A Quantitative Model-Based Approach for Adavosertib Dose Selection in
Uterine Serous Carcinoma Patients
Abstract
Aims: Adavosertib, a WEE1 inhibitor, has been studied for safety and
efficacy as monotherapy and in combination therapy. The phase 2b ADAGIO
trial evaluated adavosertib monotherapy for uterine serous carcinoma
with a recommended dose of 300 mg dosing on days 1 to 5 and days 8 to 12
of 21‑day cycle. However, reports of severe neutropaenia and dose
reduction in approximately half of patients at 300 mg suggested
potential tolerability concerns. Methods: We conducted a model-based
benefit-risk analysis, including an exposure-safety analysis, pooling
data from all AstraZeneca-sponsored monotherapy studies. The analysis
focused on the relationship between adavosertib exposure and incidence
of adverse events such as haematological and gastrointestinal
toxicities. A preliminary exposure-efficacy analysis was conducted based
on available efficacy data from the ADAGIO study. Results: A strong
correlation is observed between adavosertib exposure and predicted
probability of developing neutropenia. Also, baseline creatinine
clearance (bCLCr) was identified as an independent factor for severe
neutropaenia development. Patients with bCLCr ≥50 mL/min were less
likely to experience severe neutropaenia than those with bCLCr
<50 ml/min. The model shows that a dose reduction from 300 to
250 mg reduces the predicted probability of neutropaenia by 55% when
compared at the 95th percentile exposure range at these doses. Contrary
to exposure safety, exposure-efficacy relationship was similar across
doses. Conclusion: The model-based approach identifies risk factors,
aiding in the decision to use a 250 mg monotherapy dose. This regimen
may manage hematological toxicities across studies. Reducing adavosertib
doses minimizes risks, underscoring the need for dose adjustment