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Why, When, and How to Conduct 14C Human Studies LIFE SCIENCE I TECHNICAL BULLETIN ISSUE N°29 /OCTOBER 2009 WHY, WHEN, AND HOW TO CONDUCT 14 C HUMAN STUDIES AUTHOR: ALAIN MIGNOT, PHARM. PH.D., SR CONSULtaNT EARLY CLINICAL DEVELOPMENT, SGS LIFE SCIENCE SERVICES INTRODUCTION The knowledge of the disposition and metabolism of drugs is an important part of the drug development process to appropriately understand the safety and efficacy of drug candidates.As recently summarized by the last FDA Guidance on safety testing of drug metabolites1, there is a high concern when “drug metabolites are either identified only in humans (but this is rare) or are present at disproportionately higher levels in humans than in any of the animal species used during standard nonclinical toxicology (a more common situation)”. Overall, the FDA “encourages the identification of differences in drug metabolism between animals used in nonclinical safety assessments and humans as early as possible during the drug development process. The discovery of disproportionate drug metabolites late in drug development can cause marked delays in drug development. It is underlined that “human metabolites that can raise a safety concern are those formed at greater than 10 percent of parent drug systemic exposure at steady state”. The Guidance also depicts a decision tree that describes the circumstances where non-clinical studies using direct administration of the disproportionate human metabolite may be requested (Figure 1). As a consequence, the knowledge of the metabolic fate of a drug candidate needs to be established during the drug development process and mainly before large population of patients are enrolled in clinical trials. FIGURE 1: FDA DECISION TREE FLOW DIAGRAM LIFE SCIENCE I TECHNICAL BULLETIN 2 This article aims at presenting diverse and how the final 14C-human ADME strategies supporting the management (Absorption, Distribution, Metabolism, of the risk related to drug metabolites, Excretion) studies should be conducted. WHY CONDUCT 14C HUMAN STUDIES? Early and comprehensive knowledge of used to study the metabolism of drugs. metabolite have been identified and pharmacokinetics and key metabolites is These in vitro systems are deemed to all drug related materials eliminated critical in drug discovery and development. provide appropriate information on in vivo before having conducted human It has now been more than two decades circulating metabolites and metabolic studies (metabolic profiling of plasma since SGS Life Science Services began pathways. In a recent study2 using these samples from first-in-human studies) conducting 14C ADME studies in humans. three systems, the prediction of human and radiolabeled ADME studies in These studies have several objectives excretory and circulating metabolite human. There are even suggestions that including the: profiles of forty-height compounds the starting point for quantification of of different structures and routes of circulating metabolites should be based on a) Determination of the mass balance excretion for which the human ADME the results from the human metabolism of total drug-related material data were available was good for primary study3. b) Determination of the routes of metabolites and less reliable for secondary excretion of total drug-related metabolites. Although there is no debate on the material necessity to conduct a radiolabeled human c) Determination of the However, even in these conditions it ADME study to address all the issues pharmacokinetics of the parent is generally recognized that identifying related to the safety of drug metabolites, it drug and total drug-related material the human excretory and circulating is difficult to provide detailed requirements d) Identification of the metabolites metabolite profiles from these in vitro on what is sufficient to avoid additional e) Quantification of the relative systems is not sufficient to mitigate the toxicity studies. Overall, this uncertainty abundances of the metabolites in risk of disproportionate metabolites in reflects the complexity of the drug excreta and circulation humans. development process and therefore, one cannot be surprised that different risk- In vitro models based on liver tissue, e.g. Except for drugs that are entirely based strategies are followed to fulfil pooled human liver microsomes, liver S-9 eliminated via the kidney, it is generally the requirements of the guidance on the fraction, and hepatocytes are generally difficult to conclude that all the drug safety of testing of drug metabolites. WHEN TO CONDUCT 14C HUMAN STUDIES? While it is recognized that the human Approach 2 is resource minimized with high GLP analyses of human and radiolabeled ADME study is the necessary risk for delay consists of: toxicology samples. step to definitely fix the strategy to Evaluation of disproportionate tackle the issue of a disproportionate Preclinical ADME metabolites and decisions metabolite, different approaches to fulfil TK of parent concerning additional toxicology. the requirements in the Guidance can be PK of parent during Phase I studies Human ADME performed in envisaged. Indeed, examples of different Human ADME after Proof of Phase II to verify disproportionate approaches are described here4: Concept metabolites decisions. Synthesis of formal reference Approach 1 is resource intensive with low standards Another approach is also possible risk for delay consists of: Assessment of disproportionate as described in Figure 2, where the metabolites from toxicology and continuous building of knowledge along Extensive preclinical ADME human samples with the drug development program is Toxicokinetics (TK) of parent depicted5. and possible disproportionate Approach 3 is a compromise between metabolites approach 1 and 2 and consists of: Overall, there are several strategies Pharmacokinetics (PK) of parent regarding metabolite profiling during drug and possible disproportionate Establish metabolite profiles in development, each of which includes metabolites during Phase I studies preclinical studies; isolation of the possibility to conduct the human Phase I human ADME metabolites radiolabeled ADME study at different step Metabolite profiling in toxicology of the program. However, it is generally species recognized that this human study should Metabolite profiling in Phase I be done prior to conducting large patient studies to estimate presence of trials. disproportionate metabolites. LIFE SCIENCE I TECHNICAL BULLETIN 3 IN VITRO metaBOLITE SCREENING, IN VIVO ANIMAL metaBOLITES PRECLINICAL Is there a human unique metabolite? Is the metabolite likely to be pharmacologically active? EARLY CLINICAL metaBOLITE INVESTIGatION: metabolite identification during FIH (SAD/MAD) studies PHASE 1 Are there human metabolites not present in animal? Has potent target pharmacology or HERG activity? YES NO Case by case consideration: Do animal studies support YES PHASE 2 safety assessment for Clinical development to POC metabolites? NO YES Conduct appropriate safety studies: Is appropriate safety of POC DEMONstrated metabolite demonstrated? NO NO YES Resolve safety concern or DEFINITIVE RADIOLABELED discontinue ADME studies in animal and human PHASE 3 - - - FIGURE 2: DECISION TREE FOR metaBOLITE SAFETY RISK ASSESSMENT (ADAPTED FROM DON WALKER ET AL, 2009). FIH: First-in-Human; SAD: Single Administration Dose; MAD: Multiple Administration Dose; POC: Proof of Concept LIFE SCIENCE I TECHNICAL BULLETIN 4 HOW TO CONDUCT HUMAN 14C-ADME STUDIES A typical 14C human ADME study consists to the radiolabeled drug is quantitatively Antwerp CPU perform chemical analysis of administering male healthy subjects recovered in the excreta (thresholds pre- on raw materials and finished products, with a single dose of the drug generally specified in the study protocol, generally in microbiology assays, stability testing, as labelled with Carbone-14. The total the range of 95% total and blood < 1Bq/ well as radiopurity assay. For intra-venous radiolabeled dose used in these studies mL). Blood samples are also collected dosage forms additional controls including is in the range of 50-100 µCi depending for determination of pharmacokinetics sterility tests and assay for endotoxins are on predictions of exposures of specific of parent drug and total radioactivity. The also performed. tissues from tissue distribution studies samples obtained from this study are used conducted in animals (mainly rats). The in metabolite profiling of the excreta and Due to the safety importance of results total dose (radiolabeled + cold drug) is circulation. obtained from these samples, full Good generally in the range of pharmacologically Manufacturing and Clinical Practices apply active doses. Several aspects of the quality of the at SGS Life Science Research for both radiolabeled drug need to be managed the manufacturing of the study drugs After administration, the study subjects closely by the clinical site where the study (radiolabeled and cold) and the bioanalytical are maintained in the clinical pharmacology drug is administered to the subject. SGS methods developed for these laboratory unit (CPU) until the radioactivity related laboratories in the near vicinity of the assessments. CONCLUDING REMARKS Several risk-based strategies to assess some flexibility to perform these human With innovative study designs, metabolites exist. Whatever the strategy ADME studies at different steps during the optimal facilities and strong chosen, the conduct of a radiolabeled drug development process, they should regulatory intelligence,
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