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Published on: September 18, 2013
Population modeling analyses of crizotinib in pediatric patients with ALK-positive advanced cancers
Li Jerry1, Lin Swan2, Nickens Dana1
1Clinical Pharmacology, Pfizer Inc., New York, New York, USA.
Background:
Alterations in the ALK (anaplastic lymphoma kinase) gene play a critical role in pathogenesis of anaplastic large cell lymphoma (ALCL). Crizotinib is a small molecule competitive inhibitor of ALK, ROS1, and MET kinases and was approved for pediatric patients with ALK-positive relapsed or refractory, systemic ALCL, and ALK-positive unresectable, recurrent, or refractory inflammatory myofibroblastic tumors (IMT).
Procedure:
Crizotinib data from pediatric patients with relapsed or refractory solid tumors, IMT, or ALCL were included in the analyses. All patients received crizotinib orally at doses ranging from 100 to 365 mg/m2 twice daily (BID). PopPK analyses were conducted to characterize crizotinib disposition in pediatric patients. Exposure-response (ER) safety and antitumor analyses were conducted to characterize relationships between crizotinib dose or exposure with safety and antitumor activity endpoints of interest.
Results:
The population pharmacokinetic (popPK), ER safety, and ER antitumor analysis included 98, 110, and 36 pediatric patients, respectively. A one-compartment pharmacokinetic model with allometric scaling, first-order elimination, and first-order absorption with lag time adequately described the data. Natural log-transformed model-predicted crizotinib AUCss (steady-state area under the concentration-time curve) demonstrated a significant, positive relationship with Grade ≥3 NEUTROPENIA and Any Grade VISION DISORDER. Crizotinib dose demonstrated a positive relationship with objective response rate.
Conclusions:
No significant differences in PK were identified across a wide range of ages or across tumor types, suggesting body surface area (BSA)-based dosing adequately adjusted for differences in patient size to achieve similar systemic crizotinib exposures across young children and adolescent pediatric patients. None of the myelosuppressive events except Grade ≥3 NEUTROPENIA had significant relationships identified with crizotinib dose or exposure, suggesting crizotinib is a tolerable treatment with less hematological toxicity than traditional chemotherapy regimens for pediatric patients with ALK-mutated cancers. Results from the presented analyses support the pediatric dosing recommendations in the product label.
Insights
Crizotinib dosing in pediatric patients with ALK-mutated cancers is supported by pharmacokinetic and exposure-response analyses. The drug demonstrates tolerable safety, with dose related to objective response rate and neutropenia.
Area of Science:
- Pharmacology
- Pediatric Oncology
- Pharmacokinetics
Background:
- Anaplastic lymphoma kinase (ALK) gene alterations are key in anaplastic large cell lymphoma (ALCL) pathogenesis.
- Crizotinib, an ALK, ROS1, and MET inhibitor, is approved for pediatric ALK-positive relapsed/refractory systemic ALCL and unresectable inflammatory myofibroblastic tumors (IMT).
Purpose of the Study:
- To characterize crizotinib pharmacokinetics (PK) and exposure-response (ER) relationships in pediatric patients.
- To evaluate the safety and antitumor activity of crizotinib in pediatric populations.
- To support existing pediatric dosing recommendations for crizotinib.
Main Methods:
- Population PK (popPK) analyses were performed on data from 98 pediatric patients.
- ER safety and antitumor analyses included 110 and 36 pediatric patients, respectively.
- A one-compartment PK model with allometric scaling was utilized to describe crizotinib disposition.
Main Results:
- Crizotinib exposure (AUCss) showed a positive relationship with Grade ≥3 neutropenia and any grade vision disorder.
- Crizotinib dose was positively associated with objective response rate.
- PK did not significantly differ across ages or tumor types, supporting BSA-based dosing.
Conclusions:
- Body surface area (BSA)-based dosing effectively achieves similar crizotinib exposures in pediatric patients of varying ages and tumor types.
- Crizotinib exhibits tolerable safety with less hematological toxicity than traditional chemotherapy for pediatric ALK-mutated cancers.
- Findings support current pediatric dosing guidelines for crizotinib.
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