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Ferrer Bolufer I, Galiana Vallés X, Izquierdo Álvarez S, Serrano Mira A, Guzmán Luján C, Safont Aguilera MJ, González Tarancón R, Bolaños Naranjo M, Carrasco Salas P, Santamaría González M, Rodríguez-López R. Diversity of oncopharmacogenetic profile within Spanish population. Pharmacogenet Genomics 2024; 34:166-169. [PMID: 38488402 DOI: 10.1097/fpc.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Consensus guidelines for genotype-guided fluoropyrimidine dosing based on variation in the dihydropyrimidine dehydrogenase (DPYD) gene before treatment have been firmly established. The prior pharmacogenetic report avoids the serious toxicity that inevitably occurred in a non-negligible percentage of the treated patients. The precise description of the allelic distribution of the variants of interest in our reference populations is information of great interest for the management of the prescription of these antineoplastic drugs. We characterized the allelic distribution of the UGT1A1*28 variant (rs3064744), as well as the DPYD*2A (rs3918290) variant, c.1679T>G (rs55886062), c.2846A>T (rs67376798) and c.1129-5923C>G (rs75017182; HapB3) in series of 5251 patients who are going to receive treatment with irinotecan and fluoropyrimidines, representative of Valencian, Aragonese and Western Andalusian populations.
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Affiliation(s)
- Irene Ferrer Bolufer
- Genetics Laboratory, Clinical Analysis Service, General Hospital Consortium of Valencia, Valencia
| | - Ximo Galiana Vallés
- Genetics Laboratory, Clinical Analysis Service, General Hospital Consortium of Valencia, Valencia
| | | | - Ana Serrano Mira
- Human Genetics Unit, Clinical Analysis Service, Juan Ramón Jiménez Hospital, Huelva
| | - Carola Guzmán Luján
- Genetics Laboratory, Clinical Analysis Service, General Hospital Consortium of Valencia, Valencia
| | | | | | | | - Pilar Carrasco Salas
- Human Genetics Unit, Clinical Analysis Service, Juan Ramón Jiménez Hospital, Huelva
- Genetics Commission, Spanish Society of Laboratory Medicine, Barcelona, Spain
| | - María Santamaría González
- Genetics Laboratory, Clinical Biochemistry Service, Miguel Servet University Hospital, Zaragoza
- Genetics Commission, Spanish Society of Laboratory Medicine, Barcelona, Spain
| | - Raquel Rodríguez-López
- Genetics Laboratory, Clinical Analysis Service, General Hospital Consortium of Valencia, Valencia
- Genetics Commission, Spanish Society of Laboratory Medicine, Barcelona, Spain
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Nguyen DG, Morris SA, Hamilton A, Kwange SO, Steuerwald N, Symanowski J, Moore DC, Hanson S, Mroz K, Lopes KE, Larck C, Musselwhite L, Kadakia KC, Koya B, Chai S, Osei-Boateng K, Kalapurakal S, Swift K, Hwang J, Patel JN. Real-World Impact of an In-House Dihydropyrimidine Dehydrogenase ( DPYD) Genotype Test on Fluoropyrimidine Dosing, Toxicities, and Hospitalizations at a Multisite Cancer Center. JCO Precis Oncol 2024; 8:e2300623. [PMID: 38935897 DOI: 10.1200/po.23.00623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Fluoropyrimidine-related toxicity and mortality risk increases significantly in patients carrying certain DPYD genetic variants with standard dosing. We implemented DPYD genotyping at a multisite cancer center and evaluated its impact on dosing, toxicity, and hospitalization. METHODS In this prospective observational study, patients receiving (reactive) or planning to receive (pretreatment) fluoropyrimidine-based chemotherapy were genotyped for five DPYD variants as standard practice per provider discretion. The primary end point was the proportion of variant carriers receiving fluoropyrimidine modifications. Secondary end points included mean relative dose intensity, fluoropyrimidine-related grade 3+ toxicities, and hospitalizations. Fisher's exact test compared toxicity and hospitalization rates between pretreatment carriers, reactive carriers, and wild-type patients. Univariable and multivariable logistic regression identified factors associated with toxicity and hospitalization risk. Kaplan-Meier methods estimated time to event of first grade 3+ toxicity and hospitalization. RESULTS Of the 757 patients who received DPYD genotyping (median age 63, 54% male, 74% White, 19% Black, 88% GI malignancy), 45 (5.9%) were heterozygous carriers. Fluoropyrimidine was modified in 93% of carriers who started treatment. In 442 patients with 3-month follow-up, 64%, 31%, and 30% of reactive carriers, pretreatment carriers, and wild-type patients had grade 3+ toxicity, respectively (P = .085); 64%, 25%, and 13% were hospitalized (P < .001). Reactive carriers had 10-fold higher odds of hospitalization compared with wild-type patients (P = .001), whereas no significant difference was noted between pretreatment carriers and wild-type patients. Time-to-event of toxicity and hospitalization were significantly different between genotype groups (P < .001), with reactive carriers having the earliest onset and highest incidence. CONCLUSION DPYD genotyping prompted fluoropyrimidine modifications in most carriers. Pretreatment testing reduced toxicities and hospitalizations compared with reactive testing, thus normalizing the risk to that of wild-type patients, and should be considered standard practice.
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Affiliation(s)
- D Grace Nguyen
- Department of Cancer Pharmacology & Pharmacogenomics, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Sarah A Morris
- Department of Cancer Pharmacology & Pharmacogenomics, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Alicia Hamilton
- Molecular Biology and Genomics Core Facility, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Simeon O Kwange
- Department of Cancer Pharmacology & Pharmacogenomics, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Nury Steuerwald
- Molecular Biology and Genomics Core Facility, Atrium Health Levine Cancer Institute, Charlotte, NC
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - James Symanowski
- Department of Biostatistics and Data Sciences, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Donald C Moore
- Department of Pharmacy, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Sarah Hanson
- Department of Pharmacy, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Kaitlyn Mroz
- Department of Cancer Pharmacology & Pharmacogenomics, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Karine E Lopes
- Department of Cancer Pharmacology & Pharmacogenomics, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Chris Larck
- Department of Pharmacy, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Laura Musselwhite
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Solid Tumor Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Kunal C Kadakia
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Solid Tumor Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Brinda Koya
- Department of Solid Tumor Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Seungjean Chai
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Solid Tumor Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Kwabena Osei-Boateng
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Solid Tumor Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Sini Kalapurakal
- Department of Solid Tumor Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Kristen Swift
- Department of Solid Tumor Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Jimmy Hwang
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Solid Tumor Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Jai N Patel
- Department of Cancer Pharmacology & Pharmacogenomics, Atrium Health Levine Cancer Institute, Charlotte, NC
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
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Dierks S, Buchholz SM, König A, Liersch T, Schanz J. Incomplete DPYD haplotype B3 in a patient with locally advanced gastric cancer: Reconsidering the 5-FU dosage strategy. Eur J Cancer 2024; 204:114076. [PMID: 38663223 DOI: 10.1016/j.ejca.2024.114076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Sascha Dierks
- Department for Clinical Chemistry, University Medical Center of Göttingen, Göttingen, Germany.
| | - Sören Matthias Buchholz
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center of Göttingen, Göttingen, Germany
| | - Alexander König
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center of Göttingen, Göttingen, Germany
| | - Torsten Liersch
- Department of General, Visceral and Paediatric Surgery, University Medical Center of Göttingen, Göttingen, Germany
| | - Julie Schanz
- Department for Clinical Chemistry, University Medical Center of Göttingen, Göttingen, Germany; Department of Haematology and Medical Oncology, University Medical Center of Göttingen, Göttingen, Germany
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Gaedigk A, Turner AJ, Haidar CE, Empey PE, Offer SM. Response to "DPYD genotyping panels: Impact of population diversity". Clin Transl Sci 2024; 17:e13806. [PMID: 38637962 PMCID: PMC11026573 DOI: 10.1111/cts.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/15/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
- Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic InnovationChildren's Mercy Research Institute (CMRI)Kansas CityMissouriUSA
| | | | - Cyrine E. Haidar
- Department of Pharmacy and Pharmaceutical SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Philip E. Empey
- Department of Pharmacy and TherapeuticsUniversity of Pittsburgh School of PharmacyPittsburghPennsylvaniaUSA
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Turner AJ, Haidar CE, Yang W, Boone EC, Offer SM, Empey PE, Haddad A, Tahir S, Scharer G, Broeckel U, Gaedigk A. Updated DPYD HapB3 haplotype structure and implications for pharmacogenomic testing. Clin Transl Sci 2024; 17:e13699. [PMID: 38129972 PMCID: PMC10777430 DOI: 10.1111/cts.13699] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/22/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
The DPYD gene encodes dihydropyrimidine dehydrogenase, the rate-limiting enzyme for the metabolism of fluoropyrimidines 5-fluorouracil and capecitabine. Genetic variants in DPYD have been associated with altered enzyme activity, therefore accurate detection and interpretation is critical to predict metabolizer status for individualized fluoropyrimidine therapy. The most commonly observed deleterious variation is the causal variant linked to the previously described HapB3 haplotype, c.1129-5923C>G (rs75017182) in intron 10, which introduces a cryptic splice site. A benign synonymous variant in exon 11, c.1236G>A (rs56038477) is also linked to HapB3 and is commonly used for testing. Previously, these single-nucleotide polymorphisms (SNPs) have been reported to be in perfect linkage disequilibrium (LD); therefore, c.1236G>A is often utilized as a proxy for the function-altering intronic variant. Clinical genotyping of DPYD identified a patient who had c.1236G>A, but not c.1129-5923C>G, suggesting that these two SNPs may not be in perfect LD, as previously assumed. Additional individuals with c.1236G>A, but not c.1129-5923C>G, were identified in the Children's Mercy Data Warehouse and the All of Us Research Program version 7 cohort substantiating incomplete SNP linkage. Consequently, testing only c.1236G>A can generate false-positive results in some cases and lead to suboptimal dosing that may negatively impact patient therapy and prospect of survival. Our data show that DPYD genotyping should include the functional variant c.1129-5923C>G, and not the c.1236G>A proxy, to accurately predict DPD activity.
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Affiliation(s)
| | - Cyrine E. Haidar
- Department of Pharmacy and Pharmaceutical SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Wenjian Yang
- Department of Pharmacy and Pharmaceutical SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Erin C. Boone
- Division of Clinical Pharmacology, Toxicology & Therapeutic InnovationChildren's Mercy Research Institute (CMRI)Kansas CityMissouriUSA
| | - Steven M. Offer
- Department of Molecular Pharmacology and Experimental TherapeuticsMayo ClinicRochesterMinnesotaUSA
| | - Philip E. Empey
- Department of Pharmacy and TherapeuticsUniversity of Pittsburgh School of PharmacyPittsburghPennsylvaniaUSA
| | - Andrew Haddad
- Department of Pharmaceutical SciencesUniversity of Pittsburgh School of PharmacyPittsburghPennsylvaniaUSA
| | - Saba Tahir
- Medical College of Wisconsin, School of PharmacyMilwaukeeWisconsinUSA
| | | | | | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic InnovationChildren's Mercy Research Institute (CMRI)Kansas CityMissouriUSA
- School of MedicineUniversity of Missouri‐Kansas CityKansas CityMissouriUSA
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