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Tuteja S, Yu Z, Wilson O, Chen H, Wendt F, Chung CP, Shah SC, Hunt CM, Suzuki A, Chanfreau C, Gorman BR, Joseph J, Luoh S, Napolioni V, Robinson‐Cohen C, Tao R, Zhou J, Chang K, Hung AM. Pharmacogenetic variants and risk of remdesivir-associated liver enzyme elevations in Million Veteran Program participants hospitalized with COVID-19. Clin Transl Sci 2022; 15:1880-1886. [PMID: 35684976 PMCID: PMC9347806 DOI: 10.1111/cts.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/24/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/17/2023] Open
Abstract
Remdesivir is the first US Food and Drug Administration (FDA)-approved drug for the treatment of coronavirus disease 2019 (COVID-19). We conducted a retrospective pharmacogenetic study to examine remdesivir-associated liver enzyme elevation among Million Veteran Program participants hospitalized with COVID-19 between March 15, 2020, and June 30, 2021. Pharmacogene phenotypes were assigned using Stargazer. Linear regression was performed on peak log-transformed enzyme values, stratified by population, adjusted for age, sex, baseline liver enzymes, comorbidities, and 10 population-specific principal components. Patients on remdesivir had higher peak alanine aminotransferase (ALT) values following treatment initiation compared with patients not receiving remdesivir. Remdesivir administration was associated with a 33% and 24% higher peak ALT in non-Hispanic White (NHW) and non-Hispanic Black (NHB) participants (p < 0.001), respectively. In a multivariable model, NHW CYP2C19 intermediate/poor metabolizers had a 9% increased peak ALT compared with NHW normal/rapid/ultrarapid metabolizers (p = 0.015); this association was not observed in NHB participants. In summary, remdesivir-associated ALT elevations appear to be multifactorial, and further studies are needed.
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Affiliation(s)
- Sony Tuteja
- Corporal Michael J. Crescenz VA Medical Center and University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Zhihong Yu
- Tennessee Valley Healthcare System Nashville VA and Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Otis Wilson
- Tennessee Valley Healthcare System Nashville VA and Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Hua‐Chang Chen
- Tennessee Valley Healthcare System Nashville VA and Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Frank Wendt
- VA CT Healthcare System and Yale School of Medicine Department of PsychiatryNew HavenConnecticutUSA
| | - Cecilia P. Chung
- Tennessee Valley Healthcare System Nashville VA and Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Shailja C. Shah
- VA San Diego Healthcare System and Division of GastroenterologyUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Christine M. Hunt
- Durham VA Healthcare System and Duke University School of MedicineDurhamNorth CarolinaUSA
| | - Ayako Suzuki
- Durham VA Healthcare System and Duke University School of MedicineDurhamNorth CarolinaUSA
| | - Catherine Chanfreau
- VA Informatics and Computing Infrastructure (VINCI)VA Salt Lake City Health Care SystemSalt Lake CityUtahUSA
| | | | - Jacob Joseph
- Cardiology Section, VA Boston Healthcare System and Cardiovascular DivisionBrigham & Women's HospitalBostonMassachusettsUSA
| | | | - Valerio Napolioni
- School of Biosciences and Veterinary MedicineUniversity of CamerinoCamerinoItaly,Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Cassianne Robinson‐Cohen
- Division of Nephrology and Hypertension, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ran Tao
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jin Zhou
- Department of Epidemiology and BiostatisticsUniversity of ArizonaTucsonArizonaUSA
| | - Kyong‐Mi Chang
- Corporal Michael J. Crescenz VA Medical Center and University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Adriana M. Hung
- Tennessee Valley Healthcare System Nashville VA and Vanderbilt University Medical CenterNashvilleTennesseeUSA
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Morrow PH, Divers SG, Provencher L, Luoh S, Petrella TM, Giurescu M, Fielding L, Wang Y, Hortobagyi GN, Vahdat LT. Phase II study of sagopilone (ZK-Epo) in patients with recurrent metastatic breast cancer (MBC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1083] [Citation(s) in RCA: 2] [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] [Indexed: 11/20/2022] Open
Abstract
1083 Background: Sagopilone is a novel, fully synthetic epothilone, which represents a new class of microtubule stabilizing agents. It has shown significant pre-clinical activity in taxane resistant breast cancer cell lines and in tumor models, as well as clinical activity in both taxane naïve and pretreated MBC. Methods: MBC patients who received ≤ 3 prior anthracycline and taxane containing chemotherapies were eligible. Sagopilone was given either at 16 mg/m2 (arm A) or at 22 mg/m2 (arm B, amended additional cohort) IV over 3 hours every 21 days for up to 6 cycles. The primary end point was tumor response by RECIST. The Simon 2-Stage design required 3 responders in the first 24 evaluable patients in stage 1 and 10 responders in 65 evaluable patients to declare success. Results: Between June 2006 and June 2008, 65 patients were enrolled and treated (39 in arm A, 26 in arm B). Majority of metastases were in lymph nodes (62%), liver (55%), bone (49%), lung (37%), and cutaneous sites (19%). Median number of cycles delivered was 2 (1–17). Neither arm met Stage 1 criteria for responders. Nevertheless, 2 patients in arm A and 1 in arm B had confirmed partial response, and lasted 4, 7, and 2 months, respectively. 26% patients in arm A, and 42% in arm B had stable disease. 42 patients discontinued study prior to cycle 6 due to progressive disease/death, 14 due to adverse events, and 1 due to other reasons. All 65 patients are evaluable for safety. Adverse events documented or reported in ≥ 20% patients are: sensory neuropathy 80% (23% grade 3), nausea 57% (no grade 3), fatigue 45% (12% grade 3), vomiting 29% (no grade 3), myalgia 28% (5% grade 3), diarrhea 25% (2% grade 3), insomnia 25% (no grade 3), pain in extremity 25% (2% grade 3), headache 23% (5% grade 3), arthralgia 22% (5% grade 3), constipation 22% (2% grade 3). Conclusions: Sagopilone had limited activity in these heavily pretreated MBC patients. It appeared tolerable at both dose levels. [Table: see text]
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Affiliation(s)
- P. H. Morrow
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - S. G. Divers
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - L. Provencher
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - S. Luoh
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - T. M. Petrella
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - M. Giurescu
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - L. Fielding
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - Y. Wang
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - G. N. Hortobagyi
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - L. T. Vahdat
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
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Luoh S, Ramsey EE, Bai T, Keenan EJ. GRB7 and HER2 protein overexpression and breast cancer outcome. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.11102] [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
11102 Background: The growth factor receptor-bound protein-7 gene (GRB7) encodes a multi-domain signal transduction molecule and is located in close proximity to human epidermal growth factor receptor 2 (HER2) on chromosome 17q11–12. This study examines the roles of GRB7 protein in human breast cancer. Methods: We performed western blotting analysis of protein extracts from 563 annotated frozen breast tumors, collected from 1988 - 1998. GRB7 and HER2 bands were assigned low or high values compared to specific protein controls, and tubulin bands. Chi-square tests were used to test the hypothesis that there was no association between expression status of GRB7 or HER2 with clinical covariates and outcomes. Univariate Cox regression was performed to identify risk factors and Cox proportional hazards backward step model for variable selection to identify independent predictors of progression free survival. All P values were two sided. P values less than 0.05 were considered statistically significant. HER 2 gene amplification status was determined by fluorescence in situ hybridization (FISH). Results: GRB7 protein over-expression was associated with negative estrogen (< 5 fmole/mg protein) and progesterone receptor (< 10fmole/mg protein) status, higher grade (1, 2, or 3), larger primary tumor size (< 2.0 vs. > 2.0 cm), (more) axillary lymph node involvement (continuous), higher clinical stage (1, 2, 3, or 4) and shortened progression free survival (months). We found a discrepancy in HER2 and GRB7 protein over-expression. Isolated GRB7 protein over-expression correlated with inferior progression free survival, while HER2 protein over-expression without GRB7 protein over-expression did not. Multivariate analysis revealed that GRB7 over-expression was an independent predictor of progression free survival (hazard ratio 1.69: 95% confidence interval, 1.073 - 2.672; P = 0.0236). All 18 tumors submitted to FISH analysis that over-expressed both HER2 and GRB7 proteins and no tumors (0 / 10) with HER2 but no GRB7 protein over-expression demonstrated HER2 gene amplification. Conclusions: GRB7 protein over-expression is an independent adverse prognostic factor in breast cancer. No significant financial relationships to disclose.
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Affiliation(s)
- S. Luoh
- Oregon Health Science University, Portland VA Medical Center, Portland, OR; Oregon Health Science University, Portland, OR
| | - E. E. Ramsey
- Oregon Health Science University, Portland VA Medical Center, Portland, OR; Oregon Health Science University, Portland, OR
| | - T. Bai
- Oregon Health Science University, Portland VA Medical Center, Portland, OR; Oregon Health Science University, Portland, OR
| | - E. J. Keenan
- Oregon Health Science University, Portland VA Medical Center, Portland, OR; Oregon Health Science University, Portland, OR
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