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Samadi M, Beigi L, Yadegari F, Ansari AM, Majidzadeh-A K, Eskordi M, Farahmand L. Recognition of functional genetic polymorphism using ESE motif definition: a conservative evolutionary approach to CYP2D6/CYP2C19 gene variants. Genetica 2022; 150:289-297. [PMID: 35913522 DOI: 10.1007/s10709-022-00161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/24/2022] [Indexed: 11/04/2022]
Abstract
Although predicting the effects of variants near intron-exon boundaries is relatively straightforward, predicting the functional Exon Splicing Enhancers (ESEs) and the possible effects of variants within ESEs remains a challenge. Considering the essential role of CYP2D6/CYP2C19 genes in drug metabolism, we attempted to identify variants that are most likely to disrupt splicing through their effect on these ESEs. ESEs were predicted in these two genes using ESEfinder 3.0, incorporating a series of filters (increased threshold and evolutionary conservation). Finally, reported mutations were evaluated for their potential to disrupt splicing by affecting these ESEs. Initially, 169 and 243 ESEs were predicted for CYP2C19/CYP2D6, respectively. However, applying the filters, the number of predicted ESEs was reduced to 26 and 19 in CYP2C19/CYP2D6, respectively. Comparing prioritized predicted ESEs with known sequence variants in CYP2C19/CYP2D6 genes highlights 18 variations within conserved ESEs for each gene. We found good agreement in cases where such predictions could be compared to experimental evidence. In total, we prioritized a subset of mutational changes in CYP2C19/CYP2D6 genes that may affect the function of these genes and lead to altered drug responses. Clinical studies and functional analysis for investigating detailed functional consequences of the mentioned mutations and their phenotypic outcomes is mostly recommended.
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Affiliation(s)
- Mitra Samadi
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Laleh Beigi
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Fatemeh Yadegari
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Alireza Madjid Ansari
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Keivan Majidzadeh-A
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Maryam Eskordi
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Leila Farahmand
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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Mulder TAM, de With M, del Re M, Danesi R, Mathijssen RHJ, van Schaik RHN. Clinical CYP2D6 Genotyping to Personalize Adjuvant Tamoxifen Treatment in ER-Positive Breast Cancer Patients: Current Status of a Controversy. Cancers (Basel) 2021; 13:cancers13040771. [PMID: 33673305 PMCID: PMC7917604 DOI: 10.3390/cancers13040771] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Tamoxifen is an important adjuvant endocrine therapy in estrogen receptor (ER)-positive breast cancer patients. It is mainly catalyzed by the enzyme CYP2D6 into the most active metabolite endoxifen. Genetic variation in the CYP2D6 gene influences endoxifen formation and thereby potentially therapy outcome. However, the association between CYP2D6 genotype and clinical outcome on tamoxifen is still under debate, as contradictory outcomes have been published. This review describes the latest insights in both CYP2D6 genotype and endoxifen concentrations, as well CYP2D6 genotype and clinical outcome, from 2018 to 2020. Abstract Tamoxifen is a major option for adjuvant endocrine treatment in estrogen receptor (ER) positive breast cancer patients. The conversion of the prodrug tamoxifen into the most active metabolite endoxifen is mainly catalyzed by the enzyme cytochrome P450 2D6 (CYP2D6). Genetic variation in the CYP2D6 gene leads to altered enzyme activity, which influences endoxifen formation and thereby potentially therapy outcome. The association between genetically compromised CYP2D6 activity and low endoxifen plasma concentrations is generally accepted, and it was shown that tamoxifen dose increments in compromised patients resulted in higher endoxifen concentrations. However, the correlation between CYP2D6 genotype and clinical outcome is still under debate. This has led to genotype-based tamoxifen dosing recommendations by the Clinical Pharmacogenetic Implementation Consortium (CPIC) in 2018, whereas in 2019, the European Society of Medical Oncology (ESMO) discouraged the use of CYP2D6 genotyping in clinical practice for tamoxifen therapy. This paper describes the latest developments on CYP2D6 genotyping in relation to endoxifen plasma concentrations and tamoxifen-related clinical outcome. Therefore, we focused on Pharmacogenetic publications from 2018 (CPIC publication) to 2021 in order to shed a light on the current status of this debate.
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Affiliation(s)
- Tessa A. M. Mulder
- Department of Clinical Chemistry, Erasmus MC University Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands; (T.A.M.M.); (M.d.W.); (M.d.R.); (R.D.)
| | - Mirjam de With
- Department of Clinical Chemistry, Erasmus MC University Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands; (T.A.M.M.); (M.d.W.); (M.d.R.); (R.D.)
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus MC, Wytemaweg 80, 3015CN Rotterdam, The Netherlands;
| | - Marzia del Re
- Department of Clinical Chemistry, Erasmus MC University Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands; (T.A.M.M.); (M.d.W.); (M.d.R.); (R.D.)
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126 Pisa, Italy
| | - Romano Danesi
- Department of Clinical Chemistry, Erasmus MC University Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands; (T.A.M.M.); (M.d.W.); (M.d.R.); (R.D.)
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126 Pisa, Italy
| | - Ron H. J. Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus MC, Wytemaweg 80, 3015CN Rotterdam, The Netherlands;
| | - Ron H. N. van Schaik
- Department of Clinical Chemistry, Erasmus MC University Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands; (T.A.M.M.); (M.d.W.); (M.d.R.); (R.D.)
- Correspondence: ; Tel.: +31-10-703-3119
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Hertz DL, Kidwell KM, Douglas JA, Viale G, Leyland-Jones B, Regan M, Rae JM. DNA derived from archival tumor specimens can be used for germline pharmacogenetic analyses. Pharmacogenomics 2020; 21:899-902. [PMID: 32723153 DOI: 10.2217/pgs-2020-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-1065, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Julie A Douglas
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology, University of Milan, 20141 Milano, Italy
| | - Brian Leyland-Jones
- Molecular and Experimental Research, Avera Cancer Institute, Sioux Falls, SD 57105, USA
| | - Meredith Regan
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - James M Rae
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Tohkin M, Saito Y, Yagi S, Asano K, Maekawa K, Osabe M, Iida S, Miyata N. Clinical study designs and patient selection methods based on genomic biomarkers: Points-to-consider documents. Drug Metab Pharmacokinet 2020; 35:187-190. [PMID: 32007355 DOI: 10.1016/j.dmpk.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/23/2019] [Accepted: 01/14/2020] [Indexed: 11/19/2022]
Abstract
Recently, genomic biomarkers have been widely used clinically for prediction of the efficacy and safety of pharmacotherapy and diagnosis and prognosis of pathological conditions. Therefore, genomic biomarkers are anticipated to accelerate not only precision medicine for pharmacotherapy but also development of molecularly targeted drugs. Because the design of clinical studies involving biomarkers may differ from conventional clinical study designs, a concept paper focused on clinical studies and patient selection methods based on genomic biomarkers is desired to prompt innovative drug development. Thus, this concept paper aimed to compile and present current scientific information from the related guidelines regarding application of genomic biomarkers to clinical trials and studies for drug development. We hope that this concept paper will prompt the development of guidelines for biomarker application to drug development by industry, regulatory authorities, the medical profession, and academia.
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Affiliation(s)
- Masahiro Tohkin
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Japan.
| | - Yoshiro Saito
- Division of Medical Safety Science, National Institute of Health Sciences, Japan
| | - Satomi Yagi
- Pharmaceuticals and Medical Devices Agency, Japan
| | | | - Keiko Maekawa
- Division of Medical Safety Science, National Institute of Health Sciences, Japan
| | - Makoto Osabe
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Japan
| | - Shinsuke Iida
- Graduate School of Medical Sciences, Nagoya City University, Japan
| | - Naoki Miyata
- Graduate School of Pharmaceutical Sciences, Nagoya City University, Japan
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Sanchez-Spitman A, Swen J, Dezentje V, Moes D, Gelderblom H, Guchelaar H. Clinical pharmacokinetics and pharmacogenetics of tamoxifen and endoxifen. Expert Rev Clin Pharmacol 2019; 12:523-536. [DOI: 10.1080/17512433.2019.1610390] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- A.B. Sanchez-Spitman
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - J.J. Swen
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - V.O. Dezentje
- Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - D.J.A.R. Moes
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - H. Gelderblom
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H.J. Guchelaar
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
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Brooks JD, Comen EA, Reiner AS, Orlow I, Leong SF, Liang X, Mellemkjær L, Knight JA, Lynch CF, John EM, Bernstein L, Woods M, Doody DR, Malone KE, Bernstein JL. CYP2D6 phenotype, tamoxifen, and risk of contralateral breast cancer in the WECARE Study. Breast Cancer Res 2018; 20:149. [PMID: 30526633 PMCID: PMC6288916 DOI: 10.1186/s13058-018-1083-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tamoxifen treatment greatly reduces a woman's risk of developing a second primary breast cancer. There is, however, substantial variability in treatment response, some of which may be attributed to germline genetic variation. CYP2D6 is a key enzyme in the metabolism of tamoxifen to its active metabolites, and variants in this gene have been associated with reduced tamoxifen metabolism. The impact of variation on risk of contralateral breast cancer (CBC) is unknown. METHODS Germline DNA from 1514 CBC cases and 2203 unilateral breast cancer controls was genotyped for seven single nucleotide polymorphisms, one three-nucleotide insertion-deletion, and a full gene deletion. Each variant has an expected impact on enzyme activity, which in combination allows for the classification of women as extensive, intermediate, and poor metabolizers (EM, IM, and PM respectively). Each woman was assigned one of six possible diplotypes and a corresponding CYP2D6 activity score (AS): EM/EM (AS = 2), EM/IM (AS = 1.5), EM/PM (AS = 1), IM/IM (AS = 0.75), IM/PM (AS = 0.5), and PM/PM (AS = 0). We also collapsed categories of the AS to generate an overall phenotype (EM, AS ≥ 1; IM, AS = 0.5-0.75; PM, AS = 0). Rate ratios (RRs) and 95% confidence intervals (CIs) for the association between tamoxifen treatment and risk of CBC in our study population were estimated using conditional logistic regression, stratified by AS. RESULTS Among women with AS ≥ 1 (i.e., EM), tamoxifen treatment was associated with a 20-55% reduced RR of CBC (AS = 2, RR = - 0.81, 95% CI 0.62-1.06; AS = 1.5, RR = 0.45, 95% CI 0.30-0.68; and AS = 1, RR = 0.55, 95% CI 0.40-0.74). Among women with no EM alleles and at least one PM allele (i.e., IM and PM), tamoxifen did not appear to impact the RR of CBC in this population (AS = 0.5, RR = 1.08, 95% CI 0.59-1.96; and AS = 0, RR = 1.17, 95% CI 0.58-2.35) (p for homogeneity = - 0.02). CONCLUSION This study suggests that the CYP2D6 phenotype may contribute to some of the observed variability in the impact of tamoxifen treatment for a first breast cancer on risk of developing CBC.
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Affiliation(s)
- Jennifer D. Brooks
- University of Toronto, Dalla Lana School of Public Health Sciences, 155 College St. HSB 676, Toronto, ON M5T 3M7 Canada
| | | | - Anne S. Reiner
- Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Irene Orlow
- Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Siok F. Leong
- Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Xiaolin Liang
- Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - Julia A. Knight
- University of Toronto, Dalla Lana School of Public Health Sciences, 155 College St. HSB 676, Toronto, ON M5T 3M7 Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | | | - Esther M. John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA USA
| | - Leslie Bernstein
- Beckman Research Institute, City of Hope National Medical Centre, Duarte, CA USA
| | - Meghan Woods
- Memorial Sloan Kettering Cancer Center, New York, NY USA
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CYP2D6 as a treatment decision aid for ER-positive non-metastatic breast cancer patients: a systematic review with accompanying clinical practice guidelines. Breast Cancer Res Treat 2018; 173:521-532. [PMID: 30411242 DOI: 10.1007/s10549-018-5027-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Tamoxifen is one of the principal treatments for estrogen receptor (ER)-positive breast cancer. Unfortunately, between 30 and 50% of patients receiving this hormonal therapy relapse. Since CYP2D6 genetic variants have been reported to play an important role in survival outcomes after treatment with tamoxifen, this study sought to summarize and critically appraise the available scientific evidence on this topic. METHODS A systematic literature review was conducted to identify studies investigating associations between CYP2D6 genetic variation and survival outcomes after tamoxifen treatment. Critical appraisal of the retrieved scientific evidence was performed, and recommendations were developed for CYP2D6 genetic testing in the context of tamoxifen therapy. RESULTS Although conflicting literature exists, the majority of the current evidence points toward CYP2D6 genetic variation affecting survival outcomes after tamoxifen treatment. Of note, review of the CYP2D6 genotyping assays used in each of the studies revealed the importance of comprehensive genotyping strategies to accurately predict CYP2D6 metabolizer phenotypes. CONCLUSIONS AND RECOMMENDATIONS Critical appraisal of the literature provided evidence for the value of comprehensive CYP2D6 genotyping panels in guiding treatment decisions for non-metastatic ER-positive breast cancer patients. Based on this information, it is recommended that alternatives to standard tamoxifen treatments may be considered in CYP2D6 poor or intermediate metabolizers.
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Khan BA, Robinson R, Fohner AE, Muzquiz LI, Schilling BD, Beans JA, Olnes MJ, Trawicki L, Frydenlund H, Laukes C, Beatty P, Phillips B, Nickerson D, Howlett K, Dillard DA, Thornton TA, Thummel KE, Woodahl EL. Cytochrome P450 Genetic Variation Associated with Tamoxifen Biotransformation in American Indian and Alaska Native People. Clin Transl Sci 2018; 11:312-321. [PMID: 29436156 PMCID: PMC5944577 DOI: 10.1111/cts.12542] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/12/2017] [Accepted: 01/15/2017] [Indexed: 01/24/2023] Open
Abstract
Despite evidence that pharmacogenetics can improve tamoxifen pharmacotherapy, there are few studies with American Indian and Alaska Native (AIAN) people. We examined variation in cytochrome P450 (CYP) genes (CYP2D6, CYP3A4, CYP3A5, and CYP2C9) and tamoxifen biotransformation in AIAN patients with breast cancer (n = 42) from the Southcentral Foundation in Alaska and the Confederated Salish and Kootenai Tribes in Montana. We tested for associations between CYP diplotypes and plasma concentrations of tamoxifen and metabolites. Only the CYP2D6 variation was significantly associated with concentrations of endoxifen (P = 0.0008) and 4-hydroxytamoxifen (P = 0.0074), tamoxifen's principal active metabolites, as well as key metabolic ratios. The CYP2D6 was also the most significant predictor of active metabolites and metabolic ratios in a multivariate regression model, including all four genes as predictors, with minor roles for other CYP genes. In AIAN populations, CYP2D6 is the largest contributor to tamoxifen bioactivation, illustrating the importance of validating pharmacogenetic testing for therapy optimization in an understudied population.
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Affiliation(s)
- Burhan A. Khan
- Department of Biomedical and Pharmaceutical SciencesUniversity of MontanaMissoulaMontanaUSA
- Southcentral FoundationAnchorageAlaskaUSA
| | | | - Alison E. Fohner
- Institute for Public Health GeneticsUniversity of WashingtonSeattleWashingtonUSA
| | - LeeAnna I. Muzquiz
- Tribal Health DepartmentConfederated Salish and Kootenai TribesMontanaUSA
| | | | | | | | - Laura Trawicki
- Alaska Native Tribal Health ConsortiumAnchorageAlaskaUSA
| | | | - Cindi Laukes
- Department of Biomedical and Pharmaceutical SciencesUniversity of MontanaMissoulaMontanaUSA
- Montana Cancer Institute FoundationMissoulaMontanaUSA
| | - Patrick Beatty
- Montana Cancer Institute FoundationMissoulaMontanaUSA
- Montana Cancer SpecialistsMissoulaMontanaUSA
| | - Brian Phillips
- Department of PharmaceuticsUniversity of WashingtonSeattleWashingtonUSA
| | - Deborah Nickerson
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
| | - Kevin Howlett
- Tribal Health DepartmentConfederated Salish and Kootenai TribesMontanaUSA
| | | | | | | | - Erica L. Woodahl
- Department of Biomedical and Pharmaceutical SciencesUniversity of MontanaMissoulaMontanaUSA
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Hertz DL, Kidwell KM, Hilsenbeck SG, Oesterreich S, Osborne CK, Philips S, Chenault C, Hartmaier RJ, Skaar TC, Sikora MJ, Rae JM. CYP2D6 genotype is not associated with survival in breast cancer patients treated with tamoxifen: results from a population-based study. Breast Cancer Res Treat 2017; 166:277-287. [PMID: 28730340 PMCID: PMC6028015 DOI: 10.1007/s10549-017-4400-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE A number of studies have tested the hypothesis that breast cancer patients with low-activity CYP2D6 genotypes achieve inferior benefit from tamoxifen treatment, putatively due to lack of metabolic activation to endoxifen. Studies have provided conflicting data, and meta-analyses suggest a small but significant increase in cancer recurrence, necessitating additional studies to allow for accurate effect assessment. We conducted a retrospective pharmacogenomic analysis of a prospectively collected community-based cohort of patients with estrogen receptor-positive breast cancer to test for associations between low-activity CYP2D6 genotype and disease outcome in 500 patients treated with adjuvant tamoxifen monotherapy and 500 who did not receive any systemic adjuvant therapy. METHODS Tumor-derived DNA was genotyped for common, functionally consequential CYP2D6 polymorphisms (*2, *3, *4, *6, *10, *41, and copy number variants) and assigned a CYP2D6 activity score (AS) ranging from none (0) to full (2). Patients with poor metabolizer (AS = 0) phenotype were compared to patients with AS > 0 and in secondary analyses AS was analyzed quantitatively. Clinical outcome of interest was recurrence free survival (RFS) and analyses using long-rank test were adjusted for relevant clinical covariates (nodal status, tumor size, etc.). RESULTS CYP2D6 AS was not associated with RFS in tamoxifen treated patients in univariate analyses (p > 0.2). In adjusted analyses, increasing AS was associated with inferior RFS (Hazard ratio 1.43, 95% confidence interval 1.00-2.04, p = 0.05). In patients that did not receive tamoxifen treatment, increasing CYP2D6 AS, and AS > 0, were associated with superior RFS (each p = 0.0015). CONCLUSIONS This population-based study does not support the hypothesis that patients with diminished CYP2D6 activity achieve inferior tamoxifen benefit. These contradictory findings suggest that the association between CYP2D6 genotype and tamoxifen treatment efficacy is null or near null, and unlikely to be useful in clinical practice.
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Affiliation(s)
- D L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St, Room 3054, Ann Arbor, MI, 48109-1065, USA.
| | - K M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - S G Hilsenbeck
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - S Oesterreich
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pharmacology and Chemical Biology, Women's Cancer Research Center, Magee Women's Research Institute, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | - C K Osborne
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - S Philips
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Chenault
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - R J Hartmaier
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - T C Skaar
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - M J Sikora
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J M Rae
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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10
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Impact of CYP2D6 polymorphisms on endoxifen concentrations and breast cancer outcomes. THE PHARMACOGENOMICS JOURNAL 2017; 18:201-208. [DOI: 10.1038/tpj.2017.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/03/2017] [Accepted: 06/07/2017] [Indexed: 12/27/2022]
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Traitements personnalisés grâce à la pharmacogénétique : niveaux de preuve et de recommandations du Réseau national de pharmacogénétique (RNPGx). Therapie 2017; 72:175-183. [DOI: 10.1016/j.therap.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022]
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Abstract
Cancer treatment is becoming more and more individually based as a result of the large inter-individual differences that exist in treatment outcome and toxicity when patients are treated using population-based drug doses. Polymorphisms in genes encoding drug-metabolizing enzymes and transporters can significantly influence uptake, metabolism, and elimination of anticancer drugs. As a result, the altered pharmacokinetics can greatly influence drug efficacy and toxicity. Pharmacogenetic screening and/or drug-specific phenotyping of cancer patients eligible for treatment with chemotherapeutic drugs, prior to the start of anticancer treatment, can identify patients with tumors that are likely to be responsive or resistant to the proposed drugs. Similarly, the identification of patients with an increased risk of developing toxicity would allow either dose adaptation or the application of other targeted therapies. This review focuses on the role of genetic polymorphisms significantly altering the pharmacokinetics of anticancer drugs. Polymorphisms in DPYD, TPMT, and UGT1A1 have been described that have a major impact on the pharmacokinetics of 5-fluorouracil, mercaptopurine, and irinotecan, respectively. For other drugs, however, the association of polymorphisms with pharmacokinetics is less clear. To date, the influence of genetic variations on the pharmacokinetics of the increasingly used monoclonal antibodies has hardly been investigated. Some studies indicate that genes encoding the Fcγ-receptor family are of interest, but more research is needed to establish if screening before the start of therapy is beneficial. Considering the profound impact of polymorphisms in drug transporters and drug-metabolizing enzymes on the pharmacokinetics of chemotherapeutic drugs and hence, their toxicity and efficacy, pharmacogenetic and pharmacokinetic profiling should become the standard of care.
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Affiliation(s)
| | | | - André B P van Kuilenburg
- Department of Clinical Chemistry, Laboratory Genetic Metabolic Diseases, Academic Medical Center, University of Amsterdam, Emma Children's Hospital, F0-220, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Pharmacogenetics-based personalized therapy: Levels of evidence and recommendations from the French Network of Pharmacogenetics (RNPGx). Therapie 2017; 72:185-192. [PMID: 28237406 DOI: 10.1016/j.therap.2016.09.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/02/2016] [Indexed: 11/21/2022]
Abstract
More than 50 laboratories offer pharmacogenetic testing in France. These tests are restricted to a limited number of indications: prevention of serious adverse drug reactions; choice of most appropriate therapeutic option; dose adjustment for a specific drug. A very small proportion of these tests are mentioned in drug information labeling and the data provided (if any) are generally insufficient to ascertain whether a test is required and if it is useful. This article discusses the rationale for evaluating the performance and clinical usefulness of pharmacogenetics and provides, on behalf of the French national network of pharmacogenetics (RNPGx), three levels of recommendation for testing: essential, advisable, and possibly helpful.
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Ahern TP, Hertz DL, Damkier P, Ejlertsen B, Hamilton-Dutoit SJ, Rae JM, Regan MM, Thompson AM, Lash TL, Cronin-Fenton DP. Cytochrome P-450 2D6 (CYP2D6) Genotype and Breast Cancer Recurrence in Tamoxifen-Treated Patients: Evaluating the Importance of Loss of Heterozygosity. Am J Epidemiol 2017; 185:75-85. [PMID: 27988492 DOI: 10.1093/aje/kww178] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 10/25/2016] [Indexed: 12/11/2022] Open
Abstract
Tamoxifen therapy for estrogen receptor-positive breast cancer reduces the risk of recurrence by approximately one-half. Cytochrome P-450 2D6, encoded by the polymorphic cytochrome P-450 2D6 gene (CYP2D6), oxidizes tamoxifen to its most active metabolites. Steady-state concentrations of endoxifen (4-hydroxy-N-desmethyltamoxifen), the most potent antiestrogenic metabolite, are reduced in women whose CYP2D6 genotypes confer poor enzyme function. Thirty-one studies of the association of CYP2D6 genotype with breast cancer survival have yielded heterogeneous results. Some influential studies genotyped DNA from tumor-infiltrated tissues, and their results may have been susceptible to germline genotype misclassification from loss of heterozygosity at the CYP2D6 locus. We systematically reviewed 6 studies of concordance between genotypes obtained from paired nonneoplastic and breast tumor-infiltrated tissues, all of which showed excellent CYP2D6 genotype agreement. We applied these concordance data to a quantitative bias analysis of the subset of the 31 studies that were based on genotypes from tumor-infiltrated tissue to examine whether genotyping errors substantially biased estimates of association. The bias analysis showed negligible bias by discordant genotypes. Summary estimates of association, with or without bias adjustment, indicated no clinically important association between CYP2D6 genotype and breast cancer survival in tamoxifen-treated women.
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15
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Patel JN, Villadolid J. Cancer Drug Delivery. PHARMACEUTICAL SCIENCES 2017. [DOI: 10.4018/978-1-5225-1762-7.ch008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Advancements in cancer drug delivery have led to the development of personalized oncology care through molecularly-driven targeted therapies. Understanding molecular and cellular mechanisms which drive tumor progression and resistance is critical in managing new treatment strategies which have shifted from empiric to biomarker-directed therapy selection. Biomarker-directed therapies have improved clinical outcomes in multiple malignancies as monotherapy and in combination with other treatment modalities, however the changing scope of treatment options presents new opportunities and challenges for research. Furthermore, pharmacogenetics may provide a rationale method of personalizing anticancer drug dosing and supportive care management for oncology patients. This chapter reviews biomarker classifications and pharmacogenetics in anticancer therapy and supportive care. Examples of biomarker-directed therapies and clinical assays, in addition to future directions of molecular profiling in oncology therapy management are discussed.
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Zembutsu H, Nakamura S, Akashi-Tanaka S, Kuwayama T, Watanabe C, Takamaru T, Takei H, Ishikawa T, Miyahara K, Matsumoto H, Hasegawa Y, Kutomi G, Shima H, Satomi F, Okazaki M, Zaha H, Onomura M, Matsukata A, Sagara Y, Baba S, Yamada A, Shimada K, Shimizu D, Tsugawa K, Shimo A, Tan EY, Hartman M, Chan CW, Lee SC, Nakamura Y. Significant Effect of Polymorphisms in CYP2D6 on Response to Tamoxifen Therapy for Breast Cancer: A Prospective Multicenter Study. Clin Cancer Res 2016; 23:2019-2026. [DOI: 10.1158/1078-0432.ccr-16-1779] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/09/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
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17
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Schmidt KT, Chau CH, Price DK, Figg WD. Precision Oncology Medicine: The Clinical Relevance of Patient-Specific Biomarkers Used to Optimize Cancer Treatment. J Clin Pharmacol 2016; 56:1484-1499. [PMID: 27197880 DOI: 10.1002/jcph.765] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 12/22/2022]
Abstract
Precision medicine in oncology is the result of an increasing awareness of patient-specific clinical features coupled with the development of genomic-based diagnostics and targeted therapeutics. Companion diagnostics designed for specific drug-target pairs were the first to widely utilize clinically applicable tumor biomarkers (eg, HER2, EGFR), directing treatment for patients whose tumors exhibit a mutation susceptible to an FDA-approved targeted therapy (eg, trastuzumab, erlotinib). Clinically relevant germline mutations in drug-metabolizing enzymes and transporters (eg, TPMT, DPYD) have been shown to impact drug response, providing a rationale for individualized dosing to optimize treatment. The use of multigene expression-based assays to analyze an array of prognostic biomarkers has been shown to help direct treatment decisions, especially in breast cancer (eg, Oncotype DX). More recently, the use of next-generation sequencing to detect many potential "actionable" cancer molecular alterations is further shifting the 1 gene-1 drug paradigm toward a more comprehensive, multigene approach. Currently, many clinical trials (eg, NCI-MATCH, NCI-MPACT) are assessing novel diagnostic tools with a combination of different targeted therapeutics while also examining tumor biomarkers that were previously unexplored in a variety of cancer histologies. Results from ongoing trials such as the NCI-MATCH will help determine the clinical utility and future development of the precision-medicine approach.
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Affiliation(s)
- Keith T Schmidt
- Clinical Pharmacology Program, Office of the Clinical Director, NIH, Bethesda, MD, USA
| | - Cindy H Chau
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Douglas K Price
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - William D Figg
- Clinical Pharmacology Program, Office of the Clinical Director, NIH, Bethesda, MD, USA
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
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18
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He X, He N, Ren L, Ouyang Y, Zhang N, Ma Y, Yuan D, Kang L, Jin T. Genetic polymorphisms analysis of CYP2D6 in the Uygur population. BMC Genomics 2016; 17:409. [PMID: 27228982 PMCID: PMC4882831 DOI: 10.1186/s12864-016-2719-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate genetic polymorphisms of CYP2D6 among healthy Uygur individuals. Genetic polymorphisms of CYP2D6 could greatly affect CYP2D6 activity and lead to differences among individuals in drug efficacy or side effects. To investigate genetic polymorphisms of CYP2D6 in the Uygur population, we directly sequenced the whole gene in 96 unrelated, healthy Uygur volunteers from the Xinjiang Uygur Autonomous Region and screened for genetic variants in the promoter, intron, exons, and 3'UTR. RESULTS We detected 62 genetic polymorphisms of CYP2D6, 16 of which were novel SNP with three novel non-synonymous mutations detected for the first time. The allelic frequencies of CYP2D6*1, *10, *39, and *48 were 0.542, 0.156, 0.068, 0.229, and 0.073, respectively. The frequency of CYP2D6*1/*10 which decreased CYP2D6 enzyme activity was 31.3 %. CONCLUSIONS Our results provided basic information about CYP2D6 polymorphisms, suggested that the enzymatic activities of CYP2D6 might be different within the Uygur ethnic group, and provide a basis for safer drug administration and better therapeutic treatment of Uygur individuals.
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Affiliation(s)
- Xue He
- Key Laboratory for Basic life science Research of Tibet autonomous region School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China.,Key laboratory for molecular genetic mechanisms and intervention research on high altitude disease of Tibet autonomous region, School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China
| | - Na He
- Key Laboratory for Basic life science Research of Tibet autonomous region School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China.,Key laboratory for molecular genetic mechanisms and intervention research on high altitude disease of Tibet autonomous region, School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China
| | - Lisong Ren
- National Engineering Research Center for Miniaturized Detection Systems, Xi'an, Shaanxi, 710069, China
| | - Yongri Ouyang
- National Engineering Research Center for Miniaturized Detection Systems, Xi'an, Shaanxi, 710069, China
| | - Ning Zhang
- Key Laboratory for Basic life science Research of Tibet autonomous region School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China.,Key laboratory for molecular genetic mechanisms and intervention research on high altitude disease of Tibet autonomous region, School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China
| | - Yini Ma
- National Engineering Research Center for Miniaturized Detection Systems, Xi'an, Shaanxi, 710069, China
| | - Dongya Yuan
- Key Laboratory for Basic life science Research of Tibet autonomous region School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China.,Key laboratory for molecular genetic mechanisms and intervention research on high altitude disease of Tibet autonomous region, School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China
| | - Longli Kang
- Key Laboratory for Basic life science Research of Tibet autonomous region School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China.,Key laboratory for molecular genetic mechanisms and intervention research on high altitude disease of Tibet autonomous region, School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China
| | - Tianbo Jin
- Key Laboratory for Basic life science Research of Tibet autonomous region School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China. .,Key laboratory for molecular genetic mechanisms and intervention research on high altitude disease of Tibet autonomous region, School of Medicine, Xizang Mingzu University, Xianyang, Shaanxi, 712082, China. .,National Engineering Research Center for Miniaturized Detection Systems, Xi'an, Shaanxi, 710069, China. .,School of Life Sciences, Northwest University, Xi'an, Shaanxi, 710069, China.
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19
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Pharmacogenetic Predictors of Response. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 882:191-215. [DOI: 10.1007/978-3-319-22909-6_8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Patel JN, Papachristos A. Personalizing chemotherapy dosing using pharmacological methods. Cancer Chemother Pharmacol 2015; 76:879-96. [PMID: 26298089 DOI: 10.1007/s00280-015-2849-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/13/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Given the toxic nature and narrow therapeutic index of traditional chemotherapeutics, better methods of dose and therapy selection are critical. Pharmacological methods, including pharmacogenomics and pharmacokinetics, offer a practical method to enrich drug exposure, reduce toxicity, and improve quality of life for patients. METHODS PubMed and key abstracts from the American Society of Clinical Oncology (ASCO) and American Association for Cancer Research (AACR) were searched until July 2015 for clinical data relating to pharmacogenomic- and/or pharmacokinetic-guided dosing of anticancer drugs. RESULTS Based on the results returned from a thorough search of the literature and the plausibility of utilizing pharmacogenomic and/or pharmacokinetic methods to personalize chemotherapy dosing, we identified several chemotherapeutic agents with the potential for therapy individualization. We highlight the available data, clinical validity, and utility of using pharmacogenomics to personalize therapy for tamoxifen, 5-fluorouracil, mercaptopurine, and irinotecan, in addition to using pharmacokinetics to personalize dosing for 5-fluorouracil, busulfan, methotrexate, taxanes, and topotecan. CONCLUSION A concerted effort should be made by researchers to further elucidate the role of pharmacological methods in personalizing chemotherapy dosing to optimize the risk-benefit profile. Clinicians should be aware of the clinical validity, utility, and availability of pharmacogenomic- and pharmacokinetic-guided therapies in clinical practice, to ultimately allow optimal dosing for each and every cancer patient.
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Affiliation(s)
- Jai N Patel
- Department of Cancer Pharmacology, Levine Cancer Institute, Carolinas HealthCare System, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
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21
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Genotyping concordance in DNA extracted from formalin-fixed paraffin embedded (FFPE) breast tumor and whole blood for pharmacogenetic analyses. Mol Oncol 2015; 9:1868-76. [PMID: 26276228 DOI: 10.1016/j.molonc.2015.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cancer pharmacogenetic studies use archival tumor samples as a DNA source when germline DNA is unavailable. Genotyping DNA from formalin-fixed paraffin embedded tumors (FFPE-T) may be inaccurate due to FFPE storage, genetic aberrations, and/or insufficient DNA extraction. Our objective was to assess the extent and source of genotyping inaccuracy from FFPE-T DNA and demonstrate analytical validity of FFPE-T genotyping of candidate single nucleotide polymorphisms (SNPs) for pharmacogenetic analyses. METHODS Cancer pharmacogenetics SNPs were genotyped by Sequenom MassARRAYs in DNA harvested from matched FFPE-T, FFPE lymph node (FFPE-LN), and whole blood leukocyte samples obtained from breast cancer patients. No- and discordant-call rates were calculated for each tissue type and SNP. Analytical validity was defined as any SNP with <5% discordance between FFPE-T and blood and <10% discordance plus no-calls. RESULTS Matched samples from 114 patients were genotyped for 247 SNPs. No-call rate in FFPE-T was greater than FFPE-LN and blood (4.3% vs. 3.0% vs. 0.5%, p < 0.001). Discordant-call rate between FFPE-T and blood was very low, but greater than that between FFPE-LN and blood (1.1% vs. 0.3%, p < 0.001). Samples with heterozygous genotypes were more likely to be no- or discordantly-called in either tissue (p < 0.001). Analytical validity of FFPE-T genotyping was demonstrated for 218 (88%) SNPs. CONCLUSIONS No- and discordant-call rates were below concerning thresholds, confirming that most SNPs can be accurately genotyped from FFPE-T on our Sequenom platform. FFPE-T is a viable DNA source for prospective-retrospective pharmacogenetic analyses of clinical trial cohorts.
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22
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Zembutsu H. Pharmacogenomics toward personalized tamoxifen therapy for breast cancer. Pharmacogenomics 2015; 16:287-96. [DOI: 10.2217/pgs.14.171] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Tamoxifen has been used not only for the treatment or prevention of recurrence in patients with estrogen receptor positive breast cancers but also for recurrent breast cancer. Because CYP2D6 is known to be an important enzyme responsible for the generation of the potent tamoxifen metabolite, ‘endoxifen’, lots of studies reported that genetic variation which reduced its enzyme activity were associated with poor clinical outcome of breast cancer patients treated with tamoxifen. However, there are some discrepant reports questioning the association between CYP2D6 genotype and clinical outcome after tamoxifen therapy. Dose-adjustment study of tamoxifen based on CYP2D6 genotypes provides the evidence that dose adjustment is useful for the patients carrying reduced or null allele of CYP2D6 to maintain the effective endoxifen level. This review describes critical issues in pharmacogenomic studies as well as summarizes the results of the association of CYP2D6 genotype with tamoxifen efficacy.
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23
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Abstract
Adjuvant endocrine therapy reduces the risk of recurrence and death from breast cancer in women with hormone receptor-positive early breast cancer. Tamoxifen has been the standard therapy for decades, and this is still the case for pre-menopausal women. Ovarian suppression is of similar efficacy but currently there is no strong evidence for adding this to tamoxifen and the additional morbidity can be considerable. Results from two important trials addressing this issue are imminent. In post-menopausal women, aromatase inhibitors (AIs) (letrozole, anastrozole, or exemestane) are superior to tamoxifen in preventing recurrence but only letrozole has been shown to improve survival. The main gain is against high-risk cancers, and tamoxifen gives very similar benefit for low-risk disease. Traditionally, treatment has been given for around 5 years, but many women remain at risk of relapse for 10 years or more. The AIs, and more recently tamoxifen, have been shown to reduce further the risk of late recurrence in women still in remission after 5 years of tamoxifen if given for a further 5 years. The comparative benefits of these two options and the selection of patients most likely to benefit from long-term adjuvant endocrine therapy are important topics for further research, as is the optimum duration of AI therapy started upfront.
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24
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Brauch H, Schwab M. Prediction of tamoxifen outcome by genetic variation of CYP2D6 in post-menopausal women with early breast cancer. Br J Clin Pharmacol 2014; 77:695-703. [PMID: 24033728 DOI: 10.1111/bcp.12229] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/11/2013] [Indexed: 12/14/2022] Open
Abstract
The question of whether genetic polymorphisms of CYP2D6 can affect treatment outcome in patients with early post-menopausal oestrogen receptor (ER)-positive breast cancer has been a matter of debate over the past few years. In this article we revisit the hypothesis of CYP2D6 being a potential tamoxifen outcome predictor and provide detailed insight into the ongoing controversy that prevented the CYP2D6 marker from being accepted by the scientific and clinical community. We summarize the available pharmacokinetic, pharmacodynamic and pharmacogenetic evidence and resolve the controversy based on the recognized methodological and statistical issues. The cumulative evidence suggests that genotyping for CYP2D6 is clinically relevant in post-menopausal women. This is important, because the clarification of this issue has the potential to resolve a clinical management question that is relevant to hundreds of thousands of women diagnosed with ER-positive breast cancer each year, who should not be denied effective endocrine therapy.
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Affiliation(s)
- Hiltrud Brauch
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany; University Tuebingen, Tuebingen
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25
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Goetz MP, Sun JX, Suman VJ, Silva GO, Perou CM, Nakamura Y, Cox NJ, Stephens PJ, Miller VA, Ross JS, Chen D, Safgren SL, Kuffel MJ, Ames MM, Kalari KR, Gomez HL, Gonzalez-Angulo AM, Burgues O, Brauch HB, Ingle JN, Ratain MJ, Yelensky R. Loss of heterozygosity at the CYP2D6 locus in breast cancer: implications for germline pharmacogenetic studies. J Natl Cancer Inst 2014; 107:dju401. [PMID: 25490892 DOI: 10.1093/jnci/dju401] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Controversy exists regarding the impact of CYP2D6 genotype on tamoxifen responsiveness. We examined loss of heterozygosity (LOH) at the CYP2D6 locus and determined its impact on genotyping error when tumor tissue is used as a DNA source. METHODS Genomic tumor data from the adjuvant and metastatic settings (The Cancer Genome Atlas [TCGA] and Foundation Medicine [FM]) were analyzed to characterize the impact of CYP2D6 copy number alterations (CNAs) and LOH on Hardy Weinberg equilibrium (HWE). Additionally, we analyzed CYP2D6 *4 genotype from formalin-fixed paraffin-embedded (FFPE) tumor blocks containing nonmalignant tissue and buccal (germline) samples from patients on the North Central Cancer Treatment Group (NCCTG) 89-30-52 tamoxifen trial. All statistical tests were two-sided. RESULTS In TCGA samples (n =627), the CYP2D6 LOH rate was similar in estrogen receptor (ER)-positive (41.2%) and ER-negative (35.2%) but lower in HER2-positive tumors (15.1%) (P < .001). In FM ER+ samples (n = 290), similar LOH rates were observed (40.8%). In 190 NCCTG samples, the agreement between CYP2D6 genotypes derived from FFPE tumors and FFPE tumors containing nonmalignant tissue was moderate (weighted Kappa = 0.74; 95% CI = 0.63 to 0.84). Comparing CYP2D6 genotypes derived from buccal cells to FFPE tumor DNA, CYP2D6*4 genotype was discordant in six of 31(19.4%). In contrast, there was no disagreement between CYP2D6 genotypes derived from buccal cells with FFPE tumors containing nonmalignant tissue. CONCLUSIONS LOH at the CYP2D6 locus is common in breast cancer, resulting in potential misclassification of germline CYP2D6 genotypes. Tumor DNA should not be used to determine germline CYP2D6 genotype without sensitive techniques to detect low frequency alleles and quality control procedures appropriate for somatic DNA.
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Affiliation(s)
- Matthew P Goetz
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - James X Sun
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Vera J Suman
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Grace O Silva
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Charles M Perou
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Yusuke Nakamura
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Nancy J Cox
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Philip J Stephens
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Vincent A Miller
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Jeffrey S Ross
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - David Chen
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Stephanie L Safgren
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Mary J Kuffel
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Matthew M Ames
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Krishna R Kalari
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Henry L Gomez
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Ana M Gonzalez-Angulo
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Octavio Burgues
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Hiltrud B Brauch
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - James N Ingle
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Mark J Ratain
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Roman Yelensky
- Department of Oncology (MPG, MMA, JNI), Department of Health Sciences Research (VJS, KRK), and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, SLS, MK, MMA), Mayo Clinic, Rochester, MN; Department of Genetics, University of North Carolina, Chapel Hill, NC (GOS, CMP); Center for Personalized Therapeutics, University of Chicago, Chicago, IL (YN, NJC, MJR); Foundation Medicine Inc., Cambridge, MA (JXS, PJS, VAM, JSR, RY); Novartis Pharmaceuticals Corporation, East Hanover, NJ (DC); Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY (JSR); Division of Hematology/Oncology, Vanderbilt University, Nashville, TN (HG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (AMGA, OB); Department Breast Cancer Susceptibility and Pharmacogenomics, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, University Tuebingen, German Cancer Consortium (DKTK) and German Cancer Research (DKTK), Heidelberg, Germany (HB).Current affiliation of H. Gomez: Departamento de Medicina Oncologica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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Abstract
The variability in treatment outcomes among patients receiving the same therapy for seemingly similar tumors can be attributed in part to genetics. The tumor's (somatic) genome largely dictates the effectiveness of the therapy, and the patient's (germline) genome influences drug exposure and the patient's sensitivity to toxicity. Many potentially clinically useful associations have been discovered between common germline genetic polymorphisms and outcomes of cancer treatment. This review highlights the germline pharmacogenetic associations that are currently being used to guide cancer treatment decisions, those that are most likely to someday be clinically useful, and associations that are well known but their roles in clinical management are not yet certain. In the future, germline genetic information will likely be available from tumor genetic analyses, creating an efficient opportunity to integrate the two genomes to optimize treatment outcomes for each individual cancer patient.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan 48109;
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Li J, Czene K, Brauch H, Schroth W, Saladores P, Li Y, Humphreys K, Hall P. Association of CYP2D6 metabolizer status with mammographic density change in response to tamoxifen treatment. Breast Cancer Res 2014; 15:R93. [PMID: 24088226 PMCID: PMC3979120 DOI: 10.1186/bcr3495] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/17/2013] [Indexed: 01/13/2023] Open
Abstract
Introduction Not all breast cancer patients respond to tamoxifen treatment, possibly due to genetic predisposition. As tamoxifen-induced reductions in percent mammographic density (PMD) have been linked to the risk and prognosis of breast cancer, we conducted a candidate gene study to investigate the association between germline CYP2D6 polymorphisms and PMD change. Methods Baseline and follow-up mammograms were retrieved for 278 tamoxifen-treated subjects with CYP2D6 metabolizer status (extensive (EM), heterozygous extensive/intermediate (hetEM/IM) or poor metabolizer (PM)). Logistic regression analyses were conducted comparing subjects who experienced >10% reduction in PMD to those who experienced ≤10% reduction or increase. Results After multivariate adjustment, PMD change was found to be significantly associated with the degree of CYP2D6 enzyme functionality (Ptrend = 0.021). Compared with EM, hetEM/IM and PM were 72% (95% confidence interval (CI): 0.10 to 0.79) and 71% (0.03 to 2.62) less likely to experience a >10% reduction, respectively. Conclusions Tamoxifen-induced change in PMD appears to have a genetic component.
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On the use of pharmacogenetics in cancer treatment and clinical trials. Eur J Cancer 2014; 50:2532-43. [PMID: 25103456 DOI: 10.1016/j.ejca.2014.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/08/2014] [Indexed: 02/07/2023]
Abstract
There are an increasing number of studies devoted to the identification of associations between anticancer drug efficacy and toxicity and common polymorphisms present in the patients' genome. However, many articles presenting the results of such studies do not bring the simple and necessary background information allowing the evaluation of the relevance of the study, its significance and its potential importance for patients' treatment. This position paper first addresses clinical oncologists with the aim of giving them the basic knowledge on pharmacogenetics and on the potential use of gene polymorphisms as predictive biomarkers in routine and clinical research. A secondary objective is to give molecular biologists some recommendations on how to conceive protocols and how to publish their results when they develop pharmacogenetic studies appended to clinical trials or with autonomous goals.
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Marisi G, Passardi A, Calistri D, Zoli W, Amadori D, Ulivi P. Discrepancies between VEGF -1154 G>A polymorphism analysis performed in peripheral blood samples and FFPE tissue. Int J Mol Sci 2014; 15:13333-43. [PMID: 25079441 PMCID: PMC4159797 DOI: 10.3390/ijms150813333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/02/2014] [Accepted: 07/23/2014] [Indexed: 01/01/2023] Open
Abstract
Single nucleotide polymorphisms (SNPs) may be associated with the response or toxicity to different types of treatment. Although SNP analysis is usually performed on DNA from peripheral blood, formalin fixed paraffin-embedded (FFPE) tissue is often used for retrospective studies. We analyzed VEGF (-2578C>A, -1498C>T, -1154G>A, -634C>G, +936C>T) and eNOS (+894G>T, -786T>C, VNTR (variable number of tandem repeats) 27bp intron 4) polymorphisms by direct sequencing or Real Time PCR in 237 patients with advanced colorectal cancer. Peripheral blood was used for 153 patients, whereas only FFPE tumor tissue was available for 84 patients. All SNP frequencies were in Hardy-Weinberg Equilibrium (HWE), with the exception of VEGF -1154, which was only in HWE in peripheral blood specimens. We therefore analyzed this SNP in DNA extracted from FFPE tumor tissue compared to FFPE healthy tissue and peripheral blood from 20 patients. Numerous heterozygous patients in peripheral blood DNA were homozygous for the A-allele in both tumor and healthy FFPE tissues. Our findings indicate that, although FFPE tissue might be a suitable specimen for genotyping, VEGF -1154 does not give reliable results on this type of material. As other SNPs may also have this limitation, genotype concordance should first be confirmed by comparing results obtained from FFPE and fresh sample analyses.
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Affiliation(s)
- Giorgia Marisi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy.
| | - Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy.
| | - Daniele Calistri
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy.
| | - Wainer Zoli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy.
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy.
| | - Paola Ulivi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy.
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30
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Abstract
Given the interpatient biological heterogeneity and narrow therapeutic index of anticancer drugs, a practical method for personalizing cancer therapy is essential. Genotype-guided cancer therapy will provide an optimal approach to normalize systemic drug exposures, predict drug toxicities and/or enrich clinical efficacy. To date, over a dozen anticancer drugs approved by the US FDA require labeling regarding pharmacogenetic biomarkers (both germline and somatic). Many, but not all, have prospective, genotype-guided evidence-based data. Optimizing output from retrospective, prospective, cost-effectiveness and adaptive biomarker driven clinical trials will help drive the success of personalized cancer therapy. This review will discuss prospective genotype-guided clinical trials in patients with solid tumors and address barriers in clinical translation.
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Affiliation(s)
- Jai N Patel
- Department of Clinical Pharmacology, Levine Cancer Institute, Carolinas HealthCare System, 1021 Morehead Medical Drive, Charlotte, NC 28203, USA.
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31
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Casadevall A, Steen RG, Fang FC. Sources of error in the retracted scientific literature. FASEB J 2014; 28:3847-55. [PMID: 24928194 DOI: 10.1096/fj.14-256735] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/27/2014] [Indexed: 12/22/2022]
Abstract
Retraction of flawed articles is an important mechanism for correction of the scientific literature. We recently reported that the majority of retractions are associated with scientific misconduct. In the current study, we focused on the subset of retractions for which no misconduct was identified, in order to identify the major causes of error. Analysis of the retraction notices for 423 articles indexed in PubMed revealed that the most common causes of error-related retraction are laboratory errors, analytical errors, and irreproducible results. The most common laboratory errors are contamination and problems relating to molecular biology procedures (e.g., sequencing, cloning). Retractions due to contamination were more common in the past, whereas analytical errors are now increasing in frequency. A number of publications that have not been retracted despite being shown to contain significant errors suggest that barriers to retraction may impede correction of the literature. In particular, few cases of retraction due to cell line contamination were found despite recognition that this problem has affected numerous publications. An understanding of the errors leading to retraction can guide practices to improve laboratory research and the integrity of the scientific literature. Perhaps most important, our analysis has identified major problems in the mechanisms used to rectify the scientific literature and suggests a need for action by the scientific community to adopt protocols that ensure the integrity of the publication process.
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Affiliation(s)
- Arturo Casadevall
- Department of Microbiology and Immunology and Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, New York, USA;
| | - R Grant Steen
- MediCC! Medical Communications Consultants, Chapel Hill, North Carolina, USA; and
| | - Ferric C Fang
- Department of Laboratory Medicine and Department of Microbiology, University of Washington School of Medicine, Seattle, Washington, USA
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Goetz MP, Brauch H, Ratain MJ, Cox NJ, Nakamura Y, Weinshilboum R, Ingle JN. Re: Concordance between CYP2D6 genotypes obtained from tumor-derived and germline DNA. J Natl Cancer Inst 2014; 106:dju063. [PMID: 24700804 DOI: 10.1093/jnci/dju063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Matthew P Goetz
- Affiliations of authors: Department of Oncology (MPG, JNI) and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, RW), Mayo Clinic, Rochester, MN; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany (HB); The University of Chicago, Chicago, IL (MJR, NJC, YN).
| | - Hiltrud Brauch
- Affiliations of authors: Department of Oncology (MPG, JNI) and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, RW), Mayo Clinic, Rochester, MN; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany (HB); The University of Chicago, Chicago, IL (MJR, NJC, YN)
| | - Mark J Ratain
- Affiliations of authors: Department of Oncology (MPG, JNI) and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, RW), Mayo Clinic, Rochester, MN; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany (HB); The University of Chicago, Chicago, IL (MJR, NJC, YN)
| | - Nancy J Cox
- Affiliations of authors: Department of Oncology (MPG, JNI) and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, RW), Mayo Clinic, Rochester, MN; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany (HB); The University of Chicago, Chicago, IL (MJR, NJC, YN)
| | - Yusuke Nakamura
- Affiliations of authors: Department of Oncology (MPG, JNI) and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, RW), Mayo Clinic, Rochester, MN; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany (HB); The University of Chicago, Chicago, IL (MJR, NJC, YN)
| | - Richard Weinshilboum
- Affiliations of authors: Department of Oncology (MPG, JNI) and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, RW), Mayo Clinic, Rochester, MN; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany (HB); The University of Chicago, Chicago, IL (MJR, NJC, YN)
| | - James N Ingle
- Affiliations of authors: Department of Oncology (MPG, JNI) and Department of Molecular Pharmacology and Experimental Therapeutics (MPG, RW), Mayo Clinic, Rochester, MN; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany (HB); The University of Chicago, Chicago, IL (MJR, NJC, YN)
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Mwinyi J, Vokinger K, Jetter A, Breitenstein U, Hiller C, Kullak-Ublick GA, Trojan A. Impact of variable CYP genotypes on breast cancer relapse in patients undergoing adjuvant tamoxifen therapy. Cancer Chemother Pharmacol 2014; 73:1181-8. [PMID: 24682508 DOI: 10.1007/s00280-014-2453-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/14/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Tamoxifen is frequently used for the treatment of hormone receptor positive breast cancer (BC). Mainly CYP2D6 is responsible for the transformation to therapeutically active metabolites, but CYP2C19, CYP2C9 and CYP2B6 also are involved. We investigated the impact of polymorphisms within the genes encoding these CYP enzymes on the relapse-free time (RFT) in patients with BC. METHODS Ninety-nine patients with hormone receptor positive BC, who had undergone adjuvant tamoxifen therapy, were genotyped for seventeen common variants within the genes encoding CYP2D6, CYP2C9, CYP2C19 and CYP2B6 using TaqMan and PCR-RFLP technology. Kaplan-Meier and Cox regression analyses were performed to elucidate the impact of genetic variants on RFT. Furthermore, CYP2D6 metabolic activity was determined in a subset of 50 patients by assessing dextromethorphan/dextrorphan urinary excretion ratios. CYP2D6 activity was compared to the CYP2D6 allelic combinations to evaluate the predictive value of the CYP2D6 genotyping results on phenotype. RESULTS Although a trend toward longer RFTs in carriers of CYP2D6 allele combinations encoding for extensive and ultrafast metabolizer phenotypes was observed, none of the investigated genetic variants had a statistically significant impact on RFT. The combined analysis of five major CYP2D6 variants was useful for the discrimination between poor and non-poor metabolizers. CONCLUSIONS Comprehensive CYP2D6 genotyping has a good predictive value for CYP2D6 activity. Common variants in CYP2C9, CYP2C19, CYP2D6, and CYP2B6 did not have a significant impact on the RFT in this cohort of patients with BC.
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Affiliation(s)
- Jessica Mwinyi
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
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Brauch H, Schroth W, Goetz MP, Mürdter TE, Winter S, Ingle JN, Schwab M, Eichelbaum M. Reply to A.-S. Dieudonné et al and J.M. Rae et al. J Clin Oncol 2014; 31:2755-6. [PMID: 24040664 DOI: 10.1200/jco.2013.49.6661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Margolin S, Lindh JD, Thorén L, Xie H, Koukel L, Dahl ML, Eliasson E. CYP2D6 and adjuvant tamoxifen: possible differences of outcome in pre- and post-menopausal patients. Pharmacogenomics 2014; 14:613-22. [PMID: 23570465 DOI: 10.2217/pgs.13.47] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM Previous studies on CYP2D6 activity and the effect of adjuvant tamoxifen in breast cancer are inconsistent. We analyzed the impact of the CYP2D6 polymorphism in pre- and post-menopausal patients that were adherent to tamoxifen treatment for at least a year. MATERIALS & METHODS A total of 382 breast cancer patients prescribed adjuvant tamoxifen for 5 years constituted the study-base. Clinical information, including compliance and outcome, was retrieved from medical records. Comprehensive CYP2D6 genotyping was performed and translated into predicted metabolic activity. RESULTS & CONCLUSION In patients adherent to tamoxifen for at least one year (n = 313) there was an association between reduced CYP2D6 activity (≤50% of normal) and recurrence (p = 0.025) and breast cancer-specific mortality (p = 0.034). In a multivariable analysis, CYP2D6 remained an independent predictor of outcome. In a subgroup analysis, the effect of CYP2D6 seemed to derive mainly from premenopausal patients, which represents a new finding that needs validation in a larger study sample. Original submitted 13 November 2012; Revision submitted 1 March 2013.
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Affiliation(s)
- Sara Margolin
- Department of Oncology & Pathology, Karolinska Institutet, Stockholm, Sweden.
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Cronin-Fenton DP, Damkier P, Lash TL. Metabolism and transport of tamoxifen in relation to its effectiveness: new perspectives on an ongoing controversy. Future Oncol 2014; 10:107-22. [PMID: 24328412 PMCID: PMC4319217 DOI: 10.2217/fon.13.168] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Tamoxifen reduces the rate of breast cancer recurrence by approximately a half. Tamoxifen is metabolized to more active metabolites by enzymes encoded by polymorphic genes, including cytochrome P450 2D6 (CYP2D6). Tamoxifen is a substrate for ATP-binding cassette transporter proteins. We review tamoxifen's clinical pharmacology and use meta-analyses to evaluate the clinical epidemiology studies conducted to date on the association between CYP2D6 inhibition and tamoxifen effectiveness. Our findings indicate that the effect of both drug-induced and/or gene-induced inhibition of CYP2D6 activity is likely to be null or small, or at most moderate in subjects carrying two reduced function alleles. Future research should examine the effect of polymorphisms in genes encoding enzymes in tamoxifen's complete metabolic pathway, should comprehensively evaluate other biomarkers that affect tamoxifen effectiveness, such as the transport enzymes, and focus on subgroups of patients, such as premenopausal breast cancer patients, for whom tamoxifen is the only guideline endocrine therapy.
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Affiliation(s)
| | - Per Damkier
- Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Denmark
| | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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van Huis-Tanja L, Kweekel D, Gelderblom H, Koopman M, Punt K, Guchelaar HJ, van der Straaten T. Concordance of genotype for polymorphisms in DNA isolated from peripheral blood and colorectal cancer tumor samples. Pharmacogenomics 2013; 14:2005-12. [DOI: 10.2217/pgs.13.169] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background & aim: Results from different pharmacogenetic association studies in colorectal cancer are often conflicting. Both peripheral blood and formalin-fixed, paraffin-embedded (FFPE) tissue are routinely used as DNA source. This could cause bias due to somatic alterations in tumor tissue, such as loss of heterozygosity. We therefore compared genotypes in DNA from peripheral blood and FFPE colorectal tumor samples for SNPs with putative influence on the cytotoxicity of chemotherapy. Materials & methods: Eleven SNPs in nine genes involved in anticancer drug metabolism or efficacy were determined in matched samples from blood and FFPE tissue of colorectal tumors by pyrosequencing and TaqMan® techniques. The κ-statistic was calculated to assess concordance. Results: A total of 149 paired FFPE tissue and EDTA blood DNA samples were available for comparison. Overall, 20 out of 1418 genotypes were discordant (1.4%); in ten cases, loss of heterozygosity could not be ruled out. Only GSTP1 showed significant discordance between FFPE tissue and blood genotype (κ = 0.947; 95% CI: 0.896–0.998). Conclusion: FFPE tissue-derived DNA can be used as a valid proxy for germline DNA for a selection of SNPs in (retrospective) pharmacogenetic association studies in colorectal cancer. However, for future studies, genotyping of blood-derived DNA is preferred. Original submitted 29 May 2013; Revision submitted 23 August 2013
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Affiliation(s)
- Lieke van Huis-Tanja
- Department of Clinical Oncology (K-1-P), Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Dinemarie Kweekel
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Hans Gelderblom
- Department of Clinical Oncology (K-1-P), Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Kees Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Tahar van der Straaten
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Dezentjé VO, Gelderblom H, Van Schaik RHN, Vletter-Bogaartz JM, Van der Straaten T, Wessels JAM, Kranenbarg EMK, Berns EM, Seynaeve C, Putter H, Van de Velde CJH, Nortier JWR, Guchelaar HJ. CYP2D6 genotype in relation to hot flashes as tamoxifen side effect in a Dutch cohort of the tamoxifen exemestane adjuvant multinational (TEAM) trial. Breast Cancer Res Treat 2013; 143:171-9. [PMID: 24265036 DOI: 10.1007/s10549-013-2777-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Abstract
In tamoxifen-treated breast cancer patients the occurrence of hot flashes may be associated with effective estrogen receptor antagonism dependent on genetic variations of metabolic enzymes and the estrogen receptor. Early breast cancer patients who were randomized to receive tamoxifen, followed by exemestane within the tamoxifen exemestane adjuvant multinational trial were genotyped for five CYP2D6 alleles. CYP2D6 genotypes and phenotypes were related to the occurrence of hot flashes as adverse event during the first year of tamoxifen use (primary aim) and the time to the occurrence of hot flashes as AE during the complete time on tamoxifen (secondary aim). In addition, exploratory analyses on 22 genetic variants of other metabolic enzymes and two common polymorphisms in the estrogen receptor-1 were performed. No association was found between the CYP2D6 genotype/phenotype or any other genetic variant and hot flashes during the first year. Only higher age was related to a lower incidence of hot flashes in the first year (adjusted odds ratio 0.94, 95 % CI 0.92-0.96; p < 0.001). The ESR1 PvuII XbaI CG haplotype was associated with the time to the occurrence of hot flashes during the complete time on tamoxifen (CG/CG vs. CG/other + other/other: adjusted hazard ratio 0.49, 95 % CI 0.25-0.97; p = 0.04). In conclusion, the CYP2D6 genotypes and phenotypes were not associated with the occurrence of hot flashes. Common polymorphisms in the estrogen receptor-1 might predict hot flashes as common tamoxifen side effect, although this finding needs replication.
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Affiliation(s)
- Vincent O Dezentjé
- Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Saladores PH, Precht JC, Schroth W, Brauch H, Schwab M. Impact of metabolizing enzymes on drug response of endocrine therapy in breast cancer. Expert Rev Mol Diagn 2013; 13:349-65. [PMID: 23638818 DOI: 10.1586/erm.13.26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Estrogen-receptor positive breast cancer accounts for 75% of diagnosed breast cancers worldwide. There are currently two major options for adjuvant treatment: tamoxifen and aromatase inhibitors. Variability in metabolizing enzymes determines their pharmacokinetic profile, possibly affecting treatment response. Therefore, prediction of therapy outcome based on genotypes would enable a more personalized medicine approach, providing optimal therapy for each patient. In this review, the authors will discuss the current evidence on the most important metabolizing enzymes in endocrine therapy, with a special focus on CYP2D6 and its role in tamoxifen metabolism.
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Affiliation(s)
- Pilar H Saladores
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tübingen, Auerbachstr. 112, 70376 Stuttgart, Germany
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Lum DWK, Perel P, Hingorani AD, Holmes MV. CYP2D6 genotype and tamoxifen response for breast cancer: a systematic review and meta-analysis. PLoS One 2013; 8:e76648. [PMID: 24098545 PMCID: PMC3788742 DOI: 10.1371/journal.pone.0076648] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/27/2013] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate evidence on the association between CYP2D6 genotype and tamoxifen response through. DESIGN Systematic review and meta-analysis of prospective, cross-sectional and case-control studies published to 2012. For each study, relative risks and 95% confidence intervals were extracted and pooled with a fixed and random effects model. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed. DATA SOURCES PubMed (inception-2012) and EMBASE (inception-2012). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Criteria for inclusion were studies reporting breast cancer outcomes in patients treated with tamoxifen and genotyped for polymorphisms in the CYP2D6 gene. RESULTS Twenty-five studies of 13,629 individuals were identified, of which 22 investigated the association of CYP2D6 genotype with outcomes in breast cancer women all receiving tamoxifen treatment ("treatment-only" design). Three randomized trials evaluated the effect of CYP2D6 genotype on tamoxifen response ("effect modification" design). In analysis of treatment-only studies, the relative risk (RR) of all-cause mortality (>307 events in 4,936 patients) for carriers of a CYP2D6 reduced function allele was 1.11 (95% confidence interval (CI): 0.94 to 1.31) compared to individuals with normal/increased function CYP2D6 alleles. When we investigated a composite outcome including all-cause mortality and surrogate endpoints for overall survival (>307 events in 6,721 patients), carriers of a CYP2D6 reduced function allele had a RR of 1.27 (95% CI: 1.11 to 1.45). From two randomized trials that permitted effect-modification analysis, one had only 154 patients and showed evidence of effect modification of tamoxifen by CYP2D6 genotype for distant recurrence but was directionally opposite to that predicted, whereas a larger trial of 2,537 patients failed to show evidence of effect modification for breast cancer-free interval (P values for interaction 0.02 and 0.44, respectively). CONCLUSIONS Based on these findings, there is insufficient evidence to recommend CYP2D6 genotyping to guide tamoxifen treatment.
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Affiliation(s)
- Danny W. K. Lum
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Pablo Perel
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aroon D. Hingorani
- Centre for Clinical Pharmacology, Division of Medicine, University College London, London, United Kingdom
- Genetic Epidemiology Group, Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michael V. Holmes
- Genetic Epidemiology Group, Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, United Kingdom
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Abstract
Cytochrome P450 2D6 (CYP2D6) plays an important role in the metabolism and bioactivation of about 25% of clinically used drugs including many antidepressants, antipsychotics and opioids. CYP2D6 activity is highly variably ranging from no activity in so-called poor metabolizers to ultrarapid metabolism at the other end of the extreme of the activity distribution. A large portion of this variability can be explained by the highly polymorphic nature of the CYP2D6 gene locus for which > 100 variants and subvariants identified to date. Allele frequencies vary markedly between ethnic groups; some have exclusively or predominantly only been observed in certain populations. Pharmacogenetic testing holds the promise of individualizing drug therapy by identifying patients with CYP2D6 diplotypes that puts them at an increased risk of experiencing dose-related adverse events or therapeutic failure. Inferring a patient's CYP2D6 metabolic capacity, or phenotype, however, is a challenging task due to the complexity of the CYP2D6 gene locus. Allelic variation includes SNPs, small insertions and deletions, gene copy number variation and rearrangements with CYP2D7, a highly related non-functional gene. This review provides a summary of the intricacies of CYP2D6 variation and genotype analysis, knowledge that is invaluable for the translation of genotype into clinically useful information.
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Affiliation(s)
- Andrea Gaedigk
- Children's Mercy Hospital and Clinics, Division of Clinical Pharmacology and Innovative Therapeutics , Kansas City, Missouri , USA
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43
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Rae JM. CYP2D6 genotype should not be used to determine endocrine therapy in postmenopausal breast cancer patients. Clin Pharmacol Ther 2013; 94:183-5. [PMID: 23872830 DOI: 10.1038/clpt.2013.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA.
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CYP2D6 genotype and adjuvant tamoxifen: meta-analysis of heterogeneous study populations. Clin Pharmacol Ther 2013; 95:216-27. [PMID: 24060820 PMCID: PMC3904554 DOI: 10.1038/clpt.2013.186] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/09/2013] [Indexed: 01/13/2023]
Abstract
The International Tamoxifen Pharmacogenomics Consortium was established to address the
controversy regarding cytochrome P450 2D6 (CYP2D6) status and clinical outcomes
in tamoxifen therapy. We performed a meta-analysis on data from 4,973 tamoxifen-treated
patients (12 globally distributed sites). Using strict eligibility requirements
(postmenopausal women with estrogen receptor–positive breast cancer, receiving
20 mg/day tamoxifen for 5 years, criterion 1); CYP2D6 poor metabolizer status
was associated with poorer invasive disease–free survival (IDFS: hazard ratio =
1.25; 95% confidence interval = 1.06, 1.47; P = 0.009). However,
CYP2D6 status was not statistically significant when tamoxifen duration,
menopausal status, and annual follow-up were not specified (criterion 2, n =
2,443; P = 0.25) or when no exclusions were applied (criterion 3, n
= 4,935; P = 0.38). Although CYP2D6 is a strong predictor of IDFS
using strict inclusion criteria, because the results are not robust to inclusion criteria
(these were not defined a priori), prospective studies are necessary to fully
establish the value of CYP2D6 genotyping in tamoxifen therapy.
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Rae JM, Regan MM, Thibert JN, Gersch C, Thomas D, Leyland-Jones B, Viale G, Pusztai L, Hayes DF, Skaar T, Van Poznak C. Concordance between CYP2D6 genotypes obtained from tumor-derived and germline DNA. J Natl Cancer Inst 2013; 105:1332-4. [PMID: 23958736 DOI: 10.1093/jnci/djt204] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Formalin-fixed, paraffin-embedded tumors (FFPETs) are a valuable source of DNA for genotype association studies and are often the only germline DNA resource from cancer clinical trials. The anti-estrogen tamoxifen is metabolized into endoxifen by CYP2D6, leading to the hypothesis that patients with certain CYP2D6 genotypes may not receive benefit because of their inability to activate the drug. Studies testing this hypothesis using FFPETs have provided conflicting results. It has been postulated that CYP2D6 genotype determined using FFPET may not be accurate because of somatic tumor alterations. In this study, we determined the concordance between CYP2D6 genotypes generated using 3 tissue sources (FFPETs; formalin-fixed, paraffin-embedded unaffected lymph nodes [FFPELNs]; and whole blood cells [WBCs]) from 122 breast cancer patients. Compared with WBCs, FFPET and FFPELN genotypes were highly concordant (>94%), as were the predicted CYP2D6 metabolic phenotypes (>97%). We conclude that CYP2D6 genotypes obtained from FFPETs accurately represent the patient's CYP2D6 metabolic phenotype.
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Affiliation(s)
- James M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI 48109-5942, USA.
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Dezentjé VO, van Schaik RHN, Vletter-Bogaartz JM, van der Straaten T, Wessels JAM, Kranenbarg EMK, Berns EM, Seynaeve C, Putter H, van de Velde CJH, Nortier JWR, Gelderblom H, Guchelaar HJ. CYP2D6 genotype in relation to tamoxifen efficacy in a Dutch cohort of the tamoxifen exemestane adjuvant multinational (TEAM) trial. Breast Cancer Res Treat 2013; 140:363-73. [DOI: 10.1007/s10549-013-2619-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
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48
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Binkhorst L, Mathijssen RHJ, van Herk-Sukel MPP, Bannink M, Jager A, Wiemer EAC, van Gelder T. Unjustified prescribing of CYP2D6 inhibiting SSRIs in women treated with tamoxifen. Breast Cancer Res Treat 2013; 139:923-9. [DOI: 10.1007/s10549-013-2585-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/29/2013] [Indexed: 01/01/2023]
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Samer CF, Lorenzini KI, Rollason V, Daali Y, Desmeules JA. Applications of CYP450 testing in the clinical setting. Mol Diagn Ther 2013; 17:165-84. [PMID: 23588782 PMCID: PMC3663206 DOI: 10.1007/s40291-013-0028-5] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Interindividual variability in drug response is a major clinical problem. Polymedication and genetic polymorphisms modulating drug-metabolising enzyme activities (cytochromes P450, CYP) are identified sources of variability in drug responses. We present here the relevant data on the clinical impact of the major CYP polymorphisms (CYP2D6, CYP2C19 and CYP2C9) on drug therapy where genotyping and phenotyping may be considered, and the guidelines developed when available. CYP2D6 is responsible for the oxidative metabolism of up to 25% of commonly prescribed drugs such as antidepressants, antipsychotics, opioids, antiarrythmics and tamoxifen. The ultrarapid metaboliser (UM) phenotype is recognised as a cause of therapeutic inefficacy of antidepressant, whereas an increased risk of toxicity has been reported in poor metabolisers (PMs) with several psychotropics (desipramine, venlafaxine, amitriptyline, haloperidol). CYP2D6 polymorphism influences the analgesic response to prodrug opioids (codeine, tramadol and oxycodone). In PMs for CYP2D6, reduced analgesic effects have been observed, whereas in UMs cases of life-threatening toxicity have been reported with tramadol and codeine. CYP2D6 PM phenotype has been associated with an increased risk of toxicity of metoprolol, timolol, carvedilol and propafenone. Although conflicting results have been reported regarding the association between CYP2D6 genotype and tamoxifen effects, CYP2D6 genotyping may be useful in selecting adjuvant hormonal therapy in postmenopausal women. CYP2C19 is responsible for metabolising clopidogrel, proton pump inhibitors (PPIs) and some antidepressants. Carriers of CYP2C19 variant alleles exhibit a reduced capacity to produce the active metabolite of clopidogrel, and are at increased risk of adverse cardiovascular events. For PPIs, it has been shown that the mean intragastric pH values and the Helicobacter pylori eradication rates were higher in carriers of CYP2C19 variant alleles. CYP2C19 is involved in the metabolism of several antidepressants. As a result of an increased risk of adverse effects in CYP2C19 PMs, dose reductions are recommended for some agents (imipramine, sertraline). CYP2C9 is responsible for metabolising vitamin K antagonists (VKAs), non-steroidal anti-inflammatory drugs (NSAIDs), sulfonylureas, angiotensin II receptor antagonists and phenytoin. For VKAs, CYP2C9 polymorphism has been associated with lower doses, longer time to reach treatment stability and higher frequencies of supratherapeutic international normalised ratios (INRs). Prescribing algorithms are available in order to adapt dosing to genotype. Although the existing data are controversial, some studies have suggested an increased risk of NSAID-associated gastrointestinal bleeding in carriers of CYP2C9 variant alleles. A relationship between CYP2C9 polymorphisms and the pharmacokinetics of sulfonylureas and angiotensin II receptor antagonists has also been observed. The clinical impact in terms of hypoglycaemia and blood pressure was, however, modest. Finally, homozygous and heterozygous carriers of CYP2C9 variant alleles require lower doses of phenytoin to reach therapeutic plasma concentrations, and are at increased risk of toxicity. New diagnostic techniques made safer and easier should allow quicker diagnosis of metabolic variations. Genotyping and phenotyping may therefore be considered where dosing guidelines according to CYP genotype have been published, and help identify the right molecule for the right patient.
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Affiliation(s)
- C F Samer
- Clinical Pharmacology and Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
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Karle J, Bolbrinker J, Vogl S, Kreutz R, Denkert C, Eucker J, Wischnewsky M, Possinger K, Regierer AC. Influence of CYP2D6-genotype on tamoxifen efficacy in advanced breast cancer. Breast Cancer Res Treat 2013; 139:553-60. [PMID: 23686417 DOI: 10.1007/s10549-013-2565-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/08/2013] [Indexed: 01/17/2023]
Abstract
The influence of CYP2D6 genotype on the efficacy of tamoxifen (Tam) has been extensively analyzed in early breast cancer with conflicting results. However, there is only scarce data regarding this potential influence in advanced breast cancer (ABC). We hypothesize that Tam is more effective in patients with a functional CYP2D6 allele than in patients with impaired CYP2D6 activity. ABC patients with prior or ongoing palliative Tam treatment (20 mg/d) were eligible. Genomic DNA was extracted from blood (n = 51) and formalin-fixed, paraffin-embedded tissue (n = 43). CYP2D6*2, *3, *4, *5, *6, *10, *17, *29, *41, CYP2D6 duplication and multiplication were determined in blood and CYP2D6*4 in tissue samples. Primary endpoint was progression free survival (PFS); secondary endpoints included clinical benefit (CB), and overall survival (OS). The clinical charts were retrospectively analyzed regarding survival and treatment effects. Genotyping was performed blinded and clinical data were analyzed separately. 94 patients were identified with a median age of 59 years (29-90 years). In 6 patients genotyping did not show conclusive results, therefore these patients were excluded from further analysis. Genotyping results were as follows: 1.1 % ultrarapid, 84.1 % extensive, 3.4 % intermediate, and 11.4 % poor metabolizers. Patients without any fully functional allele (IM/IM, IM/PM, PM/PM) had a significant shorter PFS and OS compared to patients with at least one functional allele (EM/EM, EM/IM, EM/PM) (PFS: p = 0.017; HR = 2.19; 95 % CI 1.15-4.18; OS: p = 0.028; HR = 2.79; 95 % CI 1.12-6.99). The CB rate was 73 % for EM-group and 38.5 % for IM + PM-group (p = 0.019). Our results show a significant influence of the CYP2D6 genotype on the efficacy of Tam in the treatment of ABC. In contrast to the adjuvant setting, the evidence in the palliative setting is congruent. CYP2D6 testing in ABC should be considered.
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Affiliation(s)
- Jennifer Karle
- Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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