Incurred Sample Reanalysis, ISR Test

Background

Bioanalytical assays are widely used to quantify drugs and their metabolites in a variety of biological matrices. Incurred sample reanalysis (ISR) has steadily gained popularity as a quality assessment tool for bioanalytical assays. ISR analysis is repeated measurement of analyte within a selected sample set from dosed subjects in separate runs on different days to establish result reproducibility.

Method validation in pharmacokinetic and bioanalytical studies ensures high quality findings by minimizing bias and error. The validation process includes assessment of selectivity, specificity, sensitivity, accuracy, precision, recovery, and stability of analyte. We conduct these validations on quality control (QC) samples prepared by spiking drug-free matrix from human volunteers or animals with reference compound of known identity and concentration.

QC samples, however, may not always mimic test compound activity in incurred samples due to several reasons. For example, lack of compound recovery, sample non-homogeneity, metabolite presence, protein binding, and matrix suppression effects etc. Here, Incurred sample reanalysis (ISR) becomes crucial. ISR test involves reanalyzing incurred samples to ensure the accuracy and reliability of the results obtained from the original analysis.

Regulation

First discussions for the need of Incurred sample reanalysis guidelines, prompted by wide variability of reanalyzed samples compared to original results in some studies as observed by FDA, were held in May 2006 at the AAPS / FDA Bioanalytical Workshop entitled “Quantitative Bioanalytical Methods Validation and Implementation: Best Practices for Chromatographic and Ligand Binding Assays”[1]. Afterwards, industry leaders met to discuss general procedures for Incurred sample reanalysis in Feb 2008 at the AAPS/FDA Bioanalytical Workshop entitled “AAPS workshop on current topics in GLP bioanalysis: Assay reproducibility for incurred samples – implications of Crystal City recommendations”, and subsequently published expectations for ISR test conduct, documentation, and reporting in Jun 2009[2]. European Medicines Agency first provided regulatory guidance on ISR analysis. FDA followed in 2013 through publishing of its own draft document.

FDA’s ISR Mandate

Require Incurred Sample Reanalysis (ISR) for all pivotal PK / PD and in vivo human BE studies; ISR at least once for each method and species during non-clinical safety studies
Incorporate ISR analysis into method development and validation pilot to allow for remediation prior to pivotal study; monitor Incurred sample reanalysis in larger number and variety for pivotal PK / PD studies
Select up to 10% of study samples for the ISR test
Sample selection to ensure adequate coverage of entire PK / PD profile of all subjects, including assessments from time points around Cmax and end of elimination phase
Analyze using the original bioanalytical method (including number of replicates and any applied dilution factor), and compare Incurred sample reanalysis samples to freshly prepared calibrators
At least two-thirds (67%) of ISR test results should be within 20% of original results for small molecules and within 30% of original results for large molecules; percentage difference calculated as (Repeat – Original)*100 / Mean
No regulatory requirement for additional analyses, if an individual sample does not meet the above acceptance criteria; scientific judgment expected in case difference is substantial
Halt analyses and perform / document investigation, if overall Incurred sample reanalysis does not meet acceptance criteria
Document all ISR tests evaluations to reconstruct the study conduct and any follow up investigations

Study

We conducted ISR analysis on a chemotherapy drug Capecitabine used in treatment of many types of cancers, such as breast, colon, rectal, stomach, oesophageal and pancreatic cancers. The subject drug is rationally designed 5-fluorouracil (FU) prodrug that mimics continuous infusion of 5-FU while avoiding complications / inconvenience of intravenous administration. This antimetabolite drug gets absorbed intact from the gastrointestinal tract, converted enzymatically to active 5-FU, and released directly into the tumour. Therefore, accurate measurement of 5-FU through Incurred sample reanalysis is an essential study.[3]

We measured both Capecitabine and its metabolite 5-FU. For sample preparation, we put together standards and QCs containing both the analytes and internal standards. Our analysts ran separate LC-MS/MS for the two analytes due to significant retention time difference. Initially, ISR analysis passed for the parent but failed for the metabolite

During the ISR test, we noticed that the current bioanalytical method can accurately measure Capecitabine but the observed 5-FU levels were highly variable. Therefore, we initiated an investigation to find out the cause for this high variability and increased concentration of 5-FU. Note that the prodrug does not metabolizes to 5-FU directly, but goes through intermediate metabolism, as noted.

Capecitabine à 5’-deoxy-5-fluorocytidine (5’-DFCR) à 5’-deoxy-5-fluorourindine (5’-DFUR) à 5-FU
Additionally, there are specific enzymes involved in all the transformations

Carboxylesterase in the liver (5’–DFCR)
Cytidine deaminase in the liver and tumor tissue (5’-DFUR)
Thymidine phosphorylase (TP) in tumor tissue (5-FU)

Hence, it was necessary to measure other intermediate metabolites to understand the issue. We performed several experiments to deduce the reason for 5-FU Incurred sample reanalysis failure. This was primarily due to further conversion of other intermediate metabolites to 5-FU as well, resulting in its way higher concentrations during the ISR test.

Conclusion

We noted that Capecitabine and 5’DFCR are unstable in blood and in plasma on Ice and 37^oC. 5’DFUR is unstable in blood but stable in plasma. Furthermore, we observed an increase in concentration of 5’DFUR in plasma suggesting conversion from Capecitabine and 5’DFCR. Thus, we infer that multiple mechanisms must be contributing towards the increase in concentration of 5-FU in clinical samples. Hence in-vivo a positive bias towards 5-FU is possible due to instability of Capecitabine and the other intermediate metabolites.

NorthEast Biolab supports ISR for both preclinical and clinical studies. Our ISR recommendations include First-in-human, First-in-patient, Drug–drug interaction, impaired population, Bioequivalence/Biocomparability, First-time method use, and pivotal studies. Our team follows Standard Operating Procedures (SOPs) to conduct, report, and investigate ISR findings. We review and update these SOPs regularly to meet regulatory and client expectations and provide reliable, high-quality data.

[1] Viswanathan CT1, Bansal S, Booth B, DeStefano AJ, Rose MJ, Sailstad J, Shah VP, Skelly JP, Swann PG, Weiner R, Quantitative bioanalytical methods validation and implementation: best practices for chromatographic and ligand binding assays, Pharm Res. 2007 Oct;24(10):1962-73. Epub 2007 Apr 26

[2] Fast DM, Kelley M, Viswanathan CT, O’Shaughnessy J, King SP, Chaudhary A, Weiner R, DeStefano AJ, Tang D, Workshop report and follow-up–AAPS Workshop on current topics in GLP bioanalysis: Assay reproducibility for incurred samples–implications of Crystal City recommendations, AAPS J. 2009 Jun;11(2):238-41. doi: 10.1208/s12248-009-9100-9. Epub 2009 Apr 21.

[3] Chintala, L., Vaka, S., Baranda, J. et al. Oncol Rev (2011) 5: 129. https://doi.org/10.1007/s12156-011-0074-3