1
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Nindra U, Hong JH, Balakrishnar B, Pal A, Chua W. Review of Toxicities of PARP Inhibitors in Metastatic Castrate Resistant Prostate Cancer. Clin Genitourin Cancer 2023; 21:183-193. [PMID: 35927195 DOI: 10.1016/j.clgc.2022.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 04/23/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 02/01/2023]
Abstract
There is emerging evidence for the use of poly (ADP-ribose) polymerase inhibitors (PARPi) in patients with mCRPC with patients harboring germline or somatic mutations deriving clinical benefit. However, the toxicity profile of PARPi in mCRPC is not well established. In March 2022 a literature search was conducted across 4 databases - Medline, PubMed, Cochrane Library and Embase. In total, 14 relevant studies were identified cumulating in 2066 patients that were treated with PARPi. The overall ORR to PARPi alone or in combination with other therapy was 37% (246/666). In 5trials that investigated PARPi alone, the ORR was 39% (141/361). Treatment emergent adverse events (TEAEs) of any grade were reported in 96% (1034/1080) in PARPi treatment arms. TEAEs of grade >= 3 were reported in 57% (611/1080). 45% (457/1006) experienced treatment interruption whilst 31% (310/989) required dose reductions. 11% (114/1006) of patients had their treatment discontinued directly as the result of toxicity associated with the trial medications. The most common hematological toxicity was anemia, reported in 490/1160 (42%) patients. and lowered white blood cell count were the next 2most common toxicities, reported in 186/655 (28%) and 133/729 (18%) respectively. The 3most common non-hematological toxicities reported were nausea, fatigue and anorexia reported in 440/1013 (43%), 340/1013 (34%) and 274/1013 (27%) patients respectively. Overall, TRAEs associated with individual PARPi are still emerging with hematological toxicities being most apparent. Further toxicities will be informed from future clinical trials to allow improved treatment selection, education and management of toxicities in prostate cancer.
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Affiliation(s)
- Udit Nindra
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Jun Hee Hong
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Abhijit Pal
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Wei Chua
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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2
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Hong JH, Nindra U, Nguyen R, Gassner P, Balakrishnar B, Rutland T. A Rare Case of Castrate-Resistant Prostate Adenocarcinoma with a Unilateral Testicular Metastasis Mimicking a Primary Testicular Tumour. Case Rep Oncol 2022; 15:1055-1062. [PMID: 36605230 PMCID: PMC9808135 DOI: 10.1159/000525842] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Prostate adenocarcinoma with testicular metastasis is rare, present in up to 4% of autopsy diagnoses, and presents symptomatically in less than 0.5% of cases. We report an unusual case of a 55-year-old male who developed a symptomatic testicular metastasis from primary prostate cancer 4 years after initial diagnosis of metastatic castrate-sensitive prostate cancer with nodal and bone-only involvement. The patient had orchidectomy, histologically confirming the metastasis and revealing sparing of the spermatic cord. Prior treatment for his metastatic castrate-sensitive prostate cancer had included androgen deprivation therapy and upfront docetaxel chemotherapy. He had received palliative radiotherapy for symptomatic bone metastasis and managed on enzalutamide for castrate-resistant disease for the preceding 22 months with ongoing PSA response at the time of diagnosis of new testicular metastasis, with a further significant PSA response following his "testicular metastasectomy." At the time of diagnosis of testicular metastasis, he did not have any evidence of other visceral metastases, and his metastatic disease otherwise remained radiologically stable. We describe his disease course, treatment and outline the rare nature of his case of testicular metastasis from prostate cancer.
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Affiliation(s)
- Jun Hee Hong
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia
| | - Udit Nindra
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia
| | - Rebecca Nguyen
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia
| | - Paul Gassner
- Department of Urology, Liverpool Hospital, Sydney, NSW, Australia
| | | | - Tristan Rutland
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW, Australia
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3
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Khan T, Lock JG, Ma Y, Harman DG, de Souza P, Chua W, Balakrishnar B, Scott KF, Becker TM. Choice of antibody is critical for specific and sensitive detection of androgen receptor splice variant-7 in circulating tumor cells. Sci Rep 2022; 12:16159. [PMID: 36171234 PMCID: PMC9519917 DOI: 10.1038/s41598-022-20079-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
Androgen receptor variant 7 (AR-V7) is an important biomarker to guide treatment options for castration-resistant prostate cancer (CRPC) patients. Its detectability in circulating tumour cells (CTCs) opens non-invasive diagnostic avenues. While detectable at the transcript level, AR-V7 protein detection in CTCs may add additional information and clinical relevance. The aim of this study was to compare commercially available anti-AR-V7 antibodies and establish reliable AR-V7 immunocytostaining applicable to CTCs from prostate cancer (PCa) patients. We compared seven AR-V7 antibodies by western blotting and immmunocytostaining using a set of PCa cell lines with known AR/AR-V7 status. The emerging best antibody was validated for detection of CRPC patient CTCs enriched by negative depletion of leucocytes. The anti-AR-V7 antibody, clone E308L emerged as the best antibody in regard to signal to noise ratio with a specific nuclear signal. Moreover, this antibody detects CRPC CTCs more efficiently compared to an antibody previously shown to detect AR-V7 CTCs. We have determined the best antibody for AR-V7 detection of CTCs, which will open future studies to correlate AR-V7 subcellular localization and potential co-localization with other proteins and cellular structures to patient outcomes.
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Affiliation(s)
- Tanzila Khan
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia. .,Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, 2170, Australia. .,Centre of Circulating Tumour Cells Diagnostics & Research, Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia. .,South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, 2170, Australia.
| | - John G Lock
- Centre of Circulating Tumour Cells Diagnostics & Research, Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Yafeng Ma
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.,Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, 2170, Australia.,Centre of Circulating Tumour Cells Diagnostics & Research, Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, 2170, Australia
| | - David G Harman
- School of Science, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Paul de Souza
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.,Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, 2170, Australia.,Centre of Circulating Tumour Cells Diagnostics & Research, Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia
| | - Wei Chua
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.,Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, 2170, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, 2170, Australia.,Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, 2170, Australia
| | | | - Kieran F Scott
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.,Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, 2170, Australia
| | - Therese M Becker
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia. .,Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, 2170, Australia. .,Centre of Circulating Tumour Cells Diagnostics & Research, Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia. .,South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, 2170, Australia.
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4
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Arasaratnam M, Balakrishnar B, Crumbaker M, Turner S, Hayden AJ, Brooks A, Patel MI, Lau H, Woo H, Bariol S, Gurney H. Patterns of care and outcomes of men with germ cell tumors in a high-volume Australian center. Asia Pac J Clin Oncol 2021; 18:e23-e31. [PMID: 34152083 DOI: 10.1111/ajco.13548] [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: 03/28/2020] [Accepted: 11/30/2020] [Indexed: 11/27/2022]
Abstract
AIM To evaluate disease presentation, treatment practices, and outcomes of patients with germ cell tumor (GCT) treated in a high-volume cancer center in Australia. METHODS This is a retrospective analysis of 609 patients diagnosed with GCT in the Sydney West Cancer Network between 1990 and 2013. Cause and date of death, and second malignancy information was sourced from The Centre for Health Record Linkage. RESULTS The median age was 33 years (range, 14-85). Primary site was testis in 590 (96.9%), mediastinum in nine (1.5%), and retroperitoneum in nine (1.5%). History of undescended testis was present in 48 (7.9%). Pure seminoma was seen in 334 (54.8%), with 274 (82.0%) being stage I. There was a decline in use of adjuvant radiotherapy from 83% in 1990-1997 to 29% in 2006-2013. Nonseminoma GCT (NSGCT) was diagnosed in 275 (45.2%), with 162 (58.9%) being stage 1. Active surveillance has increased as the initial treatment, from 58% between 1990 and 1997 to 89% between 2006 and 2013. Metastatic disease at presentation was seen in 162 (26.6%): 55 (34.0%) seminoma and 107 (66.0%) NSGCT. With median of 15-year follow-up, 18 (3.0%) have died from GCT and 70 (11.5%) from all causes. Ten-year overall survival was 93% and GCT-specific survival was 97%. Forty patients developed a secondary malignancy, with 38 receiving chemotherapy, radiotherapy, or both. CONCLUSIONS This large Australian series illustrates a changing pattern of care and outcomes and compares them favorably with other series. This serves as a basis for future comparison of outcomes for this malignancy.
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Affiliation(s)
- Malmaruha Arasaratnam
- Department of Medical Oncology, Gosford Hospital, Sydney, New South Wales, Australia
| | - Bavanthi Balakrishnar
- Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Megan Crumbaker
- Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, New South Wales, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Amy J Hayden
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Andrew Brooks
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
| | - Howard Lau
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Henry Woo
- Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia.,Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Simon Bariol
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
| | - Howard Gurney
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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5
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Lee CI, Low SK, Maldonado R, Fox P, Balakrishnar B, Coulter S, de Bruijn P, Koolen SLW, Gao B, Lynch J, Zdenkowski N, Hui R, Liddle C, Mathijssen RHJ, Wilcken N, Wong M, Gurney H. Simplified phenotyping of CYP2D6 for tamoxifen treatment using the N-desmethyl-tamoxifen/ endoxifen ratio. Breast 2020; 54:229-234. [PMID: 33161337 PMCID: PMC7653100 DOI: 10.1016/j.breast.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction CYP2D6 protein activity can be inferred from the ratio of N-desmethyl-tamoxifen (NDMT) to endoxifen (E). CYP2D6 polymorphisms are common and can affect CYP2D6 protein activity and E level. Some retrospective studies indicate that E < 16 nM may relate to worse outcome. Materials and methods A target NDMT/E ratio was defined as associated with an E level of 15 nM in the 161 patient Test cohort of tamoxifen-treated patients, dichotomizing them into ‘Normal’ (NM) and ‘Slow’ (SM) CYP2D6 metabolizer groups. This ratio was then tested on a validation cohort of 52 patients. Patients were phenotyped based on the standard method (ultrarapid/extensive, intermediate or poor metabolizers; UM/EM, IM, PM) or a simplified system based on whether any variant allele (V) vs wildtype (wt) was present (wt/wt, wt/V, V/V). Comprehensive CYP2D6 genotyping was undertaken on germline DNA. Results A target NDMT/E ratio of 35 correlated with the 15 nM E level, dichotomizing patients into NM (<35; N = 117) and SM (>35; N = 44) groups. The ratio was independently validated by a validation cohort. The simplified system was better in predicting patients without slow metabolism, with specificity and sensitivity of 96% and 44% respectively, compared with the standard method - sensitivity 81% and specificity 83%. Conclusions The simplified classification system based on whether any variant was present better identified patients who were truly not CYP2D6 slow metabolizers more accurately than the current system. However, as CYP2D6 genotype is not the only determinant of endoxifen level, we recommend that direct measurement of endoxifen should also be considered. We used a ratio of two tamoxifen metabolites to categorize CYP2D6 metabolizer groups. We developed a simplified system to identify slow metabolizers based on genotype. The simplified system was more accurate than the standard complex system.
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Affiliation(s)
- Clara Inkyung Lee
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Department of Medical Oncology, Bankstown-Lidcombe Hospital, Bankstown, Australia; Faculty of Medicine, University of New South Wales, Australia.
| | - Siew Kee Low
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | | | - Peter Fox
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | | | - Sally Coulter
- Westmead Institute for Medical Research, Westmead, Australia
| | - Peter de Bruijn
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Bo Gao
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Jodi Lynch
- St George Hospital, Kogarah, Australia; Sutherland Hospital, Caringbah, Australia
| | | | - Rina Hui
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Christopher Liddle
- Sydney Medical School, University of Sydney, Camperdown, Australia; Westmead Institute for Medical Research, Westmead, Australia
| | | | - Nicholas Wilcken
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Mark Wong
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia; Macquarie University, Australia
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6
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Jeffreys SA, Powter B, Balakrishnar B, Mok K, Soon P, Franken A, Neubauer H, de Souza P, Becker TM. Endocrine Resistance in Breast Cancer: The Role of Estrogen Receptor Stability. Cells 2020; 9:cells9092077. [PMID: 32932819 PMCID: PMC7564140 DOI: 10.3390/cells9092077] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/04/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022] Open
Abstract
Therapy of hormone receptor positive breast cancer (BCa) generally targets estrogen receptor (ER) function and signaling by reducing estrogen production or by blocking its interaction with the ER. Despite good long-term responses, resistance to treatment remains a significant issue, with approximately 40% of BCa patients developing resistance to ET. Mutations in the gene encoding ERα, ESR1, have been identified in BCa patients and are implicated as drivers of resistance and disease recurrence. Understanding the molecular consequences of these mutations on ER protein levels and its activity, which is tightly regulated, is vital. ER activity is in part controlled via its short protein half-life and therefore changes to its stability, either through mutations or alterations in pathways involved in protein stability, may play a role in therapy resistance. Understanding these connections and how ESR1 alterations could affect protein stability may identify novel biomarkers of resistance. This review explores the current reported data regarding posttranslational modifications (PTMs) of the ER and the potential impact of known resistance associated ESR1 mutations on ER regulation by affecting these PTMs in the context of ET resistance.
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Affiliation(s)
- Sarah A. Jeffreys
- Centre for Circulating Tumour Cells Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool NSW 2170, Australia; (B.P.); (P.S.); (A.F.); (P.d.S.); (T.M.B.)
- School of Medicine, Western Sydney University, Campbelltown NSW 2560, Australia
- Correspondence: ; Tel.: +61-2-873-89022
| | - Branka Powter
- Centre for Circulating Tumour Cells Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool NSW 2170, Australia; (B.P.); (P.S.); (A.F.); (P.d.S.); (T.M.B.)
| | - Bavanthi Balakrishnar
- Department of Medical Oncology, Liverpool Hospital, Liverpool NSW 2170, Australia; (B.B.); (K.M.)
| | - Kelly Mok
- Department of Medical Oncology, Liverpool Hospital, Liverpool NSW 2170, Australia; (B.B.); (K.M.)
| | - Patsy Soon
- Centre for Circulating Tumour Cells Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool NSW 2170, Australia; (B.P.); (P.S.); (A.F.); (P.d.S.); (T.M.B.)
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool NSW 2170, Australia
- Department of Surgery, Bankstown Hospital, Bankstown NSW 2200, Australia
| | - André Franken
- Centre for Circulating Tumour Cells Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool NSW 2170, Australia; (B.P.); (P.S.); (A.F.); (P.d.S.); (T.M.B.)
- Department of Obstetrics and Gynaecology, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Hans Neubauer
- Department of Obstetrics and Gynaecology, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Paul de Souza
- Centre for Circulating Tumour Cells Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool NSW 2170, Australia; (B.P.); (P.S.); (A.F.); (P.d.S.); (T.M.B.)
- School of Medicine, Western Sydney University, Campbelltown NSW 2560, Australia
- Department of Medical Oncology, Liverpool Hospital, Liverpool NSW 2170, Australia; (B.B.); (K.M.)
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool NSW 2170, Australia
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia
| | - Therese M. Becker
- Centre for Circulating Tumour Cells Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool NSW 2170, Australia; (B.P.); (P.S.); (A.F.); (P.d.S.); (T.M.B.)
- School of Medicine, Western Sydney University, Campbelltown NSW 2560, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool NSW 2170, Australia
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7
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Hamilton B, Xu K, Honeyball F, Balakrishnar B, Zielinski R. Patterns of immunotherapy use and management of toxicities in regional and tertiary settings. Intern Med J 2019; 49:1010-1015. [PMID: 30693623 DOI: 10.1111/imj.14235] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1) immune checkpoint inhibitors and their subsequent listing on the Pharmaceutical Benefits Scheme for use in metastatic melanomas, renal cell carcinomas and non-small-cell lung cancers has resulted in routine use of these agents in oncology practices, including in regional areas. Although immunotherapeutic agents generally have a favourable toxicity profile compared to chemotherapy, they can provoke immune-related adverse effects (irAE) caused by an unregulated and hyperstimulated immune response. Some of these effects can be serious and life-threatening. AIMS To compare the utilisation of immunotherapy and the rates, management and outcomes of irAE between a regional oncology service and a tertiary service. METHODS We reviewed the medical records for all patients treated with immunotherapy in the participating services for the 5-year period from 31 July 2012 to 31 July 2017. RESULTS Data demonstrated that rates of immunotherapy use are both similar and increasing across the tertiary and regional services. The rates, types and severity of irAE are equivalent and in concordance with pre-existing literature. Immune-related adverse events appear to be identified and treated earlier in the regional service with the corresponding reduction in the duration of immunosuppression and requirement for inpatient management. CONCLUSION The use of immunotherapy in a regional setting is safe and equivalent to that of a tertiary centre.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- CTLA-4 Antigen/antagonists & inhibitors
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Drug-Related Side Effects and Adverse Reactions/epidemiology
- Female
- Humans
- Immunotherapy/adverse effects
- Immunotherapy/methods
- Lung Neoplasms/drug therapy
- Male
- Melanoma/secondary
- Middle Aged
- Neoplasm Staging
- Oncology Service, Hospital
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Retrospective Studies
- Skin Neoplasms/secondary
- Tertiary Care Centers
- Melanoma, Cutaneous Malignant
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Affiliation(s)
- Brett Hamilton
- Liverpool Cancer Therapy Centre, Sydney, New South Wales, Australia
- Central West Cancer Care Centre, Orange Health Service, Sydney, New South Wales, Australia
- Alan Coates Cancer Centre, Dubbo Base Hospital, Dubbo, New South Wales, Australia
| | - Kay Xu
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Florian Honeyball
- Alan Coates Cancer Centre, Dubbo Base Hospital, Dubbo, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Rob Zielinski
- Central West Cancer Care Centre, Orange Health Service, Sydney, New South Wales, Australia
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8
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Nimir M, Ma Y, Jeffreys SA, Opperman T, Young F, Khan T, Ding P, Chua W, Balakrishnar B, Cooper A, De Souza P, Becker TM. Detection of AR-V7 in Liquid Biopsies of Castrate Resistant Prostate Cancer Patients: A Comparison of AR-V7 Analysis in Circulating Tumor Cells, Circulating Tumor RNA and Exosomes. Cells 2019; 8:cells8070688. [PMID: 31288377 PMCID: PMC6678978 DOI: 10.3390/cells8070688] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 05/31/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022] Open
Abstract
Detection of androgen receptor (AR) variant 7 (AR-V7) is emerging as a clinically important biomarker in castrate resistant prostate cancer (CRPC). Detection is possible from tumor tissue, which is often inaccessible in the advanced disease setting. With recent progress in detecting AR-V7 in circulating tumor cells (CTCs), circulating tumor RNA (ctRNA) and exosomes from prostate cancer patients, liquid biopsies have emerged as an alternative to tumor biopsy. Therefore, it is important to clarify whether these approaches differ in sensitivity in order to achieve the best possible biomarker characterization for the patient. In this study, blood samples from 44 prostate cancer patients were processed for CTCs and ctRNA with subsequent AR-V7 testing, while exosomal RNA was isolated from 16 samples and tested. Detection of AR and AR-V7 was performed using a highly sensitive droplet digital PCR-based assay. AR and AR-V7 RNA were detectable in CTCs, ctRNA and exosome samples. AR-V7 detection from CTCs showed higher sensitivity and has proven specificity compared to detection from ctRNA and exosomes. Considering that CTCs are almost always present in the advanced prostate cancer setting, CTC samples should be considered the liquid biopsy of choice for the detection of this clinically important biomarker.
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MESH Headings
- Aged
- Aged, 80 and over
- Alternative Splicing
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Cell-Free Nucleic Acids
- Exosomes
- Humans
- Liquid Biopsy/methods
- Male
- Middle Aged
- Neoplastic Cells, Circulating/chemistry
- Prostatic Neoplasms, Castration-Resistant/blood
- Prostatic Neoplasms, Castration-Resistant/diagnosis
- Prostatic Neoplasms, Castration-Resistant/pathology
- Protein Isoforms/blood
- Protein Isoforms/genetics
- RNA, Neoplasm/blood
- RNA, Neoplasm/genetics
- Receptors, Androgen/blood
- Receptors, Androgen/genetics
- Sensitivity and Specificity
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Affiliation(s)
- Mohammed Nimir
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- South Western Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170, Australia
| | - Yafeng Ma
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- South Western Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170, Australia
| | - Sarah A Jeffreys
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Thomas Opperman
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- South Western Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170, Australia
| | - Francis Young
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- South Western Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170, Australia
| | - Tanzila Khan
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Pei Ding
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Liverpool Hospital, Elizabeth St & Goulburn St, Liverpool, NSW 2170, Australia
| | - Wei Chua
- Liverpool Hospital, Elizabeth St & Goulburn St, Liverpool, NSW 2170, Australia
| | | | - Adam Cooper
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Liverpool Hospital, Elizabeth St & Goulburn St, Liverpool, NSW 2170, Australia
| | - Paul De Souza
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Liverpool Hospital, Elizabeth St & Goulburn St, Liverpool, NSW 2170, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Therese M Becker
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170, Australia.
- South Western Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170, Australia.
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia.
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9
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Lee CI, Fox P, Balakrishnar B, Balleine RL, Gao B, Provan P, Coulter S, Liddle C, Hui R, Wong M, Gurney H, Wilcken N. Tamoxifen-induced severe hot flashes and endoxifen levels: is dose reduction a safe and effective strategy? Breast 2019; 46:52-57. [PMID: 31082762 DOI: 10.1016/j.breast.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/17/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Severe hot flash (HF) toxicity due to tamoxifen can compromise compliance. We previously found that HFs did not correlate with endoxifen level or CYP2D6 genotype. In this study, we reduced tamoxifen dose in patients with severe HFs to determine whether HFs were ameliorated whilst maintaining a purported therapeutic endoxifen level of >15 nM. MATERIALS AND METHODS Twenty patients with severe HFs on 20 mg TAM had CYP2D6genotype, trough level tamoxifen and metabolites measured with Loprinzi HF scores (HFS) derived before and after DR of tamoxifen to 10 mg. Other data collected included demographics, smoking, alcohol, menstrual and breast cancer history, previous chemotherapies, concurrent medications, BMI and other tamoxifen toxicities. RESULTS At the 20 mg tamoxifen dose, endoxifen levels were 25.6, 0-91.9 nM (median, range) with HFS 131, 22-1482 (median, range). Upon DR to 10 mg, median endoxifen level fell to 14.1, 0.6-71.9 nM (difference in means p = 0.11, two-tailed T test) with HFS 47, 5-864 (difference in means p = 0.24, two-tailed T test). Despite lacking statistical significance, 85% of patients reported subjective improvement of HFs with DR. After DR, the proportion of patients with endoxifen level <15 nM increased from 20% to 50%. HFS did not correlate with any other parameter. CONCLUSION DR of tamoxifen from 20 mg to 10 mg daily resulted in halving of endoxifen levels and subjective improvement of HF. While half the dose-reduced patients were below a potential therapeutic level of endoxifen, other recent studies suggest that low endoxifen levels may not indicate reduced effectiveness of tamoxifen.
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Affiliation(s)
- Clara I Lee
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Department of Medical Oncology, Bankstown-Lidcombe Hospital, Bankstown, Australia; Faculty of Medicine, University of New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
| | - Peter Fox
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | | | - Rosemary L Balleine
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Westmead Institute for Medical Research, Westmead, Australia
| | - Bo Gao
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Pamela Provan
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sally Coulter
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Westmead Institute for Medical Research, Westmead, Australia
| | - Christopher Liddle
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Westmead Institute for Medical Research, Westmead, Australia
| | - Rina Hui
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Mark Wong
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Macquarie University, Australia
| | - Nicholas Wilcken
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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10
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Naher S, Padinharakam S, Balakrishnar B, Chua W, Descallar J, Adams D, de Souza P, Harrison M, Lim S. Patterns of Presentation and Treatment Outcomes of Non-clear-cell Renal Cell Carcinoma and Sarcomatoid Renal Cell Carcinoma Patients in 2 Tertiary Referral Centers in Sydney, Australia. Clin Genitourin Cancer 2019; 17:e565-e569. [PMID: 30935815 DOI: 10.1016/j.clgc.2019.02.006] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-clear-cell renal cell carcinoma (nccRCC) and renal cell carcinoma with sarcomatoid features (scRCC) are rare, and represent subtypes with less defined treatment strategies. The aim of this study is to describe the patterns of care and outcomes of these patients in 2 tertiary referral centers in South Western Sydney Local Health District over a 10-year period. PATIENTS AND METHODS Patients with RCC seen at South Western Sydney Local Health District from January 1, 2005 to December 31, 2015 were identified from electronic medical records. For each patient, we extracted details regarding demographics, tumor characteristics, treatment, recurrences, and survival, which was analyzed using the Kaplan-Meier method. RESULTS Of 178 patients with RCC identified between 2005 and 2015, 23% (n = 41) had nccRCC and 8% (n = 15) had scRCC. Twenty-five patients in total had de novo metastatic disease or disease recurrence. The median follow-up was 46 and 16 months for nccRCC and scRCC, respectively. The median overall survival for nccRCC with metastatic disease was 34 months (range, 14 months to not reached). Seventy percent of these patients received systemic therapy. By contrast, the median overall survival for scRCC with metastatic disease was 10 months (range, 1.6-89 months). Less than one-half of the patients with scRCC received systemic therapy in our cohort, with only 34% receiving no more than 1 line of treatment. CONCLUSIONS Our data confirm the rapid and aggressive course of scRCC, highlighting the need for more effective therapeutic strategies in this rare patient population.
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Affiliation(s)
- Sayeda Naher
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia.
| | - Shamsudheen Padinharakam
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; School of Health Sciences, University of Tasmania, Tasmania, Australia; Launceston General Hospital, Launceston, Tasmania, Australia
| | | | - Wei Chua
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Joseph Descallar
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Diana Adams
- Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia
| | - Paul de Souza
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia
| | - Michelle Harrison
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Stephanie Lim
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia
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11
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Arasaratnam M, Balakrishnar B, Crumbaker M, Turner S, Hayden A, Brooks A, Patel M, Gurney H. Patterns of care and outcome of germ cell tumours (GCT) in an Australian high-volume centre. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Sabanathan D, Zhang A, Fox P, Coulter S, Gebski V, Balakrishnar B, Chan M, Liddle C, Gurney H. Dose individualization of sunitinib in metastatic renal cell cancer: toxicity-adjusted dose or therapeutic drug monitoring. Cancer Chemother Pharmacol 2017; 80:385-393. [DOI: 10.1007/s00280-017-3362-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
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13
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Luk AWS, Ma Y, Ding PN, Young FP, Chua W, Balakrishnar B, Dransfield DT, Souza PD, Becker TM. CTC-mRNA (AR-V7) Analysis from Blood Samples-Impact of Blood Collection Tube and Storage Time. Int J Mol Sci 2017; 18:ijms18051047. [PMID: 28498319 PMCID: PMC5454959 DOI: 10.3390/ijms18051047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 03/31/2017] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 12/29/2022] Open
Abstract
Circulating tumour cells (CTCs) are an emerging resource for monitoring cancer biomarkers. New technologies for CTC isolation and biomarker detection are increasingly sensitive, however, the ideal blood storage conditions to preserve CTC-specific mRNA biomarkers remains undetermined. Here we tested the preservation of tumour cells and CTC-mRNA over time in common anticoagulant ethylene-diamine-tetra-acetic acid (EDTA) and acid citrate dextrose solution B (Citrate) blood tubes compared to preservative-containing blood tubes. Blood samples spiked with prostate cancer cells were processed after 0, 24, 30, and 48 h storage at room temperature. The tumour cell isolation efficiency and the mRNA levels of the prostate cancer biomarkers androgen receptor variant 7 (AR-V7) and total AR, as well as epithelial cell adhesion molecule (EpCAM) were measured. Spiked cells were recovered across all storage tube types and times. Surprisingly, tumour mRNA biomarkers were readily detectable after 48 h storage in EDTA and Citrate tubes, but not in preservative-containing tubes. Notably, AR-V7 expression was detected in prostate cancer patient blood samples after 48 h storage in EDTA tubes at room temperature. This important finding presents opportunities for measuring AR-V7 expression from clinical trial patient samples processed within 48 h-a much more feasible timeframe compared to previous recommendations.
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Affiliation(s)
- Alison W S Luk
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
| | - Yafeng Ma
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
| | - Pei N Ding
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
- Department of Medical Oncology, Liverpool Hospital, Elizabeth St & Goulburn St, Liverpool, NSW 2170, Australia.
- Western Sydney University Clinical School, Elizabeth St, Liverpool, NSW 2170, Australia.
| | - Francis P Young
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
- South Western Clinical School, University of New South Wales, Goulburn St., Liverpool, NSW 2170, Australia.
| | - Wei Chua
- Department of Medical Oncology, Liverpool Hospital, Elizabeth St & Goulburn St, Liverpool, NSW 2170, Australia.
| | - Bavanthi Balakrishnar
- Department of Medical Oncology, Liverpool Hospital, Elizabeth St & Goulburn St, Liverpool, NSW 2170, Australia.
| | - Daniel T Dransfield
- Tokai Pharmaceuticals, Inc., 255 State Street, 6th Floor, Boston, MA 0210, USA.
| | - Paul de Souza
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
- Department of Medical Oncology, Liverpool Hospital, Elizabeth St & Goulburn St, Liverpool, NSW 2170, Australia.
- Western Sydney University Clinical School, Elizabeth St, Liverpool, NSW 2170, Australia.
- South Western Clinical School, University of New South Wales, Goulburn St., Liverpool, NSW 2170, Australia.
| | - Therese M Becker
- Centre for Circulating Tumour Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
- Western Sydney University Clinical School, Elizabeth St, Liverpool, NSW 2170, Australia.
- South Western Clinical School, University of New South Wales, Goulburn St., Liverpool, NSW 2170, Australia.
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14
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Ma Y, Luk A, Young FP, Lynch D, Chua W, Balakrishnar B, de Souza P, Becker TM. Droplet Digital PCR Based Androgen Receptor Variant 7 (AR-V7) Detection from Prostate Cancer Patient Blood Biopsies. Int J Mol Sci 2016; 17:E1264. [PMID: 27527157 PMCID: PMC5000662 DOI: 10.3390/ijms17081264] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 06/30/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 11/26/2022] Open
Abstract
Androgen receptor splice variant V7 (AR-V7) was recently identified as a valuable predictive biomarker in metastatic castrate-resistant prostate cancer. Here, we report a new, sensitive and accurate screen for AR-V7 mRNA expression directly from circulating tumor cells (CTCs): We combined EpCAM-based immunomagnetic CTC isolation using the IsoFlux microfluidic platform with droplet digital polymerase chain reaction (ddPCR) to analyze total AR and AR-V7 expression from prostate cancer patients CTCs. We demonstrate that AR-V7 is reliably detectable in enriched CTC samples with as little as five CTCs, even considering tumor heterogeneity, and confirm detection of AR-V7 in CTC samples from advanced prostate cancer (PCa) patients with AR-V7 detection limited to castrate resistant disease status in our sample set. Sensitive molecular analyses of circulating tumor cells (CTCs) or circulating tumor nucleic acids present exciting strategies to detect biomarkers, such as AR-V7 from non-invasive blood samples, so-called blood biopsies.
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Affiliation(s)
- Yafeng Ma
- Centre for Circulating Tumor Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
| | - Alison Luk
- Centre for Circulating Tumor Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
| | - Francis P Young
- Centre for Circulating Tumor Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
- South Western Clinical School, University of New South Wales, Goulburn St., Liverpool, NSW 2170, Australia.
| | - David Lynch
- Centre for Circulating Tumor Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
- Western Sydney University Clinical School, Elizabeth St., Liverpool, NSW 2170, Australia.
| | - Wei Chua
- Department of Medical Oncology, Liverpool Hospital, Elizabeth St & Goulburn St., Liverpool, NSW 2170, Australia.
| | - Bavanthi Balakrishnar
- Department of Medical Oncology, Liverpool Hospital, Elizabeth St & Goulburn St., Liverpool, NSW 2170, Australia.
| | - Paul de Souza
- Centre for Circulating Tumor Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
- South Western Clinical School, University of New South Wales, Goulburn St., Liverpool, NSW 2170, Australia.
- Western Sydney University Clinical School, Elizabeth St., Liverpool, NSW 2170, Australia.
- Department of Medical Oncology, Liverpool Hospital, Elizabeth St & Goulburn St., Liverpool, NSW 2170, Australia.
| | - Therese M Becker
- Centre for Circulating Tumor Cell Diagnostics and Research, Ingham Institute for Applied Medical Research, 1 Campbell St., Liverpool, NSW 2170, Australia.
- South Western Clinical School, University of New South Wales, Goulburn St., Liverpool, NSW 2170, Australia.
- Western Sydney University Clinical School, Elizabeth St., Liverpool, NSW 2170, Australia.
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15
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van Leeuwen MT, Gurney H, Turner JJ, Turner SL, Pearson SA, Laaksonen MA, Harnett P, Balakrishnar B, Sabanathan D, Vajdic CM. Patterns and trends in the incidence of paediatric and adult germ cell tumours in Australia, 1982–2011. Cancer Epidemiol 2016; 43:15-21. [DOI: 10.1016/j.canep.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/03/2016] [Accepted: 05/08/2016] [Indexed: 02/02/2023]
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16
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Lee CI, Low ASK, Fox P, Balakrishnar B, Balleine RL, Gao B, Provan P, Coulter S, Liddle C, Hui R, Wilcken N, Wong M, Gurney H. Simplified CYP2D6 metabolizer phenotype categorization of patients treated with tamoxifen: Role for endoxifen level monitoring? J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Peter Fox
- Royal Prince Alfred Hospital, Annandale, Australia
| | | | - Rosemary L Balleine
- Sydney West Cancer Network, Westmead Millennium Institute, Sydney Medical School-Westmead, Sydney, Australia
| | - Bo Gao
- Blacktown Hospital, Sydney, Australia
| | - Pamela Provan
- University of Sydney, Westmead Hospital, Sydney, Australia
| | | | - Christopher Liddle
- Storr Liver Unit, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Sydney, Australia
| | - Rina Hui
- Westmead Cancer Care Center, Westmead, Australia
| | | | - Mark Wong
- Westmead Hospital, Westmead, Australia
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17
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Fox P, Balleine RL, Lee C, Gao B, Balakrishnar B, Menzies AM, Yeap SH, Ali SS, Gebski V, Provan P, Coulter S, Liddle C, Hui R, Kefford R, Lynch J, Wong M, Wilcken N, Gurney H. Dose Escalation of Tamoxifen in Patients with Low Endoxifen Level: Evidence for Therapeutic Drug Monitoring-The TADE Study. Clin Cancer Res 2016; 22:3164-71. [PMID: 26847054 DOI: 10.1158/1078-0432.ccr-15-1470] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/17/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Endoxifen is the major mediator of tamoxifen effect and endoxifen levels <15 nmol/L may be associated with increased risk of breast cancer recurrence. We increased tamoxifen dose in breast cancer patients with low endoxifen levels and assessed the influence of various parameters on reaching 15 nmol/L and 30 nmol/L endoxifen levels. EXPERIMENTAL DESIGN Tamoxifen dose was increased in those with endoxifen levels below 30 nmol/L. Toxicity, including hot flash score, was measured. CYP2D6 metabolizer status was classified as ultra-rapid (UM), extensive (EM), intermediate (IM), or poor (PM) based genotype of somatic DNA. RESULTS Dosage was escalated in 68 of 122 participants. On 20 mg tamoxifen, 24% had endoxifen levels below 15 nmol/L and this reduced to 6% following dose escalation. In over 50% of cases, there was no identified cause for low endoxifen. Low baseline endoxifen level, and not CYP2D6 metabolizer status, independently predicted reaching threshold targets for both the 15 nmol/L and 30 nmol/L targets (P = 0.04 and 0.003 respectively). The 15 nmol/L target was reached in all UM/EM and IM patients, 63% of PM patients, and 58% of those with baseline endoxifen of <10 nmol/L. There was no correlation between hot flash score and genotype or any tamoxifen metabolite level including endoxifen (R = 0.07). CONCLUSIONS Low endoxifen on standard dose tamoxifen was the only independent predictor of failure to achieve potentially therapeutic levels. Trials examining tamoxifen dose escalation and breast cancer outcome should be guided by endoxifen levels alone, without reference to CYP2D6 genotype or presence of hot flashes. Clin Cancer Res; 22(13); 3164-71. ©2016 AACRSee related commentary by Hertz and Rae, p. 3121.
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Affiliation(s)
- Peter Fox
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Rosemary L Balleine
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. Pathology West, Institute for Clinical Pathology and Medical Research, Westmead, Australia. Sydney Medical School - Westmead, University of Sydney, Sydney, Australia. Westmead Millennium Institute for Medical Research, Westmead, Australia
| | - Clara Lee
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Bo Gao
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. Sydney Medical School - Westmead, University of Sydney, Sydney, Australia
| | | | | | - Shang Heng Yeap
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | | | - Val Gebski
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Pamela Provan
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. Sydney Medical School - Westmead, University of Sydney, Sydney, Australia
| | - Sally Coulter
- Westmead Millennium Institute for Medical Research, Westmead, Australia
| | - Christopher Liddle
- Sydney Medical School - Westmead, University of Sydney, Sydney, Australia. Westmead Millennium Institute for Medical Research, Westmead, Australia. Storr Liver Centre, Westmead Hospital, Westmead, Australia
| | - Rina Hui
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. Sydney Medical School - Westmead, University of Sydney, Sydney, Australia
| | - Richard Kefford
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. Sydney Medical School - Westmead, University of Sydney, Sydney, Australia
| | | | - Mark Wong
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. Sydney Medical School - Westmead, University of Sydney, Sydney, Australia
| | - Nicholas Wilcken
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. Sydney Medical School - Westmead, University of Sydney, Sydney, Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. Sydney Medical School - Westmead, University of Sydney, Sydney, Australia. Faculty of Medicine and Health Sciences, Macquarie University, Sydney Australia.
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18
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Lee CI, Fox P, Balakrishnar B, Balleine RL, Gao B, Provan P, Coulter S, Tomlins M, Liddle C, Hui R, Wong M, Gurney H, Wilcken N. Tamoxifen (TAM)-induced severe hot flashes (HF): Is dose reduction (DR) a safe and effective strategy? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Peter Fox
- Westmead Hospital, Sydney, Australia
| | | | - Rosemary L Balleine
- Sydney West Cancer Network, Westmead Millennium Institute, Sydney Medical School-Westmead, Sydney, Australia
| | - Bo Gao
- Westmead Hospital, Westmead, NSW, Australia
| | - Pamela Provan
- University of Sydney, Westmead Hospital, Sydney, Australia
| | | | - Mark Tomlins
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Christopher Liddle
- Storr Liver Unit, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Sydney, Australia
| | - Rina Hui
- Westmead Cancer Care Ctr, Westmead, Australia
| | - Mark Wong
- Westmead Hospital, Westmead, Australia
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19
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Zhang AY, Fox P, Coulter S, Balakrishnar B, Liddle C, Gurney H. Effect of toxicity-adjusted dose (TAD) of sunitinib on intra-patient variation of trough levels: A longitudinal study in metastatic renal cell cancer (mRCC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
| | - Peter Fox
- Westmead Hospital, Sydney, Australia
| | | | | | - Christopher Liddle
- Storr Liver Unit, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Sydney, Australia
| | - Howard Gurney
- Westmead Hospital, University of Sydney, Sydney, Australia
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20
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Kloth JSL, Klümpen HJ, Yu H, Eechoute K, Samer CF, Kam BLR, Huitema ADR, Daali Y, Zwinderman AH, Balakrishnar B, Bennink RJ, Wong M, Schellens JHM, Mathijssen RHJ, Gurney H. Predictive Value of CYP3A and ABCB1 Phenotyping Probes for the Pharmacokinetics of Sunitinib: the ClearSun Study. Clin Pharmacokinet 2014; 53:261-269. [DOI: 10.1007/s40262-013-0111-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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21
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Fox P, Gao B, Balakrishnar B, Menzies AM, Yeap SH, Ali SS, Gebski V, Provan P, Coulter S, Liddle C, Hui R, Kefford R, Lynch J, Wilcken N, Balleine RL, Gurney H. Factors predicting endoxifen levels in breast cancer patients taking standard-dose tamoxifen and following dose escalation. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.543] [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
543 Background: Tamoxifen (TAM) is transformed via CYP2D6 to its major active metabolite endoxifen (Endox). Recent data suggest that 15nM Endox may be a therapeutic threshold for breast cancer . This study identified predictors of achieving specified Endox target levels (15nM and 30nM) on standard dose TAM, and following dose escalation. Methods: Baseline Endox was measured in 122 breast cancer pts on TAM 20mg pd. Pts with baseline Endox <30nM underwent incremental dose escalation to a maximum of 60mg pd until Endox reached 30nM or dose limiting toxicity. Clinical data were collected and CYP2D6 genotype was used to specify extensive, intermediate or poor metabolizer categories (EM, IM, PM). Multiple regression analyses examined associations between Endox and potential predictive factors. Results: Baseline Endox ranged from 3.1-72.2nM (mean 27.6nM). In 19% (n=23), baseline Endox was below 15nM and 62% (n=76) were below 30nM. Low baseline Endox was associated with CYP2D6 genotype (IM or PM, p<0.001) and younger age (p=0.02). Following dose escalation, 96% (n=117) attained an Endox level of 15nM and 76% (n=93) reached 30nM. Baseline Endox level was the only variable independently associated with achieving both targets (p=0.02, p<0.001 respectively). CYP2D6 genotype did not independently predict attainment of Endox targets following dose escalation (p>0.4). The ratio of Endox to its precursor N-desmethylTAM, an indicator of CYP2D6 activity, was stable with dose escalation, suggesting that CYP2D6 was not saturated. Conclusions: Although IM/PM predict for low Endox on 20mg TAM, only low baseline Endox predicted failure to achieve both 15nM and 30nM targets following dose escalation. These results suggest a role for Endox level monitoring to determine optimal TAM dose. Clinical trial information: NCT01075802. [Table: see text]
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Affiliation(s)
- Peter Fox
- Westmead Hospital, Sydney, Australia
| | - Bo Gao
- Westmead Hospital, Sydney, Australia
| | | | - Alexander M Menzies
- Melanoma Institute Australia, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Shang Heng Yeap
- Johns Hopkins Singapore International Medical Centre, Tan Tock Seng, Singapore
| | | | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Pamela Provan
- University of Sydney, Westmead Hospital, Sydney, Australia
| | | | - Christopher Liddle
- Storr Liver Unit, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Sydney, Australia
| | - Rina Hui
- Westmead Hospital, University of Sydney, Sydney, Australia
| | - Richard Kefford
- Westmead Hospital and Melanoma Institute Australia, Westmead, Australia
| | | | | | - Rosemary L Balleine
- Sydney West Cancer Network, Westmead Millennium Institute, Sydney Medical School-Westmead, Sydney, Australia
| | - Howard Gurney
- Westmead Hospital, University of Sydney, Sydney, Australia
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Gao B, Yeap S, Clements A, Balakrishnar B, Wong M, Gurney H. Evidence for Therapeutic Drug Monitoring of Targeted Anticancer Therapies. J Clin Oncol 2012; 30:4017-25. [DOI: 10.1200/jco.2012.43.5362] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Therapeutic drug monitoring (TDM) provides valuable guidance for dose adjustment of antibiotics, immunosuppressives, antiepileptics, and other drugs, but its use for traditional anticancer therapies has been limited. Perhaps the most important obstacle is the impractical requirement of multiple blood samples to adequately define systemic exposure of drugs that have a short elimination half-life and are given by intermittent intravenous injections. However, the newer targeted anticancer therapies have different pharmacokinetic (PK) and dosing characteristics compared with traditional cytotoxic drugs, making it possible to estimate the steady-state drug exposure with a single trough-level measurement. Recent evidence indicates that certain PK parameters, including trough levels, are correlated with clinical outcomes for many of these agents, including imatinib, sunitinib, rituximab, and cetuximab. Although the current evidence is insufficient to mandate TDM in routine practice, a concerted investigation should be encouraged to determine whether the steady-state trough measurements of targeted agents will have a practical place in the clinical care of patients with cancer.
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Affiliation(s)
- Bo Gao
- Bo Gao, Arthur Clements, Bavanthi Balakrishnar, Mark Wong, and Howard Gurney, Westmead Hospital, Westmead; Bo Gao and Howard Gurney, University of Sydney, Sydney, New South Wales, Australia; and Shang Yeap, Johns Hopkins Hospital,Singapore
| | - Shang Yeap
- Bo Gao, Arthur Clements, Bavanthi Balakrishnar, Mark Wong, and Howard Gurney, Westmead Hospital, Westmead; Bo Gao and Howard Gurney, University of Sydney, Sydney, New South Wales, Australia; and Shang Yeap, Johns Hopkins Hospital,Singapore
| | - Arthur Clements
- Bo Gao, Arthur Clements, Bavanthi Balakrishnar, Mark Wong, and Howard Gurney, Westmead Hospital, Westmead; Bo Gao and Howard Gurney, University of Sydney, Sydney, New South Wales, Australia; and Shang Yeap, Johns Hopkins Hospital,Singapore
| | - Bavanthi Balakrishnar
- Bo Gao, Arthur Clements, Bavanthi Balakrishnar, Mark Wong, and Howard Gurney, Westmead Hospital, Westmead; Bo Gao and Howard Gurney, University of Sydney, Sydney, New South Wales, Australia; and Shang Yeap, Johns Hopkins Hospital,Singapore
| | - Mark Wong
- Bo Gao, Arthur Clements, Bavanthi Balakrishnar, Mark Wong, and Howard Gurney, Westmead Hospital, Westmead; Bo Gao and Howard Gurney, University of Sydney, Sydney, New South Wales, Australia; and Shang Yeap, Johns Hopkins Hospital,Singapore
| | - Howard Gurney
- Bo Gao, Arthur Clements, Bavanthi Balakrishnar, Mark Wong, and Howard Gurney, Westmead Hospital, Westmead; Bo Gao and Howard Gurney, University of Sydney, Sydney, New South Wales, Australia; and Shang Yeap, Johns Hopkins Hospital,Singapore
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Balakrishnar B, Menzies AM, Ali SS, Yeap SH, Gao B, Liddle C, Coulter S, Provan P, Gebski V, Hui R, Kefford R, Wilcken N, Balleine RL, Gurney H. CYP2D6 genotype and adverse effects as indicators of plasma endoxifen in breast cancer patients taking tamoxifen. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.550] [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
550 Background: Tamoxifen is a prodrug. Its principal active metabolite endoxifen is a product of cytochrome P450 2D6 (CYP2D6) metabolism. The CYP2D6 gene is highly polymorphic with a number of relatively common reduced function alleles. The aim of this study was to determine whether plasma endoxifen levels were reflected by CYP2D6 genotype or adverse effects in individuals taking tamoxifen. Methods: Plasma endoxifen was measured by High Performance Liquid Chromatography / Mass Spectroscopy in 90 breast cancer patients taking 20mg tamoxifen per day. Ten CYP2D6 single nucleotide polymorphisms were assessed to designate four putative CYP2D6 functional categories: ultra-rapid (UM), extensive (EM), intermediate (IM) and poor (PM) metabolizers. CYP2D6 inhibitor use and adverse effects were documented. The study was part of an ongoing Australian trial of tamoxifen dose escalation. Results: There was marked variation in plasma endoxifen levels across the cohort (mean 27.6 nM, SD 14.3). Endoxifen levels were significantly associated with metabolizer categories (p<0.001, r= -0.44), but were not distinctive between categories. For example, in the EM category (n=46) endoxifen levels ranged from 3.8-72.2 nM (mean 32.6 nM) with levels in the lowest quartile (3.8-19.7 nM) substantially overlapping the PM category (n=11); 6.1-24.7 nM. Consistent with an impact of non-CYP2D6 genotype related factors on endoxifen levels, endoxifen was significantly lower in 18 patients taking CYP2D6 inhibitor medications (p=0.005). There was no association between endoxifen levels and vasomotor symptoms or other adverse effects of tamoxifen. Conclusions: Endoxifen levels were highly variable in patients taking standard dose tamoxifen, and not predicted by CYP2D6 genotype or adverse effects. Therapeutic monitoring of endoxifen levels may be a useful approach to assess tamoxifen activity.
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Affiliation(s)
| | - Alexander M. Menzies
- Melanoma Institute Australia; Westmead Hospital, University of Sydney, Sydney, Australia
| | | | | | - Bo Gao
- Westmead Hospital, Sydney, Australia
| | - Chris Liddle
- Storr Liver Unit, Westmead Millenium Institute, University of Sydney, Westmead Hospital, Westmead, Australia
| | | | - Pamela Provan
- University of Sydney, Westmead Hospital, Sydney, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Rina Hui
- Westmead Hospital, Sydney University Hospital, Sydney, Australia
| | | | - Nicholas Wilcken
- Westmead Hospital, Sydney University Hospital, Sydney, Australia
| | - Rosemary L Balleine
- Sydney West Cancer Network, Westmead Millenium Institute, Sydney Medical School-Westmead, Sydney, Australia
| | - Howard Gurney
- Westmead Hospital, University of Sydney, Sydney, Australia
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