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Tveden-Nyborg P, Bergmann TK, Jessen N, Simonsen U, Lykkesfeldt J. BCPT 2023 policy for experimental and clinical studies. Basic Clin Pharmacol Toxicol 2023; 133:391-396. [PMID: 37732406 DOI: 10.1111/bcpt.13944] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Pernille Tveden-Nyborg
- Department of Veterinary and Animal Sciences, Section of Preclinical Disease Biology, University of Copenhagen, Copenhagen, Denmark
| | - Troels K Bergmann
- Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
| | - Niels Jessen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jens Lykkesfeldt
- Department of Veterinary and Animal Sciences, Section of Preclinical Disease Biology, University of Copenhagen, Copenhagen, Denmark
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2
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Krumborg JR, Mikkelsen N, Damkier P, Ennis ZN, Henriksen DP, Lillevang-Johansen M, Pedersen SA, Bergmann TK. ChatGPT: First glance from a perspective of clinical pharmacology. Basic Clin Pharmacol Toxicol 2023. [PMID: 37170853 DOI: 10.1111/bcpt.13879] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Julie Rudbech Krumborg
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Nicolaj Mikkelsen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Zandra Nymand Ennis
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Daniel Pilsgaard Henriksen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Mads Lillevang-Johansen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Sidsel Arnspang Pedersen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Troels K Bergmann
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
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3
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Paulsen NH, Pfeiffer P, Ewertz M, Fruekilde PBN, Feddersen S, Holm HS, Bergmann TK, Qvortrup C, Damkier P. Implementation and clinical benefit of DPYD genotyping in a Danish cancer population. ESMO Open 2023; 8:100782. [PMID: 36791638 PMCID: PMC10024141 DOI: 10.1016/j.esmoop.2023.100782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND In 2020, the European Medicines Agency recommended testing patients for dihydropyrimidine dehydrogenase (DPD) deficiency before systemic treatment with fluoropyrimidines (FP). DPD activity testing identifies patients at elevated risk of severe FP-related toxicity (FP-TOX). The two most used methods for DPD testing are DPYD genotyping and DPD phenotyping (plasma uracil concentration). The primary objective of this study was to compare the overall frequency of overall grade ≥3 FP-TOX before and after the implementation of DPYD genotyping. PATIENTS AND METHODS Two hundred thirty Danish, primarily gastrointestinal cancer patients, were DPYD-genotyped before their first dose of FP, and blood was sampled for post hoc assessment of P-uracil. The initial dose was reduced for variant carriers. Grade ≥3 FP-TOX was registered after the first three treatment cycles of FP. The frequency of toxicity was compared to a historical cohort of 492 patients with post hoc determined DPYD genotype from a biobank. RESULTS The frequency of overall grade ≥3 FP-TOX was 27% in the DPYD genotype-guided group compared to 24% in the historical cohort. In DPYD variant carriers, DPYD genotyping reduced the frequency of FP-related hospitalization from 19% to 0%. In the control group, 4.8% of DPYD variant carriers died due to FP-TOX compared to 0% in the group receiving DPYD genotype-guided dosing of FP. In the intervention group, wild-type patients with uracil ≥16 ng/ml had a higher frequency of FP-TOX than wild-type patients with uracil <16 ng/ml (55% versus 28%). CONCLUSIONS We found no population-level benefit of DPYD genotyping when comparing the risk of grade ≥3 FP-TOX before and after clinical implementation. We observed no deaths or FP-related hospitalizations in patients whose FP treatment was guided by a variant DPYD genotype. The use of DPD phenotyping may add valuable information in DPYD wild-type patients.
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Affiliation(s)
- N H Paulsen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - P Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M Ewertz
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P B N Fruekilde
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - S Feddersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - H S Holm
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - T K Bergmann
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - C Qvortrup
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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4
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Paulsen NH, Qvortrup C, Vojdeman FJ, Plomgaard P, Andersen SE, Ramlov A, Bertelsen B, Rossing M, Nielsen CG, Hoffmann-Lücke E, Greibe E, Spangsberg Holm H, Nielsen HH, Lolas IBY, Madsen JS, Bergmann ML, Mørk M, Fruekilde PBN, Bøttger P, Petersen PC, Nissen PH, Feddersen S, Bergmann TK, Pfeiffer P, Damkier P. Dihydropyrimidine dehydrogenase (DPD) genotype and phenotype among Danish cancer patients: prevalence and correlation between DPYD-genotype variants and P-uracil concentrations. Acta Oncol 2022; 61:1400-1405. [PMID: 36256873 DOI: 10.1080/0284186x.2022.2132117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Niels Herluf Paulsen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology, Pharmacy and Environmental Medicine Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Camilla Qvortrup
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Fie Juhl Vojdeman
- Department of Clinical Biochemistry, Holbaek Hospital, Holbaek, Denmark
| | - Peter Plomgaard
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Ramlov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Bertelsen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Genomic Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claus Gyrup Nielsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Elke Hoffmann-Lücke
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N, Denmark.,Institute for Clinical Medicine, Aarhus University of Health, Aarhus, Denmark
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N, Denmark.,Institute for Clinical Medicine, Aarhus University of Health, Aarhus, Denmark
| | | | - Heidi Hvid Nielsen
- Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark
| | | | - Jonna Skov Madsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Lerbaek Bergmann
- Department of Biochemistry and Immunology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Pernille Bøttger
- Department of Biochemistry and Immunology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Peter Henrik Nissen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N, Denmark.,Denmark and Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Feddersen
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Troels K Bergmann
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology, Pharmacy and Environmental Medicine Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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5
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Paulsen NH, Vojdeman F, Andersen SE, Bergmann TK, Ewertz M, Plomgaard P, Hansen MR, Esbech PS, Pfeiffer P, Qvortrup C, Damkier P. DPYD genotyping and dihydropyrimidine dehydrogenase (DPD) phenotyping in clinical oncology. A clinically focused minireview. Basic Clin Pharmacol Toxicol 2022; 131:325-346. [PMID: 35997509 PMCID: PMC9826411 DOI: 10.1111/bcpt.13782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In clinical oncology, systemic 5-fluorouracil (5-FU) and its oral pro-drugs are used to treat a broad group of solid tumours. Patients with dihydropyrimidine dehydrogenase (DPD) enzyme deficiency are at elevated risk of toxicity if treated with standard doses of 5-FU. DPYD genotyping and measurements of plasma uracil concentration (DPD phenotyping) can be applied as tests for DPD deficiency. In April 2020, the European Medicines Agency recommended pre-treatment DPD testing to reduce the risk of 5-FU-related toxicity. OBJECTIVES The objective of this study is to present the current evidence for DPD testing in routine oncological practice. METHODS Two systematic literature searches were performed following the PRISMA guidelines. We identified studies examining the possible benefit of DPYD genotyping or DPD phenotyping on the toxicity risk. FINDINGS Nine and 12 studies met the criteria for using DPYD genotyping and DPD phenotyping, respectively. CONCLUSIONS The evidence supporting either DPYD genotyping or DPD phenotyping as pre-treatment tests to reduce 5-FU toxicity is poor. Further evidence is still needed to fully understand and guide clinicians to dose by DPD activity.
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Affiliation(s)
- Niels Herluf Paulsen
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Fie Vojdeman
- Department of Clinical BiochemistryHolbaek HospitalHolbaekDenmark
| | | | - Troels K. Bergmann
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark,Department of Regional Health ResearchUniversity of Southern DenmarkEsbjergDenmark
| | - Marianne Ewertz
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Peter Plomgaard
- Department of Clinical Biochemistry, Rigshospitalet, Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Morten Rix Hansen
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Novo NordiskSøborgDenmark
| | - Peter Skov Esbech
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark
| | - Per Pfeiffer
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Department of OncologyOdense University HospitalOdenseDenmark
| | - Camilla Qvortrup
- Department of Oncology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Per Damkier
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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6
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Staatz CE, Isbel NM, Bergmann TK, Jespersen B, Buus NH. Editorial: Therapeutic Drug Monitoring in Solid Organ Transplantation. Front Pharmacol 2021; 12:815117. [PMID: 34955866 PMCID: PMC8709472 DOI: 10.3389/fphar.2021.815117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Nicole M Isbel
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Troels K Bergmann
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Denmark
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7
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Kuhlmann I, Hjelmar Petersen R, Overgaard M, Dornonville de la Cour K, Zwisler S, Bjerregaard Stage T, Hougaard Christensen MM, Bergmann TK, Damkier P, Gadegaard Jensen A, Nielsen F, Brøsen K. No significant influence of OCT1 genotypes on the pharmacokinetics of morphine in adult surgical patients. Basic Clin Pharmacol Toxicol 2021; 130:93-102. [PMID: 34599645 PMCID: PMC9298338 DOI: 10.1111/bcpt.13667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 01/02/2023]
Abstract
We investigated the impact of genetic variants in OCT1 (SLC22A1) on morphine, morphine‐3‐glucuronide (M3G) and morphine‐6‐glucuronide (M6G) pharmacokinetics in adult patients scheduled for major surgery. Blood samples were taken before and 5, 10, 15, 30, 45, 60 and 90 min after a bolus of morphine (0.15 mg/kg). Patients were genotyped for the genetic variants (rs12208357, rs34059508, rs72552763 and rs34130495) in OCT1. Eighty‐six patients completed the trial. The mean difference (95% confidence interval) for dose adjusted morphine, M3G and M6G AUC was 0.9 (−0.7–2.4), −5.9 (−11.8 to −0.03) and −1.1 (−2.5–0.4) h/L*10−6, respectively, in patients with two reduced function alleles compared to patients with no reduced function alleles in OCT1. Accordingly, the (AUCM3G/Dose)/(AUCmorphine/Dose) and (AUCM6G/Dose)/(AUCmorphine/Dose) ratio was reduced, −1.8 (−3.2 to −0.4) and −0.4 (−0.7 to −0.03), respectively, when comparing the same groups. OCT1 variants had no influence on the experience of pain, adverse events or the number of PCA doses used. In conclusion, genetic variants in OCT1 had a small and clinically unimportant impact on the exposure of morphine after intravenous administration. Our results do not support pre‐emptive genotyping for OCT1 prior to morphine administration in patients scheduled for major surgery.
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Affiliation(s)
- Ida Kuhlmann
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Morten Overgaard
- Department of Anesthesiology, Hospital of South West Jutland, Esbjerg, Denmark
| | | | - Stine Zwisler
- Department of Anesthesiology, Odense University Hospital, Odense, Denmark
| | - Tore Bjerregaard Stage
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mette Marie Hougaard Christensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Troels K Bergmann
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Flemming Nielsen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kim Brøsen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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8
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Tveden‐Nyborg P, Bergmann TK, Jessen N, Simonsen U, Lykkesfeldt J. BCPT policy for experimental and clinical studies. Basic Clin Pharmacol Toxicol 2020; 128:4-8. [PMID: 32955760 DOI: 10.1111/bcpt.13492] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Pernille Tveden‐Nyborg
- Section of Experimental Animal Models Department of Veterinary Disease Biology University of Copenhagen Copenhagen Denmark
| | - Troels K. Bergmann
- Hospital Pharmacy Hospital of South West Jutland Esbjerg Denmark
- Clinical Pharmacology and Pharmacy Department of Public Health University of Southern Denmark Odense Denmark
| | - Niels Jessen
- Department of Biomedicine Aarhus University Aarhus Denmark
- Steno Diabetes Center Aarhus Aarhus University Hospital Aarhus Denmark
| | - Ulf Simonsen
- Department of Biomedicine Aarhus University Aarhus Denmark
| | - Jens Lykkesfeldt
- Section of Experimental Animal Models Department of Veterinary Disease Biology University of Copenhagen Copenhagen Denmark
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9
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Bergmann TK, Stage TB, Stenvang J, Christophersen P, Jacobsen TA, Roest NL, Vestlev PM, Brünner N. Four phase 1 trials to evaluate the safety and pharmacokinetic profile of single and repeated dosing of SCO-101 in adult male and female volunteers. Basic Clin Pharmacol Toxicol 2020; 127:329-337. [PMID: 32628359 PMCID: PMC7539971 DOI: 10.1111/bcpt.13466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
SCO‐101 (Endovion) was discontinued 20 years ago as a new drug under development against sickle cell anaemia. Data from the phase 1 studies remained unpublished. New data indicate that SCO‐101 might be efficacious as add‐on therapy in cancer. Thus, we report the results from the four phase 1 trials performed between 2001 and 2002. Adult volunteers received SCO‐101 or placebo in four independent trials. Adverse events were recorded, and SCO‐101 was determined for pharmacokinetic analysis. Ninety‐two volunteers completed the trials. The most remarkable adverse effect was a transient and dose‐dependent increase in unconjugated bilirubin. Plasma SCO‐101 elimination was approximately log linear, with apparent oral clearances of between 315 and 2103 mL/h for single doses, and between 121 and 2433 mL/h at steady state following oral administration. There was a marked decrease in clearance with increasing dose, and for repeated dose versus single dose. Tmax was greater, and Cmax and AUC∞ were lower in the fed state compared to the fasted state. Exposure was equivalent in males and females and for African Americans and Caucasians. In conclusion, SCO‐101 appears to be a safe drug with a predictable PK profile. Its efficacy as add‐on to standard anticancer drugs has yet to be defined.
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Affiliation(s)
- Troels K Bergmann
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Hospital Pharmacy, Hospital of South West Jutland, Esbjerg, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Tore B Stage
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jan Stenvang
- Scandion Oncology A/S, Copenhagen, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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10
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Skyggedal A, Nielsen F, Bergmann TK. Drug-drug cross contamination in the Swisslog fully automated medication handling system. Eur J Hosp Pharm 2020; 28:229-230. [PMID: 34162675 DOI: 10.1136/ejhpharm-2019-002061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The risk of drug-drug cross contamination in drug dispensing robots in hospital pharmacies causes cumbersome restraints to be put on the production of the robot for example by scheduling high-risk drugs to be dispensed at the end of the day. However, we were unable to find published data on the matter, and therefore performed a worst-case scenario study to assess the magnitude of the problem. METHODS We measured dexamethasone residue left on the suction cup after the production of 100 and 400 dexamethasone tablets, and after 20 paracetamol tablets used as a negative control. RESULTS We found that 32.9 µg and 49.5 µg of dexamethasone had been transferred to the suction cup in the two experiments. This is approximately 1 per mille of the dexamethasone content in a 40 mg tablet. CONCLUSION We conclude that uncoated dexamethasone does shed measurable residue in the robot. It remains unknown to what extent this residue contaminates the subsequent production.
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Affiliation(s)
- Anne Skyggedal
- Hospital Pharmacy, Hospital of South West Denmark, Esbjerg, Denmark
| | - Flemming Nielsen
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
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11
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Mirza MR, Bergmann TK, Mau-Sørensen M, Christensen RD, Åvall-Lundqvist E, Birrer MJ, Jørgensen M, Roed H, Malander S, Nielsen F, Lassen U, Brøsen K, Bjørge L, Mäenpää J. A phase I study of the PARP inhibitor niraparib in combination with bevacizumab in platinum-sensitive epithelial ovarian cancer: NSGO AVANOVA1/ENGOT-OV24. Cancer Chemother Pharmacol 2019; 84:791-798. [PMID: 31375879 DOI: 10.1007/s00280-019-03917-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Combining poly(ADP-ribose) polymerase (PARP) inhibitors with antiangiogenic agents appeared to enhance activity vs PARP inhibitors alone in a randomized phase II trial. MATERIALS AND METHODS In AVANOVA (NCT02354131) part 1, patients with measurable/evaluable high-grade serous/endometrioid platinum-sensitive ovarian cancer received bevacizumab 15 mg/kg every 21 days with escalating doses of niraparib capsules (100, 200, or 300 mg daily) in a 3 + 3 dose-escalation design. Primary objectives were to evaluate safety and tolerability and to determine the recommended phase II dose (RP2D). RESULTS Three of 12 enrolled patients had germline BRCA2 mutations. In cycle 1, nine patients experienced grade 3 toxicities: five with hypertension, three with anemia, and one with thrombocytopenia. There was one dose-limiting toxicity (grade 4 thrombocytopenia with niraparib 300 mg), thus the RP2D was bevacizumab 15 mg/kg with niraparib 300 mg. The response rate was 50%; disease was stabilized in a further 42%. Median progression-free survival was 11.6 (95% confidence interval 8.4-20.1) months. Niraparib pharmacokinetics were consistent with historical single-agent data. Overlapping exposure was observed across the dose ranges tested on days 1 and 21. CONCLUSIONS There was one dose-limiting toxicity; other adverse events were typical PARP inhibitor and antiangiogenic class effects. Niraparib-bevacizumab showed promising activity; Part 2 (vs bevacizumab) was recently reported and phase III comparison with standard-of-care therapy is planned.
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Affiliation(s)
- Mansoor Raza Mirza
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark. .,Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Troels K Bergmann
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - René dePont Christensen
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Åvall-Lundqvist
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Michael J Birrer
- Comprehensive Cancer Center, The University of Alabama, Birmingham, USA
| | - Morten Jørgensen
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henrik Roed
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Susanne Malander
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Lund University Hospital, Lund, Sweden
| | - Flemming Nielsen
- Clinical Pharmacology and Pharmacy, Department of Public Health, Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Ulrik Lassen
- Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kim Brøsen
- Clinical Pharmacology and Pharmacy, Department of Public Health, Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Line Bjørge
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Clinical Science, Center for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Johanna Mäenpää
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Tampere University Hospital, University of Tampere, Tampere, Finland
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Bergmann TK, Christensen MMH, Haastrup MB, Damkier P. Response to Letter to the Editor concerning "Progression-free survival (PFS) in oncology: Caveat emptor!". Basic Clin Pharmacol Toxicol 2019; 124:239. [PMID: 30747495 DOI: 10.1111/bcpt.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Troels K Bergmann
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Hospital Pharmacy, Hospital of South West Denmark, Esbjerg, Denmark
| | - Mette Marie H Christensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Hospital Pharmacy, Hospital of South West Denmark, Esbjerg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maija Bruun Haastrup
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Bergmann TK, Christensen MMH, Henriksen DP, Haastrup MB, Damkier P. Progression-free survival in oncology: Caveat emptor! Basic Clin Pharmacol Toxicol 2018; 124:240-244. [PMID: 30417586 DOI: 10.1111/bcpt.13168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Overall survival (OS) is the undisputed gold standard efficacy end-point in cancer drug trials. It is with growing concern that we observe how progression-free survival (PFS) gains ground as surrogate end-point in its place. PFS has appeal because it is resource-efficient, but it has severe shortcomings. Our concern is that uncritical use of PFS will harm the evidence-based evaluation of cancer drugs when considering them for standard use in publicly financed health care systems. PFS is only valid as a surrogate end-point for OS if it correlates strongly with OS and if the cancer drug being investigated has the same effect on PFS and OS such that effects on one predict effects on the other. The latter might be less obvious than the former but is no less critical. Research indicates that in a majority of cases, correlation between surrogate end-points and OS is of medium strength or lower. PFS is therefore unreliable as a surrogate for OS. We do not find it justified to use PFS as surrogate for OS without first having assessed its validity. Stakeholders who take part in evaluating cancer drugs considered for standard use in a health care system must be particularly vigilant about this issue to minimize the risk of introducing cancer drugs that have an unacceptable cost-risk-benefit profile.
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Affiliation(s)
- Troels K Bergmann
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Hospital Pharmacy, Hospital of South West Denmark, Esbjerg, Denmark
| | - Mette Marie H Christensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Hospital Pharmacy, Hospital of South West Denmark, Esbjerg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Daniel P Henriksen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maija Bruun Haastrup
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Tveden-Nyborg P, Bergmann TK, Lykkesfeldt J. Basic & Clinical Pharmacology & Toxicology Policy for Experimental and Clinical studies. Basic Clin Pharmacol Toxicol 2018; 123:233-235. [DOI: 10.1111/bcpt.13059] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/13/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Pernille Tveden-Nyborg
- Section of Experimental Animal Models; Department of Veterinary Disease Biology; University of Copenhagen; Copenhagen Denmark
| | - Troels K. Bergmann
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
| | - Jens Lykkesfeldt
- Section of Experimental Animal Models; Department of Veterinary Disease Biology; University of Copenhagen; Copenhagen Denmark
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Abstract
Introduction Tacrolimus is a calcineurin inhibitor used as an immunosuppressant drug in solid organ transplantation, and is mainly metabolized by cytochrome P450 (CYP) 3A4 and CYP3A5. Studies have shown an association between the CYP3A5 genotype and tacrolimus dose-adjusted trough concentrations. Variants in the genes PPARA, POR and CYP3A4 have recently been shown to influence tacrolimus metabolism. Furthermore, pharmacokinetic interaction between corticosteroid treatment and tacrolimus has been shown. In the present study, we investigated a potential association between CYP3A5*3, PPARA c.209-1003G>A, POR*28 and CYP3A4*22 and dose-adjusted tacrolimus trough concentrations in a primarily corticosteroid-free (>85%) population of Danish pediatric and adult kidney transplant recipients. Methods Seventy-two patients receiving treatment with oral tacrolimus were genotyped using real-time polymerase chain reaction and Primer-Probe Detection. Tacrolimus trough concentrations, corresponding doses and covariates were retrospectively collected from the patients’ medical charts. Results It was confirmed that CYP3A5*1 wild-type carriers had lower median dose-adjusted tacrolimus trough concentrations compared with noncarriers. Adults had 56 and 77% lower trough concentrations at 6 weeks (p = 0.0003) and 1 year, respectively (p < 0.0017), and, similarly, children had 65 and 39% lower median concentrations, with p values of 0.006 and 0.011, respectively. No association was found for PPARA c.209-1003G>A, POR*28, or CYP3A4*22. An association between the PPARA c.209-1003G>A genotype and an increased number of infections with cytomegalovirus (CMV) within the first year was identified (p < 0.05). Only 29% of trough concentrations measured between 2 and 12 weeks post-transplantation were on target. Conclusion This study shows that the known association of the CYP3A5 genotype with tacrolimus dose-adjusted trough concentrations has the same impact in a corticosteroid-sparse population. The association between PPARA variance and infections with CMV will need further investigation. Electronic supplementary material The online version of this article (doi:10.1007/s40268-017-0177-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mads Juul Madsen
- Department of Nephrology, Odense University Hospital, J B WinslowsVej 19, 5000, Odense C, Denmark
| | - Troels K Bergmann
- Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
- Hospital Pharmacy, Hospital of South West Denmark, Esbjerg, Denmark.
| | - Kim Brøsen
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Helle Charlotte Thiesson
- Department of Nephrology, Odense University Hospital, J B WinslowsVej 19, 5000, Odense C, Denmark
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Agergaard K, Mau-Sørensen M, Stage TB, Jørgensen TL, Hassel RE, Steffensen KD, Pedersen JW, Milo MLH, Poulsen SH, Pottegård A, Hallas J, Brøsen K, Bergmann TK. Clopidogrel-Paclitaxel Drug-Drug Interaction: A Pharmacoepidemiologic Study. Clin Pharmacol Ther 2017; 102:547-553. [DOI: 10.1002/cpt.674] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/11/2022]
Affiliation(s)
- K Agergaard
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
| | - M Mau-Sørensen
- Department of Oncology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - TB Stage
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
- Department of Bioengineering and Therapeutics Sciences; University of California San Francisco; San Francisco California USA
| | - TL Jørgensen
- Department of Oncology; Odense University Hospital; Odense Denmark
- AgeCare, Academy of Geriatric Cancer Research; Odense University Hospital; Odense Denmark
| | - RE Hassel
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - KD Steffensen
- Department of Oncology; Lillebaelt Hospital; Vejle Denmark
| | - JW Pedersen
- Department of Oncology; Herlev Hospital, Copenhagen University Hospital; Herlev Denmark
| | - MLH Milo
- Department of Oncology; Aalborg University Hospital; Aalborg Denmark
| | - SH Poulsen
- Department of Oncology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - A Pottegård
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
| | - J Hallas
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
| | - K Brøsen
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
- OPEN; Odense Patient Data Explorative Network, Odense University Hospital; Odense Denmark
| | - TK Bergmann
- Department of Clinical Biochemistry and Pharmacology; Odense University Hospital; Odense Denmark
- Hospital Pharmacy; Hospital of South West Denmark; Esbjerg Denmark
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Ramazan-Yousif L, Albertsen S, Bergmann TK, Madsen PH, Steen NP. [Lactic acidosis in a 24-year-old woman with status asthmaticus]. Ugeskr Laeger 2016; 178:V06160459. [PMID: 27966425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 24-year-old woman with asthma presented with symptoms of upper airway infection and tachypnoea and wheezes. She had a history of admissions to intensive care units (ICU) due to respiratory insufficiency. The initial lactate concentration was 2.1 mmol/l. The treatment consisted of inhaled and intravenous β ² agonists. Hereafter, the lactate concentration rose to 9.8 mmol/l, and the patient was admitted to the ICU due to severe asthma exacerbation. The elevation of lactate concentration cleared after discontinuation of β ² agonist therapy. Although lactic acidosis is a rare side effect to β ² agonist treatment, it is important to recog-nize it when present.
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Bergmann TK, Filppula AM, Launiainen T, Nielsen F, Backman JT, Brosen K. Neurotoxicity and low paclitaxel clearance associated with concomitant clopidogrel therapy in a 60-year-old Caucasian woman with ovarian carcinoma. Br J Clin Pharmacol 2016; 81:313-5. [PMID: 26446447 DOI: 10.1111/bcp.12795] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/23/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023] Open
Abstract
AIM The aim of the present case report was to describe a novel pharmacokinetic drug–drug interaction between the antiplatelet agent clopidogrel and the antineoplastic agent paclitaxel. METHODS The patient was identified in a previously described cohort of 93 patients with ovarian carcinoma treated with paclitaxel. The effect of clopidogrel acyl-β-D-glucuronide on the metabolism of paclitaxel was assessed in human liver microsomes. The analysis of clopidogrel in plasma and the quantification of paclitaxel and 6-hydroxypaclitaxel in in vitro samples were performed by liquid chromatography tandem mass spectrometry. RESULTS The patient was a 60-year-old female treated with an unknown dose of clopidogrel at the time of paclitaxel therapy. Clopidogrel was present in all three of the plasma samples obtained during paclitaxel dosing. Estimated unbound paclitaxel clearance was 238 l h−1, which was only 62% of the cohort geometric mean (385 l h−1; range 176–726). She was hospitalized three times, developed severe neuropathy and paclitaxel treatment was subsequently discontinued. In vitro, 30-min preincubation with 100 μM clopidogrel acyl-β-D-glucuronide inhibited the depletion rate of 0.5 μM paclitaxel by 51% and the formation rate of 6-hydroxypaclitaxel by 77%. CONCLUSION This is the first report of a clopidogrel–paclitaxel interaction, suggesting that clinically used doses of clopidogrel can reduce the cytochrome P450 2C8 (CYP2C8)-mediated systemic clearance of paclitaxel, leading to an increased risk of paclitaxel toxicity. Caution should be exercised whenever the simultaneous use of paclitaxel and clopidogrel cannot be avoided.
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Lyauk YK, Stage C, Bergmann TK, Ferrero-Milliani L, Bjerre D, Thomsen R, Dalhoff KP, Rasmussen HB, Jürgens G. Population Pharmacokinetics of Methylphenidate in Healthy Adults Emphasizing Novel and Known Effects of Several Carboxylesterase 1 (CES1) Variants. Clin Transl Sci 2016; 9:337-345. [PMID: 27754602 PMCID: PMC5351003 DOI: 10.1111/cts.12423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/05/2016] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to identify demographic and genetic factors that significantly affect methylphenidate (MPH) pharmacokinetics (PK), and may help explain interindividual variability and further increase the safety of MPH. d‐MPH plasma concentrations, demographic covariates, and carboxylesterase 1 (CES1) genotypes were gathered from 122 healthy adults and analyzed using nonlinear mixed effects modeling. The structural model that best described the data was a two‐compartment disposition model with absorption transit compartments. Novel effects of rs115629050 and CES1 diplotypes, as well as previously reported effects of rs71647871 and body weight, were included in the final model. Assessment of the independent and combined effect of CES1 covariates identified several specific risk factors that may result in severely increased d‐MPH plasma exposure.
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Affiliation(s)
- Y K Lyauk
- Roskilde University Hospital, Unit of Clinical Pharmacology, Roskilde, Denmark
| | - C Stage
- Bispebjerg University Hospital, Department of Clinical Pharmacology, Roskilde, Denmark
| | - T K Bergmann
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark.,The Hospital Pharmacy, Hospital of South Jutland, Esbjerg, Denmark
| | - L Ferrero-Milliani
- Mental Health Centre Sct. Hans, Institute for Biological Psychiatry, Roskilde, Denmark
| | - D Bjerre
- Mental Health Centre Sct. Hans, Institute for Biological Psychiatry, Roskilde, Denmark
| | - R Thomsen
- University of Copenhagen, Department of Forensic Medicine, Copenhagen, Denmark
| | - K P Dalhoff
- Bispebjerg University Hospital, Department of Clinical Pharmacology, Copenhagen, Denmark
| | - H B Rasmussen
- Mental Health Centre Sct. Hans, Institute for Biological Psychiatry, Roskilde, Denmark
| | - G Jürgens
- Roskilde University Hospital, Unit of Clinical Pharmacology, Roskilde, Denmark
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Bergmann TK, Isbel NM, Ostini R, Barraclough KA, Campbell SB, McWhinney BC, Inder WJ, Russell A, Staatz CE. Exploratory study of total and free prednisolone plasma exposure and cushingoid appearance, quality of life and biochemical toxicity in adult male kidney transplant recipients. Clin Drug Investig 2016; 35:743-50. [PMID: 26403249 DOI: 10.1007/s40261-015-0334-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Long-term adverse effects of oral glucocorticoids are frequent and serious. Large between-patient variability in the pharmacokinetics of prednisolone might explain why drug dose is a poor predictor of drug-related toxicity. The aim of the study was to investigate relationships between prednisolone exposure and adverse effects. METHODS Male kidney transplant recipients were recruited for serial blood sampling and assessment of glucocorticoid-related adverse effects including dyslipidaemia, abnormal body fat distribution, Cushingoid appearance and impaired quality of life. Total and free prednisolone plasma concentrations were determined using ultra-high-performance liquid chromatography with tandem mass spectrometric detection. Prednisolone exposure was estimated using a limited sampling strategy. RESULTS Fifty-six patients were recruited. Patients had a mean age of 54 years and median time post-transplantation of 75 months. Median prednisolone dose was 5 mg. Mean area under the plasma concentration-time curve was 2390 nmol h/L (±580) (SD) and 175 nmol h/L (±78) for total and free prednisolone, respectively. Waist to upper arm circumference ratio was positively associated with free prednisolone plasma exposure with a Spearman correlation coefficient of 0.30 (p value 0.02). The correlation coefficient was 0.24 (p value 0.08) for neck to upper arm circumference ratio and free prednisolone plasma exposure. The clinical Cushingoid phenotype as determined by the Visual Assessment of Cushing's Severity (VACS) score was associated with a reduced score relating to physical functioning on the SF-12, but there was no significant relationship between free prednisolone plasma exposure and quality-of-life scores. Lipid levels and haemoglobin A1c (HbA1c) were not associated with total or free prednisolone exposure. CONCLUSIONS There is a positive correlation between free prednisolone plasma exposure and waist to upper arm circumference ratio in adult male kidney transplant recipients on low maintenance prednisolone doses. There is no significant association between total or free prednisolone plasma exposure and plasma glucose and lipid levels in the low prednisolone dose range.
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Affiliation(s)
- Troels K Bergmann
- School of Pharmacy, University of Queensland, Brisbane, Australia. .,Department of Clinical Chemistry and Pharmacology, Odense University Hospital, J.B. Winsloews Vej 19, 5000, Odense C, Denmark.
| | - Nicole M Isbel
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - Remo Ostini
- Rural Clinical School Research Centre, University of Queensland, Toowoomba, Australia
| | | | - Scott B Campbell
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Anthony Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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Staatz CE, Størset E, Bergmann TK, Hennig S, Holford N. Tacrolimus pharmacokinetics after kidney transplantation--Influence of changes in haematocrit and steroid dose. Br J Clin Pharmacol 2015; 80:1475-6. [PMID: 26235203 DOI: 10.1111/bcp.12729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Elisabet Størset
- Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Troels K Bergmann
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark and
| | - Stefanie Hennig
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Nick Holford
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
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Apellániz-Ruiz M, Sánchez-Barroso L, Gutiérrez-Gutiérrez G, Sereno M, García-Donás J, Åvall-Lundqvist E, Gréen H, Brøsen K, Bergmann TK, Rodríguez-Antona C. Replication of Genetic Polymorphisms Reported to Be Associated with Taxane-Related Sensory Neuropathy in Patients with Early Breast Cancer Treated with Paclitaxel—Letter. Clin Cancer Res 2015; 21:3092-3. [DOI: 10.1158/1078-0432.ccr-14-1885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee MY, Apellániz-Ruiz M, Johansson I, Vikingsson S, Bergmann TK, Brøsen K, Green H, Rodríguez-Antona C, Ingelman-Sundberg M. Role of cytochrome P450 2C8*3 (CYP2C8*3) in paclitaxel metabolism and paclitaxel-induced neurotoxicity. Pharmacogenomics 2015; 16:929-37. [PMID: 26115084 DOI: 10.2217/pgs.15.46] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM The CYP2C8*3 allele has been suggested as a risk factor for paclitaxel-induced neuropathy but the data hitherto published are conflicting. MATERIALS & METHODS In total 435 patients were investigated with respect to maximum neuropathy grade and accumulated paclitaxel dose. The enzymatic properties of CYP2C8.3 variant were analyzed using heterologous mammalian HEK293 cell expression system. RESULTS No significant association between CYP2C8*3 allele and neuropathy was found, although a trend was observed. The paclitaxel and amodiaquine metabolism by CYP2C8.3 were found similar to CYP2C8.1, whereas CYP2C8.3 was more efficient in the metabolism of rosiglitazone. CONCLUSION These results indicate a difference in substrate specificity between CYP2C8.1 and CYP2C8.3; however, the CYP2C8*3 allele has no major impact on paclitaxel metabolism in vitro or of paclitaxel-induced neuropathy in vivo. Original submitted on 6 February 2015; revision submitted on 9 April 2015.
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Affiliation(s)
- Mi-Young Lee
- Section of Pharmacogenetics, Department of Physiology & Pharmacology, Karolinska Institutet, SE 171 77 Stockholm, Sweden
| | - María Apellániz-Ruiz
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Inger Johansson
- Section of Pharmacogenetics, Department of Physiology & Pharmacology, Karolinska Institutet, SE 171 77 Stockholm, Sweden
| | - Svante Vikingsson
- Clinical Pharmacology, Division of Drug Research, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Troels K Bergmann
- Research Unit of Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kim Brøsen
- Research Unit of Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henrik Green
- Clinical Pharmacology, Division of Drug Research, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Forensic Genetics & Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.,ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Magnus Ingelman-Sundberg
- Section of Pharmacogenetics, Department of Physiology & Pharmacology, Karolinska Institutet, SE 171 77 Stockholm, Sweden
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Størset E, Holford N, Hennig S, Bergmann TK, Bergan S, Bremer S, Åsberg A, Midtvedt K, Staatz CE. Improved prediction of tacrolimus concentrations early after kidney transplantation using theory-based pharmacokinetic modelling. Br J Clin Pharmacol 2015; 78:509-23. [PMID: 25279405 PMCID: PMC4243902 DOI: 10.1111/bcp.12361] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims The aim was to develop a theory-based population pharmacokinetic model of tacrolimus in adult kidney transplant recipients and to externally evaluate this model and two previous empirical models. Methods Data were obtained from 242 patients with 3100 tacrolimus whole blood concentrations. External evaluation was performed by examining model predictive performance using Bayesian forecasting. Results Pharmacokinetic disposition parameters were estimated based on tacrolimus plasma concentrations, predicted from whole blood concentrations, haematocrit and literature values for tacrolimus binding to red blood cells. Disposition parameters were allometrically scaled to fat free mass. Tacrolimus whole blood clearance/bioavailability standardized to haematocrit of 45% and fat free mass of 60 kg was estimated to be 16.1 l h−1 [95% CI 12.6, 18.0 l h−1]. Tacrolimus clearance was 30% higher (95% CI 13, 46%) and bioavailability 18% lower (95% CI 2, 29%) in CYP3A5 expressers compared with non-expressers. An Emax model described decreasing tacrolimus bioavailability with increasing prednisolone dose. The theory-based model was superior to the empirical models during external evaluation displaying a median prediction error of −1.2% (95% CI −3.0, 0.1%). Based on simulation, Bayesian forecasting led to 65% (95% CI 62, 68%) of patients achieving a tacrolimus average steady-state concentration within a suggested acceptable range. Conclusion A theory-based population pharmacokinetic model was superior to two empirical models for prediction of tacrolimus concentrations and seemed suitable for Bayesian prediction of tacrolimus doses early after kidney transplantation.
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Affiliation(s)
- Elisabet Størset
- Department of Transplant Medicine, Oslo University Hospital RikshospitaletOslo, Norway
- Institute of Clinical Medicine, University of OsloOslo, Norway
- Correspondence: Ms Elisabet Størset MSc, Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Postbox 4950 Nydalen, Oslo 0424, Norway., Tel.: +47 2307 0000, Fax: +47 2307 3865, E-mail:
| | - Nick Holford
- Department of Pharmacology and Clinical Pharmacology, University of AucklandAuckland, New Zealand
| | - Stefanie Hennig
- School of Pharmacy, University of QueenslandBrisbane, Australia
- Australian Centre of PharmacometricsBrisbane, Australia
| | - Troels K Bergmann
- School of Pharmacy, University of QueenslandBrisbane, Australia
- Department of Clinical Pharmacology, Aarhus University HospitalAarhus, Denmark
| | - Stein Bergan
- Department of Pharmacology, Oslo University HospitalOslo, Norway
- School of Pharmacy, University of OsloOslo, Norway
| | - Sara Bremer
- Department of Medical Biochemistry, Oslo University HospitalOslo, Norway
| | - Anders Åsberg
- Department of Transplant Medicine, Oslo University Hospital RikshospitaletOslo, Norway
- School of Pharmacy, University of OsloOslo, Norway
| | - Karsten Midtvedt
- Department of Transplant Medicine, Oslo University Hospital RikshospitaletOslo, Norway
| | - Christine E Staatz
- School of Pharmacy, University of QueenslandBrisbane, Australia
- Australian Centre of PharmacometricsBrisbane, Australia
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Eckhoff L, Feddersen S, Knoop AS, Ewertz M, Bergmann TK. Docetaxel-induced neuropathy: a pharmacogenetic case-control study of 150 women with early-stage breast cancer. Acta Oncol 2015; 54:530-7. [PMID: 25383449 DOI: 10.3109/0284186x.2014.969846] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Docetaxel is a highly effective treatment of a wide range of malignancies but is often associated with peripheral neuropathy. The genetic variability of genes involved in the transportation or metabolism of docetaxel may be responsible for the variation in docetaxel-induced peripheral neuropathy (DIPN). The main purpose of this study was to investigate the impact of genetic variants in GSTP1 and ABCB1 on DIPN. MATERIAL AND METHODS DNA was extracted from whole blood from 150 patients with early-stage breast cancer who had received adjuvant docetaxel from February 2011 to May 2012. Two polymorphisms in GSTP1 and three in ABCB1 were selected for the primary analysis, and a host of other candidate genes was explored and compared between 75 patients with clinician-reported DIPN grade ≥ 2 and 75 patients without DIPN. RESULTS Patients with the genetic variants GSTP1 rs1138272 C/T or T/T (114Ala/114Val or 114Val/114Val) genotype had an adjusted odds ratio of 3.82; 95% confidence interval 1.34-11.09 of developing DIPN. This result was confirmed in both analysis of cumulated docetaxel dose and haplotype analysis. None of the explorative genes investigated were significantly correlated with DIPN. Patients with a BMI ≥ 30 were five-fold more likely to have DIPN than patients with BMI < 25. CONCLUSION We found that GSTP1 Ala114Val polymorphism is associated with occurrence of DIPN. This supports the theory that oxidative stress is involved in DIPN pathophysiology. If confirmed, this may be helpful in the risk assessment of DIPN and perhaps help to achieve better management of neurotoxicity.
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Affiliation(s)
- Lise Eckhoff
- Department of Oncology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
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Bergmann TK, Isbel NM, Barraclough KA, Campbell SB, McWhinney BC, Staatz CE. Comparison of the influence of cyclosporine and tacrolimus on the pharmacokinetics of prednisolone in adult male kidney transplant recipients. Clin Drug Investig 2014; 34:183-8. [PMID: 24385281 DOI: 10.1007/s40261-013-0162-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Cyclosporine has been observed to precipitate cushingoid features in kidney transplant recipients already on prednisolone. Some pharmacokinetic studies have demonstrated increased prednisolone exposure in patients on cyclosporine therapy compared with azathioprine, whereas other studies have found no difference. The objective of this study was to determine whether cyclosporine impacts on prednisolone exposure as compared with tacrolimus. METHODS Adult male kidney transplant recipients treated with prednisolone and either cyclosporine or tacrolimus were recruited for pharmacokinetic blood sampling at the outpatient clinic at the Princess Alexandra Hospital, Brisbane, Australia. Prednisolone plasma concentrations were determined using ultra-high-performance liquid chromatography. Dose-adjusted area under the plasma concentration-time curve (AUC) of free and total prednisolone was estimated using a previously developed limited sampling strategy and non-compartmental analysis. RESULTS A total of 55 patients were eligible for analysis; 38 % received cyclosporine and 62 % received tacrolimus co-therapy. No significant difference in mean dose-adjusted total prednisolone AUC from 0 to 6 h post-dose or mean dose-adjusted free prednisolone AUC from 0 to 12 h was observed between the cyclosporine and tacrolimus groups (449 versus 428 nmol·h/L/mg, p = 0.43, and 32 versus 30 nmol·h/L/mg, p = 0.51, respectively). CONCLUSION Cyclosporine does not change the dose-adjusted exposure of prednisolone compared with tacrolimus. Adult kidney transplant recipients can therefore continue on their usual prednisolone dose when changing therapy between cyclosporine and tacrolimus.
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Therkildsen C, Bergmann TK, Henrichsen-Schnack T, Ladelund S, Nilbert M. The predictive value of KRAS, NRAS, BRAF, PIK3CA and PTEN for anti-EGFR treatment in metastatic colorectal cancer: A systematic review and meta-analysis. Acta Oncol 2014; 53:852-64. [PMID: 24666267 DOI: 10.3109/0284186x.2014.895036] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In metastatic colorectal cancer, mutation testing for KRAS exon 2 is widely implemented to select patients with wild-type tumors for treatment with the monocloncal anti-EGFR antibodies cetuximab and panitumumab. The added predictive value of additional biomarkers in the RAS-RAF-MAPK and PI3K-AKT-mTOR pathways in colorectal cancer is uncertain, which led us to systematically review the impact of alterations in KRAS (outside of exon 2), NRAS, BRAF, PIK3CA and PTEN in relation to the clinical benefit from anti-EGFR treatment. METHODS In total, 22 studies that include 2395 patients formed the basis for a meta-analysis on alterations in KRAS exons 3 and 4, NRAS, BRAF, and PIK3CA and PTEN and outcome of anti-EGFR treatment. Odds ratios for objective response rate (ORR) and hazard ratios (HR) for progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS Mutations in KRAS exons 3 and 4, BRAF, PIK3CA and non-functional PTEN (mutations or loss of protein expression) significantly predicted poor ORR (OR = 0.26, OR = 0.29, OR = 0.39, and OR = 0.41, respectively). Significantly shorter PFS applied to mutations in KRAS exons 3 and 4 (HR = 2.19), NRAS (HR = 2.30) and BRAF (HR = 2.95) and non-functional PTEN (HR = 1.88). Significantly shorter OS applied to mutations in KRAS exons 3 and 4 (HR = 1.78), NRAS (HR = 1.85), BRAF (HR = 2.52), PIK3CA (HR = 1.43) and alterations in PTEN (HR = 2.09). CONCLUSIONS Meta-analysis suggests that mutations in KRAS exons 3 and 4, NRAS, BRAF and PIK3CA and non-functional PTEN predict resistance to anti-EGFR therapies and demonstrates that biomarker analysis beyond KRAS exon 2 should be implemented for prediction of clinical benefit from anti-EGFR antibodies in metastatic colorectal cancer.
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Affiliation(s)
- Christina Therkildsen
- Clinical Research Centre, Hvidovre University Hospital, Copenhagen University , Hvidovre , Denmark
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Therkildsen C, Bergmann TK, Henrichsen-Schnack T, Ladelund S, Nilbert M. The predictive value of KRAS, NRAS, BRAF, PIK3CA and PTEN for anti-EGFR treatment in metastatic colorectal cancer: A systematic review and meta-analysis. Acta Oncol 2014. [PMID: 24666267 DOI: 10.3109/0284186x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In metastatic colorectal cancer, mutation testing for KRAS exon 2 is widely implemented to select patients with wild-type tumors for treatment with the monocloncal anti-EGFR antibodies cetuximab and panitumumab. The added predictive value of additional biomarkers in the RAS-RAF-MAPK and PI3K-AKT-mTOR pathways in colorectal cancer is uncertain, which led us to systematically review the impact of alterations in KRAS (outside of exon 2), NRAS, BRAF, PIK3CA and PTEN in relation to the clinical benefit from anti-EGFR treatment. METHODS In total, 22 studies that include 2395 patients formed the basis for a meta-analysis on alterations in KRAS exons 3 and 4, NRAS, BRAF, and PIK3CA and PTEN and outcome of anti-EGFR treatment. Odds ratios for objective response rate (ORR) and hazard ratios (HR) for progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS Mutations in KRAS exons 3 and 4, BRAF, PIK3CA and non-functional PTEN (mutations or loss of protein expression) significantly predicted poor ORR (OR = 0.26, OR = 0.29, OR = 0.39, and OR = 0.41, respectively). Significantly shorter PFS applied to mutations in KRAS exons 3 and 4 (HR = 2.19), NRAS (HR = 2.30) and BRAF (HR = 2.95) and non-functional PTEN (HR = 1.88). Significantly shorter OS applied to mutations in KRAS exons 3 and 4 (HR = 1.78), NRAS (HR = 1.85), BRAF (HR = 2.52), PIK3CA (HR = 1.43) and alterations in PTEN (HR = 2.09). CONCLUSIONS Meta-analysis suggests that mutations in KRAS exons 3 and 4, NRAS, BRAF and PIK3CA and non-functional PTEN predict resistance to anti-EGFR therapies and demonstrates that biomarker analysis beyond KRAS exon 2 should be implemented for prediction of clinical benefit from anti-EGFR antibodies in metastatic colorectal cancer.
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Affiliation(s)
- Christina Therkildsen
- Clinical Research Centre, Hvidovre University Hospital, Copenhagen University , Hvidovre , Denmark
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Bergmann TK, Vach W, Feddersen S, Eckhoff L, Gréen H, Herrstedt J, Brosen K. GWAS-based association between RWDD3 and TECTA variants and paclitaxel induced neuropathy could not be confirmed in Scandinavian ovarian cancer patients. Acta Oncol 2013; 52:871-4. [PMID: 22877241 DOI: 10.3109/0284186x.2012.707787] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bergmann TK, Brasch-Andersen C, Gréen H, Mirza MR, Skougaard K, Wihl J, Keldsen N, Damkier P, Peterson C, Vach W, Brøsen K. Impact of ABCB1 Variants on Neutrophil Depression: A Pharmacogenomic Study of Paclitaxel in 92 Women with Ovarian Cancer. Basic Clin Pharmacol Toxicol 2011; 110:199-204. [DOI: 10.1111/j.1742-7843.2011.00802.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bergmann TK, Gréen H, Brasch-Andersen C, Mirza MR, Herrstedt J, Hølund B, du Bois A, Damkier P, Vach W, Brosen K, Peterson C. Retrospective study of the impact of pharmacogenetic variants on paclitaxel toxicity and survival in patients with ovarian cancer. Eur J Clin Pharmacol 2011; 67:693-700. [PMID: 21327421 DOI: 10.1007/s00228-011-1007-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 01/20/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Paclitaxel has a broad spectrum of anti-tumor activity and is useful in the treatment of ovarian, breast, and lung cancer. Paclitaxel is metabolized in the liver by CYP2C8 and CYP3A4 and transported by P-glycoprotein. The dose-limiting toxicities are neuropathy and neutropenia, but the interindividual variability in toxicity and also survival is large. The main purpose of this study was to investigate the impact of genetic variants in CYP2C8 and ABCB1 on toxicity and survival. METHODS The 182 patients previously treated for ovarian cancer with carboplatin and paclitaxel in either the AGO-OVAR-9 or the NSGO-OC9804 trial in Denmark or Sweden were eligible for this study. Genotyping was carried out on formalin-fixed tissue. The patients' toxicity profiles and survival data were derived from retrospective data. CYP2C8*3, ABCB1 C1236T, G2677T/A, and C3435T were chosen a priori for primary analysis; a host of other variants were entered into an exploratory analysis. RESULTS Clinical data and tissue were available from a total of 119 patients. Twenty-two single nucleotide polymorphisms (SNPs) in 10 genes were determined. Toxicity registration was available from 710 treatment cycles. In the primary analysis, no statistically significant correlation was found between CYP2C8*3, ABCB1 C1236T, G2677T/A, and C3435T and neutropenia, sensoric neuropathy, and overall survival. CONCLUSION CYP2C8*3 and the ABCB1 SNPs C1236T, G2677T/A, and C3435T were not statistically significantly correlated to overall survival, sensoric neuropathy, and neutropenia in 119 patients treated for ovarian cancer with paclitaxel/carboplatin.
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Affiliation(s)
- Troels K Bergmann
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, J.B. Winsleows vej 19, 2nd floor, Odense, Denmark.
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Pedersen RS, Brasch-Andersen C, Sim SC, Bergmann TK, Halling J, Petersen MS, Weihe P, Edvardsen H, Kristensen VN, Brøsen K, Ingelman-Sundberg M. Linkage disequilibrium between the CYP2C19*17 allele and wildtype CYP2C8 and CYP2C9 alleles: identification of CYP2C haplotypes in healthy Nordic populations. Eur J Clin Pharmacol 2010; 66:1199-205. [PMID: 20665013 DOI: 10.1007/s00228-010-0864-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/01/2010] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the distribution of clinically important CYP2C genotypes and allele frequencies in healthy Nordic populations with special focus on linkage disequilibrium. METHODS A total of 896 healthy subjects from three Nordic populations (Danish, Faroese, and Norwegian) were genotyped for five frequent and clinically important CYP2C allelic variants: the defective CYP2C8*3, CYP2C9*2, CYP2C9*3, and CYP2C19*2 alleles, and the CYP2C19*17 allele that causes rapid drug metabolism. Linkage disequilibrium was evaluated and CYP2C haplotypes were inferred in the entire population. RESULTS Ten CYP2C haplotypes were inferred, the most frequent of which (49%) was the CYP2C wildtype haplotype carrying CYP2C8*1, CYP2C9*1, and CYP2C19*1. The second most frequent haplotype (19%) is composed of CYP2C19*17, CYP2C8*1, and CYP2C9*1. This predicted haplotype accounts for 99.7% of the CYP2C19*17 alleles found in the 896 subjects. CONCLUSION CYP2C19*17 is a frequent genetic variant in Nordic populations that exists in strong linkage disequilibrium with wildtype CYP2C8*1 and CYP2C9*1 alleles, which effectively makes it a determinant for a haplotype exhibiting an efficient CYP2C substrate metabolism.
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Affiliation(s)
- Rasmus S Pedersen
- Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, Odense, Denmark.
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Vach W, Bergmann TK, Brøsen K. No evidence for taxane/platinum pharmacogenetic markers: just lack of power? J Clin Oncol 2008; 26:1903-4; author reply 1904-5. [PMID: 18398158 DOI: 10.1200/jco.2007.15.7776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
A case of hepatic abscesses due to Yersinia enterocolitica in an immunocompetent male is presented. Re-examination after 3 months showed that the patient had primary haemochromatosis. Treatment with repeated phlebotomies was instituted. Two years after the patient was first admitted to hospital. 17.2 g iron had been removed and all haematological and biochemical parameters had returned to normal. Genetic analysis of the patients' two sons showed that one was positive for the chromosome defect found in primary haemochromatosis; further investigation is under progress. A study of the literature showed that prior to this case only 45 cases of hepatic abscess secondary to Yersinia enterocolitica have been registered. Of the 45 reported cases, 64% had underlying haemochromatosis and 29% had diabetes mellitus. The overall mortality was 31%. Mortality before 1987 was 60% (n = 20) and since 1987 it has been 8% (n = 25).
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Affiliation(s)
- T K Bergmann
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense.
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Bergmann TK, Bathum L, Brosen K. Duplication of CYP2D6 predicts high clearance of desipramine but high clearance does not predict duplication of CYP2D6. Eur J Clin Pharmacol 2001; 57:123-7. [PMID: 11417443 DOI: 10.1007/s002280100284] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Duplication of CYP2D6 causes very rapid metabolism of CYP2D6 substrates such as desipramine. However, we have previously shown that in the Danish population, only about 15% of very rapid metabolisers, defined as subjects with a metabolic ratio of sparteine of 0.15 or less, carried a duplicated allele. The question is whether gene duplication is a relatively rare cause (perhaps predictor) of very rapid metabolism or whether a low metabolic ratio is a poor predictor of this. METHODS After measuring metabolic ratios anew, we selected six volunteers with duplication of CYP2D6 and metabolic ratios ranging from 0.07 to 0.17 and six volunteers without duplication with metabolic ratios ranging from 0.08 to 0.21. Each subject took 100 mg of desipramine. Blood and urine were collected for 48 h. RESULTS The median total oral clearance of desipramine was 372 l/h and 196 l/h [median difference 108 l/h (95.9% c.i., -304-598 l/h)] and the median partial clearance of desipramine by 2-hydroxylation was 155 l/h and 87 l/h [median difference 47 l/h (95.9% c.i., -124-141 l/h)] for the group with duplication and the group without duplication, respectively. CONCLUSION The predictive value of duplication of CYP2D6 is poor; there must be other causes (or predictors) of very rapid metabolism and with much higher frequency than duplication of CYP2D6.
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Affiliation(s)
- T K Bergmann
- Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, Winsloewparken 19, 5000 Odense, Denmark.
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