Taken together, these findings support itraconazole as a promising candidate for further in vivo and clinical investigation in selected oral cancers, including HNSCC and OSCC. Nevertheless, the definition of clinical treatment schedules will require additional comprehensive pharmacokinetic, toxicological, and clinical studies.
The topoisomerase I inhibitor payload (DXd) released from the human epidermal growth factor receptor 2-targeted antibody-drug conjugate (ADC) trastuzumab deruxtecan (T-DXd) is eliminated by hepatic uptake via OATP1B1/3, metabolism by CYP3A, biliary excretion via P-glycoprotein and breast cancer resistance protein, and urinary excretion. DDIs with ritonavir and itraconazole simulated by the PBPK model reproduced the clinical DDI study results, indicating that the impact of concomitant medications was not clinically meaningful. These findings suggest that this model may potentially be used for DDI evaluation of future DXd-containing ADCs, aiding in the prediction of DDIs under different scenarios and in specific populations.