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Khallouki F, Hajji L, Saber S, Bouddine T, Edderkaoui M, Bourhia M, Mir N, Lim A, El Midaoui A, Giesy JP, Aboul-Soud MAM, Silvente-Poirot S, Poirot M. An Update on Tamoxifen and the Chemo-Preventive Potential of Vitamin E in Breast Cancer Management. J Pers Med 2023; 13:jpm13050754. [PMID: 37240924 DOI: 10.3390/jpm13050754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Breast cancer (BC) is the most common female cancer in terms of incidence and mortality worldwide. Tamoxifen (Nolvadex) is a widely prescribed, oral anti-estrogen drug for the hormonal treatment of estrogen-receptor-positive BC, which represents 70% of all BC subtypes. This review assesses the current knowledge on the molecular pharmacology of tamoxifen in terms of its anticancer and chemo-preventive actions. Due to the importance of vitamin E compounds, which are widely taken as a supplementary dietary component, the review focuses only on the potential importance of vitamin E in BC chemo-prevention. The chemo-preventive and onco-protective effects of tamoxifen combined with the potential effects of vitamin E can alter the anticancer actions of tamoxifen. Therefore, methods involving an individually designed, nutritional intervention for patients with BC warrant further consideration. These data are of great importance for tamoxifen chemo-prevention strategies in future epidemiological studies.
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Affiliation(s)
- Farid Khallouki
- Biology Department, FSTE, Moulay Ismail University of Meknes, BP 609, Errachidia 52000, Morocco
- Biology Department, Faculty of Sciences, Moulay Ismail University of Meknes, BP. 11201 Zitoune, Meknes 50050, Morocco
| | - Lhoussain Hajji
- Biology Department, Faculty of Sciences, Moulay Ismail University of Meknes, BP. 11201 Zitoune, Meknes 50050, Morocco
| | - Somayya Saber
- Biology Department, FSTE, Moulay Ismail University of Meknes, BP 609, Errachidia 52000, Morocco
- Biology Department, Faculty of Sciences, Moulay Ismail University of Meknes, BP. 11201 Zitoune, Meknes 50050, Morocco
| | - Toufik Bouddine
- Biology Department, Faculty of Sciences, Moulay Ismail University of Meknes, BP. 11201 Zitoune, Meknes 50050, Morocco
| | - Mouad Edderkaoui
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center & University of California, Los Angeles, CA 90048, USA
| | - Mohammed Bourhia
- Higher Institute of Nursing Professions and Technical Health, Laayoune 70000, Morocco
| | - Nora Mir
- Biology Department, Faculty of Sciences, Moulay Ismail University of Meknes, BP. 11201 Zitoune, Meknes 50050, Morocco
| | - Adrian Lim
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center & University of California, Los Angeles, CA 90048, USA
| | - Adil El Midaoui
- Biology Department, FSTE, Moulay Ismail University of Meknes, BP 609, Errachidia 52000, Morocco
| | - John P Giesy
- Toxicology Centre, University of Saskatchewan, Saskatoon, SK S7N 5B3, Canada
- Department of Veterinary Biomedical Sciences, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
- Department of Integrative Biology, Michigan State University, East Lansing, MI 48824, USA
- Department of Environmental Sciences, Baylor University, Waco, TX 76706, USA
| | - Mourad A M Aboul-Soud
- Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Sandrine Silvente-Poirot
- Cancer Research Center of Toulouse, UMR 1037 INSERM, UMR 5071 CNRS, University of Toulouse III, Equipe labellisée par la Ligue Nationale Contre le Cancer, 31037 Toulouse, France
- French Network for Nutrition And Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France
| | - Marc Poirot
- Cancer Research Center of Toulouse, UMR 1037 INSERM, UMR 5071 CNRS, University of Toulouse III, Equipe labellisée par la Ligue Nationale Contre le Cancer, 31037 Toulouse, France
- French Network for Nutrition And Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France
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Zhou W, Jiang Y, Xu Y, Wang Y, Ma X, Zhou L, Lin Y, Wang Y, Wu Z, Li M, Yin W, Lu J. Comparison of adverse drug reactions between tamoxifen and toremifene in breast cancer patients with different CYP2D6 genotypes: a propensity-score matched cohort study. Int J Cancer 2021; 150:1664-1676. [PMID: 34957551 DOI: 10.1002/ijc.33919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 11/06/2022]
Abstract
CYP2D6 gene polymorphism had a profound impact upon the effect of tamoxifen as adjuvant endocrine therapy in breast cancers. However, it had never been reported whether the adverse drug reactions vary by CYP2D6 metabolic status for patients treated with tamoxifen or toremifene. We conducted an retrospective study in breast cancer patients to investigate the impact of CYP2D6 metabolizers on liver dysfunction events, gynecological events, and dyslipidemia events. According to CYP2D6*10 (100C → T) genotype, the enrolled patients were further categorized into four cohorts (extensive metabolizers taking tamoxifen [EM + TAM], extensive metabolizers taking toremifene [EM + TOR], intermediate metabolizers taking tamoxifen [IM + TAM], intermediate metabolizers taking toremifene cohort [IM + TOR]). A total of 192 patients were included into the study, with a median follow-up time of 26.2 months. In EM + TAM cohort, the risks of liver dysfunction events (P = 0.004) and gynecological events (P = 0.004) were significantly higher compared with EM + TOR cohort. In IM + TAM cohort, the risks of liver dysfunction events (P = 0.14) and gynecological events (P = 0.99) were not significantly different from IM + TOR cohort. Significant decrease of total cholesterol was observed in EM + TAM cohort around 1 year after taking tamoxifen (P < 0.001). Significant interactions between CYP2D6 metabolic status and endocrine agents were observed in terms of liver dysfunction events (p-interaction = 0.007) and gynecological events (p-interaction = 0.026). These findings suggested that CYP2D6 gene polymorphism played a significant role in predicting liver dysfunction, gynecological diseases and lipid metabolism changes among patients taking tamoxifen or toremifene. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Weihang Zhou
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiwei Jiang
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yaqian Xu
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yaohui Wang
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaowei Ma
- Department of Clinical Laboratory, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liheng Zhou
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanping Lin
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Wang
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ziping Wu
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Min Li
- Department of Clinical Laboratory, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjin Yin
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinsong Lu
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Robin C, Hennart B, Broly F, Gruchala P, Robin G, Catteau-Jonard S. Could Cytochrome P450 2D6, 3A4 and 3A5 Polymorphisms Explain the Variability in Clinical Response to Clomiphene Citrate of Anovulatory PCOS Women? Front Endocrinol (Lausanne) 2021; 12:718917. [PMID: 34690927 PMCID: PMC8535872 DOI: 10.3389/fendo.2021.718917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/20/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Cytochrome P450 2D6, 3A4 and 3A5 are involved in the metabolism of many drugs. These enzymes have a genetic polymorphism responsible for different metabolic phenotypes. They play a role in the metabolism of clomiphene citrate (CC), which is used to induce ovulation. Response to CC treatment is variable, and no predictive factors have thus far been identified. OBJECTIVE To study a possible link between the cytochrome P450 2D6, 3A4 and 3A5 polymorphisms and clinical response to CC. STUDY DESIGN Seventy-seven women with anovulatory Polycystic Ovarian Syndrome (PCOS) treated with CC were included which determined their cytochrome P450 2D6, 3A4 and 3A5 genotypes and used the results to predict ovarian response to this drug. Predicted responses based on the cytochrome genotypes were compared with the observed clinical responses using the calculation of a weighted Kappa coefficient. MAIN OUTCOME MEASURES Number of dominant follicles assessed by ultrasound at the end of the follicular phase and confirmation of ovulation by blood progesterone assay in the luteal phase. RESULTS Concordance between the predicted and observed responses for the combination of the three cytochromes was 36.71%, with a negative Kappa coefficient (K = -0.0240), which corresponds to a major disagreement. Similarly, for predictions based on the cytochrome P450 2D6 genotype alone, only 39.24% of predictions were verified (coefficient K = -0.0609). CONCLUSION The genetic polymorphism of cytochromes P450 2D6, 3A4 and 3A5 does not appear to influence clinical response to CC used to induce ovulation in anovulatory PCOS women.
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Affiliation(s)
- Camille Robin
- University of Lille, Centre Hospitalier Universitaire (CHU) Lille, Department of Reproductive Medicine, Lille, France
- *Correspondence: Camille Robin,
| | - Benjamin Hennart
- University of Lille, CHU Lille, Service de Toxicologie et Génopathies, Pôle de Biochimie et Biologie Moléculaire, Centre de Biologie Pathologie, Lille, France
| | - Franck Broly
- University of Lille, CHU Lille, Service de Toxicologie et Génopathies, Pôle de Biochimie et Biologie Moléculaire, Centre de Biologie Pathologie, Lille, France
| | - Philippine Gruchala
- University of Lille, Centre Hospitalier Universitaire (CHU) Lille, Department of Reproductive Medicine, Lille, France
| | - Geoffroy Robin
- University of Lille, Centre Hospitalier Universitaire (CHU) Lille, Department of Reproductive Medicine, Lille, France
- University of Lille, CHU Lille, EA 4308 “Gametogenesis and Gamete Quality”, Lille, France
| | - Sophie Catteau-Jonard
- University of Lille, Centre Hospitalier Universitaire (CHU) Lille, Department of Reproductive Medicine, Lille, France
- University of Lille, CHU Lille, INSERM U1172, Lille, France
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Role of cholesterol metabolism in the anticancer pharmacology of selective estrogen receptor modulators. Semin Cancer Biol 2020; 73:101-115. [PMID: 32931953 DOI: 10.1016/j.semcancer.2020.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
Selective estrogen receptor modulators (SERMs) are a class of compounds that bind to estrogen receptors (ERs) and possess estrogen agonist or antagonist actions in different tissues. As such, they are widely used drugs. For instance, tamoxifen, the most prescribed SERM, is used to treat ERα-positive breast cancer. Aside from their therapeutic targets, SERMs have the capacity to broadly affect cellular cholesterol metabolism and handling, mainly through ER-independent mechanisms. Cholesterol metabolism reprogramming is crucial to meet the needs of cancer cells, and different key processes involved in cholesterol homeostasis have been associated with cancer progression. Therefore, the effects of SERMs on cholesterol homeostasis may be relevant to carcinogenesis, either by contributing to the anticancer efficacy of these compounds or, conversely, by promoting resistance to treatment. Understanding these aspects of SERMs actions could help to design more efficacious therapies. Herein we review the effects of SERMs on cellular cholesterol metabolism and handling and discuss their potential in anticancer pharmacology.
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CYP2D6-inhibiting medication use and inherited CYP2D6 variation in relation to adverse breast cancer outcomes after tamoxifen therapy. Cancer Causes Control 2018; 30:103-112. [PMID: 30542984 DOI: 10.1007/s10552-018-1117-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Tamoxifen is widely used to reduce the risk of breast cancer (BC) recurrence and extend disease-free survival among women with estrogen-sensitive breast cancers. Tamoxifen efficacy is thought to be attributable to its active metabolite, which is formed through a reaction catalyzed by the P450 enzyme, CYP2D6. Inhibition of tamoxifen metabolism as a result of germline genetic variation and/or use of CYP2D6-inhibiting medications ("inhibitors") is hypothesized to increase the risk of adverse BC outcomes among women taking tamoxifen. METHODS The present cohort study of 960 women diagnosed with early-stage BC between 1993 and 1999 examined the association between concomitant use of CYP2D6 inhibitors and adjuvant tamoxifen and the risk of adverse BC outcomes (recurrence, second primary BC, BC mortality), both overall and according to CYP2D6 metabolic phenotype. RESULTS Six or more months of CYP2D6 inhibitor use concomitant with tamoxifen was not associated with any appreciable increase in risk of recurrence or second primary BC or BC mortality, and there was no clear evidence of variation by CYP2D6 metabolic phenotype. CONCLUSIONS These results are consistent with the relatively few other large, population-based studies conducted to date that have not observed an increased risk of adverse BC outcomes associated with CYP2D6 inhibition.
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Jahn HM, Kasakow CV, Helfer A, Michely J, Verkhratsky A, Maurer HH, Scheller A, Kirchhoff F. Refined protocols of tamoxifen injection for inducible DNA recombination in mouse astroglia. Sci Rep 2018; 8:5913. [PMID: 29651133 PMCID: PMC5897555 DOI: 10.1038/s41598-018-24085-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/27/2018] [Indexed: 01/26/2023] Open
Abstract
Inducible DNA recombination of floxed alleles in vivo by liver metabolites of tamoxifen (TAM) is an important tool to study gene functions. Here, we describe protocols for optimal DNA recombination in astrocytes, based on the GLAST-CreERT2/loxP system. In addition, we demonstrate that quantification of genomic recombination allows to determine the proportion of cell types in various brain regions. We analyzed the presence and clearance of TAM and its metabolites (N-desmethyl-tamoxifen, 4-hydroxytamoxifen and endoxifen) in brain and serum of mice by liquid chromatographic-high resolution-tandem mass spectrometry (LC-HR-MS/MS) and assessed optimal injection protocols by quantitative RT-PCR of several floxed target genes (p2ry1, gria1, gabbr1 and Rosa26-tdTomato locus). Maximal recombination could be achieved in cortex and cerebellum by single daily injections for five and three consecutive days, respectively. Furthermore, quantifying the loss of floxed alleles predicted the percentage of GLAST-positive cells (astroglia) per brain region. We found that astrocytes contributed 20 to 30% of the total cell number in cortex, hippocampus, brainstem and optic nerve, while in the cerebellum Bergmann glia, velate astrocytes and white matter astrocytes accounted only for 8% of all cells.
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Affiliation(s)
- Hannah M Jahn
- Molecular Physiology, Center for Integrative Physiology and Molecular Medicine (CIPMM), University of Saarland, 66421 Homburg, Germany
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University Hospital of Cologne, Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
| | - Carmen V Kasakow
- Molecular Physiology, Center for Integrative Physiology and Molecular Medicine (CIPMM), University of Saarland, 66421 Homburg, Germany
| | - Andreas Helfer
- Department of Experimental and Clinical Toxicology, University of Saarland, 66421, Homburg, Germany
| | - Julian Michely
- Department of Experimental and Clinical Toxicology, University of Saarland, 66421, Homburg, Germany
| | - Alexei Verkhratsky
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Hans H Maurer
- Department of Experimental and Clinical Toxicology, University of Saarland, 66421, Homburg, Germany
| | - Anja Scheller
- Molecular Physiology, Center for Integrative Physiology and Molecular Medicine (CIPMM), University of Saarland, 66421 Homburg, Germany
| | - Frank Kirchhoff
- Molecular Physiology, Center for Integrative Physiology and Molecular Medicine (CIPMM), University of Saarland, 66421 Homburg, Germany.
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Abraham O, Schleiden LJ, Brothers AL, Albert SM. Managing sleep problems using non-prescription medications and the role of community pharmacists: older adults' perspectives. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 25:438-446. [PMID: 28261882 PMCID: PMC5724494 DOI: 10.1111/ijpp.12334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/21/2016] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To examine older adults' perspectives regarding managing sleep problems through selection and use of non-prescription sleep aids, and the role of pharmacists. METHODS Telephone interviews were conducted from May to June 2015 with 116 individuals aged ≥60 years in Pittsburgh, Pennsylvania. Participants reported in a previous survey to have used at least one non-prescription sleep aid in the past 30 days and were willing to participate in a follow-up interview. Interview guides were designed to elicit perspectives of sleep problems, selection and use of non-prescription sleep aids, and consultation with healthcare professionals. Interview transcripts underwent content analysis. KEY FINDINGS Four themes emerged as follows: experiences with sleep problems, selection of non-prescription sleep aids, non-prescription sleep aid use and interactions with healthcare professionals. Over half of participants reported using a non-prescription sleep aid for >1 year, were satisfied with its use and perceived it improved sleep quality. Participants commonly used an antihistamine-only sleep aid; 36% of participants self-recommended their sleep aid; and 16% of participants consulted healthcare professionals. Few participants read medication dosage labels (22%), side effects or warnings (19%), and many reported they disregarded directions. Participants did not typically consult pharmacists about sleep problems (65%) but perceived that they could assist with medication concerns. CONCLUSIONS Although most participants had favourable perceptions of non-prescription sleep aids, older adults may be inappropriately using non-prescription sleep aids to self-manage sleep problems by frequently disregarding medication labels and directions for safe use. Also, few older adults are discussing their sleep aid selection and use with pharmacists.
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Affiliation(s)
- Olufunmilola Abraham
- Department of Pharmacy and TherapeuticsSchool of PharmacyUniversity of PittsburghPittsburghPAUSA
| | - Loren J. Schleiden
- Department of Pharmacy and TherapeuticsSchool of PharmacyUniversity of PittsburghPittsburghPAUSA
| | - Amanda L. Brothers
- Department of Pharmacy and TherapeuticsSchool of PharmacyUniversity of PittsburghPittsburghPAUSA
| | - Steven M. Albert
- Department of Behavioral and Community Health SciencesGraduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
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Weber A, Szalai R, Sipeky C, Magyari L, Melegh M, Jaromi L, Matyas P, Duga B, Kovesdi E, Hadzsiev K, Melegh B. Increased prevalence of functional minor allele variants of drug metabolizing CYP2B6 and CYP2D6 genes in Roma population samples. Pharmacol Rep 2015; 67:460-4. [DOI: 10.1016/j.pharep.2014.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 11/04/2014] [Accepted: 11/13/2014] [Indexed: 01/11/2023]
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Cerrato F, Fernández-Suárez ME, Alonso R, Alonso M, Vázquez C, Pastor O, Mata P, Lasunción MA, Gómez-Coronado D. Clinically used selective oestrogen receptor modulators increase LDL receptor activity in primary human lymphocytes. Br J Pharmacol 2015; 172:1379-94. [PMID: 25395200 DOI: 10.1111/bph.13016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/28/2014] [Accepted: 11/06/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND PURPOSE Treatment with selective oestrogen receptor modulators (SERMs) reduces low-density lipoprotein (LDL) cholesterol levels. We assessed the effect of tamoxifen, raloxifene and toremifene and their combinations with lovastatin on LDL receptor activity in lymphocytes from normolipidaemic and familial hypercholesterolaemic (FH) subjects, and human HepG2 hepatocytes and MOLT-4 lymphoblasts. EXPERIMENTAL APPROACH Lymphocytes were isolated from peripheral blood, treated with different compounds, and 1,1'-dioctadecyl-3,3,3,3'-tetramethylindocarbocyanine perchlorate (DiI)-labelled LDL uptake was analysed by flow cytometry. KEY RESULTS Tamoxifen, toremifene and raloxifene, in this order, stimulated DiI-LDL uptake by lymphocytes by inhibiting LDL-derived cholesterol trafficking and subsequent down-regulation of LDL receptor expression. Differently to what occurred in HepG2 and MOLT-4 cells, only tamoxifen consistently displayed a potentiating effect with lovastatin in primary lymphocytes. The SERM-mediated increase in LDL receptor activity was not altered by the anti-oestrogen ICI 182,780 nor was it reproduced by 17β-oestradiol. However, the tamoxifen-active metabolite endoxifen was equally effective as tamoxifen. The SERMs produced similar effects on LDL receptor activity in heterozygous FH lymphocytes as in normal lymphocytes, although none of them had a potentiating effect with lovastatin in heterozygous FH lymphocytes. The SERMs had no effect in homozygous FH lymphocytes. CONCLUSIONS AND IMPLICATIONS Clinically used SERMs up-regulate LDL receptors in primary human lymphocytes. There is a mild enhancement between SERMs and lovastatin of lymphocyte LDLR activity, the potentiation being greater in HepG2 and MOLT-4 cells. The effect of SERMs is independent of oestrogen receptors but is preserved in the tamoxifen-active metabolite endoxifen. This mechanism may contribute to the cholesterol-lowering action of SERMs.
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Affiliation(s)
- F Cerrato
- Servicio de Bioquímica-Investigación, Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, Spain
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Viedma-Rodríguez R, Baiza-Gutman L, Salamanca-Gómez F, Diaz-Zaragoza M, Martínez-Hernández G, Ruiz Esparza-Garrido R, Velázquez-Flores MA, Arenas-Aranda D. Mechanisms associated with resistance to tamoxifen in estrogen receptor-positive breast cancer (review). Oncol Rep 2014; 32:3-15. [PMID: 24841429 DOI: 10.3892/or.2014.3190] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/03/2014] [Indexed: 11/06/2022] Open
Abstract
Anti-estrogens such as tamoxifen are widely used in the clinic to treat estrogen receptor-positive breast tumors. Patients with estrogen receptor-positive breast cancer initially respond to treatment with anti-hormonal agents such as tamoxifen, but remissions are often followed by the acquisition of resistance and, ultimately, disease relapse. The development of a rationale for the effective treatment of tamoxifen-resistant breast cancer requires an understanding of the complex signal transduction mechanisms. In the present study, we explored some mechanisms associated with resistance to tamoxifen, such as pharmacologic mechanisms, loss or modification in estrogen receptor expression, alterations in co-regulatory proteins and the regulation of the different signaling pathways that participate in different cellular processes such as survival, proliferation, stress, cell cycle, inhibition of apoptosis regulated by the Bcl-2 family, autophagy, altered expression of microRNA, and signaling pathways that regulate the epithelial-mesenchymal transition in the tumor microenvironment. Delineation of the molecular mechanisms underlying the development of resistance may aid in the development of treatment strategies to enhance response and compromise resistance.
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Affiliation(s)
- Rubí Viedma-Rodríguez
- Molecular Genetics Laboratory, Medical Research Unit in Human Genetics, Pediatric Hospital, National Medical Center Century XXI (CMN-SXXI), Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Luis Baiza-Gutman
- Unit of Morphology and Function, Faculty of Higher Studies (FES) Iztacala, National Autonomous University of Mexico (UNAM), Los Reyes Iztacala, State of Mexico, Mexico
| | - Fabio Salamanca-Gómez
- Molecular Genetics Laboratory, Medical Research Unit in Human Genetics, Pediatric Hospital, National Medical Center Century XXI (CMN-SXXI), Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | | | - Guadalupe Martínez-Hernández
- Unit of Morphology and Function, Faculty of Higher Studies (FES) Iztacala, National Autonomous University of Mexico (UNAM), Los Reyes Iztacala, State of Mexico, Mexico
| | - Ruth Ruiz Esparza-Garrido
- Molecular Genetics Laboratory, Medical Research Unit in Human Genetics, Pediatric Hospital, National Medical Center Century XXI (CMN-SXXI), Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Miguel Angel Velázquez-Flores
- Molecular Genetics Laboratory, Medical Research Unit in Human Genetics, Pediatric Hospital, National Medical Center Century XXI (CMN-SXXI), Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Diego Arenas-Aranda
- Molecular Genetics Laboratory, Medical Research Unit in Human Genetics, Pediatric Hospital, National Medical Center Century XXI (CMN-SXXI), Mexican Social Security Institute (IMSS), Mexico City, Mexico
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Muroi Y, Saito T, Takahashi M, Sakuyama K, Niinuma Y, Ito M, Tsukada C, Ohta K, Endo Y, Oda A, Hirasawa N, Hiratsuka M. Functional characterization of wild-type and 49 CYP2D6 allelic variants for N-desmethyltamoxifen 4-hydroxylation activity. Drug Metab Pharmacokinet 2014; 29:360-6. [PMID: 24647041 DOI: 10.2133/dmpk.dmpk-14-rg-014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Genetic variations in cytochrome P450 2D6 (CYP2D6) contribute to interindividual variability in the metabolism of clinically used drugs, e.g., tamoxifen. CYP2D6 is genetically polymorphic and is associated with large interindividual variations in therapeutic efficacy and drug toxicity. In this study, we performed an in vitro analysis of 50 allelic variants of CYP2D6 proteins. Wild-type CYP2D6.1 and 49 variants were transiently expressed in COS-7 cells, and the enzymatic activities of the CYP2D6 variants were characterized using N-desmethyltamoxifen as a substrate. The kinetic parameters K(m), V(max), and intrinsic clearance (V(max)/K(m)) of N-desmethyltamoxifen 4-hydroxylation were determined. Among the 50 CYP2D6 variants, the kinetic parameters for N-desmethyltamoxifen 4-hydroxylation were determined for 20 CYP2D6 variants. On the other hand, the kinetic parameters of 30 CYP2D6 variants could not be determined because the amount of metabolite produced was at or below the detection limit at the lower substrate concentrations. Among them, 8 variants, i.e., CYP2D6.2, .9, .26, .28, .32, .43, .45, and .70, showed decreased intrinsic clearance at <50% of CYP2D6.1. The comprehensive in vitro assessment of CYP2D6 variants provides novel insights into allele-specific activity towards tamoxifen and may be valuable when interpreting in vivo studies.
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Affiliation(s)
- Yuka Muroi
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University
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Pharmacogenetics in American Indian populations: analysis of CYP2D6, CYP3A4, CYP3A5, and CYP2C9 in the Confederated Salish and Kootenai Tribes. Pharmacogenet Genomics 2014; 23:403-14. [PMID: 23778323 DOI: 10.1097/fpc.0b013e3283629ce9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Cytochrome P450 enzymes play a dominant role in drug elimination and variation in these genes is a major source of interindividual differences in drug response. Little is known, however, about pharmacogenetic variation in American Indian and Alaska Native (AI/AN) populations. We have developed a partnership with the Confederated Salish and Kootenai Tribes (CSKT) in northwestern Montana to address this knowledge gap. METHODS We resequenced CYP2D6 in 187 CSKT individuals and CYP3A4, CYP3A5, and CYP2C9 in 94 CSKT individuals. RESULTS We identified 67 variants in CYP2D6, 15 in CYP3A4, 10 in CYP3A5, and 41 in CYP2C9. The most common CYP2D6 alleles were CYP2D6*4 and *41 (20.86 and 11.23%, respectively). CYP2D6*3, *5, *6, *9, *10, *17, *28, *33, *35, *49, *1xN, *2xN, and *4xN frequencies were less than 2%. CYP3A5*3, CYP3A4*1G, and *1B were detected with frequencies of 92.47, 26.81, and 2.20%, respectively. Allelic variation in CYP2C9 was low: CYP2C9*2 (5.17%) and *3 (2.69%). In general, allele frequencies in CYP2D6, CYP2C9, and CYP3A5 were similar to those observed in European Americans. There was, however, a marked divergence in CYP3A4 for the CYP3A4*1G allele. We also observed low levels of linkage between CYP3A4*1G and CYP3A5*1 in the CSKT. The combination of nonfunctional CYP3A5*3 and putative reduced function CYP3A4*1G alleles may predict diminished clearance of CYP3A substrates. CONCLUSION These results highlight the importance of carrying out pharmacogenomic research in AI/AN populations and show that extrapolation from other populations is not appropriate. This information could help optimize drug therapy for the CSKT population.
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Areepium N, Panomvana D, Rungwanonchai P, Sathaporn S, Voravud N. Effects of CYP2D6 and UGT2B7 polymorphisms on pharmacokinetics of tamoxifen in Thai breast cancer patients. BREAST CANCER (DOVE MEDICAL PRESS) 2013; 5:73-8. [PMID: 24648760 PMCID: PMC3929327 DOI: 10.2147/bctt.s47172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of this study was to evaluate the impact of CYP2D6 and UGT2B7 polymorphisms on tamoxifen (TAM) pharmacokinetics in Thai breast cancer patients. METHODS Thai female breast cancer patients treated with TAM were included in the study. Patients were genotyped for CYP2D6 and UGT2B7 polymorphism, and plasma levels of TAM and its potent active metabolite endoxifen (END), at steady state, were identified. RESULTS Fifty-nine female breast cancer patients were included in the study. The average age was 50 ± 9.3 years old; 76% were premenopausal and 85% had estrogen receptor-positive breast cancer. The allele frequencies of CYP2D6*10 and UGT2B7*2 were 53% and 28%, respectively. Patients with CYP2D6*10/*10 had lower END concentrations compared with CYP2D26*1/*10 and CYP2D6*1/*1 (9.62 ng/mL versus 15.67 ng/mL and 21.55 ng/mL, respectively, P = 0.045). Polymorphisms of UGT2B7 alone did not have any impact on TAM metabolism. However, among 20 patients with CYP2D6*10/*10, one with UGT2B7*2/*2 had higher END concentrations compared against patients with UGT2B7*1/*1 and UGT2B7*1/*2 (31.36 ng/mL versus 7.86 ng/mL, respectively, P = 0.023). CONCLUSION Results from this study confirmed the impacts of CYP2D6 polymorphisms on the pharmacokinetics of TAM, while UGT2B7 polymorphisms tended to have impact on TAM metabolism in patients with homozygous CYP2D6*10.
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Affiliation(s)
- N Areepium
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - D Panomvana
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - P Rungwanonchai
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - S Sathaporn
- Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - N Voravud
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Visvanathan K, Hurley P, Bantug E, Brown P, Col NF, Cuzick J, Davidson NE, DeCensi A, Fabian C, Ford L, Garber J, Katapodi M, Kramer B, Morrow M, Parker B, Runowicz C, Vogel VG, Wade JL, Lippman SM. Use of Pharmacologic Interventions for Breast Cancer Risk Reduction: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2013; 31:2942-62. [DOI: 10.1200/jco.2013.49.3122] [Citation(s) in RCA: 242] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose To update the 2009 American Society of Clinical Oncology guideline on pharmacologic interventions for breast cancer (BC) risk reduction. Methods A systematic review of randomized controlled trials and meta-analyses published from June 2007 through June 2012 was completed using MEDLINE and Cochrane Collaboration Library. Primary outcome of interest was BC incidence (invasive and noninvasive). Secondary outcomes included BC mortality, adverse events, and net health benefits. Guideline recommendations were revised based on an Update Committee's review of the literature. Results Nineteen articles met the selection criteria. Six chemoprevention agents were identified: tamoxifen, raloxifene, arzoxifene, lasofoxifene, exemestane, and anastrozole. Recommendations In women at increased risk of BC age ≥ 35 years, tamoxifen (20 mg per day for 5 years) should be discussed as an option to reduce the risk of estrogen receptor (ER) –positive BC. In postmenopausal women, raloxifene (60 mg per day for 5 years) and exemestane (25 mg per day for 5 years) should also be discussed as options for BC risk reduction. Those at increased BC risk are defined as individuals with a 5-year projected absolute risk of BC ≥ 1.66% (based on the National Cancer Institute BC Risk Assessment Tool or an equivalent measure) or women diagnosed with lobular carcinoma in situ. Use of other selective ER modulators or other aromatase inhibitors to lower BC risk is not recommended outside of a clinical trial. Health care providers are encouraged to discuss the option of chemoprevention among women at increased BC risk. The discussion should include the specific risks and benefits associated with each chemopreventive agent.
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Affiliation(s)
- Kala Visvanathan
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Patricia Hurley
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Elissa Bantug
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Powel Brown
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Nananda F. Col
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Jack Cuzick
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Nancy E. Davidson
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Andrea DeCensi
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Carol Fabian
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Leslie Ford
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Judy Garber
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Maria Katapodi
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Barnett Kramer
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Monica Morrow
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Barbara Parker
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Carolyn Runowicz
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Victor G. Vogel
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - James L. Wade
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
| | - Scott M. Lippman
- Kala Visvanathan, Johns Hopkins Medical Institutions; Elissa Bantug, Johns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore; Leslie Ford and Barnett Kramer, National Cancer Institute, Bethesda, MD; Patricia Hurley, American Society of Clinical Oncology, Alexandria, VA; Powel Brown, MD Anderson Cancer Center, University of Texas, Houston, TX; Nananda F. Col, University of New England, Biddeford, ME; Jack Cuzick, Queen Mary University of London, London, United Kingdom; Nancy E
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Trends in co-prescribing of antidepressants and tamoxifen among women with breast cancer, 2004-2010. Breast Cancer Res Treat 2012; 137:285-96. [PMID: 23149465 DOI: 10.1007/s10549-012-2330-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/30/2012] [Indexed: 12/30/2022]
Abstract
Nearly a decade ago, researchers identified a potential interaction between tamoxifen and strong CYP2D6 inhibitors, including several frequently used antidepressants. Based on evidence available at that time, a United States Food and Drug Administration advisory committee recommended tamoxifen's label be changed in October 2006, noting that postmenopausal women with estrogen receptor-positive breast cancer who are poor CYP2D6 metabolizers by genotype or drug interactions may be at increased risk of cancer recurrence. The impact of accumulating drug risk information on antidepressant use is unknown. We conducted a retrospective, longitudinal cohort study of 13,205 women aged 50-95 with breast cancer initiating tamoxifen between July 2004 and December 2009. We evaluated trends in strong, moderate, and weak CYP2D6-inhibitor antidepressants and tamoxifen co-prescribing and factors associated with ongoing strong inhibitor use. A propensity score matched control group (aromatase inhibitor initiators) was used to estimate changes in co-prescribing, accounting for secular trends. In each month, approximately 24 % of tamoxifen and aromatase inhibitor users were prescribed antidepressants. Among women using tamoxifen and antidepressants, 34 % used strong inhibitors between 2004 and 2006 versus 15 % in 2010. Strong inhibitor use decreased more among tamoxifen users than aromatase inhibitor users (difference-in-differences [DD] -0.09; 95 % confidence interval [CI] -0.15, -0.03). Weak inhibitor use increased among tamoxifen users from 32 % between 2004 and 2006 to 52 % in 2010, more rapidly than among aromatase inhibitor users (DD 0.15; CI 0.08, 0.23). The factor most strongly associated with strong inhibitor and tamoxifen co-prescribing after 2006 was prior strong inhibitor use (RR 4.73; CI 3.62-6.18). In conclusion, there were substantial declines in strong CYP2D6-inhibitor use among tamoxifen users following dissemination of information suggesting a potential for increased risk with co-prescribing. Whether patients and providers will continue to avoid strong inhibitor antidepressants is yet to be seen, but clinicians appear to be responsive to drug interaction risk information in this setting.
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Justenhoven C, Obazee O, Brauch H. The pharmacogenomics of sex hormone metabolism: breast cancer risk in menopausal hormone therapy. Pharmacogenomics 2012; 13:659-75. [PMID: 22515609 DOI: 10.2217/pgs.11.144] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
With women in western countries spending nearly one-third of their lifetime beyond menopause and a substantial number of these women facing severe menopausal symptoms, the goal of sex hormone pharmacogenomics is to promote the safe use of hormone replacement therapy (HRT). This could be achieved by providing molecular predictors for the upfront stratification of women in need of relief from menopausal symptoms into those with a likely benefit from HRT and those with a contraindication due to an HRT-associated breast cancer risk or other adverse effects. An increasing knowledge base of sex hormone metabolism and its variability, HRT outcomes and breast cancer susceptibility, as well as emerging examples of pharmacogenomic predictors, underscore the potential relevance of genetic variations for HRT outcome. The genes responsible for the metabolism, signaling and action of sex hormones are at the heart of this research; however, pharmacogenomic investigation of their therapeutic effects due to the enormous complexity of the biological pathways involved is still in its infancy. This article discusses the current knowledge, challenges and potential future directions towards the goal of genotype-guided safer HRT use.
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Affiliation(s)
- Christina Justenhoven
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart & University of Tübingen, Auerbachstrasse 112, 70376 Stuttgart, Germany
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Steroid receptor coactivators, HER-2 and HER-3 expression is stimulated by tamoxifen treatment in DMBA-induced breast cancer. BMC Cancer 2012; 12:247. [PMID: 22703232 PMCID: PMC3420308 DOI: 10.1186/1471-2407-12-247] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 06/15/2012] [Indexed: 12/16/2022] Open
Abstract
Background Steroid receptor coactivators (SRCs) may modulate estrogen receptor (ER) activity and the response to endocrine treatment in breast cancer, in part through interaction with growth factor receptor signaling pathways. In the present study the effects of tamoxifen treatment on the expression of SRCs and human epidermal growth factor receptors (HERs) were examined in an animal model of ER positive breast cancer. Methods Sprague-Dawley rats with DMBA-induced breast cancer were randomized to 14 days of oral tamoxifen 40 mg/kg bodyweight/day or vehicle only (controls). Tumors were measured throughout the study period. Blood samples and tumor tissue were collected at sacrifice and tamoxifen and its main metabolites were quantified using LC-MS/MS. The gene expression in tumor of SRC-1, SRC-2/transcription intermediary factor-2 (TIF-2), SRC-3/amplified in breast cancer 1 (AIB1), ER, HER-1, -2, -3 and HER-4, as well as the transcription factor Ets-2, was measured by real-time RT-PCR. Protein levels were further assessed by Western blotting. Results Tamoxifen and its main metabolites were detected at high concentrations in serum and accumulated in tumor tissue in up to tenfolds the concentration in serum. Mean tumor volume/rat decreased in the tamoxifen treated group, but continued to increase in controls. The mRNA expression levels of SRC-1 (P = 0.035), SRC-2/TIF-2 (P = 0.002), HER-2 (P = 0.035) and HER-3 (P = 0.006) were significantly higher in tamoxifen treated tumors compared to controls, and the results were confirmed at the protein level using Western blotting. SRC-3/AIB1 protein was also higher in tamoxifen treated tumors. SRC-1 and SRC-2/TIF-2 mRNA levels were positively correlated with each other and with HER-2 (P ≤ 0.001), and the HER-2 mRNA expression correlated with the levels of the other three HER family members (P < 0.05). Furthermore, SRC-3/AIB1 and HER-4 were positively correlated with each other and Ets-2 (P < 0.001). Conclusions The expression of SRCs and HER-2 and -3 is stimulated by tamoxifen treatment in DMBA-induced breast cancer. Stimulation and positive correlation of coactivators and HERs may represent an early response to endocrine treatment. The role of SRCs and HER-2 and -3 should be further studied in order to evaluate their effects on response to long-term tamoxifen treatment.
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Teoh DCW, Aw DCW, Jaffar H, Ling W, Yong WP, Lee YS, Choo SN, Tan KB. Tamoxifen-induced eccrine squamous syringometaplasia. J Cutan Pathol 2012; 39:554-7. [PMID: 22390276 DOI: 10.1111/j.1600-0560.2011.01860.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 74-year-old woman had carcinoma of her right breast for which surgery was performed. Four weeks following the start of tamoxifen therapy, she developed papules and plaques over her face, trunk and limbs. A skin biopsy showed perivascular and periadnexal mixed inflammatory cellular infiltrate with fibroplasia. Notably, the dermis also showed squamous epithelial islands, which in foci were noted to be closely associated with eccrine epithelium. This was confirmed with double peroxidase - alkaline phosphatase immunohistochemistry - the eccrine lumina highlighted with carcinoembryonic antigen (polyclonal) and the squamous metaplasia positive for cytokeratin 5/6. Eccrine squamous syringometaplasia was diagnosed. With close clinicopathological correlation, the cutaneous eruption was attributed to tamoxifen. Following discontinuation of the drug, the eruption resolved. Eccrine squamous syringometaplasia has been reported to occur in association with diverse conditions, including skin ulcers, burns and as a cutaneous adverse drug reaction, most commonly to chemotherapeutic drugs. This is believed to be the first report involving tamoxifen.
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Affiliation(s)
- David C-W Teoh
- University Medicine Cluster, National University Health System, Singapore
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Kitzmiller JP, Groen DK, Phelps MA, Sadee W. Pharmacogenomic testing: relevance in medical practice: why drugs work in some patients but not in others. Cleve Clin J Med 2011; 78:243-57. [PMID: 21460130 DOI: 10.3949/ccjm.78a.10145] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Genetics may account for much of the variability in our patients' responses to drug therapies. This article offers the clinician an up-to-date overview of pharmacogenomic testing, discussing implications and limitations of emerging validated tests relevant to the use of warfarin (Coumadin), clopidogrel (Plavix), statins, tamoxifen (Nolvadex), codeine, and psychotropic drugs. It also discusses the future role of pharmacogenomic testing in medicine.
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Affiliation(s)
- Joseph P Kitzmiller
- Department of Pharmacology, Division of Clinical Trials, College of Medicine, The Ohio State University, Columbus, USA.
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Iusuf D, Teunissen SF, Wagenaar E, Rosing H, Beijnen JH, Schinkel AH. P-Glycoprotein (ABCB1) Transports the Primary Active Tamoxifen Metabolites Endoxifen and 4-Hydroxytamoxifen and Restricts Their Brain Penetration. J Pharmacol Exp Ther 2011; 337:710-7. [DOI: 10.1124/jpet.110.178301] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Berstein LM. Modern approach to metabolic rehabilitation of cancer patients: biguanides (phenformin and metformin) and beyond. Future Oncol 2010; 6:1313-23. [PMID: 20799876 DOI: 10.2217/fon.10.87] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Comparing the experience accumulated for more than 40 years in the Laboratory of Endocrinology of Petrov Institute of Oncology (St Petersburg, Russia) with similar approaches practiced elsewhere, evidence supports the reasonability of metabolic rehabilitation of patients suffering from breast cancer or other hormone-dependent malignancies. The primary objective of such approaches is to improve treatment results by ameliorating hormonal-metabolic disturbances, including excess body fat, glucose intolerance, insulin resistance and manifestations of endocrine-genotoxic switchings, and modify tissue and cellular targets or mechanisms related or nondirectly related to the aforementioned disturbances. The relevant measures may be categorized as pharmacological (antidiabetic biguanides exemplified with metformin being most popular but not exclusive) and nonpharmacological (rational nutrition, moderate physical activity and so forth) and used separately or in different combinations.
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Affiliation(s)
- Lev M Berstein
- N.N.Petrov Research Institute of Oncology, Pesochny-2, Leningradskaja 68, St Petersburg, Russia.
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An ultra performance liquid chromatography–tandem MS assay for tamoxifen metabolites profiling in plasma: First evidence of 4′-hydroxylated metabolites in breast cancer patients. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:3402-14. [DOI: 10.1016/j.jchromb.2010.10.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 11/23/2022]
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Bardia A, Stearns V. Pharmacogenomics of Tamoxifen: Ready for Prime Time? CURRENT BREAST CANCER REPORTS 2010. [DOI: 10.1007/s12609-010-0004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wiechec E, Hansen LL. The effect of genetic variability on drug response in conventional breast cancer treatment. Eur J Pharmacol 2009; 625:122-30. [DOI: 10.1016/j.ejphar.2009.08.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 08/20/2009] [Accepted: 08/26/2009] [Indexed: 12/16/2022]
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Connolly R, Stearns V. The role of pharmacogenetics in selection of breast cancer treatment. CURRENT BREAST CANCER REPORTS 2009. [DOI: 10.1007/s12609-009-0027-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cleator SJ, Ahamed E, Coombes RC, Palmieri C. A 2009 Update on the Treatment of Patients with Hormone Receptor—Positive Breast Cancer. Clin Breast Cancer 2009; 9 Suppl 1:S6-S17. [DOI: 10.3816/cbc.2009.s.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Visvanathan K, Chlebowski RT, Hurley P, Col NF, Ropka M, Collyar D, Morrow M, Runowicz C, Pritchard KI, Hagerty K, Arun B, Garber J, Vogel VG, Wade JL, Brown P, Cuzick J, Kramer BS, Lippman SM. American society of clinical oncology clinical practice guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction. J Clin Oncol 2009; 27:3235-58. [PMID: 19470930 DOI: 10.1200/jco.2008.20.5179] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To update the 2002 American Society of Clinical Oncology guideline on pharmacologic interventions for breast cancer (BC) risk reduction. METHODS A literature search identified relevant randomized trials published since 2002. Primary outcome of interest was BC incidence (invasive and noninvasive). Secondary outcomes included BC mortality, adverse events, and net health benefits. An expert panel reviewed the literature and developed updated consensus guidelines. Results Seventeen articles met inclusion criteria. In premenopausal women, tamoxifen for 5 years reduces the risk of BC for at least 10 years, particularly estrogen receptor (ER) -positive invasive tumors. Women < or = 50 years of age experience fewer serious side effects. Vascular and vasomotor events do not persist post-treatment across all ages. In postmenopausal women, raloxifene and tamoxifen reduce the risk of ER-positive invasive BC with equal efficacy. Raloxifene is associated with a lower risk of thromboembolic disease, benign uterine conditions, and cataracts than tamoxifen in postmenopausal women. No evidence exists establishing whether a reduction in BC risk from either agent translates into reduced BC mortality. Recommendations In women at increased risk for BC, tamoxifen (20 mg/d for 5 years) may be offered to reduce the risk of invasive ER-positive BC, with benefits for at least 10 years. In postmenopausal women, raloxifene (60 mg/d for 5 years) may also be considered. Use of aromatase inhibitors, fenretinide, or other selective estrogen receptor modulators to lower BC risk is not recommended outside of a clinical trial. Discussion of risks and benefits of preventive agents by health providers is critical to patient decision making.
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Affiliation(s)
- Kala Visvanathan
- Cancer Policy and Clinical Affairs, 2318 Mill Rd, Suite 800, Alexandria, VA 22314, USA
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Fuggetta MP, Lanzilli G, Fioretti D, Rinaldi M. In vitro end points for the assessment of cellular immune response-modulating drugs. Expert Opin Drug Discov 2009; 4:473-93. [PMID: 23485082 DOI: 10.1517/17460440902821632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The concept of immunotoxicology and the development of a battery of immune-function assays to screen potential immunotoxic compounds have been increasingly used in the past. Immunotoxic outcome generally seems appropriate to evaluate the risk in drug development. Improving this approach is possible, by using methods now available, to study the effect of a chemical compound on the immune system. OBJECTIVE The goal of this review is to provide an overview of the current and recent methodologies for testing the immunological effect and immunotoxic risks in drug candidates. METHODS The methodological details here discussed include a synthetic description of the immunocompetent cells in cell-mediated immunity and the choice of the most appropriate assay (bioassays, immunoassays, molecular biology techniques, flow cytometry). CONCLUSION This review offers an assessment of in vitro models to study the toxic impact of (bio)pharmaceuticals on cellular immune system and aid drug scientists in understanding the significance and the methods to approach immunotoxicology.
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Affiliation(s)
- Maria Pia Fuggetta
- Institute of Neurobiology and Molecular Medicine, CNR, Via Fosso del Cavaliere 100, 00133 Rome, Italy +39 06 4993 4610 ; +39 06 4993 4257 ;
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