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Leenhardt F, Mbatchi L, Evrard A, Cupissol D, Lesage C. [Unusual association of BRAF and MEK inhibitors: Clinical response of metastatic melanoma treated with dabrafenib-cobimetinib]. Bull Cancer 2023:S0007-4551(23)00137-6. [PMID: 36966054 DOI: 10.1016/j.bulcan.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/10/2022] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/27/2023]
Abstract
Despite the efficacy of targeted therapies in melanoma, the management of adverse events with BRAFi and MEKi (inhibitors) is one of the limits of these treatments. Close monitoring is required to ensure efficacy and patient safety. In this case study, we report a patient treated for metastatic melanoma with an unusual and innovative combination of dabrafenib (BRAFi) and cobimetinib (MEKi), to manage pyrexia, and lead to complete remission for 19 months. This is the first case ever reported of metastatic melanoma treated with this off-label combination and characterized by the use of therapeutic drug monitoring.
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Affiliation(s)
- Fanny Leenhardt
- Institut du cancer de Montpellier, service de pharmacie, Montpellier, France; Université de Montpellier, faculté de pharmacie, laboratoire de pharmacocinétique, Montpellier, France; Université de Montpellier, institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France.
| | - Litaty Mbatchi
- Université de Montpellier, faculté de pharmacie, laboratoire de pharmacocinétique, Montpellier, France; Université de Montpellier, institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France
| | - Alexandre Evrard
- Université de Montpellier, faculté de pharmacie, laboratoire de pharmacocinétique, Montpellier, France; Université de Montpellier, institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France
| | - Didier Cupissol
- Institut du cancer de Montpellier, département d'oncologie médicale, Montpellier, France
| | - Candice Lesage
- Institut du cancer de Montpellier, département d'oncologie médicale, Montpellier, France
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Thomas QD, Firmin N, Mbatchi L, Evrard A, Quantin X, Leenhardt F. Combining Three Tyrosine Kinase Inhibitors: Drug Monitoring Is the Key. Int J Mol Sci 2023; 24:ijms24065518. [PMID: 36982592 PMCID: PMC10054357 DOI: 10.3390/ijms24065518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023] Open
Abstract
A combination of tyrosine kinase inhibitors (TKIs) is likely to be a therapeutic option for numerous oncological situations due to high frequency of oncogenic addiction and progress in precision oncology. Non-small cell lung cancer (NSCLC) represents a subtype of tumors for which oncogenic drivers are frequently involved. To the best of our knowledge, we report the first case of a patient treated with three different TKIs. Osimertinib and crizotinib were administered concurrently for an epidermal growth factor receptor (EGFR)-mutated NSCLC developing a MET amplification as a resistance mechanism to osimertinib. Simultaneously, imatinib was administered for a metastatic gastrointestinal stromal tumor. The progression-free survival was 7 months for both tumors with this tritherapy. The use of therapeutic drug monitoring to assess plasma concentrations of each TKI was a powerful tool to manage the toxicity profile of this combination (creatine phosphokinase elevation) while preserving an optimal exposure to each TKI and treatment efficacy. We observed an imatinib over-exposition related to crizotinib introduction, probably explained by drug–drug interaction mediated by crizotinib enzymatic inhibition on cytochrome P-450 3A4. Posology adjustment due to therapeutic drug monitoring was probably involved in the good survival outcome of the patient. This tool should be used more routinely for patients treated by TKIs to prevent co-treatment interactions and, in particular, for patients receiving TKI combinations to obtain optimal therapeutic exposure and efficacy while reducing possible side-effects.
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Affiliation(s)
- Quentin Dominique Thomas
- Montpellier Cancer Institute (ICM), 34090 Montpellier, France
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
- Correspondence:
| | - Nelly Firmin
- Montpellier Cancer Institute (ICM), 34090 Montpellier, France
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
| | - Litaty Mbatchi
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
- Pharmacokinetics Laboratory, Faculty of Pharmacy, University of Montpellier, 34090 Montpellier, France
| | - Alexandre Evrard
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
- Pharmacokinetics Laboratory, Faculty of Pharmacy, University of Montpellier, 34090 Montpellier, France
| | - Xavier Quantin
- Montpellier Cancer Institute (ICM), 34090 Montpellier, France
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
| | - Fanny Leenhardt
- Montpellier Cancer Institute (ICM), 34090 Montpellier, France
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
- Pharmacokinetics Laboratory, Faculty of Pharmacy, University of Montpellier, 34090 Montpellier, France
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Adenis A, Ghiringhelli F, Gauthier L, Mazard T, Evesque L, Etienne PL, Evrard A, Chalbos P, Bleuse JP, Tosi D, Gourgou S, Ychou M. Regorafenib (REGO) plus FOLFIRINOX as frontline treatment in patients (pts) with RAS-mutated metastatic colorectal cancer (mCRC): A phase I/II, dose-escalation and dose-expansion study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3561 Background: Standard treatment options for RAS-mutated mCRC pts include the combination of bevacizumab with FOLFIRINOX, a three-drug chemotherapy regimen. Unlike bevacizumab, REGO – an oral multi-tyrosine kinase agent - exhibits not only antiangiogenic properties with cytostatic effects but also true cytotoxic effects. We report the preliminary results of the FOLFIRINOX-R trial (NCT03828799), in which we evaluated the safety and the efficacy of REGO in combination with FOLFIRINOX in pts with RAS-mutated mCRC. Methods: FOLFIRINOX-R trial is a prospective, dose-finding, phase I/II study whose dose-escalation part has been completed. Dose escalation was implemented following a 3 + 3 design and included three dose levels (DL). FOLFIRINOX regimen includes oxaliplatin (85 mg/m²), folinic acid (400 mg/m²), irinotecan (150–180 mg/m²), 5-fluorouracil (400 mg/m² in bolus then 2400 mg/m² over 46h), and was administered every 14 days. REGO (80 to 160 mg per day, as per DL) was administered on days 4 to 10 of each cycle. Treatment was continued up to 12 cycles or until progression or unacceptable toxicity. The primary objectives of the dose-finding part of the study were to determine the maximum tolerated dose (MTD) using as endpoint the incidence of DLTs during the three first cycles of treatment, and to select the recommended phase 2 dose (RP2D). Key eligibility criteria include ECOG PS ≤1 and RAS-mutated mCRC not amenable to surgery with curative intent and not previously treated for metastatic disease. Patients with the 7/7 variant of the UGT1A1*28 polymorphism were not eligible. Prophylactic G-CSF was administered from Day-7 to Day-12. Results: Thirteen pts were enrolled across the 3 DL (DL 1: 3 pts, DL 2: 6 pts, DL 3: 4 pts); 46% of pts were female, the median age was 65 yo [range: 40 ; 76]. One pt (at DL 3) was not evaluable for DLT because of poor observance during the first 2 cycles. At data cut-off, median treatment duration and median follow-up were 4.6 mo. (range: 2.3; 10) and 13.4 mo. (range: 3.8; 18.0), respectively. One DLT (a grade 3 hypokalaemia related to grade 2 diarrhoea) occurred at DL 2. MTD was not reached at DL 3 (REGO 160 mg/day). The most common grade ≥3 TRAE per patient were grade 3 neutropenia (n = 1), grade 4 neutropenia (n = 1), grade 3 neuropathy (n = 2) and grade 3 diarrhoea (n = 7). Dose reductions/discontinuations due to grade ≥3 TRAE were necessary in 12/13 (92%) pts. The ORR was 62% (95% CI 32%-86%) and median PFS was 9.1 mo (range: 3.1; 15.4). Conclusions: Full-dose FOLFIRINOX plus full-dose REGO (160mg/day, days 4 to 10) can be administered safely. Due to the manageable toxicity profile and the promising efficacy observed in the dose-escalation stage, this regimen deserves to be evaluated in the dose-expansion stage. Clinical trial information: NCT03828799.
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Affiliation(s)
| | | | | | - Thibault Mazard
- Institut régional du Cancer de Montpellier, Montpellier, France
| | | | | | | | - Patrick Chalbos
- Institut régional du Cancer de Montpellier, Montpellier, France
| | | | - Diego Tosi
- Medical Oncology Departement, Institut du Cancer de Montpellier Inserm U1194, Montpellier University, Montpellier, France
| | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | - Marc Ychou
- Montpellier Cancer Institute, Montpellier, France
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Leenhardt F, Fiteni F, Gauthier L, Alexandre M, Guiu S, Firmin N, Pouderoux S, Gautier C, Lossaint G, Payen A, Gongora C, Mbatchi L, Evrard A, Jacot W. Abstract P5-13-23: Pharmacokinetic determinants of palbociclib hematological toxicity. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-13-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction CDK4/6 inhibitors, such as palbociclib, are prescribed in association with hormonal therapy in metastatic breast cancer patients. In Phase II/III studies, high neutropenia occurred in more than one in two patients leading to significant dose reductions, palbociclib interruptions and additional hematological samplings. Like most oral targeted drug, therapeutic drug monitoring (TDM) may be of interest for monitoring plasma exposition and optimize their dosage. We evaluated the correlation of this toxicity with palbociclib pharmacokinetics (PK), and classical sources of PK variabilities. Materials and method This is an open-label biomarker study conducted in subjects with first-line ER+/HER2- metastatic breast cancer treated with a palbociclib-aromatase inhibitor association (NCT04025541). Primary endpoint was the correlation between palbociclib trough concentration (Ctrough) at day 15 of first cycle of treatment (D15C1) and incidence of grade 3/4 neutropenia, within the first two months of treatment. Secondary endpoints included the analysis of variables associated with grade 3/4 neutropenia, with D15C1 palbociclib Ctrough values, and correlations with genetic polymorphisms in selected genes involved in palbociclib PK. Co-medications were collected to assess drug-drug interactions (DDI) risk and the potential impact on palbociclib PK. Results 58 patients, with mean age of 62.9 years, were included and followed up for 1 year. Clinicopathological variables were classical for the setting. One third of the population was taking concurrently a CYP3A4 and/or Pgp inhibitor, and one fourth an anti-acid medication, drugs that may interact with palbociclib. High-grade neutropenia occurred in 67.2% of patients (70.7% all grade neutropenia). One third of patients required a dose reduction, mainly for hematological toxicity. The geometric median of palbociclib plasma Ctrough was 74.1 ng/ml (interquartile range 61.3 - 101.5). Other covariates influencing the PK of palbociclib were significant in the univariate analysis. Indeed, while age > 65.5 years old (median) and reduced renal function (< 88.5 ml/min, median) were correlated with increased palbociclib concentration (p=0.003 and p=0.017, respectively) in univariate analysis. In multivariate analysis, higher neutrophil counts at inclusion (HR=0.54 for each 109/L increase in neutrophils count, range 0.33 - 0.87, p=0.002) while higher (>74.1 ng/mL, HR 5.51, range 1.10 - 27.6, p=0.024) plasma concentration of palbociclib were the only 2 variables correlated with the incidence of neutropenia. PK of palbociclib is closely related to co-medications, with majored exposition in CYP3A4 inhibitor cohort (106 vs 71.3 ng/ml, p=0.031, HR 0.22) or reduced exposition in anti-acid cohort (72.2 vs 80 ng/ml, p= 0.016, HR -0.27). Lastly, the homozygote G/G allele of the NRI2 (PXR) variant (Rs10934498) was associated with reduced palbociclib concentration (p=0.031) in univariate analysis. Conclusion We have characterized PK/toxicity correlation of palbociclib, regarding high-grade neutropenia. D15C1 higher palbociclib Ctrough is associated with the occurrence of high-grade neutropenia. As drug-drug interaction appears to be the most relevant source of palbociclib Ctrough variability in our cohort, a special attention must be paid to comedications in this population of patients. This is the first prospective study which characterizes biomarkers of toxicity associated with palbociclib treatment. Therapeutic drug monitoring can be a tool to limit high grade toxicities under palbociclib.
Citation Format: Fanny Leenhardt, Frédéric Fiteni, Ludovic Gauthier, Marie Alexandre, Séverine Guiu, Nelly Firmin, Stéphane Pouderoux, Chloé Gautier, Gerald Lossaint, Alexandre Payen, Celine Gongora, Litaty Mbatchi, Alexandre Evrard, William Jacot. Pharmacokinetic determinants of palbociclib hematological toxicity [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-23.
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Affiliation(s)
| | | | | | | | - Séverine Guiu
- Institut du Cancer de Montpellier, Montpellier, France
| | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
| | | | - Chloé Gautier
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Celine Gongora
- Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Montpellier, France
| | | | | | - William Jacot
- Institut du Cancer de Montpellier, Montpellier, France
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Matheux A, Gassiot M, Fromont G, Leenhardt F, Boulahtouf A, Fabbrizio E, Marchive C, Garcin A, Agherbi H, Combès E, Evrard A, Houédé N, Balaguer P, Gongora C, Mbatchi LC, Pourquier P. PXR Modulates the Prostate Cancer Cell Response to Afatinib by Regulating the Expression of the Monocarboxylate Transporter SLC16A1. Cancers (Basel) 2021; 13:cancers13143635. [PMID: 34298852 PMCID: PMC8305337 DOI: 10.3390/cancers13143635] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary Many kinase inhibitors have been tested as potential alternatives for the treatment of castration-resistant prostate cancers. However, none of these clinical trials led to drug approval despite interesting responses. Our study reveals that genes involved in drug metabolism and their master regulator PXR (Pregnane X Receptor) could be responsible, at least in part, for these disappointing results as they can modulate tumor cell response to specific kinase inhibitors. We found that stable expression of PXR sensitized prostate cancer cells to erlotinib, dabrafenib, and afatinib, while it rendered cells resistant to dasatinib and had no effect for other inhibitors tested. We also report for the first time that sensitization to afatinib is due to an alteration in drug transport that involves the SLC16A1 monocarboxylate transporter. Together, our results further indicate that PXR might be considered as a biomarker of response to kinase inhibitors in castration-resistant prostate cancers. Abstract Resistance to castration is a crucial issue in the treatment of metastatic prostate cancer. Kinase inhibitors (KIs) have been tested as potential alternatives, but none of them are approved yet. KIs are subject of extensive metabolism at both the hepatic and the tumor level. Here, we studied the role of PXR (Pregnane X Receptor), a master regulator of metabolism, in the resistance to KIs in a prostate cancer setting. We confirmed that PXR is expressed in prostate tumors and is more frequently detected in advanced forms of the disease. We showed that stable expression of PXR in 22Rv1 prostate cancer cells conferred a resistance to dasatinib and a higher sensitivity to erlotinib, dabrafenib, and afatinib. Higher sensitivity to afatinib was due to a ~ 2-fold increase in its intracellular accumulation and involved the SLC16A1 transporter as its pharmacological inhibition by BAY-8002 suppressed sensitization of 22Rv1 cells to afatinib and was accompanied with reduced intracellular concentration of the drug. We found that PXR could bind to the SLC16A1 promoter and induced its transcription in the presence of PXR agonists. Together, our results suggest that PXR could be a biomarker of response to kinase inhibitors in castration-resistant prostate cancers.
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Affiliation(s)
- Alice Matheux
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Carémeau, F-30029 Nîmes, France
| | - Matthieu Gassiot
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Gaëlle Fromont
- Département de Pathologie, CHU de Tours, Université François Rabelais, Inserm UMR 1069, F-37044 Tours, France;
| | - Fanny Leenhardt
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, F-34090 Montpellier, France
| | - Abdelhay Boulahtouf
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Eric Fabbrizio
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Candice Marchive
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Aurélie Garcin
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Hanane Agherbi
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Eve Combès
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Alexandre Evrard
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Carémeau, F-30029 Nîmes, France
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, F-34090 Montpellier, France
| | - Nadine Houédé
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
- Département d’Oncologie Médicale, Institut de Cancérologie du Gard—CHU Carémeau, F-30029 Nîmes, France
| | - Patrick Balaguer
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Céline Gongora
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
| | - Litaty C. Mbatchi
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Carémeau, F-30029 Nîmes, France
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, F-34090 Montpellier, France
| | - Philippe Pourquier
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, ICM, F-34298 Montpellier, France; (A.M.); (M.G.); (F.L.); (A.B.); (E.F.); (C.M.); (A.G.); (H.A.); (E.C.); (A.E.); (N.H.); (P.B.); (C.G.); (L.C.M.)
- Correspondence: ; Tel.: +33-4-66-68-32-31
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6
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Deyme L, Barbolosi D, Mbatchi LC, Tubiana-Mathieu N, Ychou M, Evrard A, Gattacceca F. Population pharmacokinetic model of irinotecan and its four main metabolites in patients treated with FOLFIRI or FOLFIRINOX regimen. Cancer Chemother Pharmacol 2021; 88:247-258. [PMID: 33912999 DOI: 10.1007/s00280-021-04255-9] [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: 08/21/2020] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present study was to characterize the pharmacokinetics of irinotecan and its four main metabolites (SN-38, SN-38G, APC and NPC) in metastatic colorectal cancer patients treated with FOLFIRI and FOLFIRINOX regimens and to quantify and explain the inter-individual pharmacokinetic variability in this context. METHODS A multicenter study including 109 metastatic colorectal cancer patients treated with FOLFIRI or FOLFIRINOX regimen, associated or not with a monoclonal antibody, was conducted. Concentrations of irinotecan and its four main metabolites were measured in 506 blood samples during the first cycle of treatment. Collected data were analyzed using the population approach. First, fixed and random effects models were selected using statistical and graphical methods; second, the impact of covariates on pharmacokinetic parameters was evaluated to explain the inter-individual variability in pharmacokinetic parameters. RESULTS A seven-compartment model best described the pharmacokinetics of irinotecan and its four main metabolites. First-order rates were assigned to distribution, elimination, and metabolism processes, except for the transformation of irinotecan to NPC which was nonlinear. Addition of a direct conversion of NPC into SN-38 significantly improved the model. Co-administration of oxaliplatin significantly modified the distribution of SN-38. CONCLUSION To our knowledge, the present model is the first to allow a simultaneous description of irinotecan pharmacokinetics and of its four main metabolites. Moreover, a direct conversion of NPC into SN-38 had never been described before in a population pharmacokinetic model of irinotecan. The model will be useful to develop pharmacokinetic-pharmacodynamic models relating SN-38 concentrations to efficacy and digestive toxicities. CLINICAL TRIALS REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT00559676.
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Affiliation(s)
- Laure Deyme
- SMARTc, Centre de Recherche en Cancérologie de Marseille (CRCM), Faculté de Pharmacie, INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Marseille, France.
| | - Dominique Barbolosi
- SMARTc, Centre de Recherche en Cancérologie de Marseille (CRCM), Faculté de Pharmacie, INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Marseille, France
| | - Litaty Céphanoée Mbatchi
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Nîmes-Carémeau, Nîmes, France.,IRCM, Inserm U1194, Université de Montpellier, Montpellier, France
| | | | - Marc Ychou
- Institut Régional du Cancer de Montpellier (ICM)-Val d'Aurelle, Montpellier, France
| | - Alexandre Evrard
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Nîmes-Carémeau, Nîmes, France.,IRCM, Inserm U1194, Université de Montpellier, Montpellier, France
| | - Florence Gattacceca
- SMARTc, Centre de Recherche en Cancérologie de Marseille (CRCM), Faculté de Pharmacie, INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Marseille, France
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7
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Leenhardt F, Viala M, Tosi D, Samalin-Scalzi E, Evrard A, Mbatchi LC. Therapeutic Bayesian monitoring of sunitinib in two patients with impaired absorption or elimination. J Clin Pharm Ther 2021; 46:1182-1184. [PMID: 33821517 DOI: 10.1111/jcpt.13424] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/03/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Sunitinib pharmacokinetics can be influenced by the physio-pathological conditions of individual patients. Therapeutic drug monitoring (TDM) helps to optimize efficacy and reduce the risk of adverse effects. We report on the use of Bayesian analysis to optimize sunitinib blood levels. CASE SUMMARY We describe two patients with risk of sunitinib pharmacokinetic variability due to gastrectomy and ongoing haemodialysis, respectively. TDM and Bayesian estimation allowed maintaining their sunitinib pharmacokinetic profiles within the usual limits. WHAT IS NEW AND CONCLUSION Our analysis showed that Bayesian analysis can be successfully applied for real-time TDM to optimize sunitinib blood levels in patients with major comorbidities.
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Affiliation(s)
- Fanny Leenhardt
- Service Pharmacie, Institut du Cancer de Montpellier, Université de Montpellier, Montpellier, France.,Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France
| | - Marie Viala
- Département d'oncologie médicale, Institut du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Diego Tosi
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France.,Département d'oncologie médicale, Institut du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Emmanuelle Samalin-Scalzi
- Département d'oncologie médicale, Institut du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Alexandre Evrard
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France.,Laboratoire de Biochimie et Biologie moléculaire, Centre Hospitalier Universitaire Nîmes, Nîmes, France
| | - Litaty C Mbatchi
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France.,Laboratoire de Biochimie et Biologie moléculaire, Centre Hospitalier Universitaire Nîmes, Nîmes, France
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8
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Leenhardt F, Gracia M, Perrin C, Muracciole-Bich C, Marion B, Roques C, Alexandre M, Firmin N, Pouderoux S, Mbatchi L, Gongora C, Jacot W, Evrard A. Abstract PS5-16: Impact of drug-drug interaction on palbociclib serum levels: Interest of therapeutic drug monitoring. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps5-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The CDK4/6 inhibitors palbociclib is prescribed in association with hormonal therapy for the management of metastatic breast cancer patients. Like most oral targeted drug, therapeutic drug monitoring may be used for personalize their dosage. Using a recently published dosing technique (LC-MS/MS), we aimed at evaluating the correlation between first-cycle palbociclib plasma exposition and co-medications in order to evaluate drug-drug interaction (DDI) impact under palbociclib treatment.Methods: This is an open-label phase 4 study conducted in female subjects with first-line metastatic breast cancer (NCT04025541) treated with a palbociclib-aromatase inhibitor association. Plasma concentration of palbociclib was assessed at 24 hours postdose (plasma trough concentration Ctrough) at day 15 of first cycle of treatment. A dedicated pharmacist consultation allowed the determination of clinical covariates of interest, such as weight, body surface area, ethnicity, food intake, co-medications use and DDI before Palbociclib initiation and retrospectively at the end of clinical trial. Patients were classified then according to their risk of DDI potentially leading to inhibition of CYP3A4 and/or P-glycoprotein and gastric pH increase by gastric acid-suppressive (GAS) agents (such as proton pump inhibitors, histamine H2-receptor blockers or alginic acid). Relevant drug known to have an inhibition of CYP3A4 and/or P-glycoprotein or pH-modification activity were checked in databases (e.g. DDI predictor®, Drugs.com®, Pubmed®). Results: To date, after Ctrough analysis of the 35 first cases, the geometric mean (± standard deviation [min-max]) of palbociclib plasma Ctrough was 79.5 ng/ml (± 26.1% [43.6 ng/mL - 133 ng/mL]) at day 15, similar to what reported in the PALOMA trials. No correlation between plasma concentration and body weight, body area or also age of the patients was found in our cohort. Regarding ethnicity, all the included patients were from Caucasian origin. 31% of patients (11/35) were identified of taking drugs that could cause DDI CYP3A4 and P-glycoprotein inhibition mediated (amlodipine n=3, simvastatin n=3, losartan n=2, fluconazole n=1, atorvastatin n=1, ivabradine n=1). These potential DDI interactions were associated with a significantly higher palbociclib concentration DDI subgroup (102 ng/mL vs 69 ng/mL) (p=0.000272) (Table 1). No CYP3A4 and/or P-glycoprotein inductor were reported in cohort. 1.4% of patients (5/35) were identified of taking GAS agents (pantoprazole n=2, ranitidine n=2, alginic acid n=1). We found a significantly reduction of palbociclib concentration (59.2 ng/mL vs 79.8 ng/mL) (p=0.048) in patients taking GAS medications (Table 1).
Conclusion : These preliminary results, in real-life settings, obtained with our recently-published HPLC-MS/MS method, give important information on palbociclib monitoring and pharmacokinetic variability. DDI appear to have a significant impact on palbociclib plasma exposure, GAS agents are already know to modified palbociclib absorption. Additional studies are needed to characterize palbociclib plasma concentration variations between patients, and their clinical impact on efficacy and safety. The study is ongoing and will evaluate additional potential clinical and biological impact of DDI on neutropenia occurrence, on a larger population of patients.
Table 1: Patients’ plasma palbociclib concentration (day 15 of cycle 1 of treatment).Plasma palbociclib concentrations (ng/ml), global cohort (n=35)Geometric mean (CV%) (min;max)79.5 (26.1%) (43.6;133)Plasma palbociclib concentrations (ng/ml), cohort with DDI CYP3A4 and P-gp mediated (n=11)Geometric mean (CV%)102 (24.3%)Plasma palbociclib concentrations (ng/ml), cohort without DDI CYP3A4 and P-gp mediated (n=24)Geometric mean (CV%)69 (19.8%)Plasma palbociclib concentrations (ng/ml), cohort with GAS treatment (n=5)Geometric mean (CV%)59.2 (15.9%)Plasma palbociclib concentrations (ng/ml), cohort without GAS treatment (n=30)Geometric mean (CV%)82.9 (26.1%)
Citation Format: Fanny Leenhardt, Matthieu Gracia, Catherine Perrin, Claudia Muracciole-Bich, Bénédicte Marion, Celine Roques, Marie Alexandre, Nelly Firmin, Stephane Pouderoux, Litaty Mbatchi, Celine Gongora, William Jacot, Alexandre Evrard. Impact of drug-drug interaction on palbociclib serum levels: Interest of therapeutic drug monitoring [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS5-16.
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Affiliation(s)
| | - Matthieu Gracia
- 2Institut de Recherche en Cancerologie de Montpellier, Montpellier, France
| | | | | | | | - Celine Roques
- 3Institut des Biomolécules Max Mousseron, Montpellier, France
| | | | - Nelly Firmin
- 1Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Celine Gongora
- 2Institut de Recherche en Cancerologie de Montpellier, Montpellier, France
| | - William Jacot
- 1Institut du Cancer de Montpellier, Montpellier, France
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9
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Ba HL, Mbatchi L, Gattacceca F, Evrard A, Lacarelle B, Blanchet B, Ciccolini J, Salas S. Pharmacogenetics and pharmacokinetics modeling of unexpected and extremely severe toxicities after sorafenib intake. Pharmacogenomics 2021; 21:173-179. [PMID: 31967518 DOI: 10.2217/pgs-2019-0127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 53-year-old woman with papillary thyroid cancer treated with 800 mg sorafenib therapy rapidly experienced grade 3 toxicities. Dosing was reduced in a step-wise manner with several treatment discontinuations down to 200 mg every 2 days but severe toxicities continued. Plasma drug monitoring showed high exposure, even at low dose. Dosing was then further reduced at 200 mg every 3 days and tolerance was finally acceptable (i.e., grade 1 toxicity) with stable disease upon RECIST imaging. Pharmacogenetic investigations showed polymorphisms affecting both UGT1A9 (UGT1A9-rs3832043) and nuclear receptor PXR (NR1I2-rs3814055, NR1I2-rs2472677 and NR1I2-rs10934498), possibly resulting in downregulation of liver metabolizing enzymes of sorafenib (i.e., CYP and UGT). Patient's clearance (0.48 l/h) estimated by Bayesian approach was consistently lower than usually described. This is the first time that, in addition to mutations affecting UGT1A9, genetic polymorphisms of NR1I2 have possibly been associated with both plasma overexposure and severe toxicities upon sorafenib intake.
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Affiliation(s)
- Hai le Ba
- SMARTc Unit, CRCM, Inserm U1068, Aix Marseille University, Marseille, France
| | - Litaty Mbatchi
- Clinical Biochemistry Department, Caremeau University Hospital of Nîmes, Nîmes, France
| | - Florence Gattacceca
- SMARTc Unit, CRCM, Inserm U1068, Aix Marseille University, Marseille, France
| | - Alexandre Evrard
- Clinical Biochemistry Department, Caremeau University Hospital of Nîmes, Nîmes, France
| | - Bruno Lacarelle
- SMARTc Unit, CRCM, Inserm U1068, Aix Marseille University, Marseille, France
| | - Benoit Blanchet
- Biologie du Médicament - Toxicologie, Hôpital Cochin, AP-HP, Paris, France
| | - Joseph Ciccolini
- SMARTc Unit, CRCM, Inserm U1068, Aix Marseille University, Marseille, France
| | - Sébastien Salas
- Medical Oncology Unit, La Timone University Hospital of Marseille Assistance Publique Hôpitaux de Marseille, Marseille, France
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10
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Perin N, Roger C, Marin G, Molinari N, Evrard A, Lavigne JP, Barbar S, Claret PG, Boutin C, Muller L, Lipman J, Lefrant JY, Jaber S, Roberts JA. Vancomycin Serum Concentration after 48 h of Administration: A 3-Years Survey in an Intensive Care Unit. Antibiotics (Basel) 2020; 9:antibiotics9110793. [PMID: 33182613 PMCID: PMC7698174 DOI: 10.3390/antibiotics9110793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/27/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
The present study assessed the proportion of intensive care unit (ICU) patients who had a vancomycin serum concentration between 20 and 25 mg/L after 24–48 h of intravenous vancomycin administration. From 2016 to 2018, adult ICU patients with vancomycin continuous infusion (CI) for any indication were included. The primary outcome was the proportion of patients with a first-available vancomycin serum concentration between 20–25 mg/L at 24 h (D2) or 48 h (D3). Of 3894 admitted ICU patients, 179 were included. A median loading dose of 15.6 (interquartile range (IQR) = (12.5–20.8) mg/kg) was given in 151/179 patients (84%). The median daily doses of vancomycin infusion for D1 and D2 were 2000 [(IQR (1600–2000)) and 2000 (IQR (2000–2500)) mg/d], respectively. The median duration of treatment was 4 (2–7) days. At D2 or D3, the median value of first serum vancomycin concentration was 19.8 (IQR (16.0–25.1)) with serum vancomycin concentration between 20–25 mg/L reported in 43 patients (24%). Time spent in the ICU before vancomycin initiation was the only risk factor of non-therapeutic concentration at D2 or D3. Acute kidney injury occurred significantly more when vancomycin concentration was supra therapeutic at D2 or D3. At D28, 44 (26%) patients had died. These results emphasize the need of appropriate loading dose and regular monitoring to improve vancomycin efficacy and avoid renal toxicity.
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Affiliation(s)
- Nicolas Perin
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
- Correspondence:
| | - Claire Roger
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Grégory Marin
- IMAG, CNRS, Université de Montpellier, Department of Statistics, CHU Montpellier, 34295 Montpellier, France; (G.M.); (N.M.)
| | - Nicolas Molinari
- IMAG, CNRS, Université de Montpellier, Department of Statistics, CHU Montpellier, 34295 Montpellier, France; (G.M.); (N.M.)
| | - Alexandre Evrard
- Laboratoire de Biochimie, Centre Hospitalier Universitaire (CHU) de Nîmes, Hôpital Carémeau, 30029 Nîmes, France;
| | - Jean-Philippe Lavigne
- VBMI, INSERM U1047, Université de Montpellier, Laboratoire de Microbiologie, CHU de Nîmes, 30029 Nîmes, France;
| | - Saber Barbar
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Pierre Géraud Claret
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Caroline Boutin
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Laurent Muller
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Jeffrey Lipman
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
- VBMI, INSERM U1047, Université de Montpellier, Laboratoire de Microbiologie, CHU de Nîmes, 30029 Nîmes, France;
- Department of Intensive Care Medicine, Royal Brisbane and Womens’ Hospital, Brisbane 4029, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane 4029, QLD, Australia
| | - Jean-Yves Lefrant
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Samir Jaber
- Département d’Anesthésie Réanimation B, Saint Eloi ICU, Montpellier University Hospital, 34295 Montpellier, France;
| | - Jason A. Roberts
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
- UQ Centre for Clinical Research, The University of Queensland, Brisbane 4029, QLD, Australia
- Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane 4029, QLD, Australia
- Pharmacy Department, Royal Brisbane and Womens’ Hospital, Brisbane 4029, QLD, Australia
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11
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Puszkiel A, Arellano C, Vachoux C, Evrard A, Le Morvan V, Boyer JC, Robert J, Delmas C, Dalenc F, Debled M, Venat-Bouvet L, Jacot W, Dohollou N, Bernard-Marty C, Laharie-Mineur H, Filleron T, Roché H, Chatelut E, Thomas F, White-Koning M. Model-Based Quantification of Impact of Genetic Polymorphisms and Co-Medications on Pharmacokinetics of Tamoxifen and Six Metabolites in Breast Cancer. Clin Pharmacol Ther 2020; 109:1244-1255. [PMID: 33047329 DOI: 10.1002/cpt.2077] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/04/2020] [Indexed: 12/21/2022]
Abstract
Variations in clinical response to tamoxifen (TAM) may be related to polymorphic cytochromes P450 (CYPs) involved in forming its active metabolite endoxifen (ENDO). We developed a population pharmacokinetic (PopPK) model for tamoxifen and six metabolites to determine clinically relevant factors of ENDO exposure. Concentration-time data for TAM and 6 metabolites come from a prospective, multicenter, 3-year follow-up study of adjuvant TAM (20 mg/day) in patients with breast cancer, with plasma samples drawn every 6 months, and genotypes for 63 genetic polymorphisms (PHACS study, NCT01127295). Concentration data for TAM and 6 metabolites from 928 patients (n = 27,433 concentrations) were analyzed simultaneously with a 7-compartment PopPK model. CYP2D6 phenotype (poor metabolizer (PM), intermediate metabolizer (IM), normal metabolizer (NM), and ultra-rapid metabolizer (UM)), CYP3A4*22, CYP2C19*2, and CYP2B6*6 genotypes, concomitant CYP2D6 inhibitors, age, and body weight had a significant impact on TAM metabolism. Formation of ENDO from N-desmethyltamoxifen was decreased by 84% (relative standard error (RSE) = 14%) in PM patients and by 47% (RSE = 9%) in IM patients and increased in UM patients by 27% (RSE = 12%) compared with NM patients. Dose-adjustment simulations support an increase from 20 mg/day to 40 and 80 mg/day in IM patients and PM patients, respectively, to reach ENDO levels similar to those in NM patients. However, when considering Antiestrogenic Activity Score (AAS), a dose increase to 60 mg/day in PM patients seems sufficient. This PopPK model can be used as a tool to predict ENDO levels or AAS according to the patient's CYP2D6 phenotype for TAM dose adaptation.
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Affiliation(s)
- Alicja Puszkiel
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France
| | - Cécile Arellano
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France
| | - Christelle Vachoux
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France
| | - Alexandre Evrard
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire Nîmes-Carémeau, Nîmes, France.,IRCM, Inserm, Université de Montpellier, ICM, Montpellier, France
| | - Valérie Le Morvan
- Inserm U1218, Université de Bordeaux, Bordeaux, France.,Institut Bergonié, Bordeaux, France
| | - Jean-Christophe Boyer
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire Nîmes-Carémeau, Nîmes, France
| | - Jacques Robert
- Inserm U1218, Université de Bordeaux, Bordeaux, France.,Institut Bergonié, Bordeaux, France
| | - Caroline Delmas
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France.,Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Florence Dalenc
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France.,Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | | | | | - William Jacot
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | | | - Thomas Filleron
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Henri Roché
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Etienne Chatelut
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France.,Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Fabienne Thomas
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France.,Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Melanie White-Koning
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France
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12
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Le Louedec F, Leenhardt F, Marin C, Chatelut É, Evrard A, Ciccolini J. Cancer Immunotherapy Dosing: A Pharmacokinetic/Pharmacodynamic Perspective. Vaccines (Basel) 2020; 8:E632. [PMID: 33142728 PMCID: PMC7712135 DOI: 10.3390/vaccines8040632] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
Immune check-point inhibitors are drugs that are markedly different from other anticancer drugs because of their indirect mechanisms of antitumoral action and their apparently random effect in terms of efficacy and toxicity. This marked pharmacodynamics variability in patients calls for reconsidering to what extent approved dosing used in clinical practice are optimal or whether they should require efforts for customization in outlier patients. To better understand whether or not dosing could be an actionable item in oncology, in this review, preclinical and clinical development of immune checkpoint inhibitors are described, particularly from the angle of dose finding studies. Other issues in connection with dosing issues are developed, such as the flat dosing alternative, the putative role therapeutic drug monitoring could play, the rise of combinatorial strategies, and pharmaco-economic aspects.
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Affiliation(s)
- Félicien Le Louedec
- Institut Claudius-Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, and Cancer Research Center of Toulouse (CRCT), Inserm U1037, University of Toulouse, 31100 Toulouse, France;
| | - Fanny Leenhardt
- Institut de Cancérologie de Montpellier (ICM) and Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, University of Montpellier, 34090 Montpellier, France;
| | - Clémence Marin
- Assistance Publique—Hôpitaux de Marseille (AP-HM) and Simulation Modeling Adaptive Response for Therapeutics in cancer (SMARTc), Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm U1068, Aix Marseille University, 13009 Marseille, France; (C.M.); (J.C.)
| | - Étienne Chatelut
- Institut Claudius-Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, and Cancer Research Center of Toulouse (CRCT), Inserm U1037, University of Toulouse, 31100 Toulouse, France;
| | - Alexandre Evrard
- Centre Hospitalier Universitaire de Nîmes Carémeau, Nîmes, France and IRCM U1194, University of Montpellier, 34090 Montpellier, France;
| | - Joseph Ciccolini
- Assistance Publique—Hôpitaux de Marseille (AP-HM) and Simulation Modeling Adaptive Response for Therapeutics in cancer (SMARTc), Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm U1068, Aix Marseille University, 13009 Marseille, France; (C.M.); (J.C.)
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13
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Creusot N, Gassiot M, Alaterre E, Chiavarina B, Grimaldi M, Boulahtouf A, Toporova L, Gerbal-Chaloin S, Daujat-Chavanieu M, Matheux A, Rahmani R, Gongora C, Evrard A, Pourquier P, Balaguer P. The Anti-Cancer Drug Dabrafenib Is a Potent Activator of the Human Pregnane X Receptor. Cells 2020; 9:cells9071641. [PMID: 32650447 PMCID: PMC7407672 DOI: 10.3390/cells9071641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022] Open
Abstract
The human pregnane X receptor (hPXR) is activated by a large set of endogenous and exogenous compounds and plays a critical role in the control of detoxifying enzymes and transporters regulating liver and gastrointestinal drug metabolism and clearance. hPXR is also involved in both the development of multidrug resistance and enhanced cancer cells aggressiveness. Moreover, its unintentional activation by pharmaceutical drugs can mediate drug–drug interactions and cause severe adverse events. In that context, the potential of the anticancer BRAF inhibitor dabrafenib suspected to activate hPXR and the human constitutive androstane receptor (hCAR) has not been thoroughly investigated yet. Using different reporter cellular assays, we demonstrate that dabrafenib can activate hPXR as efficiently as its reference agonist SR12813, whereas it does not activate mouse or zebrafish PXR nor hCAR. We also showed that dabrafenib binds to recombinant hPXR, induces the expression of hPXR responsive genes in colon LS174T-hPXR cancer cells and human hepatocytes and finally increases the proliferation in LS174T-hPXR cells. Our study reveals that by using a panel of different cellular techniques it is possible to improve the assessment of hPXR agonist activity for new developed drugs.
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Affiliation(s)
- Nicolas Creusot
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Matthieu Gassiot
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Elina Alaterre
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Barbara Chiavarina
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Marina Grimaldi
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Abdelhay Boulahtouf
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Lucia Toporova
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Sabine Gerbal-Chaloin
- IRMB, Université de Montpellier, INSERM, CHU Montpellier, 34090 Montpellier, France; (S.G.-C.); (M.D.-C.)
| | - Martine Daujat-Chavanieu
- IRMB, Université de Montpellier, INSERM, CHU Montpellier, 34090 Montpellier, France; (S.G.-C.); (M.D.-C.)
| | - Alice Matheux
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Roger Rahmani
- INRA UMR 1331 TOXALIM, 06560 Sophia Antipolis, France;
| | - Céline Gongora
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Alexandre Evrard
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
| | - Philippe Pourquier
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
- Correspondence: (P.P.); (P.B.); Tel.: +33-467613787 (P.P.); +33-467612409 (P.B.); Fax: +33-467613787 (P.P.); +33-467612337 (P.B.)
| | - Patrick Balaguer
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, ICM, 34298 Montpellier, France; (N.C.); (M.G.); (E.A.); (B.C.); (M.G.); (A.B.); (L.T.); (A.M.); (C.G.); (A.E.)
- Correspondence: (P.P.); (P.B.); Tel.: +33-467613787 (P.P.); +33-467612409 (P.B.); Fax: +33-467613787 (P.P.); +33-467612337 (P.B.)
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Pladys P, Zaoui C, Girard L, Mons F, Reynaud A, Casper C, Kuhn P, Souet G, Fichtner C, Laprugne‐garcia E, Legouais S, Zores C, Thiriez G, Duboz MA, Knezovic‐Daniel N, Renesme L, Brandicourt A, Gonnaud F, Picaud JC, Julie‐Fische C, Tourneux P, Truffert P, Berne Audeoud F, Pierrat V, Caeymaex L, Granier M, Bouvard C, Evrard A, Saliba E, Allen A, Sizun J, Zana‐Taieb E, Huppi P. French neonatal society position paper stresses the importance of an early family-centred approach to discharging preterm infants from hospital. Acta Paediatr 2020; 109:1302-1309. [PMID: 31774567 DOI: 10.1111/apa.15110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
AIM The families of hospitalised preterm infants risk depression and post-traumatic stress and the preterm infants risk re-hospitalisation. The French neonatal society's aim was to review the literature on how the transition from hospital to home could limit these risks and to produce a position paper. METHODS A systematic literature review was performed covering 1 January 2000 to 1 January 2018, and multidisciplinary experts examined the scientific evidence. RESULTS We identified 939 English and French papers and 169 are quoted in the position paper. Most studies stressed the importance of early, personalised and progressive involvement of the family. Healthcare staff and families should assess discharge preparations jointly. This evaluation should assess the capacities of the newborn infant, with regard to its physiological maturity. It should also assess the family's ability to supply the medical, psychological and social assistance required before and after discharge. There should be a structured follow-up process that includes effective communication, various tools, interventions, networks, health and social professionals. CONCLUSION Discharge preparations may improve the transition from hospital to home and the outcomes for the parents and newborn preterm infant. This early family-centred approach should be structured, coordinated and based on individual needs and circumstances.
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Affiliation(s)
- Patrick Pladys
- CHU Rennes Inserm LTSI ‐ UMR 1099 Univ Rennes Rennes France
| | | | | | | | - Audrey Reynaud
- SOS‐Prema family association Boulogne‐Billancourt France
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15
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Leenhardt F, Gracia M, Perrin C, Muracciole-Bich C, Marion B, Roques C, Alexandre M, Firmin N, Pouderoux S, Mbatchi L, Gongora C, Jacot W, Evrard A. Liquid chromatography-tandem mass spectrometric assay for the quantification of CDK4/6 inhibitors in human plasma in a clinical context of drug-drug interaction. J Pharm Biomed Anal 2020; 188:113438. [PMID: 32623316 DOI: 10.1016/j.jpba.2020.113438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
Abstract
The CDK4/6 inhibitors palbociclib and ribociclib are kinase inhibitors used in association with hormonal therapy for the management of patients with metastatic breast cancer. Like most kinase inhibitors, therapeutic drug monitoring may be used for personalize their dosage. To this aim, we developed and validated a sensitive and specific HPLC-MS/MS method for palbociclib and ribociclib quantification in blood samples. We then quantified exposure to palbociclib (plasma trough concentration; Ctrough) in a real-life cohort of patients with locally invasive or metastatic breast cancer (n = 18) at day 15 of the first cycle of palbociclib treatment to characterize palbociclib concentration at steady state (Clinicaltrials.gov identifier NCT04025541, IdRCB n° 2018-A00064-51, 03/07/2018). The geometric mean (± standard deviation [min-max]) of palbociclib plasma Ctrough was 88.58 ng/mL (± 26.4 [46.5 ng/mL - 133 ng/mL]) at day 15. Some covariates, such as drug-drug interactions, could explain the concentration variations observed in our Caucasian cohort. These first results in real-life settings obtained with our HPLC-MS/MS method give important information on palbociclib monitoring and pharmacokinetic variability.
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Affiliation(s)
- Fanny Leenhardt
- Laboratoire de Pharmacocinétique, Université de Montpellier, Faculté de Pharmacie, France; Service Pharmacie, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France.
| | - Matthieu Gracia
- Laboratoire de Pharmacocinétique, Université de Montpellier, Faculté de Pharmacie, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France
| | - Catherine Perrin
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247-CNRS-UM-ENSCM, Montpellier, France
| | | | - Bénédicte Marion
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247-CNRS-UM-ENSCM, Montpellier, France
| | - Celine Roques
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247-CNRS-UM-ENSCM, Montpellier, France
| | - Marie Alexandre
- Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Nelly Firmin
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France; Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Stephane Pouderoux
- Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Litaty Mbatchi
- Laboratoire de Pharmacocinétique, Université de Montpellier, Faculté de Pharmacie, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France; Laboratoire de Biochimie et Biologie moléculaire, Centre Hospitalier Universitaire Nîmes, France
| | - Celine Gongora
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France
| | - William Jacot
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France; Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Alexandre Evrard
- Laboratoire de Pharmacocinétique, Université de Montpellier, Faculté de Pharmacie, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France; Laboratoire de Biochimie et Biologie moléculaire, Centre Hospitalier Universitaire Nîmes, France
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16
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Renesme L, Allen A, Audeoud F, Bouvard C, Brandicourt A, Casper C, Cayemaex L, Denoual H, Duboz MA, Evrard A, Fichtner C, Fischer-Fumeaux CJ, Girard L, Gonnaud F, Haumont D, Hüppi P, Knezovic N, Laprugne-Garcia E, Legouais S, Mons F, Pelofy V, Picaud JC, Pierrat V, Pladys P, Reynaud A, Souet G, Thiriez G, Tourneux P, Touzet M, Truffert P, Zaoui C, Zana-Taieb E, Zores C, Sizun J, Kuhn P. Recommendation for hygiene and topical in neonatology from the French Neonatal Society. Eur J Pediatr 2019; 178:1545-1558. [PMID: 31463766 DOI: 10.1007/s00431-019-03451-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/10/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022]
Abstract
We sought to establish guidelines for hygiene care in newborns based on a systematic review of the literature and grading of evidence using the Groupe de Réflexion et d'Evaluation de l'Environement des Nouveau-nés (GREEN) methodology. We examined 45 articles and 4 reports from safety agencies. These studies recommend a tub bath (rather than a sponge bath) for full-term infants and a swaddle bath for preterm newborns. They also recommend against daily cleansing of preterm infants. The literature emphasized that hygiene care must consider the clinical state of the newborn, including the level of awareness and behavioral responses. Hospitalized newborns treated with topical agents may also experience high exposure to potentially harmful excipients of interest. Caregivers should therefore be aware of the excipients present in the different products they use. In high-resource countries, the available data do not support the use of protective topical agents for preterm infants.Conclusions: We recommend individualization of hygiene care for newborns. There is increasing concern regarding the safety of excipients in topical agents that are used in neonatology. A multidisciplinary approach should be used to identify an approach that requires lower levels of excipients and alternative excipients. What is known: • Hygiene care is one of the most basic and widespread types of care received by healthy and sick newborns worldwide. • There is no current guideline on hygiene for preterm or hospitalized term newborn. What is new: • The French Group of Reflection and Evaluation of the environment of Newborns (GREEN) provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' behavioral responses to hygiene care, exposition to excipients of interest, and the potential risk of protective topical agents in a preterm infant. provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' possible behavioral responses to hygiene care, exposition to excipients of interest and the potential risk of protective topical agents in a preterm infant.
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Affiliation(s)
- Laurent Renesme
- Unité de Néonatalogie Soins Intensifs-Pédiatrie de Maternité, Centre Aliénor d'Aquitaine, Centre Hospitalier Universitaire de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - A Allen
- Port Royal Assitance Publique Hôpitaux de Paris, Paris, France
| | - F Audeoud
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - C Bouvard
- Association SOS Préma, Boulogne-Billancourt, France
| | - A Brandicourt
- Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - C Casper
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - L Cayemaex
- Centre Hospitalier Inter-Communal de Créteil, Créteil, France
| | - H Denoual
- Centre Hospitalier du Mans, Le Mans, France
| | - M A Duboz
- Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - A Evrard
- Comité Inter-Associatif de la Naissance, Paris, France
| | - C Fichtner
- Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | - L Girard
- Association Co-Naître, Pertuis, France
| | - F Gonnaud
- Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - D Haumont
- Hôpital Saint-Pierre Bruxelles, Brussels, Belgium
| | - P Hüppi
- Centre Hospitalier Universitaire de Genève, Genève, Switzerland
| | - N Knezovic
- Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | | | | | - F Mons
- Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - V Pelofy
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J C Picaud
- Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - V Pierrat
- Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - P Pladys
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - A Reynaud
- Association SOS Préma, Boulogne-Billancourt, France
| | - G Souet
- Agence Régionale de Santé Centre, Orleans, France
| | - G Thiriez
- Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - P Tourneux
- Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - M Touzet
- Port Royal Assitance Publique Hôpitaux de Paris, Paris, France
| | - P Truffert
- Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - C Zaoui
- Centre Hospitalier Général de Valenciennes, Valenciennes, France
| | - E Zana-Taieb
- Port Royal Assitance Publique Hôpitaux de Paris, Paris, France
| | - C Zores
- Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - J Sizun
- Centre Hospitalier Universitaire de Brest, Brest, France
| | - P Kuhn
- Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
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17
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Makhalov V, Satoor T, Evrard A, Chalopin T, Lopes R, Nascimbene S. Probing Quantum Criticality and Symmetry Breaking at the Microscopic Level. Phys Rev Lett 2019; 123:120601. [PMID: 31633983 DOI: 10.1103/physrevlett.123.120601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Indexed: 06/10/2023]
Abstract
We report on an experimental study of the Lipkin-Meshkov-Glick model of quantum spins interacting at infinite range in a transverse magnetic field, which exhibits a ferromagnetic phase transition in the thermodynamic limit. We use dysprosium atoms of electronic spin J=8, subjected to a quadratic Zeeman light shift, to simulate 2J=16 interacting spins 1/2. We probe the system microscopically using single magnetic sublevel resolution, giving access to the spin projection parity, which is the collective observable characterizing the underlying Z_{2} symmetry. We measure the thermodynamic properties and dynamical response of the system, and we study the quantum critical behavior around the transition point. In the ferromagnetic phase, we achieve coherent tunneling between symmetry-broken states, and we test the link between symmetry breaking and the appearance of a finite order parameter.
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Affiliation(s)
- Vasiliy Makhalov
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Tanish Satoor
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Alexandre Evrard
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Thomas Chalopin
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Raphael Lopes
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Sylvain Nascimbene
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
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18
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Broudic-Guibert M, Blay JY, Vazquez L, Evrard A, Karanian M, Taïeb S, Hoog-Labouret N, Oukhatar CMA, Boustany-Grenier R, Arnaud A. Persistent response to vemurafenib in metastatic ameloblastoma with BRAF mutation: a case report. J Med Case Rep 2019; 13:245. [PMID: 31340860 PMCID: PMC6657072 DOI: 10.1186/s13256-019-2140-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 05/03/2019] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Ameloblastomas are uncommon locally aggressive tumors of odontogenic epithelium that rarely metastasize. Currently, there is no standard of care for the metastatic forms. Several studies have shown that ameloblastomas frequently have a BRAF mutation. Case presentation We report a case of a 33-year-old Caucasian woman with ameloblastoma diagnosed 30 years ago who developed lung metastasis 19 years ago. Systemic oral treatment with vemurafenib, a BRAF inhibitor, was initiated 28 months ago within the AcSé French basket clinical trial of vemurafenib. Conclusions The patient has shown a durable clinical, functional, and radiographic partial response with vemurafenib. These observations suggest the possibility of introducing neoadjuvant and/or adjuvant targeted therapy in locally advanced ameloblastoma to improve outcome. BRAF inhibition has proved to be an efficient strategy in patients with a BRAF-mutated ameloblastoma.
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Affiliation(s)
| | - Jean-Yves Blay
- Léon Bérard Center, University Claude Bernard Lyon 1, Lyon, France
| | - Léa Vazquez
- Sainte-Catherine Institut, 250 Chemin de Baigne-Pieds, 84000, Avignon, France
| | | | - Marie Karanian
- Léon Bérard Center, University Claude Bernard Lyon 1, Lyon, France
| | | | | | | | | | - Antoine Arnaud
- Sainte-Catherine Institut, 250 Chemin de Baigne-Pieds, 84000, Avignon, France.
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19
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Evrard A, Makhalov V, Chalopin T, Sidorenkov LA, Dalibard J, Lopes R, Nascimbene S. Enhanced Magnetic Sensitivity with Non-Gaussian Quantum Fluctuations. Phys Rev Lett 2019; 122:173601. [PMID: 31107084 DOI: 10.1103/physrevlett.122.173601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 06/09/2023]
Abstract
The precision of a quantum sensor can overcome its classical counterpart when its constituents are entangled. In Gaussian squeezed states, quantum correlations lead to a reduction of the quantum projection noise below the shot noise limit. However, the most sensitive states involve complex non-Gaussian quantum fluctuations, making the required measurement protocol challenging. Here we measure the sensitivity of nonclassical states of the electronic spin J=8 of dysprosium atoms, created using light-induced nonlinear spin coupling. Magnetic sublevel resolution enables us to reach the optimal sensitivity of non-Gaussian (oversqueezed) states, well above the capability of squeezed states and about half the Heisenberg limit.
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Affiliation(s)
- Alexandre Evrard
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Vasiliy Makhalov
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Thomas Chalopin
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Leonid A Sidorenkov
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Jean Dalibard
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Raphael Lopes
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
| | - Sylvain Nascimbene
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-PSL University, Sorbonne Université, 11 Place Marcelin Berthelot, 75005 Paris, France
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Framery B, Gutowski M, Dumas K, Evrard A, Muller N, Dubois V, Quinonero J, Scherninski F, Pèlegrin A, Cailler F. Toxicity and pharmacokinetic profile of SGM-101, a fluorescent anti-CEA chimeric antibody for fluorescence imaging of tumors in patients. Toxicol Rep 2019; 6:409-415. [PMID: 31080749 PMCID: PMC6506861 DOI: 10.1016/j.toxrep.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/08/2018] [Revised: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 12/26/2022] Open
Abstract
Fluorescence guided surgery represents a considerable advance for oncology surgeons. SGM-101 is an innovative antibody-dye conjugate targeting carcinoembryonic antigen on digestive tumors. Pre-clinical toxicology, pharmacology and pharmacokinetic results are in favor of clinical use of SGM-101.
The real-time improvement of the intraoperative discrimination between different tissue types (particularly between tumor and adjacent normal tissue) using intraoperative imaging represents a considerable advance for oncology surgeons. However, the development of imaging agents is much slower than that of drug therapies, although surgery represents one of the few curative treatments for many solid tumors. SGM-101 is a recently described, innovative antibody conjugate in which the near-infrared fluorochrome BM-104 is covalently linked to a chimeric monoclonal antibody against carcinoembryonic antigen (CEA). SGM-101 was developed with the goal of providing oncology surgeons with an intraoperative imaging tool that allows the visualization of CEA-overexpressing tumors. This antigen is overexpressed in a wide range of human carcinomas, such as colorectal, gastric, pancreatic, non-small cell lung and breast carcinomas. Here we characterized SGM-101 safety prior to its clinical testing for real-time cancer mapping by oncology surgeons. Safety pharmacology and toxicology studies were performed after intravenous injection of SGM-101 in Wistar rats and in Beagle dogs. SGM-101 metabolism and pharmacokinetics were analyzed in rats and mice. Finally, the potential toxicity of the BM-104 dye and SGM-101 cross-reactivity were assessed in a panel of 42 human tissues. Our pre-clinical toxicology, pharmacology and pharmacokinetic results demonstrated the absence of significant adverse effects of both SGM-101 and BM-104 at doses well above the anticipated maximal human exposure. Taken together, the results of the pharmacology, pharmacokinetic and toxicology studies support the development of SGM-101 as a potentially useful and safe tumor-specific imaging tool that might improve the complete tumor resection rate.
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Key Words
- AUC, Area Under the Curve
- CEA, carcinoembryonic antigen
- Cancer
- Carcinoembryonic antigen
- FGS, fluorescence guided surgery
- Fluorescence guided surgery
- GLP, Good Laboratory Practices
- ICG, indocyanine green
- MRT, Mean Residence Time
- MTD, maximum tolerated dose
- NIR, near infra-red
- NOAEL, no observable adverse effect level (NOAEL)
- Near-infrared fluorochrome
- PK, pharmacokinetics
- Pharmacokinetics
- TMDD, target-mediated drug disposition
- Toxicity
- mAb, monoclonal antibody
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Affiliation(s)
- Bérénice Framery
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
| | - Marian Gutowski
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France
| | - Karen Dumas
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
| | - Alexandre Evrard
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, France.,INSERM, U1194, Montpellier, F-34298, France.,Université de Montpellier, Montpellier, F-34298, France
| | - Nathalie Muller
- Leads to Development, 3-5 Impasse Reille, 75014, Paris, France
| | - Vincent Dubois
- Leads to Development, 3-5 Impasse Reille, 75014, Paris, France
| | | | | | - André Pèlegrin
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, France.,INSERM, U1194, Montpellier, F-34298, France.,Université de Montpellier, Montpellier, F-34298, France
| | - Françoise Cailler
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
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21
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Puszkiel A, Arellano C, Vachoux C, Evrard A, Le Morvan V, Boyer JC, Robert J, Delmas C, Dalenc F, Debled M, Venat-Bouvet L, Jacot W, Suc E, Sillet-Bach I, Filleron T, Roché H, Chatelut E, White-Koning M, Thomas F. Factors Affecting Tamoxifen Metabolism in Patients With Breast Cancer: Preliminary Results of the French PHACS Study. Clin Pharmacol Ther 2019; 106:585-595. [PMID: 30786012 DOI: 10.1002/cpt.1404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/08/2019] [Indexed: 12/14/2022]
Abstract
In addition to the effect of cytochrome P450 (CYP) 2D6 genetic polymorphisms, the metabolism of tamoxifen may be impacted by other factors with possible consequences on therapeutic outcome (efficacy and toxicity). This analysis focused on the pharmacokinetic (PK)-pharmacogenetic evaluation of tamoxifen in 730 patients with adjuvant breast cancer included in a prospective multicenter study. Plasma concentrations of tamoxifen and six major metabolites, the genotype for 63 single-nucleotide polymorphisms, and comedications were obtained 6 months after treatment initiation. Plasma concentrations of endoxifen were significantly associated with CYP2D6 diplotype (P < 0.0001), CYP3A4*22 genotype (P = 0.0003), and concomitant intake of potent CYP2D6 inhibitors (P < 0.001). Comparison of endoxifen levels showed that the CYP2D6 phenotype classification could be improved by grouping intermediate metabolizer (IM)/IM and IM/poor metabolizer diplotype into IM phenotype for future use in tamoxifen therapy optimization. Finally, the multivariable regression analysis showed that formation of tamoxifen metabolites was independently impacted by CYP2D6 diplotype and CYP3A4*22, CYP2C19*2, and CYP2B6*6 genetic polymorphisms.
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Affiliation(s)
- Alicja Puszkiel
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France
| | - Cécile Arellano
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France
| | - Christelle Vachoux
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France
| | - Alexandre Evrard
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Nîmes-Carémeau, Nîmes, France.,IRCM, Inserm, Université de Montpellier, ICM, Montpellier, France
| | | | | | | | - Caroline Delmas
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France.,Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Florence Dalenc
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France.,Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | | | | | - William Jacot
- IRCM, Inserm, Université de Montpellier, ICM, Montpellier, France.,Institut du Cancer de Montpellier, Montpellier, France
| | - Etienne Suc
- Clinique Saint Jean du Languedoc, Toulouse, France
| | | | - Thomas Filleron
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Henri Roché
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Etienne Chatelut
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France.,Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Melanie White-Koning
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France
| | - Fabienne Thomas
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier, Toulouse, France.,Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
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22
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Lemaitre F, Goirand F, Launay M, Chatelut E, Boyer JC, Evrard A, Paludetto MN, Guilhaumou R, Ciccolini J, Schmitt A. [5-fluorouracil therapeutic drug monitoring: Update and recommendations of the STP-PT group of the SFPT and the GPCO-Unicancer]. Bull Cancer 2018; 105:790-803. [PMID: 30103904 DOI: 10.1016/j.bulcan.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
Despite being 60-years old now, 5-FU remains the backbone of numerous regimen to treat a variety of solid tumors such as breast, head-and-neck and digestive cancers either in neo-adjuvant, adjuvant or metastatic settings. Standard 5-FU usually claims 15-40% of severe toxicities and up to 1% of toxic-death. Numerous studies show a stiff relationship between 5-FU exposure and toxicity or efficacy. In addition, 5-FU pharmacokinetics is highly variable between patients. Indeed, 80% of the 5-FU dose is catabolized in the liver by dihydropyrimidine dehydrogenase (DPD) into inactive compounds. It is now well established that DPD deficiency could lead to severe toxicities and, thus, require dose reduction in deficient patients. However, despite dosage adaptation based on DPD status, some patients may still experience under- or over-exposure, leading to inefficacy or major toxicity. The "Suivi thérapeutique pharmacologique et personnalisation des traitements" (STP-PT) group of the "Société française de pharmacologie et de thérapeutique" (SFPT) and the "Groupe de pharmacologie clinique oncologique" (GPCO)-Unicancer, based on the latest and most up-to-date literature data, recommend the implementation of 5-FU Therapeutic Drug Monitoring in order to ensure an adequate 5-FU exposure.
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Affiliation(s)
- Florian Lemaitre
- Université Rennes 1, CHU de Rennes, centre d'investigation clinique Inserm 1414, service de pharmacologie clinique, laboratoire de pharmacologie expérimentale et clinique, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Françoise Goirand
- Centre hospitalo-universitaire de Dijon-Bourgogne, 5, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Manon Launay
- Hôpital européen Georges-Pompidou, laboratoire de pharmacologie et de toxicologie, service de pharmacologie, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - Etienne Chatelut
- Institut Claudius-Regaud et centre de recherches en cancérologie de Toulouse, IUCT - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Jean-Christophe Boyer
- CHU de Nîmes Carémeau, laboratoire de biochimie et biologie moléculaire, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Alexandre Evrard
- CHU de Nîmes Carémeau, laboratoire de biochimie et biologie moléculaire, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Marie-Noelle Paludetto
- Institut Claudius-Regaud et centre de recherches en cancérologie de Toulouse, IUCT - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Romain Guilhaumou
- AP-HM, CHU Timone, service de pharmacologie clinique et pharmacovigilance, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Joseph Ciccolini
- AP-HM, CHU Timone, SMARTc CRCM UMR Inserm U1068, laboratoire de pharmacocinétique clinique, 265, rue St-Pierre, 13385 Marseille, France
| | - Antonin Schmitt
- Centre Georges-François-Leclerc, service pharmacie, 1, rue Pr.-Marion, 21000 Dijon, France.
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White-Koning M, Arellano C, Le Morvan V, Evrard A, Puzskiel A, Vachoux C, Dauba J, Houyau P, Poublanc M, Robert J, Boyer JC, Roché H, Thomas F, Chatelut E. Abstract P3-12-03: Impact of genetic polymorphisms on plasma levels of tamoxifen and its metabolites and toxicity: 6-months results of the adjuvant breast cancer longitudinal PHACS study (NCT01127295). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-12-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Supported by a PHRC grant (#09-18-005)
Background: The role of CYP2D6 genetic polymorphisms and plasma levels of active metabolites of tamoxifen (TAM) on clinical response and occurrence of side effects remains controversial. We conducted a prospective, adjuvant, multicentre, 3-year follow-up study of breast cancer patients in order to evaluate the relationships between pharmacogenetics, pharmacokinetics and toxicity of TAM and its metabolites (n=879) or aromatase inhibitors (AI, n=1098). The present report focuses on the evaluation at 6 months after inclusion of 864 patients treated with 20 mg/day TAM.The clinical results and the AI PG/PK analyses are described elsewhere (abstracts #851544 and #851525).
Methods: Residual plasma concentrations for tamoxifen and its 6 major metabolites (endoxifen ENDO, 4-hydroxy-tamoxifen 4-OH-TAM, N-desmethyl TAM, TAM-N-oxyde, 4'-OH-TAM and Z'ENDO) at 6 months after start of treatment were measured by UPLC-MS/MS in 789 patients. Nine patients with TAM concentrations below the limit of quantification were excluded for non-compliance. SNP genotyping of 95 selected SNPs was performed on the Biomark (Fluidigm) in a microfluidic multiplex 96 dynamic array chip with Taqman assays and was available for 857 patients. Patients were classified according to their CYP2D6 metaboliser status (MS) (PM, IM, EM and UM) based on presence of functional, decreased function or no functional alleles (*4, *6, *7, *9, *10, *17, *41) and number of CYP2D6 copies (*5 or duplication). Metabolic ratios (MR) were calculated for TAM/4-OH-TAM, TAM/N-desmethyl tamoxifen (NDT), NDT/ENDO and 4-OH-TAM/ENDO. Anti-estrogenic activity score (AAS) was calculated according to a recently proposed algorithm (De Vries Schultink et al.,Breast Cancer Res Treat. 2017).Toxicity was measured as a binary outcome (first occurrence or worsening of hot flushes, fatigue, depression, pain, arthralgia, vaginal dryness). All genetic associations were adjusted for multiple testing.
Results: ENDO concentration and AAS increased significantly with CYP2D6 MS (p<0.001). The presence of a CYP3A4*22 allele was significantly associated with endoxifen concentrations; this association remained significant after adjusting for CYP2D6 MS. TAM/4-OH-TAM MR was significantly influenced by the presence of CYP3A4*22, CYP2C19*2 and *17, and CYP2D6 status. The percentage of patients having an AAS>=1798 (i.e., threshold previously associated with recurrence-free survival RFS by De Vries et al. 2017) was 6%, 50%, 84% and 91% of patients respectively classified as PM, IM, EM and UM. Side effects were not significantly associated with higher levels of TAM metabolites concentrations. After correction for multiple testing, SNPs or CYP2D6 MS were not significantly associated with occurrence or worsening of adverse events, premature treatment discontinuations or switch due to toxicity within the first 6 months.
Conclusions: In this large prospective study, we quantified the impact of PG on TAM PK and AAS, previously shown to predict RFS. Although the toxicity observed after 6 months of TAM does not seem correlated with PK or PG, these relationships need to be re-evaluated during the 3-year follow-up.
Citation Format: White-Koning M, Arellano C, Le Morvan V, Evrard A, Puzskiel A, Vachoux C, Dauba J, Houyau P, Poublanc M, Robert J, Boyer J-C, Roché H, Thomas F, Chatelut E. Impact of genetic polymorphisms on plasma levels of tamoxifen and its metabolites and toxicity: 6-months results of the adjuvant breast cancer longitudinal PHACS study (NCT01127295) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-03.
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Affiliation(s)
- M White-Koning
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - C Arellano
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - V Le Morvan
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - A Evrard
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - A Puzskiel
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - C Vachoux
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - J Dauba
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - P Houyau
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - M Poublanc
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - J Robert
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - J-C Boyer
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - H Roché
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - F Thomas
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
| | - E Chatelut
- CRCT, Inserm, Université de Toulouse, UPS, Toulouse, Cedex 1, France; Institut Bergonié, Bordeaux, France; CHU Carrémeau, Nîmes, France; CH Mont-de-Marsan, Mont-de-Marsan, France; Clinique Claude Bernard, Albi, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France
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Roché H, Venat-Bouvet L, Debled M, Jacot W, Suc E, Dalenc F, Molnar-Stanciu D, Dohollou N, Franck D, Ferrer C, Laharie-Mineur H, Lavau-Denes S, Massabeau C, Mauries V, Robert J, Pinguet F, Marquet P, Evrard A, Chatelut E, Filleron T. Abstract P3-12-10: First 6-month report of the longitudinal PHACS study ( Pharmacology and Hormonotherapy (HT) for Adjuvant breast Cancer (BC) Study, NCT01127295). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-12-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: BC is a hormone-dependent disease for 75% of pts. HT is used in both adjuvant and metastatic settings for hormone–receptor (HR) positive tumors. In adjuvant situation, a 5-year HT period at least is recommended. Side-effects (SE) frequently alter quality of life and compliance, reducing the well-known benefits in risks of relapses and specific deaths. Underlying mechanisms are well understood for estrogen deprivation-induced events such as hot flashes, but little is known on arthralgia under aromatase inhibitors (AI). So, pharmacogenomics (PG), pharmacokinetics (PK), potential medications interactions are of value to explain individual drugs exposures, possible related side-effects and compliance to treatment.
Methods: We performed a prospective, multicenter, longitudinal study registering early clinical outcomes and SE during the first 3 years of adjuvant HT with tamoxifen (T) or AI. All tumors expressed at least one HR (>10%). The choice of HT molecule and one-drug or sequential treatment were left to the investigator. Pts were followed every 6 months with clinical examination by the referent oncologist and PK sampling each time. Biologic research consisted in PG investigations of different genes involved in the PK and pharmacodynamics of T and AI (95 SNPs) at baseline. SE, concurrent medications and compliance were registered by both the pts on a diary card and the physician. Evaluation was done only on new occurrence or increased grade of symptoms.
Results: This first report focuses on characteristics of the population and the results after the 6 first months of treatment. Between June 2010 and October 2014, 23 centers recruited 2000 pts. 23 were excluded leaving 1977 fully evaluable women; 879 (44%) started with T, 1098 (55%) with AI (554 letrozole (L), 390 anastrozole (A), 154 exemestane (E)). 56% of them had previously received chemotherapy, 96% radiotherapy and 8% trastuzumab.
Main characteristics were well balanced between the 2 classes of drugs; T was given mainly for pre- or perimenopausal pts. Most frequent co-morbidities were hypertension (8% T, 31% AI) and dyslipidemia or diabetes (T 11%, AI 26%). To note, almost 30% of pts described arthralgias at entrance and 37% had hot flashes.
At 6 months, 122 pts (6%; 43 T, 79 AI) had stopped treatment mainly for toxicity (11 T; 12 AI), progression or death (7 T; 4 IA), personal reasons (15 T; 37AI); 4 asked for changing T and 52 AI (equally for the 3 drugs). All these events were significantly more frequent for AI pts (p=0.042) and with E within the AI class (p<0.001).
Main changes in onset or increased intensity of symptoms concerned hot flushes with all drugs (30%), asthenia (20%), insomnia (20%), weight gain (17%), arthralgias (15% for T, 30% for AI), thrombotic events (24 of which 11 with T). 3 grade3 SAE HT-related were reported.
Biological data are reported in 2 other abst. (M. White-Koning. abst.#850248, F. Thomas, abst.#851525).
Conclusions: These preliminary data on the first 6-months exposure to HT on adjuvant setting in the real-life confirm early rates of withdraws and toxicities. Longer follow-up and subsequent PK analysis should help to understand persistent side-effects and reasons for non-compliance to adjuvant HT.
Citation Format: Roché H, Venat-Bouvet L, Debled M, Jacot W, Suc E, Dalenc F, Molnar-Stanciu D, Dohollou N, Franck D, Ferrer C, Laharie-Mineur H, Lavau-Denes S, Massabeau C, Mauries V, Robert J, Pinguet F, Marquet P, Evrard A, Chatelut E, Filleron T. First 6-month report of the longitudinal PHACS study (Pharmacology and Hormonotherapy (HT) for Adjuvant breast Cancer (BC) Study, NCT01127295) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-10.
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Affiliation(s)
- H Roché
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - L Venat-Bouvet
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - M Debled
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - W Jacot
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - E Suc
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - F Dalenc
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - D Molnar-Stanciu
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - N Dohollou
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - D Franck
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - C Ferrer
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - H Laharie-Mineur
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - S Lavau-Denes
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - C Massabeau
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - V Mauries
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - J Robert
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - F Pinguet
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - P Marquet
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - A Evrard
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - E Chatelut
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
| | - T Filleron
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, Cedex 9, France, Metropolitan; CHU Limoges, Limoges, France, Metropolitan; Institut Bergonié, Bordeaux, France, Metropolitan; Institut de Cancérologie de Montpellier, Montpellier, France, Metropolitan; Clinique St Jean du Languedoc, Toulouse, France, Metropolitan; Centre Hospitalier, Brive, France, Metropolitan; Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Metropolitan; Clinique Pasteur, Toulouse, France, Metropolitan; CHU Carémeau, Nîmes, France, Metropolitan; Clinique Tivoli, Bordeaux, France, Metropolitan; Centre de Recherche en Cancérologie de Toulouse, INSERM, Toulouse, France, Metropolitan
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Thomas F, Marquet P, Pinguet F, White-Koning M, Robert J, Tafzi N, Solassol I, Despax R, Levasseur N, Ellis S, Massoubre A, Mbatchi L, Le Morvan V, Roché H, Chatelut E, Evrard A. Abstract P3-12-07: Pharmacogenetic determinants of aromatase inhibitors pharmacokinetics and side effects: 6-month results of the adjuvant breast cancer longitudinal PHACS study (NCT01127295). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-12-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Supported by a PHRC grant (#09-18-005)
Background: Recent literature has suggested that germline genetic variants of drug-metabolizing enzymes or CYP19A1 (coding for aromatase) may be involved in the systemic aromatase inhibitors (AI) concentrations or the occurrence of side effects (Hertz et al. Pharmacogenomics 2017). A prospective multicentre 3-year follow-up study was carried out to investigate the relationships between pharmacogenetics (PG), pharmacokinetics (PK) and toxicity in breast cancer patients treated with adjuvant AI (n=1098) or tamoxifen (n=879). The clinical results and the tamoxifen PG/PK analyses are described elsewhere (abstracts #851544 and #850248).
Methods: SNP genotyping of 95 SNPs was performed on the Biomark (Fluidigm) with Taqman assays and was available for 373, 515 and 151 patients treated with anastrozole (ANA), letrozole (LETRO) and exemestane (EXE) respectively. CYP2A6 metaboliser status (MS) (poor, intermediate or normal) was determined based on alleles function (*1, *9, *2) and number of CYP2A6 copies. Trough plasma concentrations of each drug were determined 6 months after the start of the study by UPLC-MS/MS and were available for 342, 463 and 130 patients of the ANA, LETRO and EXE arms. Patients with AI concentrations below the limit of quantification were excluded for non-compliance (9 patients for ANA, 8 patients for LETRO and 7 patients for EXE). Toxicity was measured as a binary outcome (occurrence or worsening of hot flushes, fatigue, pain, arthralgia, vaginal dryness). All genetic associations were adjusted for multiple testing.
Results: ANA concentration was significantly higher in patients experiencing pain (p=0.025) and was associated with rs28365063 (UGT2B7 g.372A>G).
LETRO concentrations were strongly associated with CYP2A6 metabolizer status (p=0.0001) but did not differ in patients with or without toxicity.
In the EXE arm, patients with hot flushes or arthralgia had a significantly lower level of exemestane (p= 0.0002 and p=0.023 respectively) but since the metabolism of EXE leads to active 17-hydroexemestane, we can hypothesize that the lower EXE concentration is an indirect reflection of the metabolite formation. A SNP (rs2307424) in NR1I3 gene (coding for the constitutive androstane receptor CAR) was associated with EXE concentrations. CAR has been shown to regulate CYP2B6, which is involved in the formation of 6-hydroxy-methyl-exemestane (inactive metabolite).
Regarding the relationships between PG and toxicity, in the ANA arm, 3 SNPs of CYP19A1 gene tended to be associated with hot flushes worsening (rs934635) and arthralgia (rs10046 and rs2304463) but did not remain significant after multiple tests correction. In the EXE arm, several SNPs in NR1I3 gene were associated with fatigue.
In the LETRO arm, patients with a poor CYP2A6 MS had a higher risk of experiencing depression.
Conclusions: Our study confirms the predominant role of CYP2A6 in LETRO PK. To our knowledge, this is the first study to report on the role of UGT2B7 rs28365063 in ANA and NR1I3 in EXE PK and side effects. These relationships need to be re-evaluated with the drug concentrations obtained during the 3-year follow-up.
Citation Format: Thomas F, Marquet P, Pinguet F, White-Koning M, Robert J, Tafzi N, Solassol I, Despax R, Levasseur N, Ellis S, Massoubre A, Mbatchi L, Le Morvan V, Roché H, Chatelut E, Evrard A. Pharmacogenetic determinants of aromatase inhibitors pharmacokinetics and side effects: 6-month results of the adjuvant breast cancer longitudinal PHACS study (NCT01127295) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-07.
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Affiliation(s)
- F Thomas
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - P Marquet
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - F Pinguet
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - M White-Koning
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - J Robert
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - N Tafzi
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - I Solassol
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - R Despax
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - N Levasseur
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - S Ellis
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - A Massoubre
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - L Mbatchi
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - V Le Morvan
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - H Roché
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - E Chatelut
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
| | - A Evrard
- Institut Claudius Regaud, IUCT-O, Toulouse, France; CRCT, Inserm, Univ Toulouse, Toulouse, France; CHU Limoges, Limoges, France; ICRM, Montpellier, France; Institut Bergonié, Bordeaux, France; Clinique Pasteur, Toulouse, France; CH Cahors, Cahors, France; Centre Catalan d'Oncologie, Perpignan, France; CHU Carémeaux, Nîmes, France
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Mbatchi LC, Brouillet JP, Evrard A. Genetic variations of the xenoreceptors NR1I2 and NR1I3 and their effect on drug disposition and response variability. Pharmacogenomics 2017; 19:61-77. [PMID: 29199543 DOI: 10.2217/pgs-2017-0121] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 12/11/2022] Open
Abstract
NR1I2 (PXR) and NR1I3 (CAR) are nuclear receptors that are classified as xenoreceptors. Upon activation by various xenobiotics, including marketed drugs, they regulate the transcription level of major drug-metabolizing enzymes and transporters and facilitate the elimination of xenobiotics from the body. The modulation of the activity of these two xenoreceptors by various ligands is a major source of pharmacokinetic variability of environmental origin. NR1I2 and NR1I3 genetic polymorphisms can affect the pharmacokinetics and therapeutic response to many drugs, such as irinotecan, tacrolimus and atazanavir. This review provides an overview of NR1I2 and NR1I3 pharmacogenetic studies in various therapeutic fields (oncology, immunomodulation and infectiology) and discusses the implementation of NR1I2 and NR1I3 genetic polymorphism testing in the clinical routine.
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Affiliation(s)
- Litaty Céphanoée Mbatchi
- Laboratoire de biochimie, Centre Hospitalier Universitaire (CHU) of Nîmes, Hôpital Carémeau, Nîmes, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, INSERM, U1194 France.,Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France
| | - Jean-Paul Brouillet
- Laboratoire de biochimie, Centre Hospitalier Universitaire (CHU) of Nîmes, Hôpital Carémeau, Nîmes, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, INSERM, U1194 France
| | - Alexandre Evrard
- Laboratoire de biochimie, Centre Hospitalier Universitaire (CHU) of Nîmes, Hôpital Carémeau, Nîmes, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, INSERM, U1194 France.,Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France
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Etienne-Grimaldi MC, Le Guellec CB, Boyer JC, Chatelut E, Evrard A, Loriot MA, Paci A, Royer B, Thomas F, Ciccolini J. Prevention of 5-fluorouracil-induced early severe toxicity by pre-therapeutic dihydropyrimidine dehydrogenase deficiency screening: The multiparametric approach is not convincing. Semin Oncol 2017; 44:159-160. [PMID: 28923215 DOI: 10.1053/j.seminoncol.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/19/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Etienne Chatelut
- Laboratoire de Biologie Médicale Oncologique, Institut Claudius-Regaud, CRCT, Toulouse, France
| | | | - Marie-Anne Loriot
- Biochemistry Department, Hopital Européen Georges Pompidou, Paris, France
| | - Angelo Paci
- Department of Clinical Pharmacy, SIPAM, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Bernard Royer
- Department of Clinical Pharmacology, CHU Jean Minjoz, Besançon, France
| | - Fabienne Thomas
- Laboratoire de Biologie Médicale Oncologique, Institut Claudius-Regaud, CRCT, Toulouse, France
| | - Joseph Ciccolini
- SMARTc, Department of Pharmacokinetics, CHU Timone, Marseille, France
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Faulkner C, Zhou J, Evrard A, Bourdais G, MacLean D, Häweker H, Eckes P, Robatzek S. An automated quantitative image analysis tool for the identification of microtubule patterns in plants. Traffic 2017; 18:683-693. [PMID: 28746801 DOI: 10.1111/tra.12505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 09/26/2016] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 12/20/2022]
Abstract
High throughput confocal imaging poses challenges in the computational image analysis of complex subcellular structures such as the microtubule cytoskeleton. Here, we developed CellArchitect, an automated image analysis tool that quantifies changes to subcellular patterns illustrated by microtubule markers in plants. We screened microtubule-targeted herbicides and demonstrate that high throughput confocal imaging with integrated image analysis by CellArchitect can distinguish effects induced by the known herbicides indaziflam and trifluralin. The same platform was used to examine 6 other compounds with herbicidal activity, and at least 3 different effects induced by these compounds were profiled. We further show that CellArchitect can detect subcellular patterns tagged by actin and endoplasmic reticulum markers. Thus, the platform developed here can be used to automate image analysis of complex subcellular patterns for purposes such as herbicide discovery and mode of action characterisation. The capacity to use this tool to quantitatively characterize cellular responses lends itself to application across many areas of biology.
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Affiliation(s)
| | - Ji Zhou
- Norwich Research Park, The Sainsbury Laboratory, Norwich, UK
| | | | - Gildas Bourdais
- Norwich Research Park, The Sainsbury Laboratory, Norwich, UK
| | - Dan MacLean
- Norwich Research Park, The Sainsbury Laboratory, Norwich, UK
| | - Heidrun Häweker
- Norwich Research Park, The Sainsbury Laboratory, Norwich, UK
| | - Peter Eckes
- Bayer AG, Crop Science Division, Industrial Park Hoechst, Frankfurt, Germany
| | - Silke Robatzek
- Norwich Research Park, The Sainsbury Laboratory, Norwich, UK
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29
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Mbatchi LC, Gassiot M, Pourquier P, Goberna A, Mahammedi H, Mourey L, Joly F, Lumbroso S, Evrard A, Houede N. Association of NR1I2, CYP3A5 and ABCB1 genetic polymorphisms with variability of temsirolimus pharmacokinetics and toxicity in patients with metastatic bladder cancer. Cancer Chemother Pharmacol 2017; 80:653-659. [PMID: 28676933 DOI: 10.1007/s00280-017-3379-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/14/2017] [Accepted: 06/27/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE Temsirolimus is a mammalian target of rapamycin (mTOR) inhibitor that exhibits antitumor activity in renal cell carcinoma and mantle cell lymphoma. The metabolism of temsirolimus and its active metabolite sirolimus mainly depends on cytochrome P450 3A4/5 (CYP3A4/A5) and the ABCB1 transporter. Differently from sirolimus, no pharmacogenetic study on temsirolimus has been conducted. Therefore, the aim of this pilot study was to identify genetic determinants of the inter-individual variability in temsirolimus pharmacokinetics and toxicity. METHODS Pharmacokinetic profiles were obtained for 16 patients with bladder cancer after intravenous infusion of 25 mg temsirolimus. Non-compartmental analysis was performed to calculate the pharmacokinetic parameters of temsirolimus and sirolimus, its main metabolite. The presence of single nucleotide polymorphisms (SNPs) in CYP3A5, ABCB1 and in their transcriptional regulator NR1I2 (PXR) was assessed by genotyping. Non-parametric statistical tests were used to assess associations between candidate SNPs and temsirolimus pharmacokinetics and toxicity. RESULTS The ratio between sirolimus AUC and temsirolimus AUC was 1.6-fold higher in patients who experienced serious toxic events (p = 0.034). The frequency of adverse events was significantly higher in patients homozygous for the NR1I2-rs6785049 A allele (OR = 0.065, p = 0.04) or NR1I2-rs3814055 C allele (OR = 0.032, p = 0.006). These NR1I2 SNPs were also predictive of temsirolimus half-life and global exposure to temsirolimus and sirolimus. Finally, the effect of the ABCB1-rs1128503, ABCB1-rs2032582 and CYP3A5*3 SNPs on sirolimus pharmacokinetics was confirmed. CONCLUSIONS Our findings suggest that SNPs of NR1I2 and its target genes CYP3A5 and ABCB1 are genetic determinants of temsirolimus pharmacokinetics and toxicity in patients with bladder cancer.
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Affiliation(s)
- Litaty C Mbatchi
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Nîmes, Hôpital Carémeau, Place du Professeur Robert Debré, 30029, Nîmes, Cedex 9, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, 34298, Montpellier, France.,Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France
| | - Matthieu Gassiot
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Nîmes, Hôpital Carémeau, Place du Professeur Robert Debré, 30029, Nîmes, Cedex 9, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, 34298, Montpellier, France
| | - Philippe Pourquier
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, 34298, Montpellier, France
| | - Alejando Goberna
- Département de Recherche Clinique et d'Epidémiologie, Institut Bergonié, Bordeaux, France
| | - Hakim Mahammedi
- Département d'Oncologie Médicale, Centre Jean Perrin, Clermont Ferrand, France
| | - Loic Mourey
- Département d'Oncologie Médicale, IUCT Oncopole, Toulouse, France
| | - Florence Joly
- Département d'Oncologie Médicale, Centre François Baclesse, Caen, France
| | - Serge Lumbroso
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Nîmes, Hôpital Carémeau, Place du Professeur Robert Debré, 30029, Nîmes, Cedex 9, France
| | - Alexandre Evrard
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Nîmes, Hôpital Carémeau, Place du Professeur Robert Debré, 30029, Nîmes, Cedex 9, France. .,IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, 34298, Montpellier, France. .,Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France.
| | - Nadine Houede
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, 34298, Montpellier, France.,Département d'Oncologie Médicale, CHU Nîmes, Hôpital Carémeau, Nîmes, France
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30
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Etienne-Grimaldi MC, Boyer JC, Beroud C, Mbatchi L, van Kuilenburg A, Bobin-Dubigeon C, Thomas F, Chatelut E, Merlin JL, Pinguet F, Ferrand C, Meijer J, Evrard A, Llorca L, Romieu G, Follana P, Bachelot T, Chaigneau L, Pivot X, Dieras V, Largillier R, Mousseau M, Goncalves A, Roché H, Bonneterre J, Servent V, Dohollou N, Château Y, Chamorey E, Desvignes JP, Salgado D, Ferrero JM, Milano G. New advances in DPYD genotype and risk of severe toxicity under capecitabine. PLoS One 2017; 12:e0175998. [PMID: 28481884 PMCID: PMC5421769 DOI: 10.1371/journal.pone.0175998] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/04/2017] [Indexed: 12/29/2022] Open
Abstract
Background Deficiency in dihydropyrimidine dehydrogenase (DPD) enzyme is the main cause of severe and lethal fluoropyrimidine-related toxicity. Various approaches have been developed for DPD-deficiency screening, including DPYD genotyping and phenotyping. The goal of this prospective observational study was to perform exhaustive exome DPYD sequencing and to examine relationships between DPYD variants and toxicity in advanced breast cancer patients receiving capecitabine. Methods Two-hundred forty-three patients were analysed (88.5% capecitabine monotherapy). Grade 3 and grade 4 capecitabine-related digestive and/or neurologic and/or hemato-toxicities were observed in 10.3% and 2.1% of patients, respectively. DPYD exome, along with flanking intronic regions 3’UTR and 5’UTR, were sequenced on MiSeq Illumina. DPD phenotype was assessed by pre-treatment plasma uracil (U) and dihydrouracil (UH2) measurement. Results Among the 48 SNPs identified, 19 were located in coding regions, including 3 novel variations, each observed in a single patient (among which, F100L and A26T, both pathogenic in silico). Combined analysis of deleterious variants *2A, I560S (*13) and D949V showed significant association with grade 3–4 toxicity (sensitivity 16.7%, positive predictive value (PPV) 71.4%, relative risk (RR) 6.7, p<0.001) but not with grade 4 toxicity. Considering additional deleterious coding variants D342G, S492L, R592W and F100L increased the sensitivity to 26.7% for grade 3–4 toxicity (PPV 72.7%, RR 7.6, p<0.001), and was significantly associated with grade 4 toxicity (sensitivity 60%, PPV 27.3%, RR 31.4, p = 0.001), suggesting the clinical relevance of extended targeted DPYD genotyping. As compared to extended genotype, combining genotyping (7 variants) and phenotyping (U>16 ng/ml) did not substantially increase the sensitivity, while impairing PPV and RR. Conclusions Exploring an extended set of deleterious DPYD variants improves the performance of DPYD genotyping for predicting both grade 3–4 and grade 4 toxicities (digestive and/or neurologic and/or hematotoxicities) related to capecitabine, as compared to conventional genotyping restricted to consensual variants *2A, *13 and D949V.
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Affiliation(s)
| | | | - Christophe Beroud
- Aix-Marseille University, INSERM UMR S910, GMGF, Marseille, France
- APHM Hôpital Timone, Laboratoire de Génétique Moléculaire, Marseille, France
| | - Litaty Mbatchi
- Faculté de Pharmacie de Montpellier, Montpellier, France
| | - André van Kuilenburg
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam,The Netherlands
| | | | - Fabienne Thomas
- Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Etienne Chatelut
- Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean-Louis Merlin
- Institut de Cancérologie de Lorraine, UMR CNRS 7039 CRAN, Université de Lorraine, Nancy, France
| | | | | | - Judith Meijer
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam,The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | - Henri Roché
- Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | | | | | | | | | | | - David Salgado
- Aix-Marseille University, INSERM UMR S910, GMGF, Marseille, France
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Lehmann-Che J, Poirot B, Boyer JC, Evrard A. La génétique somatique des tumeurs solides, un incontournable à l’ère de la médecine de précision. Therapie 2017; 72:217-230. [DOI: 10.1016/j.therap.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
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32
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Dupont C, Carayol M, Le Ray C, Barasinski C, Beranger R, Burguet A, Chantry A, Chiesa C, Coulm B, Evrard A, Fischer C, Gaucher L, Guillou C, Leroy F, Phan E, Rousseau A, Tessier V, Vendittelli F, Deneux-Tharaux C, Riethmuller D. Recommandations pour l’administration d’oxytocine au cours du travail spontané. Texte court des recommandations. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.sagf.2016.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Targeted therapies have revolutionized the treatment of many cancers. Widely developed over the last decade, this new concept of precision medicine relies on the use of genomic technologies to analyze tumor samples in order to identify actionable targets and biomarkers of resistance. The goal is to optimize treatment by identifying which therapeutic approach is best for each patient, i.e. the treatment that is effective, has minimal adverse effects, and avoids unnecessary intervention and cost. The purpose of this review is to highlight, using a few seminal examples of therapeutic targets, the important contribution of appropriate analysis of key oncogenes or driver genes in making clinical decisions. Cancer genomics is now an indispensable part of clinical management. Furthermore, the development of next generation sequencing (NGS) will enable exploration of more and more genes of interest, leading to new treatment options for personalized medicine.
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Affiliation(s)
- Jacqueline Lehmann-Che
- Laboratoire d'oncologie moléculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux 75475 Paris cedex 10, France; Unité CNRS UMR7212/U944, équipe de recherche translationnelle en oncologie, bâtiment Jean-Bernard, 75475 Paris, France.
| | - Brigitte Poirot
- Laboratoire d'oncologie moléculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux 75475 Paris cedex 10, France; Unité CNRS UMR7212/U944, équipe de recherche translationnelle en oncologie, bâtiment Jean-Bernard, 75475 Paris, France
| | - Jean-Christophe Boyer
- Laboratoire de biochimie, CHU de Nîmes Carémeau, 30029 Nîmes, France; EA 2415, « Aide à la décision médicale personnalisée : aspects méthodologiques » IURC, faculté de médecine de Montpellier, 34093 Montpellier, France
| | - Alexandre Evrard
- Laboratoire de biochimie, CHU de Nîmes Carémeau, 30029 Nîmes, France; Unité Inserm U1194, Institut de recherche en cancérologie de Montpellier (IRCM), 34298 Montpellier, France
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Dupont C, Carayol M, Le Ray C, Barasinski C, Beranger R, Burguet A, Chantry A, Chiesa C, Coulm B, Evrard A, Fischer C, Gaucher L, Guillou C, Leroy F, Phan E, Rousseau A, Tessier V, Vendittelli F, Deneux-Tharaux C, Riethmuller D. [Oxytocin administration during spontaneous labour: Guidelines for clinical practice. Guidelines short text]. ACTA ACUST UNITED AC 2017; 45:56-61. [PMID: 28238320 DOI: 10.1016/j.gofs.2016.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. METHOD A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. RESULTS The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1cm per 4hour during the first part of the active phase, and below 1cm per 2hours above 7cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrated. However, in the case of an extension of the second stage beyond 2hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2mUI/min, to respect at least 30min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2mUI/min intervals without surpassing a maximum IV flow rate of 20mUI/min. The reported maternal adverse effects concern uterine hyperstimulation, uterine rupture and post-partum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyperstimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. CONCLUSION The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file.
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Affiliation(s)
- C Dupont
- Pôle IMER, Réseau périnatal Aurore, hospices civils de Lyon, 69003 Lyon, France; HESPER EA 7425, université Lyon, université Claude-Bernard-Lyon 1, 69008 Lyon, France.
| | - M Carayol
- Service de PMI, direction des familles et de la petite enfance, mairie de Paris, 75196 Paris, France
| | - C Le Ray
- Maternité Port Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - C Barasinski
- EA 4681 PEPRADE, université d'Auvergne, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - R Beranger
- Inserm U1085, IRSET, équipe 9 « recherches épidémiologiques sur l'environnement, la reproduction et le développement », 35000 Rennes, France
| | | | - A Chantry
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France; École de sages-femmes Baudelocque, université Paris Descartes, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - C Chiesa
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - B Coulm
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - A Evrard
- Association bien naître, 69003 Lyon, France
| | - C Fischer
- Maternité Port Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - L Gaucher
- HESPER EA 7425, université Lyon, université Claude-Bernard-Lyon 1, 69008 Lyon, France; Hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69500 Bron, France; Pôle information médicale évaluation recherche, 69003 Lyon, France
| | - C Guillou
- Clinique Natecia, 69008 Lyon, France
| | - F Leroy
- Hôpital Montélimar, 26200 Montélimar, France
| | - E Phan
- Association d'usagers, collectif inter-associatif autour de la naissance (CIANE), 75014 Paris, France
| | - A Rousseau
- Département de Maïeutique, UFR des sciences de la santé Simone-Veil, université Versailles-Saint-Quentin, 78000 Versailles, France
| | - V Tessier
- Département hospitalo-universitaire « risques et grossesse », groupe hospitalier Cochin, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France
| | - F Vendittelli
- EA 4681 PEPRADE, université d'Auvergne, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - C Deneux-Tharaux
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
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Casper C, Caeymaex L, Dicky O, Akrich M, Reynaud A, Bouvard C, Evrard A, Kuhn P. [Parental perception of their involvement in the care of their children in French neonatal units]. Arch Pediatr 2016; 23:974-82. [PMID: 27496640 DOI: 10.1016/j.arcped.2016.06.010] [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] [Received: 06/29/2015] [Revised: 06/10/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The experience of becoming the parent of a sick or premature newborn can be particularly distressing for parents. They often encounter challenges to the development of their parenting roles. Perception of the hospital stay has never been analyzed on a large scale. OBJECTIVE To analyze parents' perception of their involvement in the care of their newborn. METHODS An internet-based survey started in France in February 2014 on the basis of a validated questionnaire composed of 222 neonatal care-related items. A quantitative and qualitative analysis was performed on the items dealing with parents' involvement until August 2014. RESULTS The survey was completed by 1500 parents, 98 % of whom were mothers. The infants had a mean GA of 32 weeks and a mean birth weight of 1600g. Parents rated their first care of their infant with mixed emotions (joy, stress, etc.). Parents were willing to practice new skills through guided participation, even for more complex care. Skin-to-skin care was only proposed after 7 days for 20 % of the parents; 10 % of the parents did not feel secure during this practice. The need for privacy and professional guidance was essential for meaningful skin-to-skin contact. DISCUSSION Parents' perception of participating actively in their infant's care was positive and they felt guided by the nursing team. Most of them would have been more active with guidance. Skin-to-skin care was appreciated and desired, but could become stressful if the conditions were not optimal.
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Affiliation(s)
- C Casper
- Unité de néonatologie, hôpital des enfants, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
| | - L Caeymaex
- Service de médecine néonatale, centre hospitalier intercommunal de Créteil, 97010 Créteil, France
| | - O Dicky
- Unité de néonatologie, hôpital des enfants, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - M Akrich
- Collectif inter-associatif autour de la naissance (CIANE), 75014 Paris, France
| | - A Reynaud
- Association SOS Préma, 32, rue du Chemin-vert, 92100 Boulogne-Billancourt, France
| | - C Bouvard
- Association SOS Préma, 32, rue du Chemin-vert, 92100 Boulogne-Billancourt, France
| | - A Evrard
- Collectif inter-associatif autour de la naissance (CIANE), 75014 Paris, France
| | - P Kuhn
- Service de réanimation néonatale, hôpital Hautepierre, CHU de Strasbourg, 67098 Strasbourg, France
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Postma J, Liebrand TWH, Bi G, Evrard A, Bye RR, Mbengue M, Kuhn H, Joosten MHAJ, Robatzek S. Avr4 promotes Cf-4 receptor-like protein association with the BAK1/SERK3 receptor-like kinase to initiate receptor endocytosis and plant immunity. New Phytol 2016; 210:627-642. [PMID: 26765243 DOI: 10.1101/019471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/10/2015] [Indexed: 05/20/2023]
Abstract
The first layer of plant immunity is activated by cell surface receptor-like kinases (RLKs) and proteins (RLPs) that detect infectious pathogens. Constitutive interaction with the SUPPRESSOR OF BIR1 (SOBIR1) RLK contributes to RLP stability and kinase activity. As RLK activation requires transphosphorylation with a second associated RLK, it remains elusive how RLPs initiate downstream signaling. We employed live-cell imaging, gene silencing and coimmunoprecipitation to investigate the requirement of associated kinases for functioning and ligand-induced subcellular trafficking of Cf RLPs that mediate immunity of tomato against Cladosporium fulvum. Our research shows that after elicitation with matching effector ligands Avr4 and Avr9, BRI1-ASSOCIATED KINASE 1/SOMATIC EMBRYOGENESIS RECEPTOR KINASE 3 (BAK1/SERK3) associates with Cf-4 and Cf-9. BAK1/SERK3 is required for the effector-triggered hypersensitive response and resistance of tomato against C. fulvum. Furthermore, Cf-4 interacts with SOBIR1 at the plasma membrane and is recruited to late endosomes upon Avr4 trigger, also depending on BAK1/SERK3. These observations indicate that RLP-mediated resistance and endocytosis require ligand-induced recruitment of BAK1/SERK3, reminiscent of BAK1/SERK3 interaction and subcellular fate of the FLAGELLIN SENSING 2 (FLS2) RLK. This reveals that diverse classes of cell surface immune receptors share common requirements for initiation of resistance and endocytosis.
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Affiliation(s)
- Jelle Postma
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
| | - Thomas W H Liebrand
- Laboratory of Phytopathology, Wageningen University, Droevendaalsesteeg 1, 6708 PB, Wageningen, the Netherlands
| | - Guozhi Bi
- Laboratory of Phytopathology, Wageningen University, Droevendaalsesteeg 1, 6708 PB, Wageningen, the Netherlands
| | - Alexandre Evrard
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
| | - Ruby R Bye
- Laboratory of Phytopathology, Wageningen University, Droevendaalsesteeg 1, 6708 PB, Wageningen, the Netherlands
| | - Malick Mbengue
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
| | - Hannah Kuhn
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
- Unit of Plant Molecular Cell Biology, Institute of Biology I, RWTH Aachen, Worringerweg 1, 52056, Aachen, Germany
| | - Matthieu H A J Joosten
- Laboratory of Phytopathology, Wageningen University, Droevendaalsesteeg 1, 6708 PB, Wageningen, the Netherlands
| | - Silke Robatzek
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
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Postma J, Liebrand TWH, Bi G, Evrard A, Bye RR, Mbengue M, Kuhn H, Joosten MHAJ, Robatzek S. Avr4 promotes Cf-4 receptor-like protein association with the BAK1/SERK3 receptor-like kinase to initiate receptor endocytosis and plant immunity. New Phytol 2016; 210:627-42. [PMID: 26765243 DOI: 10.1111/nph.13802] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/10/2015] [Indexed: 05/05/2023]
Abstract
The first layer of plant immunity is activated by cell surface receptor-like kinases (RLKs) and proteins (RLPs) that detect infectious pathogens. Constitutive interaction with the SUPPRESSOR OF BIR1 (SOBIR1) RLK contributes to RLP stability and kinase activity. As RLK activation requires transphosphorylation with a second associated RLK, it remains elusive how RLPs initiate downstream signaling. We employed live-cell imaging, gene silencing and coimmunoprecipitation to investigate the requirement of associated kinases for functioning and ligand-induced subcellular trafficking of Cf RLPs that mediate immunity of tomato against Cladosporium fulvum. Our research shows that after elicitation with matching effector ligands Avr4 and Avr9, BRI1-ASSOCIATED KINASE 1/SOMATIC EMBRYOGENESIS RECEPTOR KINASE 3 (BAK1/SERK3) associates with Cf-4 and Cf-9. BAK1/SERK3 is required for the effector-triggered hypersensitive response and resistance of tomato against C. fulvum. Furthermore, Cf-4 interacts with SOBIR1 at the plasma membrane and is recruited to late endosomes upon Avr4 trigger, also depending on BAK1/SERK3. These observations indicate that RLP-mediated resistance and endocytosis require ligand-induced recruitment of BAK1/SERK3, reminiscent of BAK1/SERK3 interaction and subcellular fate of the FLAGELLIN SENSING 2 (FLS2) RLK. This reveals that diverse classes of cell surface immune receptors share common requirements for initiation of resistance and endocytosis.
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Affiliation(s)
- Jelle Postma
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
| | - Thomas W H Liebrand
- Laboratory of Phytopathology, Wageningen University, Droevendaalsesteeg 1, 6708 PB, Wageningen, the Netherlands
| | - Guozhi Bi
- Laboratory of Phytopathology, Wageningen University, Droevendaalsesteeg 1, 6708 PB, Wageningen, the Netherlands
| | - Alexandre Evrard
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
| | - Ruby R Bye
- Laboratory of Phytopathology, Wageningen University, Droevendaalsesteeg 1, 6708 PB, Wageningen, the Netherlands
| | - Malick Mbengue
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
| | - Hannah Kuhn
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
- Unit of Plant Molecular Cell Biology, Institute of Biology I, RWTH Aachen, Worringerweg 1, 52056, Aachen, Germany
| | - Matthieu H A J Joosten
- Laboratory of Phytopathology, Wageningen University, Droevendaalsesteeg 1, 6708 PB, Wageningen, the Netherlands
| | - Silke Robatzek
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
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Roger C, Nucci B, Louart B, Friggeri A, Knani H, Evrard A, Lavigne JP, Allaouchiche B, Lefrant JY, Roberts JA, Muller L. Impact of 30 mg/kg amikacin and 8 mg/kg gentamicin on serum concentrations in critically ill patients with severe sepsis. J Antimicrob Chemother 2015; 71:208-12. [DOI: 10.1093/jac/dkv291] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/18/2015] [Indexed: 01/01/2023] Open
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Mbatchi LC, Schmitt A, Thomas F, Cazaubon Y, Robert J, Lumbroso S, Brouillet JP, Pourquier P, Chatelut E, Boyer JC, Evrard A. Polymorphisms in SLCO1B3 and NR1I2 as genetic determinants of hematotoxicity of carboplatin and paclitaxel combination. Pharmacogenomics 2015; 16:1439-50. [DOI: 10.2217/pgs.15.84] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The goal of our study was to assess the impact of patients’ genetic background on their sensitivity to carboplatin/paclitaxel hematotoxicity. Patients & methods: Parameters describing sensitivity to neutropenia and to thrombocytopenia of 201 patients were extracted from a previous pharmacokinetic/pharmacodynamics analysis, in order to assess their association with 52 candidates SNPs in 18 genes. Results: Carriers of a T allele of SLCO1B3-rs4149117 were 19% less sensitive to thrombocytopenia than the homozygotes for the G allele (p = 0.00279). Carriers of two copies of the ATG haplotypes of NR1I2-rs1523130, rs3814055 and rs1523127 were 19% less sensitive to thrombocytopenia than those harboring other haplotypes (p = 0.025). Conclusion: Our results revealed the importance of SLCO1B3 and NR1I2 in the sensitivity to carboplatin/paclitaxel thrombocytopenia.
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Affiliation(s)
- Litaty Céphanoée Mbatchi
- Laboratoire de biochimie, Centre Hospitalier Universitaire (CHU) of Nîmes, Hôpital Carémeau, Nîmes, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, INSERM, U1194 France
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France
| | - Antonin Schmitt
- EA4553 Institut Claudius-Regaud, and Université Paul-Sabatier, Toulouse, France
| | - Fabienne Thomas
- EA4553 Institut Claudius-Regaud, and Université Paul-Sabatier, Toulouse, France
| | - Yoann Cazaubon
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France
| | - Jacques Robert
- INSERM U916, Institut Bergonié, Université de Bordeaux, France
| | - Serge Lumbroso
- Laboratoire de biochimie, Centre Hospitalier Universitaire (CHU) of Nîmes, Hôpital Carémeau, Nîmes, France
| | - Jean-Paul Brouillet
- Laboratoire de biochimie, Centre Hospitalier Universitaire (CHU) of Nîmes, Hôpital Carémeau, Nîmes, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, INSERM, U1194 France
| | - Philippe Pourquier
- IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, INSERM, U1194 France
| | - Etienne Chatelut
- EA4553 Institut Claudius-Regaud, and Université Paul-Sabatier, Toulouse, France
| | - Jean-Christophe Boyer
- Laboratoire de biochimie, Centre Hospitalier Universitaire (CHU) of Nîmes, Hôpital Carémeau, Nîmes, France
| | - Alexandre Evrard
- Laboratoire de biochimie, Centre Hospitalier Universitaire (CHU) of Nîmes, Hôpital Carémeau, Nîmes, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, INSERM, U1194 France
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Université de Montpellier, Montpellier, France
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Breuker C, Planque C, Rajabi F, Nault JC, Couchy G, Zucman-Rossi J, Evrard A, Kantar J, Chevet E, Bioulac-Sage P, Ramos J, Assenat E, Joubert D, Pannequin J, Hollande F, Pascussi JM. Characterization of a novel PXR isoform with potential dominant-negative properties. J Hepatol 2014; 61:609-16. [PMID: 24798619 DOI: 10.1016/j.jhep.2014.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 04/08/2014] [Accepted: 04/24/2014] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS The nuclear Pregnane X Receptor (PXR, NR1I2) plays a pivotal role in xenobiotic metabolism. Here, we sought to characterize a new PXR isoform (hereafter called small PXR or sPXR) stemming from alternative transcription starting sites downstream of a CpG Island located near exon 3 of the human PXR gene. METHODS Quantitative RT-PCR, western blot, methylation-specific PCR, luciferase reporter assays, electro-mobility shift assays, and stable sPXR overexpression were used to examine sPXR expression and function in hepatocellular cell lines, healthy human liver (n=99), hepatocellular adenomas (HCA, n=91) and hepatocellular carcinoma samples (HCC, n=213). RESULTS Liver sPXR mRNA expression varied importantly among individuals and encodes a 37kDa nuclear protein consisting of the ligand-binding domain of PXR that behaves as a dominant-negative of PXR transactivation properties. In vitro methylation of the sPXR upstream promoter abolished its activity, while the demethylation agent 5-aza-2-deoxycytidine increased sPXR mRNA expression in several cell lines. Finally, we observed that sPXR mRNA expression displayed significant differences related to HCA or HCC biology. CONCLUSIONS This novel PXR isoform, displaying a dominant-negative activity and regulated by DNA methylation, is associated with outcomes of patients with HCC treated by resection, suggesting that it represents a key modulator of PXR.
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Affiliation(s)
- Cyril Breuker
- Centre National de la Recherche Scientifique, UMR5203, Institut de Génomique Fonctionnelle, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, France; Université Montpellier 1 et 2, UMR5203, Montpellier, France; Service de Pharmacie, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France
| | - Chris Planque
- Centre National de la Recherche Scientifique, UMR5203, Institut de Génomique Fonctionnelle, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, France; Université Montpellier 1 et 2, UMR5203, Montpellier, France
| | - Fatemeh Rajabi
- Centre National de la Recherche Scientifique, UMR5203, Institut de Génomique Fonctionnelle, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, France; Université Montpellier 1 et 2, UMR5203, Montpellier, France
| | - Jean-Charles Nault
- Institut National de la Santé et de la Recherche Médicale, U674, Paris, France; Université Paris Descartes, Paris, France
| | - Gabrielle Couchy
- Institut National de la Santé et de la Recherche Médicale, U674, Paris, France; Université Paris Descartes, Paris, France
| | - Jessica Zucman-Rossi
- Institut National de la Santé et de la Recherche Médicale, U674, Paris, France; Université Paris Descartes, Paris, France
| | - Alexandre Evrard
- Centre National de la Recherche Scientifique, UMR5203, Institut de Génomique Fonctionnelle, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, France; Université Montpellier 1 et 2, UMR5203, Montpellier, France; Laboratoire de Biochimie, Centre Hospitalier Universitaire, Nîmes, France
| | - Jovana Kantar
- Laboratoire de Biochimie, Centre Hospitalier Universitaire, Nîmes, France
| | - Eric Chevet
- Institut National de la Santé et de la Recherche Médicale, U1053, Bordeaux, France
| | - Paulette Bioulac-Sage
- Service d'anatomie pathologique, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - Jeanne Ramos
- Service d'anatomie pathologique, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - Eric Assenat
- Service d'anatomie pathologique, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France; Centre Val d'Aurelle, Montpellier, France
| | - Dominique Joubert
- Centre National de la Recherche Scientifique, UMR5203, Institut de Génomique Fonctionnelle, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, France; Université Montpellier 1 et 2, UMR5203, Montpellier, France
| | - Julie Pannequin
- Centre National de la Recherche Scientifique, UMR5203, Institut de Génomique Fonctionnelle, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, France; Université Montpellier 1 et 2, UMR5203, Montpellier, France
| | - Frédéric Hollande
- Centre National de la Recherche Scientifique, UMR5203, Institut de Génomique Fonctionnelle, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, France; Université Montpellier 1 et 2, UMR5203, Montpellier, France; Department of Pathology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Jean Marc Pascussi
- Centre National de la Recherche Scientifique, UMR5203, Institut de Génomique Fonctionnelle, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, France; Université Montpellier 1 et 2, UMR5203, Montpellier, France.
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Garcia AV, Charrier A, Schikora A, Bigeard J, Pateyron S, de Tauzia-Moreau ML, Evrard A, Mithöfer A, Martin-Magniette ML, Virlogeux-Payant I, Hirt H. Salmonella enterica flagellin is recognized via FLS2 and activates PAMP-triggered immunity in Arabidopsis thaliana. Mol Plant 2014; 7:657-74. [PMID: 24198231 DOI: 10.1093/mp/sst145] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Infections with Salmonella enterica belong to the most prominent causes of food poisoning and infected fruits and vegetables represent important vectors for salmonellosis. Recent evidence indicates that plants recognize S. enterica and raise defense responses. Nonetheless, the molecular mechanisms controlling the interaction of S. enterica with plants are still largely unclear. Here, we show that flagellin from S. enterica represents a prominent pathogen-associated molecular pattern (PAMP) in Arabidopsis thaliana, which induces PAMP-triggered immunity (PTI) via the recognition of the flg22 domain by the receptor kinase FLS2. The Arabidopsis fls2 mutant shows reduced though not abolished PTI activation, indicating that plants rely also on recognition of other S. enterica PAMPs. Interestingly, the S. enterica type III secretion system (T3SS) mutant prgH- induced stronger defense gene expression than wild-type bacteria in Arabidopsis, suggesting that T3SS effectors are involved in defense suppression. Furthermore, we observe that S. enterica strains show variation in the flg22 epitope, which results in proteins with reduced PTI-inducing activity. Altogether, these results show that S. enterica activates PTI in Arabidopsis and suggest that, in order to accomplish plant colonization, S. enterica evolved strategies to avoid or suppress PTI.
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Affiliation(s)
- Ana Victoria Garcia
- Unité de Recherche en Génomique Végétale (URGV), UMR INRA/CNRS/Université d'Evry Val d'Essonne, 91057 Evry, France
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Mathieu T, Bermont L, Boyer JC, Versuyft C, Evrard A, Cuvelier I, Couderc R, Peoc'h K. Lexical fields of predictive and personalized medicine. ACTA ACUST UNITED AC 2013; 28:125-32. [PMID: 23740683 DOI: 10.1515/dmdi-2013-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 11/15/2022]
Abstract
With human genome mapping, the omics revolution and the empowering sequencing technologies developed at the turn of the century, the new goals in medicine are to switch from population medicine to individualized therapies, not only to cure diseases but also to prevent them. The purpose of this review by the pharmacogenetics and predictive medicine working group of the French clinical biology society (SFBC) is to situate in their correct context the notions of personalized medicine, pharmacogenetics, genetics and genomics, emphasizing their interactions and discussing their significance for researchers and clinicians.
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Affiliation(s)
- Thierry Mathieu
- Institut de Biologie Clinique Schaffner, Lens, LABCO, Paris, France
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43
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Mazard T, Causse A, Simony J, Leconet W, Vezzio-Vie N, Torro A, Jarlier M, Evrard A, Del Rio M, Assenat E, Martineau P, Ychou M, Robert B, Gongora C. Sorafenib overcomes irinotecan resistance in colorectal cancer by inhibiting the ABCG2 drug-efflux pump. Mol Cancer Ther 2013; 12:2121-34. [PMID: 23960095 DOI: 10.1158/1535-7163.mct-12-0966] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite recent advances in the treatment of colorectal cancer (CRC), tumor resistance is a frequent cause of chemotherapy failure. Therefore, new treatment options are needed to improve survival of patients with irinotecan-refractory CRCs, particularly those bearing KRAS mutations that preclude the use of anti-EGFR therapies. In this study, we investigated whether sorafenib could reverse irinotecan resistance, thereby enhancing the therapeutic efficacy of routinely used irinotecan-based chemotherapy. We used both in vitro (the HCT116, SW48, SW620, and HT29 colon adenocarcinoma cell lines and four SN-38-resistant HCT-116 and SW48 clones) and in vivo models (nude mice xenografted with SN-38-resistant HCT116 cells) to test the efficacy of sorafenib alone or in combination with irinotecan or its active metabolite, SN-38. We have shown that sorafenib improved the antitumoral activity of irinotecan in vitro, in both parental and SN-38-resistant colon adenocarcinoma cell lines independently of their KRAS status, as well as in vivo, in xenografted mice. By inhibiting the drug-efflux pump ABCG2, sorafenib favors irinotecan intracellular accumulation and enhances its toxicity. Moreover, we found that sorafenib improved the efficacy of irinotecan by inhibiting the irinotecan-mediated p38 and ERK activation. In conclusion, our results show that sorafenib can suppress resistance to irinotecan and suggest that sorafenib could be used to overcome resistance to irinotecan-based chemotherapies in CRC, particularly in KRAS-mutated tumors.
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Affiliation(s)
- Thibault Mazard
- Corresponding Author: Dr. Céline Gongora, IRCM INSERM U896, 208, rue des Apothicaires, 34298 Montpellier, France.
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Evrard A, Kumar M, Lecourieux D, Lucks J, von Koskull-Döring P, Hirt H. Regulation of the heat stress response in Arabidopsis by MPK6-targeted phosphorylation of the heat stress factor HsfA2. PeerJ 2013; 1:e59. [PMID: 23638397 PMCID: PMC3628891 DOI: 10.7717/peerj.59] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [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: 11/28/2012] [Accepted: 03/07/2013] [Indexed: 01/02/2023] Open
Abstract
So far little is known on the functional role of phosphorylation in the heat stress response of plants. Here we present evidence that heat stress activates the Arabidopsis mitogen-activated protein kinase MPK6. In vitro and in vivo evidence is provided that MPK6 specifically targets the major heat stress transcription factor HsfA2. Activation of MPK6 results in complex formation with HsfA2. MPK6 phosphorylates HsfA2 on T249 and changes its intracellular localisation. Protein kinase and phosphatase inhibitor studies indicate that HsfA2 protein stability is regulated in a phosphorylation-dependent manner, but this mechanism is independent of MPK6. Overall, our data show that heat stress-induced targeting of HsfA2 by MPK6 participates in the complex regulatory mechanism how plants respond to heat stress.
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Affiliation(s)
| | - Mukesh Kumar
- Department of Plant Molecular Biology, Max F. Perutz Laboratories, University of Vienna, Vienna, Austria
| | - David Lecourieux
- UMR Ecophysiologie et Génomique Fonctionnelle de la Vigne, France
| | - Jessica Lucks
- Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University, Frankfurt, Germany
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45
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Roy SJ, Huang W, Wang XJ, Evrard A, Schmöckel SM, Zafar ZU, Tester M. A novel protein kinase involved in Na(+) exclusion revealed from positional cloning. Plant Cell Environ 2013; 36:553-68. [PMID: 22897323 DOI: 10.1111/j.1365-3040.2012.02595.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Salinity is a major abiotic stress which affects crop plants around the world, resulting in substantial loss of yield and millions of dollars of lost revenue. High levels of Na(+) in shoot tissue have many adverse effects and, crucially, yield in cereals is commonly inversely proportional to the extent of shoot Na(+) accumulation. We therefore need to identify genes, resistant plant cultivars and cellular processes that are involved in salinity tolerance, with the goal of introducing these factors into commercially available crops. Through the use of an Arabidopsis thaliana mapping population, we have identified a highly significant quantitative trait locus (QTL) linked to Na(+) exclusion. Fine mapping of this QTL identified a protein kinase (AtCIPK16), related to AtSOS2, that was significantly up-regulated under salt stress. Greater Na(+) exclusion was associated with significantly higher root expression of AtCIPK16, which is due to differences in the gene's promoter. Constitutive overexpression of the gene in Arabidopsis leads to plants with significant reduction in shoot Na(+) and greater salinity tolerance. amiRNA knock-downs of AtCIPK16 in Arabidopsis show a negative correlation between the expression levels of the gene and the amount of shoot Na(+) . Transgenic barley lines overexpressing AtCIPK16 show increased salinity tolerance.
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Affiliation(s)
- S J Roy
- Australian Centre for Plant Functional Genomics and the University of Adelaide, PMB 1, Glen Osmond, SA 5064, Australia.
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46
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Affiliation(s)
- Alexandre Evrard
- Biochemistry & Toxicology Department, University Hospital of Nîmes, Nîmes, France
| | - Bruno Lacarelle
- Pharmacokinetics Laboratory, U911 Cro2 Aix Marseille University, APHM, Marseille, France
| | - Joseph Ciccolini
- Transfer Oncology Laboratory & Pharmacokinetics Laboratory, U911 Cro2 Aix-Marseille University, APHM, Marseille, France
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47
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Evrard A, Mbatchi L. Genetic Polymorphisms of Drug Metabolizing Enzymes and Transporters: The Long Way from Bench to Bedside. Curr Top Med Chem 2012; 12:1720-9. [DOI: 10.2174/156802612803531388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 04/13/2012] [Accepted: 04/13/2012] [Indexed: 11/22/2022]
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49
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Ciccolini J, Evrard A, M’Batchi L, Pourroy B, Mercier C, Iliadis A, Lacarelle B, Verschuur A, Ouafik L, André N. CDA deficiency as a possible culprit for life-threatening toxicities after cytarabine plus 6-mercaptopurine therapy: pharmacogenetic investigations. Pharmacogenomics 2012; 13:393-7. [DOI: 10.2217/pgs.11.175] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
We describe here the case of a 7-year old girl with lymphoma who developed life-threatening toxicities upon cytarabine plus mercaptopurine. Surprisingly, initial investigations on canonical thiopurine methyltransferase genetic polymorphism proved to be negative. We focused next on deregulations affecting the CDA gene implicated in the liver disposition of cytarabine. This patient was homozygous for both the 79A>C and the -31delC polymorphisms on the CDA gene and promoter, two genotypes with reported opposite effects on CDA phenotype. To determine the CDA status of this patient, additional functional testing was performed and eventually demonstrated that this patient was a poor metabolizer. This case demonstrates that besides affecting thiopurine methyltransferase, dysregulations with CDA should be screened to anticipate toxicities with the cytarabine plus mercaptopurine combination.
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Affiliation(s)
- Joseph Ciccolini
- Laboratoire de Pharmacocinétique, La Timone University Hospital of Marseille, UMR 911, Aix-Marseille University, Marseille, France
- Laboratoire de Transfert en Oncologie, Nord University Hospital of Marseille, UMR 911, Aix-Marseille University, Marseille, France
- Pharmacokinetics Laboratory, UMR 911, Aix-Marseille University, Marseille, France
| | - Alexandre Evrard
- Clinical Biochemistry Laboratory, Caremeau University Hospital of Nîmes, France
| | - Lithaty M’Batchi
- Clinical Biochemistry Laboratory, Caremeau University Hospital of Nîmes, France
| | - Bertrand Pourroy
- Pharmacy Departement, La Timone University Hospital of Marseille, France
| | - Cédric Mercier
- Pharmacokinetics Laboratory, UMR 911, Aix-Marseille University, Marseille, France
| | - Athanassios Iliadis
- Pharmacokinetics Laboratory, UMR 911, Aix-Marseille University, Marseille, France
| | - Bruno Lacarelle
- Laboratoire de Pharmacocinétique, La Timone University Hospital of Marseille, UMR 911, Aix-Marseille University, Marseille, France
- Pharmacokinetics Laboratory, UMR 911, Aix-Marseille University, Marseille, France
| | - Arnaud Verschuur
- Hematology & Oncology Pediatric Department, Hôpital-Enfants La Timone, AP-HM, 235 rue St Pierre, 13885 Marseille Cedex 5, France
| | - L’Houcine Ouafik
- Laboratoire de Transfert en Oncologie, Nord University Hospital of Marseille, UMR 911, Aix-Marseille University, Marseille, France
| | - Nicolas André
- Hematology & Oncology Pediatric Department, Hôpital-Enfants La Timone, AP-HM, 235 rue St Pierre, 13885 Marseille Cedex 5, France
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Dahan L, Ciccolini J, Evrard A, Mbatchi L, Tibbitts J, Ries P, Norguet E, Mercier C, Iliadis A, Ouafik L, Lacarelle B, Seitz JF. Sudden Death Related to Toxicity in a Patient on Capecitabine and Irinotecan Plus Bevacizumab Intake: Pharmacogenetic Implications. J Clin Oncol 2012; 30:e41-4. [DOI: 10.1200/jco.2011.37.9289] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Laetitia Dahan
- La Timone University Hospital of Marseille, Aix-Marseille Univ, CRO2 UMR 911, Marseille, France
| | - Joseph Ciccolini
- Hôpital Nord; La Timone University Hospital of Marseille; Aix-Marseille Univ, CRO2 UMR 911, Marseille, France
| | | | | | | | - Pauline Ries
- La Timone University Hospital of Marseille, Marseille, France
| | | | | | | | - L'Houcine Ouafik
- Nord University Hospital of Marseille; Aix-Marseille Univ, CRO2 UMR 911, Marseille, France
| | - Bruno Lacarelle
- La Timone University Hospital of Marseille, Aix-Marseille Univ, CRO2 UMR 911, Marseille, France
| | - Jean-Francois Seitz
- La Timone University Hospital of Marseille, Aix-Marseille Univ, CRO2 UMR 911, Marseille, France
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