were Cmax and AUC0–24. Results: Sixty (22 FO, 20 HF, 18 LF) and 52 (25 fasting, 27 fed) patients were evaluable for primary endpoints in parts I and II, respectively. MeanCmax and AUC0–168 after a single dose were higher in HF than FO patients [ratios of geometric means (90% CI) 1⁄4 1.75 (1.30, 2.34) and 1.74 (1.25, 2.42), respectively]. There were no significant differences in Cmax or AUC0–24 between fasting and fed groups after daily dosing. The frequencies of drug-related toxicities were similar in both groups. Conclusions: A HF meal increases plasma exposure to a single dose of vismodegib, but there are no pharmacokinetic or safety differences between fasting and fed groups at steady-state. Vismodegib may be taken with or without food for daily dosing. Clin Cancer Res; 19(11); 1–9. 2013 AACR.