Diagnostic application of the exponentially modified Gaussian model for peak quality and quantitation in high-throughput liquid chromatography-tandem mass spectrometry.

Typical area calculation for a chromatographic peak assumes the observed signal strength at every measurement is an exactly accurate count of the signal. We compared that approach to one using the exponentially modified Gaussian (EMG) in an automated, clinical production setting. Peak areas in a 47 analyte high throughput clinical production liquid chromatography-tandem mass spectrometry assay were compared across four months of production data to determine trends over the lifespan of a chromatographic column. The EMG parameters were superior to traditional quality control methods for monitoring data reproducibility, accuracy and precision. Because the EMG calculations are performed for every peak in the system, a constant monitor of system health is integrated into the operational workflow. Parameter trends confirmed the need for column replacement, and indicated the opportunity for a reduced schedule of preventive and routine maintenance.

Phase I studies of sirolimus alone or in combination with pharmacokinetic modulators in advanced cancer patients.

PURPOSE: Sirolimus is the eponymous inhibitor of the mTOR; however, only its analogs have been approved as cancer therapies. Nevertheless, sirolimus is readily available, has been well studied in organ transplant patients, and shows efficacy in several preclinical cancer models. EXPERIMENTAL DESIGN: Three simultaneously conducted phase I studies in advanced cancer patients used an adaptive escalation design to find the dose of oral, weekly sirolimus alone or in combination with either ketoconazole or grapefruit juice that achieves similar blood concentrations as its intravenously administered and approved prodrug, temsirolimus. In addition, the effect of sirolimus on inhibition of p70S6 kinase phosphorylation in peripheral T cells was determined. RESULTS: Collectively, the three studies enrolled 138 subjects. The most commonly observed toxicities were hyperglycemia, hyperlipidemia, and lymphopenia in 52%, 43%, and 41% of subjects, respectively. The target sirolimus area under the concentration curve (AUC) of 3,810 ng-h/mL was achieved at sirolimus doses of 90, 16, and 25 mg in the sirolimus alone, sirolimus plus ketoconazole, and sirolimus plus grapefruit juice studies, respectively. Ketoconazole and grapefruit juice increased sirolimus AUC approximately 500% and 350%, respectively. Inhibition of p70 S6 kinase phosphorylation was observed at all doses of sirolimus and correlated with blood concentrations. One partial response was observed in a patient with epithelioid hemangioendothelioma. CONCLUSION: Sirolimus can be feasibly administered orally, once weekly with a similar toxicity and pharmacokinetic profile compared with other mTOR inhibitors and warrants further evaluation in studies of its comparative effectiveness relative to recently approved sirolimus analogs.