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Kadakia KC, Kidwell KM, Seewald NJ, Snyder CF, Storniolo AM, Otte JL, Flockhart DA, Hayes DF, Stearns V, Henry NL. Prospective assessment of patient-reported outcomes and estradiol and drug concentrations in patients experiencing toxicity from adjuvant aromatase inhibitors. Breast Cancer Res Treat 2017; 164:411-419. [PMID: 28451964 DOI: 10.1007/s10549-017-4260-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 04/18/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Aromatase inhibitors (AI), which decrease circulating estradiol concentrations in post-menopausal women, are associated with toxicities that limit adherence. Approximately one-third of patients will tolerate a different AI after not tolerating the first. We report the effect of crossover from exemestane to letrozole or vice versa on patient-reported outcomes (PROs) and whether the success of crossover is due to lack of estrogen suppression. METHODS Post-menopausal women enrolled on a prospective trial initiating AI therapy for early-stage breast cancer were randomized to exemestane or letrozole. Those that discontinued for intolerance were offered protocol-directed crossover to the other AI after a washout period. Changes in PROs, including pain [Visual Analog Scale (VAS)] and functional status [Health Assessment Questionnaire (HAQ)], were compared after 3 months on the first versus the second AI. Estradiol and drug concentrations were measured. RESULTS Eighty-three patients participated in the crossover protocol, of whom 91.3% reported improvement in symptoms prior to starting the second AI. Functional status worsened less after 3 months with the second AI (HAQ mean change AI #1: 0.2 [SD 0.41] vs. AI #2: -0.05 [SD 0.36]; p = 0.001); change in pain scores was similar between the first and second AI (VAS mean change AI #1: 0.8 [SD 2.7] vs. AI #2: -0.2 [SD 2.8]; p = 0.19). No statistical differences in estradiol or drug concentrations were found between those that continued or discontinued AI after crossover. CONCLUSIONS Although all AIs act via the same mechanism, a subset of patients intolerant to one AI report improved PROs with a different one. The mechanism of this tolerance remains unknown, but does not appear to be due to non-adherence to, or insufficient estrogen suppression by, the second AI.
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Affiliation(s)
- Kunal C Kadakia
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Claire F Snyder
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anna Maria Storniolo
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julie L Otte
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel F Hayes
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Vered Stearns
- Breast Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - N Lynn Henry
- Division of Oncology, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr. #3362, Salt Lake City, UT, 84112, USA.
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Robarge JD, Desta Z, Nguyen AT, Li L, Hertz D, Rae JM, Hayes DF, Storniolo AM, Stearns V, Flockhart DA, Skaar TC, Henry NL. Effects of exemestane and letrozole therapy on plasma concentrations of estrogens in a randomized trial of postmenopausal women with breast cancer. Breast Cancer Res Treat 2017; 161:453-461. [PMID: 27943008 PMCID: PMC5429096 DOI: 10.1007/s10549-016-4077-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Inter-individual differences in estrogen concentrations during treatment with aromatase inhibitors (AIs) may contribute to therapeutic response and toxicity. The aim of this study was to determine plasma concentrations of estradiol (E2), estrone (E1), and estrone sulfate (E1S) in a large cohort of AI-treated breast cancer patients. METHODS In a randomized, multicenter trial of postmenopausal women with early-stage breast cancer starting treatment with letrozole (n = 241) or exemestane (n = 228), plasma estrogen concentrations at baseline and after 3 months were quantitated using a sensitive mass spectrometry-based assay. Concentrations and suppression below the lower limit of quantification (LLOQ) were compared between estrogens and between drugs. RESULTS The ranges of baseline estrogen concentrations were CONCLUSIONS Letrozole had greater suppression of plasma E1 and E1S than exemestane, though the response was highly variable among patients. Additional research is required to examine the clinical relevance of differential estrogen suppression.
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Affiliation(s)
- Jason D Robarge
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zereunesay Desta
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anne T Nguyen
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lang Li
- Center for Computational Biology and Bioinformatics, Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel Hertz
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - James M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Daniel F Hayes
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Anna M Storniolo
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Vered Stearns
- Breast Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Todd C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Lynn Henry
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr #3362, Salt Lake City, UT, 84112, USA.
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Tisdale JE, Jaynes HA, Overholser BR, Sowinski KM, Flockhart DA, Kovacs RJ. Influence of Oral Progesterone Administration on Drug-Induced QT Interval Lengthening: A Randomized, Double-Blind, Placebo-Controlled Crossover Study. JACC Clin Electrophysiol 2016; 2:765-774. [PMID: 28451647 DOI: 10.1016/j.jacep.2016.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We tested the hypothesis that oral progesterone administration attenuates drug-induced QT interval lengthening. BACKGROUND Evidence from preclinical and human investigations suggests that higher serum progesterone concentrations may be protective against drug-induced QT interval lengthening. METHODS In this prospective, double-blind, crossover study, 19 healthy female volunteers (21-40 years) were randomized to receive progesterone 400 mg or matching placebo orally once daily for 7 days timed to the menses phase of the menstrual cycle (between-phase washout period = 49 days). On day 7, ibutilide 0.003 mg/kg was infused over 10 minutes, after which QT intervals were recorded and blood samples collected for 12 hours. Prior to the treatment phases, subjects underwent ECG monitoring for 12 hours to calculate individualized heart rate-corrected QT intervals (QTcI). RESULTS Fifteen subjects completed all study phases. Maximum serum ibutilide concentrations in the progesterone and placebo phases were similar (1247±770 vs 1172±709 pg/mL, p=0.43). Serum progesterone concentrations were higher during the progesterone phase (16.2±11.0 vs 1.2±1.0 ng/mL, p<0.0001), while serum estradiol concentrations in the two phases were similar (89.3±62.8 vs 71.8±31.7 pg/mL, p=0.36). Pre-ibutilide lead II QTcI was significantly lower in the progesterone phase (412±15 vs 419±14 ms, p=0.04). Maximum ibutilide-associated QTcI (443±17 vs 458±19 ms, p=0.003), maximum percent increase in QTcI from pretreatment value (7.5±2.4 vs 9.3±3.4%, p=0.02) and area under the effect (QTcI) curve during the first hour post-ibutilide (497±13 vs 510±16 ms-hr, p=0.002) were lower during the progesterone phase. Progesterone-associated adverse effects included fatigue/malaise and vertigo. CONCLUSIONS Oral progesterone administration attenuates drug-induced QTcI lengthening.
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Affiliation(s)
- James E Tisdale
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Indiana.,Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Heather A Jaynes
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Indiana
| | - Brian R Overholser
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Indiana.,Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Kevin M Sowinski
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Indiana.,Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Richard J Kovacs
- Krannert Institute of Cardiology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana
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Zhao LM, Jin HS, Liu J, Skaar TC, Ipe J, Lv W, Flockhart DA, Cushman M. A new Suzuki synthesis of triphenylethylenes that inhibit aromatase and bind to estrogen receptors α and β. Bioorg Med Chem 2016; 24:5400-5409. [PMID: 27647367 DOI: 10.1016/j.bmc.2016.08.064] [Citation(s) in RCA: 16] [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: 07/10/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/23/2022]
Abstract
The design and synthesis of dual aromatase inhibitors/selective estrogen receptor modulators (AI/SERMs) is an attractive strategy for the discovery of new breast cancer therapeutic agents. Previous efforts led to the preparation of norendoxifen (4) derivatives with dual aromatase inhibitory activity and estrogen receptor binding activity. In the present study, some of the structural features of the potent AI letrozole were incorporated into the lead compound (norendoxifen) to afford a series of new dual AI/SERM agents based on a symmetrical diphenylmethylene substructure that eliminates the problem of E,Z isomerization encountered with norendoxifen-based AI/SERMs. Compound 12d had good aromatase inhibitory activity (IC50=62.2nM) while also exhibiting good binding activity to both ER-α (EC50=72.1nM) and ER-β (EC50=70.8nM). In addition, a new synthesis was devised for the preparation of norendoxifen and its analogues through a bis-Suzuki coupling strategy.
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Affiliation(s)
- Li-Ming Zhao
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, United States; School of Chemistry and Chemical Engineering, and Jiangsu Key Laboratory of Green Synthetic Chemistry for Functional Materials, Jiangsu Normal University, Xuzhou 221116, Jiangsu, China
| | - Hai-Shan Jin
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, United States; School of Chemistry and Chemical Engineering, and Jiangsu Key Laboratory of Green Synthetic Chemistry for Functional Materials, Jiangsu Normal University, Xuzhou 221116, Jiangsu, China
| | - Jinzhong Liu
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indiana Institute for Personalized Medicine, Indianapolis, IN 46202, United States
| | - Todd C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indiana Institute for Personalized Medicine, Indianapolis, IN 46202, United States
| | - Joseph Ipe
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indiana Institute for Personalized Medicine, Indianapolis, IN 46202, United States
| | - Wei Lv
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, United States
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indiana Institute for Personalized Medicine, Indianapolis, IN 46202, United States
| | - Mark Cushman
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, United States.
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Kreutz RP, Breall JA, Sinha A, von der Lohe E, Kovacs RJ, Flockhart DA. Simultaneous administration of high-dose atorvastatin and clopidogrel does not interfere with platelet inhibition during percutaneous coronary intervention. Clin Pharmacol 2016; 8:45-50. [PMID: 27350760 PMCID: PMC4902146 DOI: 10.2147/cpaa.s98790] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Reloading with high-dose atorvastatin shortly before percutaneous coronary interventions (PCIs) has been proposed as a strategy to reduce periprocedural myonecrosis. There has been a concern that statins that are metabolized by cytochrome P450 3A4 may interfere with clopidogrel metabolism at high doses. The impact of simultaneous administration of high doses of atorvastatin and clopidogrel on the efficacy of platelet inhibition has not been established. Methods Subjects (n=60) were randomized to receive atorvastatin 80 mg together with clopidogrel 600 mg loading dose (n=28) versus clopidogrel 600 mg alone (n=32) at the time of PCI. Platelet aggregation was measured at baseline, 4 hours after clopidogrel loading dose, and 16–24 hours after clopidogrel loading dose by light transmittance aggregometry using adenosine diphosphate as agonist. Results Platelet aggregation was similar at baseline in both the atorvastatin and the control groups (adenosine diphosphate 10 µM: 57%±19% vs 61%±21%; P=0.52). There was no significant difference in platelet aggregation between the atorvastatin and the control groups at 4 hours (37%±18% vs 39%±21%; P=0.72) and 16–24 hours post-clopidogrel loading dose (35%±17% vs 37%±18%; P=0.75). No significant difference in incidence of periprocedural myonecrosis was observed between the atorvastatin and control groups (odds ratio: 1.02; 95% confidence interval 0.37–2.8). Conclusion High-dose atorvastatin given simultaneously with clopidogrel loading dose at the time of PCI does not significantly alter platelet inhibition by clopidogrel. Statin reloading with high doses of atorvastatin at the time of PCI appears to be safe without adverse effects on platelet inhibition by clopidogrel (ClinicalTrials.gov: NCT00979940).
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Affiliation(s)
- Rolf P Kreutz
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA; Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeffrey A Breall
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anjan Sinha
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elisabeth von der Lohe
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard J Kovacs
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David A Flockhart
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA
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7
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Hertz DL, Deal A, Ibrahim JG, Walko CM, Weck KE, Anderson S, Magrinat G, Olajide O, Moore S, Raab R, Carrizosa DR, Corso S, Schwartz G, Graham M, Peppercorn JM, Jones DR, Desta Z, Flockhart DA, Evans JP, McLeod HL, Carey LA, Irvin WJ. Tamoxifen Dose Escalation in Patients With Diminished CYP2D6 Activity Normalizes Endoxifen Concentrations Without Increasing Toxicity. Oncologist 2016; 21:795-803. [PMID: 27226358 DOI: 10.1634/theoncologist.2015-0480] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/23/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Polymorphic CYP2D6 is primarily responsible for metabolic activation of tamoxifen to endoxifen. We previously reported that by increasing the daily tamoxifen dose to 40 mg/day in CYP2D6 intermediate metabolizer (IM), but not poor metabolizer (PM), patients achieve endoxifen concentrations similar to those of extensive metabolizer patients on 20 mg/day. We expanded enrollment to assess the safety of CYP2D6 genotype-guided dose escalation and investigate concentration differences between races. METHODS PM and IM breast cancer patients currently receiving tamoxifen at 20 mg/day were enrolled for genotype-guided escalation to 40 mg/day. Endoxifen was measured at baseline and after 4 months. Quality-of-life data were collected using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and Breast Cancer Prevention Trial Menopausal Symptom Scale at baseline and after 4 months. RESULTS In 353 newly enrolled patients, genotype-guided dose escalation eliminated baseline concentration differences in IM (p = .08), but not PM (p = .009), patients. Endoxifen concentrations were similar in black and white patients overall (p = .63) and within CYP2D6 phenotype groups (p > .05). In the quality-of-life analysis of 480 patients, dose escalation did not meaningfully diminish quality of life; in fact, improvements were seen in several measures including the FACT Breast Cancer subscale (p = .004) and limitations in range of motion (p < .0001) in IM patients. CONCLUSION Differences in endoxifen concentration during treatment can be eliminated by doubling the tamoxifen dose in IM patients, without an appreciable effect on quality of life. Validation of the association between endoxifen concentration and efficacy or prospective demonstration of improved efficacy is necessary to warrant clinical uptake of this personalized treatment strategy. IMPLICATIONS FOR PRACTICE This secondary analysis of a prospective CYP2D6 genotype-guided tamoxifen dose escalation study confirms that escalation to 40 mg/day in patients with low-activity CYP2D6 phenotypes (poor or intermediate metabolizers) increases endoxifen concentrations without any obvious increases in treatment-related toxicity. It remains unknown whether endoxifen concentration is a useful predictor of tamoxifen efficacy, and thus, there is no current role in clinical practice for CYP2D6 genotype-guided tamoxifen dose adjustment. If future studies confirm the importance of endoxifen concentrations for tamoxifen efficacy and report a target concentration, this study provides guidance for a dose-adjustment approach that could maximize efficacy while maintaining patient quality of life.
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Affiliation(s)
| | - Allison Deal
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph G Ibrahim
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Karen E Weck
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven Anderson
- Laboratory Corporation of America, Burlington, North Carolina, USA
| | - Gustav Magrinat
- Moses Cone Health Cancer Center, Greensboro, North Carolina, USA
| | | | - Susan Moore
- REX Hematology Oncology Associates, Raleigh, North Carolina, USA
| | - Rachel Raab
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | | | - Steven Corso
- Palmetto Hematology Oncology, Spartanburg, South Carolina, USA
| | - Garry Schwartz
- Levine Cancer Institute Concord, Concord, North Carolina, USA
| | - Mark Graham
- Waverly Hematology/Oncology, Cary, North Carolina, USA
| | | | | | | | | | - James P Evans
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lisa A Carey
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William J Irvin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Bon Secours Cancer Institute, Richmond, Virginia, USA
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Stearns V, O'Neill AM, Schneider BP, Flockhart DA, Skaar TC, Liu MC, Lohrisch CA, Goetz MP, Vallejos Sologuren C, Sparano JA, Villa D, Silverman P, Cheema PS, Moore DF, Sledge GW. A phase II prospective trial correlating progression-free survival (PFS) with CYP2D6 activity in patients with metastatic breast cancer treated with tamoxifen: ECOG-ACRIN E3108. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.546] [Citation(s) in RCA: 2] [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)
- Vered Stearns
- School of Medicine and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | | | - Todd C. Skaar
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | | | | | | | - Diego Villa
- British Columbia Cancer Agency, Vancouver, BC, Canada
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Leonard CE, Han X, Bilker WB, Flory JH, Brensinger CM, Flockhart DA, Gagne JJ, Cardillo S, Hennessy S. Comparative risk of severe hypoglycemia among concomitant users of thiazolidinedione antidiabetic agents and antihyperlipidemics. Diabetes Res Clin Pract 2016; 115:60-7. [PMID: 27242124 PMCID: PMC4890073 DOI: 10.1016/j.diabres.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/08/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
We conducted high-dimensional propensity score-adjusted cohort studies to examine whether thiazolidinedione use with a statin or fibrate was associated with an increased risk of severe hypoglycemia. We found that concomitant therapy with a thiazolidinedione+fibrate was associated with a generally delayed increased risk of severe hypoglycemia.
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Affiliation(s)
- Charles E Leonard
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States.
| | - Xu Han
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, United States
| | - James H Flory
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Department of Healthcare Policy and Research, Division of Comparative Effectiveness, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065, United States
| | - Colleen M Brensinger
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States
| | - David A Flockhart
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN 46202, United States
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, United States
| | - Serena Cardillo
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine at the University of Pennsylvania, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States
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Robarge JD, Duarte DB, Shariati B, Wang R, Flockhart DA, Vasko MR. Aromatase inhibitors augment nociceptive behaviors in rats and enhance the excitability of sensory neurons. Exp Neurol 2016; 281:53-65. [PMID: 27072527 DOI: 10.1016/j.expneurol.2016.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/28/2016] [Accepted: 04/05/2016] [Indexed: 12/22/2022]
Abstract
Although aromatase inhibitors (AIs) are commonly used therapies for breast cancer, their use is limited because they produce arthralgia in a large number of patients. To determine whether AIs produce hypersensitivity in animal models of pain, we examined the effects of the AI, letrozole, on mechanical, thermal, and chemical sensitivity in rats. In ovariectomized (OVX) rats, administering a single dose of 1 or 5mg/kg letrozole significantly reduced mechanical paw withdrawal thresholds, without altering thermal sensitivity. Repeated injection of 5mg/kg letrozole in male rats produced mechanical, but not thermal, hypersensitivity that extinguished when drug dosing was stopped. A single dose of 5mg/kg letrozole or daily dosing of letrozole or exemestane in male rats also augmented flinching behavior induced by intraplantar injection of 1000nmol of adenosine 5'-triphosphate (ATP). To determine whether sensitization of sensory neurons contributed to AI-induced hypersensitivity, we evaluated the excitability of neurons isolated from dorsal root ganglia of male rats chronically treated with letrozole. Both small and medium-diameter sensory neurons isolated from letrozole-treated rats were more excitable, as reflected by increased action potential firing in response to a ramp of depolarizing current, a lower resting membrane potential, and a lower rheobase. However, systemic letrozole treatment did not augment the stimulus-evoked release of the neuropeptide calcitonin gene-related peptide (CGRP) from spinal cord slices, suggesting that the enhanced nociceptive responses were not secondary to an increase in peptide release from sensory endings in the spinal cord. These results provide the first evidence that AIs modulate the excitability of sensory neurons, which may be a primary mechanism for the effect of these drugs to augment pain behaviors in rats.
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Affiliation(s)
- Jason D Robarge
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Djane B Duarte
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Laboratório de Farmacologia Molecular, Faculdade de Ciências da Saúde, Universidade de Brasília, Brazil.
| | - Behzad Shariati
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Ruizhong Wang
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - David A Flockhart
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Michael R Vasko
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States.
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11
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Eadon MT, Desta Z, Levy KD, Decker BS, Pierson RC, Pratt VM, Callaghan JT, Rosenman MB, Carpenter JS, Holmes AM, McDonald CA, Benson EA, Patil AS, Vuppalanchi R, Gufford BT, Dave N, Robarge JD, Hyder MA, Haas DM, Kreutz RP, Dexter PR, Skaar TC, Flockhart DA. Implementation of a pharmacogenomics consult service to support the INGENIOUS trial. Clin Pharmacol Ther 2016; 100:63-6. [PMID: 26850569 DOI: 10.1002/cpt.347] [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: 10/22/2015] [Accepted: 01/31/2016] [Indexed: 12/19/2022]
Abstract
Hospital systems increasingly utilize pharmacogenomic testing to inform clinical prescribing. Successful implementation efforts have been modeled at many academic centers. In contrast, this report provides insights into the formation of a pharmacogenomics consultation service at a safety-net hospital, which predominantly serves low-income, uninsured, and vulnerable populations. The report describes the INdiana GENomics Implementation: an Opportunity for the UnderServed (INGENIOUS) trial and addresses concerns of adjudication, credentialing, and funding.
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Affiliation(s)
- M T Eadon
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Z Desta
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - K D Levy
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - B S Decker
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - R C Pierson
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - V M Pratt
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - J T Callaghan
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA.,Department of Veterans Affairs, Indianapolis, Indiana, USA
| | - M B Rosenman
- Department of Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - J S Carpenter
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - A M Holmes
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - C A McDonald
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - E A Benson
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - A S Patil
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA.,Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana, USA
| | - R Vuppalanchi
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - B T Gufford
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - N Dave
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - J D Robarge
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - M A Hyder
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - D M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana, USA
| | - R P Kreutz
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - P R Dexter
- Regenstrief Institute for Health Care, Indiana University, Indianapolis, Indiana, USA
| | - T C Skaar
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - D A Flockhart
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
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12
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Kadakia KC, Snyder CF, Kidwell KM, Seewald NJ, Flockhart DA, Skaar TC, Desta Z, Rae JM, Otte JL, Carpenter JS, Storniolo AM, Hayes DF, Stearns V, Henry NL. Patient-Reported Outcomes and Early Discontinuation in Aromatase Inhibitor-Treated Postmenopausal Women With Early Stage Breast Cancer. Oncologist 2016; 21:539-46. [PMID: 27009936 PMCID: PMC4861358 DOI: 10.1634/theoncologist.2015-0349] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/27/2015] [Indexed: 12/03/2022] Open
Abstract
In the prospective Exemestane and Letrozole Pharmacogenetics trial of adjuvant aromatase inhibitor (AI) therapy for early-stage breast cancer, worsening of multiple treatment-related symptoms during AI therapy predicted AI early discontinuation. If these findings are confirmed in independent trials, early detection of changes in PRO measures could be used clinically to target interventions in patients at high risk for early discontinuation. Background. Early discontinuation of aromatase inhibitors (AIs) is common and leads to poor outcomes but is challenging to predict. In the Exemestane and Letrozole Pharmacogenetics trial, a high rate of early discontinuation due to intolerance was observed. We hypothesized that early changes in patient-reported outcomes (PROs) predict AI discontinuation and that biochemical factors are associated with changes in PROs. Patients and Methods. Postmenopausal women with early-stage breast cancer enrolled in a prospective randomized trial of exemestane versus letrozole completed questionnaires at baseline and serially over 24 months to assess overall quality of life (EuroQOL Visual Analog Scale [VAS]); mood; and multiple symptoms, including a musculoskeletal symptom cluster. A joint mixed-effects/survival model was used to estimate the effect of the change in PROs on AI discontinuation. Associations between biochemical factors and change in PROs were examined. Results. A total of 490 patients were analyzed. Worsening of EuroQOL VAS and the musculoskeletal cluster were associated with the highest risk for early discontinuation (hazard ratio [HR], 2.77 [95% confidence interval (CI), 2.72–2.81; p = .015]; HR, 4.39 [95% CI, 2.40–8.02; p < .0001], respectively). Pharmacokinetics and estrogen metabolism were not consistently associated with change in PRO measures. No clinically significant differences in any PRO between AIs were observed. Conclusion. Changes in PROs early during AI therapy were associated with treatment discontinuation. Identification of these changes could be used to target interventions in patients at high risk for early discontinuation. Implications for Practice: Early changes in patient-reported outcomes (PROs) can predict nonpersistence to aromatase inhibitor therapy. If used in clinical practice, PROs might identify women at highest risk for early discontinuation and allow for interventions to improve tolerance before significant toxicities develop. Further research is needed to improve capturing PROs in routine clinical practice.
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Affiliation(s)
- Kunal C Kadakia
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Claire F Snyder
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nicholas J Seewald
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Todd C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zereunesay Desta
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James M Rae
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Julie L Otte
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | | | - Anna M Storniolo
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel F Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Vered Stearns
- Breast Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - N Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
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13
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Levy KD, Pratt VM, Skaar TC, Vance GH, Flockhart DA. FDA's draft guidance on laboratory-developed tests increases clinical and economic risk to adoption of pharmacogenetic testing. J Clin Pharmacol 2016; 55:725-7. [PMID: 26053647 DOI: 10.1002/jcph.492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/26/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Kenneth D Levy
- Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victoria M Pratt
- Pharmacogenetics Laboratory, Department of Genetics and Molecular Medicine, Indiana University School of Medicine, Indiananpolis, IN, USA
| | - Todd C Skaar
- Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gail H Vance
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - David A Flockhart
- Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Institute for Personalized Medicine, Indianapolis, IN, USA
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14
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Hertz DL, Kidwell KM, Seewald NJ, Gersch CL, Desta Z, Flockhart DA, Storniolo AM, Stearns V, Skaar TC, Hayes DF, Henry NL, Rae JM. Abstract P5-12-05: CYP3A4*22 polymorphism is associated with increased exemestane concentrations in postmenopausal breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-12-05] [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: Exemestane is a second generation steroidal aromatase inhibitor (AI) used for the treatment of estrogen receptor (ER) positive breast cancer in postmenopausal women. Variability in AI treatment efficacy and side effects seen across patients may be due, in part, to inter-patient differences in drug exposure. This exposure variability is likely caused by patient genetics factors, such as single nucleotide polymorphisms (SNPs) in drug metabolizing enzymes, or clinical factors such as patient body size, organ function, and comorbidities. The objective of this secondary correlative analysis was to identify genetic and clinical characteristics that affect steady state exemestane concentration, with a specific focus on the influence of inherited genetic variants and baseline hepatic function.
Methods: 500 patients were enrolled on the Exemestane and Letrozole Pharmacogenetics (ELPh) Study and randomized to either drug. Clinical data and DNA were collected at baseline and blood samples were collected after 1 or 3 months of treatment to measure steady-state exemestane concentration via HPLC/MS. Genotyping was performed on a custom Sequenom MassARRAY iPLEX that included the recently discovered low activity CYP3A4*22 (rs35599367) SNP and several other SNPs with putative functional consequence in enzymes thought to be involved in exemestane metabolism (CYP1A1/2, CYP1B1, CYP3A4, CYP4A11, AKR1C3/4, AKR7A2). Our primary hypothesis was that patients carrying CYP3A4*22 variants would have higher serum exemestane concentrations. Other SNPs and clinical characteristics (hepatic and renal function, age, body mass index (BMI), time of sample collection, prior chemotherapy) were assessed for independent association, and then adjusted for in a multivariable tobit regression model for CYP3A4*22 on log-transformed censored exemestane concentration.
Results: 246 (225 randomized to exemestane arm, 21 crossed-over from letrozole arm) patients had exemestane steady state levels and were evaluable in this analysis. As hypothesized, the CYP3A4*22 polymorphism (minor allele frequency=0.06) was associated with a 54% increase in exemestane concentration (95% CI: 14% - 109%, p<0.01). Exemestane concentration was 44% greater in patients who had evidence of hepatic impairment (AST or ALT>40) at baseline (95% CI: 2% - 104%, p=0.02), 1% lower per unit increase in BMI (95% CI: 0% - 3%, p=0.05), and 20% lower in patients who received prior chemotherapy (95% CI: 4% - 34%, p=0.03). Age, renal impairment, and other SNPs were not associated with exemestane concentration. After adjustment for significant clinical covariates the CYP3A4*22 SNP remained significant (p<0.01).
Conclusions: Genetic and clinical predictors of exemestane concentration were discovered in a large cohort of prospectively enrolled estrogen responsive breast cancer patients. Ongoing analyses will determine whether the variability in exemestane concentration was associated with downstream effects on estrogen depletion or treatment-related toxicity. If so, these genetic and clinical characteristics could be useful for individualizing dosing of exemestane to ensure that all patients are receiving maximal benefit with minimal toxicity.
Citation Format: Hertz DL, Kidwell KM, Seewald NJ, Gersch CL, Desta Z, Flockhart DA, Storniolo AM, Stearns V, Skaar TC, Hayes DF, Henry NL, Rae JM. CYP3A4*22 polymorphism is associated with increased exemestane concentrations in postmenopausal breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-12-05.
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Affiliation(s)
- DL Hertz
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - KM Kidwell
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - NJ Seewald
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - CL Gersch
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - Z Desta
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - DA Flockhart
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - AM Storniolo
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - V Stearns
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - TC Skaar
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - DF Hayes
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - NL Henry
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
| | - JM Rae
- University of Michigan, Ann Arbor, MI; Indiana University; Johns Hopkins University
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15
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Hertz DL, Danko W, Deal A, Walko CM, Flockhart DA, McLeod HL, Ibrahim JG, Irvin WJ. Abstract P5-12-06: Comprehensive assessment of the effect of genetic polymorphisms in drug metabolizing enzymes and transporters on tamoxifen activation to endoxifen. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-12-06] [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: Tamoxifen is the most commonly prescribed hormonal drug for estrogen receptor positive breast cancer treatment. Tamoxifen itself has weak anti-estrogenic activity, but is bioactivated to the more potent inhibitor endoxifen. Recent data suggest inferior efficacy of tamoxifen treatment in patients who have low systemic endoxifen concentration. Genetic variability in drug metabolizing enzymes and transporters, particularly CYP2D6, are known to effect serum endoxifen concentration. The association of CYP2D6 genotype and endoxifen concentration is well established; however, there is a paucity of data regarding the effects of genetic variants in other drug metabolizing enzymes and transporters on endoxifen concentrations. The objective of our study was to comprehensively screen known, functionally consequential polymorphisms and copy number variations in genes of interest to detect additional pharmacogenetic predictors of endoxifen concentration during tamoxifen treatment.
Methods: This analysis includes patients prospectively enrolled on the Lineberger Comprehensive Cancer Center 0801 trial. Patients had received tamoxifen for a minimum of 4 months prior to enrollment and were not concurrently taking strong or moderate CYP2D6 inhibitors. Samples were collected at enrollment for measurement of steady state endoxifen level and collection of germline DNA. Genotyping was performed for CYP2D6 using the Amplichip® CYP450 test (Roche Diagnostics) and for other candidate genes (CYP2C9, CYP3A4, CYP3A5, ABCB1, SLCO1B1, SULT1A1, SULT1A2, and UGT2B7) using the iPLEX® ADME PGx Pro Panel (Agena Bioscience). Activity phenotype for each gene was inferred from genotype data based on known activity of variant alleles or copy numbers. Metabolite concentrations were measured via LC/MS-MS assay at Indiana University and square root transformed prior to analysis to improve normality. Linear regression models were used to evaluate the association of each gene individually with endoxifen concentration, assuming an additive pharmacogenetic effect, after adjustment for CYP2D6 phenotype (EM/UM, IM or PM).
Results: 304 Patients with steady-state endoxifen concentration and successful genotyping were included in the analysis. After transformation and adjustment, endoxifen concentration was significantly associated with carrying low-activity CYP2C9 variant alleles (*2, *3, *5, *6, *8, *11, *12) (p=0.016). Predicted endoxifen concentration based on CYP2C9 and CYP2D6 genotype can be found in.
Predicted endoxifen concentration (ng/mL) based on CYP2C9 and CYP2D6 Phenotype CYP2D6 EM/UMCYP2D6 IMCYP2D6 PMCYP2C9 WT/WT9.716.553.41CYP2C9 WT/Var8.375.482.63CYP2C9 Var/Var7.134.481.96Abbreviations: WT= wild-type, Var=Variant allele for CYP2C9
Phenotype activity of other enzymes and transporters was not associated with endoxifen concentration (all p>0.05).
Conclusions: Polymorphisms in CYP2C9 and CYP2D6, but not other enzymes or transporters, contribute to variation in endoxifen exposure. If endoxifen exposure is validated to predict tamoxifen efficacy, personalized tamoxifen dosing algorithms should include CYP2C9, in addition to CYP2D6 and clinical factors, to improve efficacy and minimize side effects.
Citation Format: Hertz DL, Danko W, Deal A, Walko CM, Flockhart DA, McLeod HL, Ibrahim JG, Irvin Jr WJ. Comprehensive assessment of the effect of genetic polymorphisms in drug metabolizing enzymes and transporters on tamoxifen activation to endoxifen. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-12-06.
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Affiliation(s)
- DL Hertz
- University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; Moffitt Cancer Center, Tampa, FL; Indiana University; Bon Secours Cancer Institute, Richmond, VA
| | - W Danko
- University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; Moffitt Cancer Center, Tampa, FL; Indiana University; Bon Secours Cancer Institute, Richmond, VA
| | - A Deal
- University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; Moffitt Cancer Center, Tampa, FL; Indiana University; Bon Secours Cancer Institute, Richmond, VA
| | - CM Walko
- University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; Moffitt Cancer Center, Tampa, FL; Indiana University; Bon Secours Cancer Institute, Richmond, VA
| | - DA Flockhart
- University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; Moffitt Cancer Center, Tampa, FL; Indiana University; Bon Secours Cancer Institute, Richmond, VA
| | - HL McLeod
- University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; Moffitt Cancer Center, Tampa, FL; Indiana University; Bon Secours Cancer Institute, Richmond, VA
| | - JG Ibrahim
- University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; Moffitt Cancer Center, Tampa, FL; Indiana University; Bon Secours Cancer Institute, Richmond, VA
| | - WJ Irvin
- University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; Moffitt Cancer Center, Tampa, FL; Indiana University; Bon Secours Cancer Institute, Richmond, VA
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16
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Kadakia KC, Kidwell KM, Seewald NJ, Snyder CF, Flockhart DA, Carpenter JS, Otte JL, Hayes DF, Storniolo AM, Stearns V, Henry NL. Crossover from one aromatase inhibitor (AI) to another in the Exemestane and Letrozole Pharmacogenetics (ELPh) trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.158] [Citation(s) in RCA: 2] [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] [Indexed: 11/20/2022] Open
Abstract
158 Background: Tolerance of AI therapy can be poor due to treatment-emergent toxicities and can lead to early discontinuation (non-persistence). Patients often switch from one AI to another when toxicities develop; however, limited prospective data exist on patients who switch AI. Here we describe the effect of switching from E to L or L to E on tolerance of and persistence with therapy. Methods: Postmenopausal women initiating AI therapy were enrolled on the ELPh trial and randomized to E or L. Those that stopped their AI for self-reported intolerance were offered crossover to alternate AI after a 2-6 week washout. Kaplan-Meier estimates of proportions on AI after 1, 3, and 6 months were assessed during 1st and 2nd AI. Associations between time on 2ndAI and clinicopathologic factors were analyzed using univariable Cox proportional hazards model. To evaluate effect of crossover on patient-reported outcomes, multiple questionnaires, including a pain visual analog scale (VAS), were assessed serially. Results: 83 women, mean age 60 years, 45% prior chemotherapy, and 31% with prior tamoxifen use, participated in the crossover protocol. 71% reported improvement in symptoms a mean 4.72 weeks after discontinuing 1st AI therapy. Median time on 1st AI was 6.8 months (95% CI 5.8-9 months), and on 2nd AI was 11.5 months (6.9-24.2). The probability of persistence at 1, 3, and 6 months for the 1st AI was 94%, 76%, and 55% and for the 2nd AI was 89%, 73%, and 62%, respectively. There was no significant association between duration on 2nd AI and 1st AI (L vs. E), duration on 1st AI, age, body mass index, or prior therapies. The change in pain VAS from baseline to 1 or 3 months was not significantly different during treatment with the 1st or 2ndAI. Conclusions: Although all AI medications have similar mechanisms of activity, nearly two-thirds of patients who are intolerant of one AI are able to maintain therapy for at least 6 months following switch to 2nd AI. Switching is a reasonable approach for women who cannot tolerate 1st AI that may improve persistence with therapy. The mechanisms for intrapatient variation in tolerance warrant further study. Clinical trial information: NCT00228956.
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Affiliation(s)
- Kunal C. Kadakia
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | - Daniel F. Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Vered Stearns
- School of Medicine and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Norah Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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17
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Leonard CE, Bilker WB, Brensinger CM, Han X, Flory JH, Flockhart DA, Gagne JJ, Cardillo S, Hennessy S. Severe hypoglycemia in users of sulfonylurea antidiabetic agents and antihyperlipidemics. Clin Pharmacol Ther 2016; 99:538-47. [PMID: 26566262 DOI: 10.1002/cpt.297] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/07/2015] [Indexed: 12/15/2022]
Abstract
Drug-drug interactions causing severe hypoglycemia due to antidiabetic drugs is a major clinical and public health problem. We assessed whether sulfonylurea use with a statin or fibrate was associated with severe hypoglycemia. We conducted cohort studies of users of glyburide, glipizide, and glimepiride plus a statin or fibrate within a Medicaid population. The outcome was a validated, diagnosis-based algorithm for severe hypoglycemia. Among 592,872 persons newly exposed to a sulfonylurea+antihyperlipidemic, the incidence of severe hypoglycemia was 5.8/100 person-years. Adjusted hazard ratios (HRs) for sulfonylurea+statins were consistent with no association. Most overall HRs for sulfonylurea+fibrate were elevated, with sulfonylurea-specific adjusted HRs as large as 1.50 (95% confidence interval (CI): 1.24-1.81) for glyburide+gemfibrozil, 1.37 (95% CI: 1.11-1.69) for glipizide+gemfibrozil, and 1.63 (95% CI: 1.29-2.06) for glimepiride+fenofibrate. Concomitant therapy with a sulfonylurea and fibrate is associated with an often delayed increased rate of severe hypoglycemia.
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Affiliation(s)
- C E Leonard
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - W B Bilker
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C M Brensinger
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - X Han
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J H Flory
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Healthcare Policy and Research, Division of Comparative Effectiveness, Weill Cornell Medical College, New York, New York, USA
| | - D A Flockhart
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - J J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - S Cardillo
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S Hennessy
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Carpenter JS, Rosenman MB, Knisely MR, Decker BS, Levy KD, Flockhart DA. Pharmacogenomically actionable medications in a safety net health care system. SAGE Open Med 2016; 4:2050312115624333. [PMID: 26835014 PMCID: PMC4724767 DOI: 10.1177/2050312115624333] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022] Open
Abstract
Objective: Prior to implementing a trial to evaluate the economic costs and clinical outcomes of pharmacogenetic testing in a large safety net health care system, we determined the number of patients taking targeted medications and their clinical care encounter sites. Methods: Using 1-year electronic medical record data, we evaluated the number of patients who had started one or more of 30 known pharmacogenomically actionable medications and the number of care encounter sites the patients had visited. Results: Results showed 7039 unique patients who started one or more of the target medications within a 12-month period with visits to 73 care sites within the system. Conclusion: Findings suggest that the type of large-scale, multi-drug, multi-gene approach to pharmacogenetic testing we are planning is widely relevant, and successful implementation will require wide-scale education of prescribers and other personnel involved in medication dispensing and handling.
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Affiliation(s)
- Janet S Carpenter
- Department of Science of Nursing Care, School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Marc B Rosenman
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Mitchell R Knisely
- Department of Science of Nursing Care, School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Brian S Decker
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Kenneth D Levy
- Department of Medicine, Indiana University, Indianapolis, IN, USA
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19
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Weitzel KW, Alexander M, Bernhardt BA, Calman N, Carey DJ, Cavallari LH, Field JR, Hauser D, Junkins HA, Levin PA, Levy K, Madden EB, Manolio TA, Odgis J, Orlando LA, Pyeritz R, Wu RR, Shuldiner AR, Bottinger EP, Denny JC, Dexter PR, Flockhart DA, Horowitz CR, Johnson JA, Kimmel SE, Levy MA, Pollin TI, Ginsburg GS. The IGNITE network: a model for genomic medicine implementation and research. BMC Med Genomics 2016; 9:1. [PMID: 26729011 PMCID: PMC4700677 DOI: 10.1186/s12920-015-0162-5] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/17/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients, clinicians, researchers and payers are seeking to understand the value of using genomic information (as reflected by genotyping, sequencing, family history or other data) to inform clinical decision-making. However, challenges exist to widespread clinical implementation of genomic medicine, a prerequisite for developing evidence of its real-world utility. METHODS To address these challenges, the National Institutes of Health-funded IGNITE (Implementing GeNomics In pracTicE; www.ignite-genomics.org ) Network, comprised of six projects and a coordinating center, was established in 2013 to support the development, investigation and dissemination of genomic medicine practice models that seamlessly integrate genomic data into the electronic health record and that deploy tools for point of care decision making. IGNITE site projects are aligned in their purpose of testing these models, but individual projects vary in scope and design, including exploring genetic markers for disease risk prediction and prevention, developing tools for using family history data, incorporating pharmacogenomic data into clinical care, refining disease diagnosis using sequence-based mutation discovery, and creating novel educational approaches. RESULTS This paper describes the IGNITE Network and member projects, including network structure, collaborative initiatives, clinical decision support strategies, methods for return of genomic test results, and educational initiatives for patients and providers. Clinical and outcomes data from individual sites and network-wide projects are anticipated to begin being published over the next few years. CONCLUSIONS The IGNITE Network is an innovative series of projects and pilot demonstrations aiming to enhance translation of validated actionable genomic information into clinical settings and develop and use measures of outcome in response to genome-based clinical interventions using a pragmatic framework to provide early data and proofs of concept on the utility of these interventions. Through these efforts and collaboration with other stakeholders, IGNITE is poised to have a significant impact on the acceleration of genomic information into medical practice.
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Affiliation(s)
- Kristin Wiisanen Weitzel
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida (UF) College of Pharmacy, Gainesville, FL, USA.
| | - Madeline Alexander
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Barbara A Bernhardt
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Neil Calman
- Institute for Family Health, New York, NY, USA.
| | - David J Carey
- Weis Center for Research, Geisinger Health System, Danville, PA, USA.
| | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida (UF) College of Pharmacy, Gainesville, FL, USA.
| | - Julie R Field
- Institute for Clinical and Translational Research, School of Medicine, Vanderbilt University, Nashville, TN, USA.
| | | | - Heather A Junkins
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Phillip A Levin
- Bay West Endocrinology Associates and MODEL Clinical Research, Baltimore, MD, USA.
| | - Kenneth Levy
- Department of Medicine, Indiana University School of Medicine, Indiana, IN, USA.
| | - Ebony B Madden
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Teri A Manolio
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Jacqueline Odgis
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Lori A Orlando
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, 101 Science Dr, Rm 2111, CIEMAS Bldg, Durham, NC, 27708, USA.
| | - Reed Pyeritz
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - R Ryanne Wu
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, 101 Science Dr, Rm 2111, CIEMAS Bldg, Durham, NC, 27708, USA.
| | - Alan R Shuldiner
- University of Maryland School of Medicine, Baltimore, MD, USA.
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA.
| | - Erwin P Bottinger
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Joshua C Denny
- Departments of Biomedical Informatics and Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Paul R Dexter
- Department of Medicine, Indiana University School of Medicine, Indiana, IN, USA.
| | - David A Flockhart
- Department of Medicine, Indiana University School of Medicine, Indiana, IN, USA.
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida (UF) College of Pharmacy, Gainesville, FL, USA.
| | - Stephen E Kimmel
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Clinical Epidemiology and Biostatistics, Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Mia A Levy
- Departments of Biomedical Informatics and Medicine, Division of Hematology and Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Toni I Pollin
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Geoffrey S Ginsburg
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, 101 Science Dr, Rm 2111, CIEMAS Bldg, Durham, NC, 27708, USA.
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20
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Lv W, Liu J, Skaar TC, O'Neill E, Yu G, Flockhart DA, Cushman M. Synthesis of Triphenylethylene Bisphenols as Aromatase Inhibitors That Also Modulate Estrogen Receptors. J Med Chem 2015; 59:157-70. [PMID: 26704594 DOI: 10.1021/acs.jmedchem.5b01677] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A series of triphenylethylene bisphenol analogues of the selective estrogen receptor modulator (SERM) tamoxifen were synthesized and evaluated for their abilities to inhibit aromatase, bind to estrogen receptor α (ER-α) and estrogen receptor β (ER-β), and antagonize the activity of β-estradiol in MCF-7 human breast cancer cells. The long-range goal has been to create dual aromatase inhibitor (AI)/selective estrogen receptor modulators (SERMs). The hypothesis is that in normal tissue the estrogenic SERM activity of a dual AI/SERM could attenuate the undesired effects stemming from global estrogen depletion caused by the AI activity of a dual AI/SERM, while in breast cancer tissue the antiestrogenic SERM activity of a dual AI/SERM could act synergistically with AI activity to enhance the antiproliferative effect. The potent aromatase inhibitory activities and high ER-α and ER-β binding affinities of several of the resulting analogues, together with the facts that they antagonize β-estradiol in a functional assay in MCF-7 human breast cancer cells and they have no E/Z isomers, support their further development in order to obtain dual AI/SERM agents for breast cancer treatment.
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Affiliation(s)
- Wei Lv
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University , West Lafayette, Indiana 47907, United States
| | - Jinzhong Liu
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana 46202, United States
| | - Todd C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana 46202, United States
| | - Elizaveta O'Neill
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University , West Lafayette, Indiana 47907, United States
| | - Ge Yu
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University , West Lafayette, Indiana 47907, United States
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana 46202, United States
| | - Mark Cushman
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University , West Lafayette, Indiana 47907, United States
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21
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Abstract
Motivation:CYP2D6 is highly polymorphic gene which encodes the (CYP2D6) enzyme, involved in the metabolism of 20–25% of all clinically prescribed drugs and other xenobiotics in the human body. CYP2D6 genotyping is recommended prior to treatment decisions involving one or more of the numerous drugs sensitive to CYP2D6 allelic composition. In this context, high-throughput sequencing (HTS) technologies provide a promising time-efficient and cost-effective alternative to currently used genotyping techniques. To achieve accurate interpretation of HTS data, however, one needs to overcome several obstacles such as high sequence similarity and genetic recombinations between CYP2D6 and evolutionarily related pseudogenes CYP2D7 and CYP2D8, high copy number variation among individuals and short read lengths generated by HTS technologies. Results: In this work, we present the first algorithm to computationally infer CYP2D6 genotype at basepair resolution from HTS data. Our algorithm is able to resolve complex genotypes, including alleles that are the products of duplication, deletion and fusion events involving CYP2D6 and its evolutionarily related cousin CYP2D7. Through extensive experiments using simulated and real datasets, we show that our algorithm accurately solves this important problem with potential clinical implications. Availability and implementation: Cypiripi is available at http://sfu-compbio.github.io/cypiripi. Contact:cenk@sfu.ca.
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Affiliation(s)
- Ibrahim Numanagić
- School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA
| | - Salem Malikić
- School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA
| | - Victoria M Pratt
- School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA
| | - Todd C Skaar
- School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA
| | - David A Flockhart
- School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA
| | - S Cenk Sahinalp
- School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA School of Computing Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada, Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA and School of Informatics and Computing, Indiana University, Bloomington, IN 47401, USA
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22
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Oesterreich S, Henry NL, Kidwell KM, Van Poznak CH, Skaar TC, Dantzer J, Li L, Hangartner TN, Peacock M, Nguyen AT, Rae JM, Desta Z, Philips S, Storniolo AM, Stearns V, Hayes DF, Flockhart DA. Associations between genetic variants and the effect of letrozole and exemestane on bone mass and bone turnover. Breast Cancer Res Treat 2015; 154:263-73. [PMID: 26536870 DOI: 10.1007/s10549-015-3608-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
Adjuvant therapy for hormone receptor (HR) positive postmenopausal breast cancer patients includes aromatase inhibitors (AI). While both the non-steroidal AI letrozole and the steroidal AI exemestane decrease serum estrogen concentrations, there is evidence that exemestane may be less detrimental to bone. We hypothesized that single nucleotide polymorphisms (SNP) predict effects of AIs on bone turnover. Early stage HR-positive breast cancer patients were enrolled in a randomized trial of exemestane versus letrozole. Effects of AI on bone mineral density (BMD) and bone turnover markers (BTM), and associations between SNPs in 24 candidate genes and changes in BMD or BTM were determined. Of the 503 enrolled patients, paired BMD data were available for 123 and 101 patients treated with letrozole and exemestane, respectively, and paired BTM data were available for 175 and 173 patients, respectively. The mean change in lumbar spine BMD was significantly greater for letrozole-treated (-3.2 %) compared to exemestane-treated patients (-1.0 %) (p = 0.0016). Urine N-telopeptide was significantly increased in patients treated with exemestane (p = 0.001) but not letrozole. Two SNPs (rs4870061 and rs9322335) in ESR1 and one SNP (rs10140457) in ESR2 were associated with decreased BMD in letrozole-treated patients. In the exemestane-treated patients, SNPs in ESR1 (Rs2813543) and CYP19A1 (Rs6493497) were associated with decreased bone density. Exemestane had a less negative impact on bone density compared to letrozole, and the effects of AI therapy on bone may be impacted by genetic variants in the ER pathway.
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Affiliation(s)
- Steffi Oesterreich
- Department of Pharmacology and Chemical Biology, Women's Cancer Research Center, Magee Womens Research Institute, University of Pittsburgh Cancer Institute (UPCI), 204 Craft Avenue, Pittsburgh, PA, 15261, USA.
| | - N Lynn Henry
- Breast Oncology Program, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, 48109, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Catherine H Van Poznak
- Breast Oncology Program, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, 48109, USA
| | - Todd C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jessica Dantzer
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Lang Li
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Thomas N Hangartner
- BioMedical Imaging Laboratory, Wright State University, Dayton, OH, 45435, USA
| | - Munro Peacock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Anne T Nguyen
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - James M Rae
- Breast Oncology Program, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, 48109, USA
| | - Zeruesenay Desta
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Santosh Philips
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Anna M Storniolo
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, 46202, USA
| | - Vered Stearns
- Breast Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Daniel F Hayes
- Breast Oncology Program, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, 48109, USA
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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23
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Han X, Quinney SK, Wang Z, Zhang P, Duke J, Desta Z, Elmendorf JS, Flockhart DA, Li L. Identification and Mechanistic Investigation of Drug-Drug Interactions Associated With Myopathy: A Translational Approach. Clin Pharmacol Ther 2015; 98:321-7. [PMID: 25975815 PMCID: PMC4664558 DOI: 10.1002/cpt.150] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 12/02/2014] [Revised: 11/11/2015] [Accepted: 05/12/2015] [Indexed: 01/29/2023]
Abstract
Myopathy is a group of muscle diseases that can be induced or exacerbated by drug–drug interactions (DDIs). We sought to identify clinically important myopathic DDIs and elucidate their underlying mechanisms. Five DDIs were found to increase the risk of myopathy based on analysis of observational data from the Indiana Network of Patient Care. Loratadine interacted with simvastatin (relative risk 95% confidence interval [CI] = [1.39, 2.06]), alprazolam (1.50, 2.31), ropinirole (2.06, 5.00), and omeprazole (1.15, 1.38). Promethazine interacted with tegaserod (1.94, 4.64). In vitro investigation showed that these DDIs were unlikely to result from inhibition of drug metabolism by CYP450 enzymes or from inhibition of hepatic uptake via the membrane transporter OATP1B1/1B3. However, we did observe in vitro synergistic myotoxicity of simvastatin and desloratadine, suggesting a role in loratadine–simvastatin interaction. This interaction was epidemiologically confirmed (odds ratio 95% CI = [2.02, 3.65]) using the data from the US Food and Drug Administration Adverse Event Reporting System.
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Affiliation(s)
- X Han
- Department of Pharmacology and Toxicology, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Center for Computational Biology and Bioinformatics, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology in the Department of Medicine, Indiana University at Indianapolis, Indianapolis, Indiana, USA
| | - S K Quinney
- Center for Computational Biology and Bioinformatics, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Department of Obstetrics and Gynecology, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Indiana Institute of Personalized Medicine, School of Medicine, Indiana University at Indianapolis, Indianapolis, Indiana, USA
| | - Z Wang
- Center for Computational Biology and Bioinformatics, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Department of Medical and Molecular Genetics, Indiana University at Indianapolis, Indianapolis, Indiana, USA
| | - P Zhang
- Center for Computational Biology and Bioinformatics, Indiana University at Indianapolis, Indianapolis, Indiana, USA
| | - J Duke
- Regenstrief Institute, Indiana University at Indianapolis, Indianapolis, Indiana, USA
| | - Z Desta
- Division of Clinical Pharmacology in the Department of Medicine, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Indiana Institute of Personalized Medicine, School of Medicine, Indiana University at Indianapolis, Indianapolis, Indiana, USA
| | - J S Elmendorf
- Department of Cellular & Integrative Physiology, Indiana University at Indianapolis, Indianapolis, Indiana, USA
| | - D A Flockhart
- Division of Clinical Pharmacology in the Department of Medicine, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Indiana Institute of Personalized Medicine, School of Medicine, Indiana University at Indianapolis, Indianapolis, Indiana, USA
| | - L Li
- Center for Computational Biology and Bioinformatics, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology in the Department of Medicine, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Department of Medical and Molecular Genetics, Indiana University at Indianapolis, Indianapolis, Indiana, USA.,Regenstrief Institute, Indiana University at Indianapolis, Indianapolis, Indiana, USA
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24
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Haas DM, Lai D, Sharma S, Then J, Kho A, Flockhart DA, Tantisira K, Foroud T. Steroid Pathway Genes and Neonatal Respiratory Distress After Betamethasone Use in Anticipated Preterm Birth. Reprod Sci 2015; 23:680-6. [PMID: 26507871 DOI: 10.1177/1933719115612129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/15/2022]
Abstract
OBJECTIVE To test several key glucocorticoid genes that are enhanced in lung development for associations with respiratory distress syndrome (RDS) after antenatal corticosteroid use. METHODS A prospective cohort of women received betamethasone to accelerate fetal lung maturity for threatened preterm delivery. DNA was obtained from mothers and newborns. Neonatal RDS was the primary outcome. Genotyping for single-nucleotide polymorphisms (SNPs) in 68 glucocorticoid genes found to be differentially expressed during lung development was performed. Multivariable analysis tested for associations of SNPs in the candidate genes with RDS. RESULTS Genotypic results for 867 SNPs in 96 mothers and 73 babies were included. Thirty-nine (53.4%) babies developed RDS. Maternal SNPs in the centromeric protein E (CENPE), GLRX, CD9, and AURKA genes provided evidence of association with RDS (P < .01). In newborns, SNPs in COL4A3, BHLHE40, and SRGN provided evidence of association with RDS (P < .01). CONCLUSION Single-nucleotide polymorphisms in several glucocorticoid responsive genes suggest association with neonatal RDS after antenatal corticosteroid use.
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Affiliation(s)
- David M Haas
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dongbing Lai
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunita Sharma
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jenny Then
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alvin Kho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | | | - Kelan Tantisira
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Tatiana Foroud
- Indiana University School of Medicine, Indianapolis, IN, USA
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25
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Santa-Maria CA, Blackford A, Nguyen AT, Skaar TC, Philips S, Oesterreich S, Rae JM, Desta Z, Robarge J, Henry NL, Storniolo AM, Hayes DF, Blumenthal RS, Ouyang P, Post WS, Flockhart DA, Stearns V. Association of Variants in Candidate Genes with Lipid Profiles in Women with Early Breast Cancer on Adjuvant Aromatase Inhibitor Therapy. Clin Cancer Res 2015; 22:1395-402. [PMID: 26463708 DOI: 10.1158/1078-0432.ccr-15-1213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/09/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Aromatase inhibitors can exert unfavorable effects on lipid profiles; however, previous studies have reported inconsistent results. We describe the association of single-nucleotide polymorphisms (SNP) in candidate genes with lipid profiles in women treated with adjuvant aromatase inhibitors. EXPERIMENTAL DESIGN We conducted a prospective observational study to test the associations between SNPs in candidate genes in estrogen signaling and aromatase inhibitor metabolism pathways with fasting lipid profiles during the first 3 months of aromatase inhibitor therapy in postmenopausal women with early breast cancer randomized to adjuvant letrozole or exemestane. We performed genetic association analysis and multivariable linear regressions using dominant, recessive, and additive models. RESULTS A total of 303 women had complete genetic and lipid data and were evaluable for analysis. In letrozole-treated patients, SNPs in CYP19A1, including rs4646, rs10046, rs700518, rs749292, rs2289106, rs3759811, and rs4775936 were significantly associated with decreases in triglycerides by 20.2 mg/dL and 39.3 mg/dL (P < 0.00053), respectively, and with variable changes in high-density lipoprotein (HDL-C) from decreases by 4.2 mg/dL to increases by 9.8 mg/dL (P < 0.00053). CONCLUSIONS Variants in CYP19A1 are associated with decreases in triglycerides and variable changes in HDL-C in postmenopausal women on adjuvant aromatase inhibitors. Future studies are needed to validate these findings, and to identify breast cancer survivors who are at higher risk for cardiovascular disease with aromatase inhibitor therapy.
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Affiliation(s)
| | - Amanda Blackford
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne T Nguyen
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Santosh Philips
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - James M Rae
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | | | - Jason Robarge
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Norah Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | | | - Daniel F Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | | | - Pamela Ouyang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wendy S Post
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Vered Stearns
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
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26
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Hertz DL, Snavely AC, McLeod HL, Walko CM, Ibrahim JG, Anderson S, Weck KE, Magrinat G, Olajide O, Moore S, Raab R, Carrizosa DR, Corso S, Schwartz G, Peppercorn JM, Evans JP, Jones DR, Desta Z, Flockhart DA, Carey LA, Irvin WJ. In vivo assessment of the metabolic activity of CYP2D6 diplotypes and alleles. Br J Clin Pharmacol 2015; 80:1122-30. [PMID: 25907378 DOI: 10.1111/bcp.12665] [Citation(s) in RCA: 32] [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] [Received: 01/08/2015] [Revised: 04/07/2015] [Accepted: 04/11/2015] [Indexed: 01/13/2023] Open
Abstract
AIMS A prospectively enrolled patient cohort was used to assess whether the prediction of CYP2D6 phenotype activity from genotype data could be improved by reclassification of diplotypes or alleles. METHODS Three hundred and fifty-five patients receiving tamoxifen 20 mg were genotyped for CYP2D6 and tamoxifen metabolite concentrations were measured. The endoxifen : N-desmethly-tamoxifen metabolic ratio, as a surrogate of CYP2D6 activity, was compared across four diplotypes (EM/IM, EM/PM, IM/IM, IM/PM) that are typically collapsed into an intermediate metabolizer (IM) phenotype. The relative metabolic activity of each allele type (UM, EM, IM, and PM) and each EM and IM allele was estimated for comparison with the activity scores typically assigned, 2, 1, 0.5 and 0, respectively. RESULTS Each of the four IM diplotypes have distinct CYP2D6 activity from each other and from the EM and PM phenotype groups (each P < 0.05). Setting the activity of an EM allele at 1.0, the relative activities of a UM, IM and PM allele were 0.85, 0.67 and 0.52, respectively. The activity of the EM alleles were statistically different (P < 0.0001), with the CYP2D6*2 allele (scaled activity = 0.63) closer in activity to an IM than an EM allele. The activity of the IM alleles were also statistically different (P = 0.014). CONCLUSION The current systems for translating CYP2D6 genotype into phenotype are not optimally calibrated, particularly in regards to IM diplotypes and the *2 allele. Additional research is needed to improve the prediction of CYP2D6 activity from genetic data for individualized dosing of CYP2D6 dependent drugs.
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Affiliation(s)
| | - Anna C Snavely
- RTI International, Research Triangle Park, NC, 27709-2194, USA
| | | | | | - Joseph G Ibrahim
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Steven Anderson
- Laboratory Corporation of America, Burlington, NC, 27215, USA
| | - Karen E Weck
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gustav Magrinat
- Moses Cone Health Cancer Center, Greensboro, NC, 27401-1020, USA
| | | | - Susan Moore
- Rex Hematology Oncology Associates, Raleigh, NC, 27607, USA
| | - Rachel Raab
- Brody School of Medicine at East Carolina University, Greenville, NC, 27834, USA
| | | | - Steven Corso
- Palmetto Hematology Oncology, Spartanburg, SC, 29303, USA
| | - Garry Schwartz
- Levine Cancer Institute Concord, Concord, NC, 28025, USA
| | | | - James P Evans
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | | | | | - Lisa A Carey
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - William J Irvin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Bon Secours Cancer Institute, Richmond, VA, 23230, USA
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Cho DY, Shen JHQ, Lemler SM, Skaar TC, Li L, Blievernicht J, Zanger UM, Kim KB, Shin JG, Flockhart DA, Desta Z. Rifampin enhances cytochrome P450 (CYP) 2B6-mediated efavirenz 8-hydroxylation in healthy volunteers. Drug Metab Pharmacokinet 2015; 31:107-16. [PMID: 27053325 DOI: 10.1016/j.dmpk.2015.07.002] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/29/2015] [Accepted: 07/14/2015] [Indexed: 01/11/2023]
Abstract
The effect of rifampin on the in vivo metabolism of the antiretroviral drug efavirenz was evaluated in healthy volunteers. In a cross-over placebo control trial, healthy subjects (n = 20) were administered a single 600 mg oral dose of efavirenz after pretreatment with placebo or rifampin (600 mg/day for 10 days). Plasma and urine concentrations of efavirenz, 8-hydroxyefavirenz and 8,14-dihydroxyefavirenz were measured by LC-MS/MS. Compared to placebo treatment, rifampin increased the oral clearance (by ∼2.5-fold) and decreased maximum plasma concentration (Cmax) and area under the plasma concentration-time curve (AUC0-∞) of efavirenz (by ∼1.6- and ∼2.5-fold respectively) (p < 0.001). Rifampin treatment substantially increased the Cmax and AUC0-12h of 8-hydroxyefavirenz and 8,14-dihydroxyefavirenz, metabolic ratio (AUC0-72h of metabolites to AUC0-72h efavirenz) and the amount of metabolites excreted in urine (Ae0-12hr) (all, p < 0.01). Female subjects had longer elimination half-life (1.6-2.2-fold) and larger weight-adjusted distribution volume (1.6-1.9-fold) of efavirenz than male subjects (p < 0.05) in placebo and rifampin treated groups respectively. In conclusion, rifampin enhances CYP2B6-mediated efavirenz 8-hydroxylation in vivo. The metabolism of a single oral dose of efavirenz may be a suitable in vivo marker of CYP2B6 activity to evaluate induction drug interactions involving this enzyme.
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Affiliation(s)
- Doo-Yeoun Cho
- Indiana University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Indianapolis, IN 46202, USA
| | - Joan H Q Shen
- Indiana University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Indianapolis, IN 46202, USA
| | - Suzanne M Lemler
- Indiana University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Indianapolis, IN 46202, USA
| | - Todd C Skaar
- Indiana University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Indianapolis, IN 46202, USA
| | - Lang Li
- Indiana University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Indianapolis, IN 46202, USA
| | - Julia Blievernicht
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Ulrich M Zanger
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Kwon-Bok Kim
- Inje University College of Medicine, Inje University Busan Paik Hospital, Busan 614-735, Republic of Korea
| | - Jae-Gook Shin
- Inje University College of Medicine, Inje University Busan Paik Hospital, Busan 614-735, Republic of Korea
| | - David A Flockhart
- Indiana University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Indianapolis, IN 46202, USA
| | - Zeruesenay Desta
- Indiana University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Indianapolis, IN 46202, USA.
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Maximov PY, McDaniel RE, Fernandes DJ, Korostyshevskiy VR, Bhatta P, Mürdter TE, Flockhart DA, Jordan VC. Simulation with cells in vitro of tamoxifen treatment in premenopausal breast cancer patients with different CYP2D6 genotypes. Br J Pharmacol 2015; 171:5624-35. [PMID: 25073551 DOI: 10.1111/bph.12864] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/25/2014] [Accepted: 07/22/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Tamoxifen is a prodrug that is metabolically activated by 4-hydroxylation to the potent primary metabolite 4-hydroxytamoxifen (4OHT) or via another primary metabolite N-desmethyltamoxifen (NDMTAM) to a biologically active secondary metabolite endoxifen through a cytochrome P450 2D6 variant system (CYP2D6). To elucidate the mechanism of action of tamoxifen and the importance of endoxifen for its effect, we determined the anti-oestrogenic efficacy of tamoxifen and its metabolites, including endoxifen, at concentrations corresponding to serum levels measured in breast cancer patients with various CYP2D6 genotypes (simulating tamoxifen treatment). EXPERIMENTAL APPROACH The biological effects of tamoxifen and its metabolites on cell growth and oestrogen-responsive gene modulation were evaluated in a panel of oestrogen receptor-positive breast cancer cell lines. Actual clinical levels of tamoxifen metabolites in breast cancer patients were used in vitro along with actual levels of oestrogens observed in premenopausal patients taking tamoxifen. KEY RESULTS Tamoxifen and its primary metabolites (4OHT and NDMTAM) only partially inhibited the stimulant effects of oestrogen on cells. The addition of endoxifen at concentrations corresponding to different CYP2D6 genotypes was found to enhance the anti-oestrogenic effect of tamoxifen and its metabolites with an efficacy that correlated with the concentration of endoxifen; at concentrations corresponding to the extensive metabolizer genotype it further inhibited the actions of oestrogen. In contrast, lower concentrations of endoxifen (intermediate and poor metabolizers) had little or no anti-oestrogenic effects. CONCLUSIONS AND IMPLICATIONS Endoxifen may be a clinically relevant metabolite in premenopausal patients as it provides additional anti-oestrogenic actions during tamoxifen treatment.
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Affiliation(s)
- Philipp Y Maximov
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Schneider BP, Li L, Radovich M, Shen F, Miller KD, Flockhart DA, Jiang G, Vance G, Gardner L, Vatta M, Bai S, Lai D, Koller D, Zhao F, O'Neill A, Smith ML, Railey E, White C, Partridge A, Sparano J, Davidson NE, Foroud T, Sledge GW. Genome-Wide Association Studies for Taxane-Induced Peripheral Neuropathy in ECOG-5103 and ECOG-1199. Clin Cancer Res 2015; 21:5082-5091. [PMID: 26138065 DOI: 10.1158/1078-0432.ccr-15-0586] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/08/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Taxane-induced peripheral neuropathy (TIPN) is an important survivorship issue for many cancer patients. Currently, there are no clinically implemented biomarkers to predict which patients might be at increased risk for TIPN. We present a comprehensive approach to identification of genetic variants to predict TIPN. EXPERIMENTAL DESIGN We performed a genome-wide association study (GWAS) in 3,431 patients from the phase III adjuvant breast cancer trial, ECOG-5103 to compare genotypes with TIPN. We performed candidate validation of top SNPs for TIPN in another phase III adjuvant breast cancer trial, ECOG-1199. RESULTS When evaluating for grade 3-4 TIPN, 120 SNPs had a P value of <10(-4) from patients of European descent (EA) in ECOG-5103. Thirty candidate SNPs were subsequently tested in ECOG-1199 and SNP rs3125923 was found to be significantly associated with grade 3-4 TIPN (P = 1.7 × 10(-3); OR, 1.8). Race was also a major predictor of TIPN, with patients of African descent (AA) experiencing increased risk of grade 2-4 TIPN (HR, 2.1; P = 5.6 × 10(-16)) and grade 3-4 TIPN (HR, 2.6; P = 1.1 × 10(-11)) compared with others. An SNP in FCAMR, rs1856746, had a trend toward an association with grade 2-4 TIPN in AA patients from the GWAS in ECOG-5103 (OR, 5.5; P = 1.6 × 10(-7)). CONCLUSIONS rs3125923 represents a validated SNP to predict grade 3-4 TIPN. Genetically determined AA race represents the most significant predictor of TIPN.
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Affiliation(s)
| | - Lang Li
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Milan Radovich
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Fei Shen
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Kathy D Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Guanglong Jiang
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Gail Vance
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura Gardner
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Matteo Vatta
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Shaochun Bai
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Dongbing Lai
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Daniel Koller
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Fengmin Zhao
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Anne O'Neill
- Dana Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | - Joseph Sparano
- Albert Einstein university, Montefiore Medical Center, Bronx, New York
| | - Nancy E Davidson
- University of Pittsburgh Cancer Center, Pittsburgh, Pennsylvania
| | - Tatiana Foroud
- Indiana University School of Medicine, Indianapolis, Indiana
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Ingle JN, Kalari KR, Buzdar AU, Robson ME, Goetz MP, Desta Z, Barman P, Dudenkov TT, Northfelt DW, Perez EA, Flockhart DA, Williard CV, Wang L, Weinshilboum RM. Estrogens and their precursors in postmenopausal women with early breast cancer receiving anastrozole. Steroids 2015; 99:32-8. [PMID: 25163006 PMCID: PMC4339673 DOI: 10.1016/j.steroids.2014.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/09/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We determined hormone concentrations (estradiol [E2], estrone [E1], estrone conjugates [E1-C], androstenedione [A], testosterone [T]) before and on anastrozole therapy where we also determined plasma concentrations of anastrozole and its metabolites. EXPERIMENTAL Postmenopausal women who were to receive adjuvant anastrozole for resected early breast cancer were studied. Pretreatment, blood samples were obtained for the acquisition of DNA and for plasma hormone measurements (E2, E1, E1-C, A, and T). A second blood draw was obtained at least 4 weeks after starting anastrozole for hormone, anastrozole and metabolite measurements. For hormone assays, a validated bioanalytical method using gas chromatography negative ionization tandem mass spectrometry was used. Anastrozole and metabolite assays involved extraction of plasma followed by LC/MS/MS assays. RESULTS 649 patients were evaluable. Pretreatment and during anastrozole, there was large inter-individual variability in E2, E1, and E1-C as well as anastrozole and anastrozole metabolite concentrations. E2 and E1 concentrations were below the lower limits of quantitation in 79% and 70%, respectively, of patients on anastrozole therapy, but those with reliable concentrations had a broad range (0.627-234.0 pg/mL, 1.562-183.2 pg/mL, respectively). Considering E2, 8.9% had the same or higher concentration relative to baseline while on anastrozole, documented by the presence of drug. CONCLUSIONS We demonstrated large inter-individual variability in anastrozole and anastrozole metabolite concentrations as well as E1, E2, E1-C, A, and T concentrations before and while on anastrozole. These findings suggest that the standard 1mg daily dose of anastrozole is not optimal for a substantial proportion of women with breast cancer.
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Affiliation(s)
- James N Ingle
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
| | - Krishna R Kalari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Aman U Buzdar
- Department of Breast Oncology, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mark E Robson
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Matthew P Goetz
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Zeruesenay Desta
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Poulami Barman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Tanda T Dudenkov
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Donald W Northfelt
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, United States
| | - Edith A Perez
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - David A Flockhart
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, United States
| | | | - Liewei Wang
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Richard M Weinshilboum
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
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Kadakia KC, Snyder CF, Kidwell KM, Seewald NJ, Storniolo AM, Flockhart DA, Carpenter JS, Hayes DF, Stearns V, Henry NL. Associations between treatment-emergent symptoms and early discontinuation of aromatase inhibitor (AI) therapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20745] [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)
- Kunal C. Kadakia
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Kelley M Kidwell
- University of Michigan, Department of Biostatistics, Ann Arbor, MI
| | | | | | | | | | - Daniel F. Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Vered Stearns
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Norah Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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32
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Schelleman H, Han X, Brensinger CM, Quinney SK, Bilker WB, Flockhart DA, Li L, Hennessy S. Pharmacoepidemiologic and in vitro evaluation of potential drug-drug interactions of sulfonylureas with fibrates and statins. Br J Clin Pharmacol 2015; 78:639-48. [PMID: 24548191 DOI: 10.1111/bcp.12353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 02/06/2014] [Indexed: 11/28/2022] Open
Abstract
AIMS To examine whether initiation of fibrates or statins in sulfonylurea users is associated with hypoglycaemia, and examine in vitro inhibition of cytochrome P450 (CYP) enzymes by statins, fenofibrate and glipizide. METHODS We used healthcare data to conduct nested case-control studies of serious hypoglycaemia (i.e. resulting in hospital admission or emergency department treatment) in persons taking glipizide or glyburide, and calculated adjusted overall and time-stratified odds ratios (ORs) and 95% confidence intervals (CIs). We also characterized the in vitro inhibition of CYP enzymes by statins, fenofibrate and glipizide using fluorometric CYP450 inhibition assays, and estimated area under the concentration-time curve ratios (AUCRs) for the drug pairs. RESULTS We found elevated adjusted overall ORs for glyburide-fenofibrate (OR 1.84, 95% CI 1.37, 2.47) and glyburide-gemfibrozil (OR 1.57, 95% CI 1.25, 1.96). The apparent risk did decline over time as might be expected from a pharmacokinetic mechanism. Fenofibrate was a potent in vitro inhibitor of CYP2C19 (IC50 = 0.2 μm) and CYP2B6 (IC50 = 0.7 μm) and a moderate inhibitor of CYP2C9 (IC50 = 9.7 μm). The predicted CYP-based AUCRs for fenofibrate-glyburide and gemfibrozil-glyburide interactions were only 1.09 and 1.04, suggesting that CYP inhibition is unlikely to explain such an interaction. CONCLUSIONS Use of fenofibrate or gemfibrozil together with glyburide was associated with elevated overall risks of serious hypoglycaemia. CYP inhibition seems unlikely to explain this observation. We speculate that a pharmacodynamic effect of fibrates (e.g. activate peroxisome proliferator-activator receptor alpha) may contribute to these apparent interactions.
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Affiliation(s)
- H Schelleman
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Kreutz RP, Bitar A, Owens J, Desta Z, Breall JA, von der Lohe E, Sinha A, Vatta M, Nystrom P, Jin Y, Flockhart DA. Factor XIII Val34Leu polymorphism and recurrent myocardial infarction in patients with coronary artery disease. J Thromb Thrombolysis 2015; 38:380-7. [PMID: 24510702 DOI: 10.1007/s11239-014-1059-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Factor XIII (FXIII) is necessary for cross linking of fibrin strands and generation of stable fibrin clot. FXIII Val34Leu is a common genetic single nucleotide polymorphism that has been associated with accelerated fibrin stabilization and reduced rate of fibrinolysis. The contribution of Val34Leu to long term risk of recurrent myocardial infarction (MI) in patients with coronary stenting has not been conclusively established. The objective of the study was to examine the effects of Val34Leu on fibrin generation, platelet aggregation, and long term clinical outcomes in patients with coronary artery disease treated with dual antiplatelet therapy. Patients with angiographically documented coronary artery disease who were treated with aspirin and clopidogrel were enrolled (n = 211). Light transmittance aggregometry and plasma fibrin clot formation using thrombelastography (TEG) were determined. Genotyping of Val34Leu was performed using Taqman assay. Clinical events during follow up were recorded. Homozygous carriers of 34 Leu variant had significantly shorter fibrin clot formation time as compared to wild type individuals (TEG K: 1.27 ± 0.3 vs. 1.68 ± 1.1 min, p = 0.011). The Val34Leu variant was associated with gene dose dependent increased risk of MI (log rank, p = 0.002) or occurrence of composite of MI and CV death (log rank, p = 0.005) with highest event rates observed in homozygous carriers of 34 Leu. In summary, FXIII Val34Leu polymorphism was associated with increased rate of fibrin stabilization in homozygous carriers of the variant and may increase risk of recurrent MI and death in patients with angiographically established coronary artery disease treated with dual antiplatelet therapy.
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Affiliation(s)
- Rolf P Kreutz
- Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 N. Capitol Ave, ME-400, Indianapolis, IN, 46202, USA,
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34
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Hertz DL, Snavely AC, McLeod HL, Walko CM, Ibrahim JG, Anderson S, Weck KE, Rubin P, Olajide O, Moore S, Raab R, Carrizosa DR, Corso S, Schwartz G, Peppercorn JM, Evans JP, Desta Z, Flockhart DA, Carey LA, Irvin WJ. Abstract P1-03-02: CYP2D6 intermediate metabolizers includes patient groups with distinct metabolic activity. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p1-03-02] [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: Tamoxifen is a selective estrogen receptor modulator that is the most commonly used and cost effective hormonal agent for pre-menopausal hormone-receptor positive breast cancer patients. CYP2D6 activity phenotype, which is classified by genotype, predicts the extent of metabolic activation of tamoxifen to endoxifen. We previously reported that increasing the daily dose to 40 mg/day in intermediate metabolizers (IMs), but not poor metabolizers (PMs), achieves target endoxifen concentrations, defined as that of extensive metabolizers (EMs) on 20 mg/day. There was substantial endoxifen variability in the IM phenotype group, which is composed of several discrete diplophenotypes (EM/IM, EM/PM, IM/IM, IM/PM). We enrolled a second, larger cohort of patients in order to determine whether these diplophenotypes should be combined into a single IM phenotype or segregated.
Methods: 380 patients on tamoxifen ≥ 4 months and not on potent CYP2D6 inhibiting medications enrolled in Lineberger Comprehensive Cancer Center (LCCC) trial 0801. Genotyping was performed using the Amplichip® CYP450 test (Roche Diagnostics) for CYP2D6, followed by systematic assignment of phenotype based on diplophenotype. Tamoxifen was increased from 20 to 40 mg/day in PMs and IMs. Endoxifen concentrations in IM diplophenotypes were compared with EM/EMs and PM/PMs at baseline and at 4 months (after dose increase in patients with IM and PM phenotypes).
Results: After exclusion of UM patients and patients missing endoxifen data at baseline and/or 4 months, 295 patients were included in this analysis. At baseline the EM/IM patients had similar endoxifen level to the EM/EM patients while the IM/IM and IM/PM patients had similar levels to the PM/PMs. After 4 months on 40 mg/day the endoxifen concentrations in EM/IM patients were significantly greater than EM/EMs; EM/PM and IM/IM patients were similar to EM/EMs; but IM/PM patients remained significantly lower than EM/EMs and similar to PM/PMs (See Table 1 for results).
Conclusions: The large group of patients currently defined as CYP2D6 intermediate metabolizers is comprised of four distinct CYP2D6 diplophentoypes. The most metabolically active diplophenotype (EM/IM) are very similar to EM/EMs while the least active diplophenotype (IM/PM) are similar to PM/PMs. A more accurate CYP2D6 activity classification system may be necessary if genetic association testing and genotype-guided therapy are pursued.
Endoxifen Level at Baseline and 4 Months by CYP2D6 Diplophenotype Baseline Endoxifen 4-Month Endoxifen DiplophenotypenMedian (SD)P-val vs. EM/EMP-val vs. PM/PMMedian (SD)P-val vs. EM/EMP-val vs. PM/PMEM/EM11038.67 (6.01)NAp=0.00018.23 (5.09)NAp=0.007EM/IM2568.02 (4.75)p=0.09p=0.00213.11 (9.38)p<0.0001p<0.0001EM/PM2745.72 (4.45)p=0.0001p=0.028.91 (5.28)p=0.42p=0.003IM/IM2174.29 (4.10)p=0.001p=0.266.52 (5.53)p=0.27p=0.24IM/PM2323.90 (3.17)p<0.0001p=0.485.82 (3.47)p=0.0009p=0.77PM/PM3133.33 (2.89)p=0.0001NA6.08 (2.57)p=0.007NA1Diplophenotype classified as extensive metabolizer phenotype, continued on 20 mg/day. 2Diplophenotypes classified as intermediate metabolizer phenotype, changed to 40 mg/day. 3Diplophenotype classified as poor metabolizer phenotype, changed to 40 mg/day.
Citation Format: Daniel L Hertz, Anna C Snavely, Howard L McLeod, Christine M Walko, Joseph G Ibrahim, Steven Anderson, Karen E Weck, Peter Rubin, Oludamilola Olajide, Susan Moore, Rachel Raab, Daniel R Carrizosa, Steven Corso, Gary Schwartz, Jeffrey M Peppercorn, James P Evans, Zeruesenay Desta, David A Flockhart, Lisa A Carey, William J Irvin Jr. CYP2D6 intermediate metabolizers includes patient groups with distinct metabolic activity [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-03-02.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Rachel Raab
- 7Brody School of Medicine, East Carolina University
| | | | | | - Gary Schwartz
- 8Carolinas Medical Center Hematology-Oncology Associates
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Lv W, Liu J, Skaar TC, Flockhart DA, Cushman M. Design and synthesis of norendoxifen analogues with dual aromatase inhibitory and estrogen receptor modulatory activities. J Med Chem 2015; 58:2623-48. [PMID: 25751283 DOI: 10.1021/jm501218e] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Both selective estrogen receptor modulators and aromatase inhibitors are widely used for the treatment of breast cancer. Compounds with both aromatase inhibitory and estrogen receptor modulatory activities could have special advantages for treatment of breast cancer. Our previous efforts led to the discovery of norendoxifen as the first compound with dual aromatase inhibitory and estrogen receptor binding activities. To optimize its efficacy and aromatase selectivity versus other cytochrome P450 enzymes, a series of structurally related norendoxifen analogues were designed and synthesized. The most potent compound, 4'-hydroxynorendoxifen (10), displayed elevated inhibitory potency against aromatase and enhanced affinity for estrogen receptors when compared to norendoxifen. The selectivity of 10 for aromatase versus other cytochrome P450 enzymes was also superior to norendoxifen. 4'-Hydroxynorendoxifen is therefore an interesting lead for further development to obtain new anticancer agents of potential value for the treatment of breast cancer.
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Affiliation(s)
- Wei Lv
- †Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University, 575 Stadium Mall Drive, West Lafayette, Indiana 47907, United States
| | - Jinzhong Liu
- ‡Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indiana Institute for Personalized Medicine, Indianapolis, Indiana 46202, United States
| | - Todd C Skaar
- ‡Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indiana Institute for Personalized Medicine, Indianapolis, Indiana 46202, United States
| | - David A Flockhart
- ‡Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indiana Institute for Personalized Medicine, Indianapolis, Indiana 46202, United States
| | - Mark Cushman
- †Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University, 575 Stadium Mall Drive, West Lafayette, Indiana 47907, United States
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Leonard CE, Bilker WB, Brensinger CM, Flockhart DA, Freeman CP, Kasner SE, Kimmel SE, Hennessy S. Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors. Stroke 2015; 46:722-31. [PMID: 25657176 DOI: 10.1161/strokeaha.114.006866] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE There is controversy and little information about whether individual proton pump inhibitors (PPIs) differentially alter the effectiveness of clopidogrel in reducing ischemic stroke risk. We, therefore, aimed to elucidate the risk of ischemic stroke among concomitant users of clopidogrel and individual PPIs. METHODS We conducted a propensity score-adjusted cohort study of adult new users of clopidogrel, using 1999 to 2009 Medicaid claims from 5 large states. Exposures were defined by prescriptions for esomeprazole, lansoprazole, omeprazole, rabeprazole, and pantoprazole-with pantoprazole serving as the referent. The end point was hospitalization for acute ischemic stroke, defined by International Classification of Diseases Ninth Revision Clinical Modification codes in the principal position on inpatient claims, within 180 days of concomitant therapy initiation. RESULTS Among 325 559 concomitant users of clopidogrel and a PPI, we identified 1667 ischemic strokes for an annual incidence of 2.4% (95% confidence interval, 2.3-2.5). Adjusted hazard ratios for ischemic stroke versus pantoprazole were 0.98 (0.82-1.17) for esomeprazole; 1.06 (0.92-1.21) for lansoprazole; 0.98 (0.85-1.15) for omeprazole; and 0.85 (0.63-1.13) for rabeprazole. CONCLUSIONS PPIs of interest did not increase the rate of ischemic stroke among clopidogrel users when compared with pantoprazole, a PPI thought to be devoid of the potential to interact with clopidogrel.
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Affiliation(s)
- Charles E Leonard
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.).
| | - Warren B Bilker
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Colleen M Brensinger
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - David A Flockhart
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Cristin P Freeman
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Scott E Kasner
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Stephen E Kimmel
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Sean Hennessy
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
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Abstract
Personalized medicine seeks to identify the right dose of the right drug for the right patient at the right time. Typically, individualization of therapy is based on the pharmacogenomic makeup of the individual and environmental factors that alter drug disposition and response. In addition to these factors, during pregnancy, a woman's body undergoes many changes that can impact the therapeutic efficacy of medications. Yet, there is minimal research regarding personalized medicine in obstetrics. Adoption of pharmacogenetic testing into the obstetrical care is dependent on evidence of analytical validity, clinical validity, and clinical utility. Here, we briefly present information regarding the potential utility of personalized medicine for treating the obstetric patient for pain with narcotics, hypertension, and preterm labor, and discuss the impediments of bringing personalized medicine to the obstetrical clinic.
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Affiliation(s)
- Sara K Quinney
- Department of Obstetrics and Gynecology and Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
| | - David A Flockhart
- Departments of Medicine, Medical Genetics, and Pharmacology; Indiana Institute of Personalized Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Avinash S Patil
- Departments of Obstetrics & Gynecology and Medicine; Indiana Institute for Personalized Medicine, Indiana University School of Medicine, Indianapolis, IN
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Schneider BP, Li L, Shen F, Miller KD, Radovich M, O'Neill A, Gray RJ, Lane D, Flockhart DA, Jiang G, Wang Z, Lai D, Koller D, Pratt JH, Dang CT, Northfelt D, Perez EA, Shenkier T, Cobleigh M, Smith ML, Railey E, Partridge A, Gralow J, Sparano J, Davidson NE, Foroud T, Sledge GW. Genetic variant predicts bevacizumab-induced hypertension in ECOG-5103 and ECOG-2100. Br J Cancer 2014; 111:1241-8. [PMID: 25117820 PMCID: PMC4453857 DOI: 10.1038/bjc.2014.430] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/26/2014] [Accepted: 07/08/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bevacizumab has broad anti-tumour activity, but substantial risk of hypertension. No reliable markers are available for predicting bevacizumab-induced hypertension. METHODS A genome-wide association study (GWAS) was performed in the phase III bevacizumab-based adjuvant breast cancer trial, ECOG-5103, to evaluate for an association between genotypes and hypertension. GWAS was conducted in those who had experienced systolic blood pressure (SBP) >160 mm Hg during therapy using binary analysis and a cumulative dose model for the total exposure of bevacizumab. Common toxicity criteria (CTC) grade 3-5 hypertension was also assessed. Candidate SNP validation was performed in the randomised phase III trial, ECOG-2100. RESULTS When using the phenotype of SBP>160 mm Hg, the most significant association in SV2C (rs6453204) approached and met genome-wide significance in the binary model (P=6.0 × 10(-8); OR=3.3) and in the cumulative dose model (P=4.7 × 10(-8); HR=2.2), respectively. Similar associations with rs6453204 were seen for CTC grade 3-5 hypertension but did not meet genome-wide significance. Validation study from ECOG-2100 demonstrated a statistically significant association between this SNP and grade 3/4 hypertension using the binary model (P-value=0.037; OR=2.4). CONCLUSIONS A genetic variant in SV2C predicted clinically relevant bevacizumab-induced hypertension in two independent, randomised phase III trials.
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Affiliation(s)
- B P Schneider
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - L Li
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - F Shen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - K D Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - M Radovich
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - A O'Neill
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - R J Gray
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - D Lane
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - D A Flockhart
- Indiana Institute for Personalized Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - G Jiang
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Z Wang
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - D Lai
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - D Koller
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - J H Pratt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - C T Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - D Northfelt
- Department of Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - E A Perez
- Mayo Clinic, Jacksonville, FL 32224, USA
| | - T Shenkier
- BCCA – Vancouver Cancer Center, Vancouver, BC, V5Z 4E6, USA
| | - M Cobleigh
- Department of Internal Medicine , Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA
| | - M L Smith
- Research Advocacy Network, Plano, TX 75093, USA
| | - E Railey
- Research Advocacy Network, Plano, TX 75093, USA
| | - A Partridge
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - J Gralow
- University of Washington, Seattle, WA 98195, USA
| | - J Sparano
- Department of Oncology, Montefiore Hospital and Medical Center, Bronx, NY 10467, USA
| | - N E Davidson
- Cancer Institute and University of Pittsburgh Cancer Center, Pittsburgh, PA 15232, USA
| | - T Foroud
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - G W Sledge
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
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Levy KD, Decker BS, Carpenter JS, Flockhart DA, Dexter PR, Desta Z, Skaar TC. Prerequisites to implementing a pharmacogenomics program in a large health-care system. Clin Pharmacol Ther 2014; 96:307-9. [PMID: 24807457 PMCID: PMC4441093 DOI: 10.1038/clpt.2014.101] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/01/2014] [Indexed: 11/09/2022]
Abstract
Pharmacogenomics (PGx) technology is advancing rapidly; however, clinical adoption is lagging. The Indiana Institute of Personalized Medicine (IIPM) places a strong focus on translating PGx research into clinical practice. We describe what have been found to be the key requirements that must be delivered in order to ensure a successful and enduring PGx implementation within a large health-care system.
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Affiliation(s)
- K D Levy
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - B S Decker
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - J S Carpenter
- Department of Nursing Science Care, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - D A Flockhart
- 1] Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Indiana Institute for Personalized Medicine, Indianapolis, Indiana, USA
| | - P R Dexter
- 1] Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Health Information and Translational Sciences, Indianapolis, Indiana, USA
| | - Z Desta
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - T C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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40
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Kreutz RP, Owens J, Lu D, Nystrom P, Jin Y, Kreutz Y, Desta Z, Flockhart DA. Platelet factor XIIIa release during platelet aggregation and plasma clot strength measured by thrombelastography in patients with coronary artery disease treated with clopidogrel. Platelets 2014; 26:358-63. [PMID: 24833046 DOI: 10.3109/09537104.2014.916793] [Citation(s) in RCA: 8] [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] [Indexed: 11/13/2022]
Abstract
It has been estimated that up to half of circulating factor XIIIa (FXIIIa) is stored in platelets. The release of FXIIIa from platelets upon stimulation with adenosine diphosphate (ADP) in patients with coronary artery disease treated with dual antiplatelet therapy has not been previously examined. Samples from 96 patients with established coronary artery disease treated with aspirin and clopidogrel were examined. Platelet aggregation was performed by light transmittance aggregometry in platelet-rich plasma (PRP), with platelet-poor plasma (PPP) as reference, and ADP 5 µM as agonist. Kaolin-activated thrombelastography (TEG) was performed in citrate PPP. PRP after aggregation was centrifuged and plasma supernatant (PSN) collected. FXIIIa was measured in PPP and PSN. Platelet aggregation after stimulation with ADP 5 µM resulted in 24% additional FXIIIa release in PSN as compared to PPP (99.3 ± 27 vs. 80.3 ± 24%, p < 0.0001). FXIIIa concentration in PSN correlated with maximal plasma clot strength (TEG-G) (r = 0.48, p < 0.0001), but not in PPP (r = 0.15, p = 0.14). Increasing quartiles of platelet-derived FXIIIa were associated with incrementally higher TEG-G (p = 0.012). FXIIIa release was similar between clopidogrel responders and non-responders (p = 0.18). In summary, platelets treated with aspirin and clopidogrel release a significant amount of FXIIIa upon aggregation by ADP. Platelet-derived FXIIIa may contribute to differences in plasma TEG-G, and thus, in part, provide a mechanistic explanation for high clot strength observed as a consequence of platelet activation. Variability in clopidogrel response does not significantly influence FXIIIa release from platelets.
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41
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Kidwell KM, Harte SE, Hayes DF, Storniolo AM, Carpenter J, Flockhart DA, Stearns V, Clauw DJ, Williams DA, Henry NL. Patient-reported symptoms and discontinuation of adjuvant aromatase inhibitor therapy. Cancer 2014; 120:2403-11. [PMID: 24802413 DOI: 10.1002/cncr.28756] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [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: 01/09/2014] [Revised: 02/24/2014] [Accepted: 03/03/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aromatase inhibitor (AI) therapy results in substantial survival benefits for patients with hormone receptor-positive breast cancer. The rates of poor adherence and discontinuation of AI therapy are high, primarily because of treatment-related toxicities like musculoskeletal pain. Although pain-related symptoms may worsen during AI therapy, the authors hypothesized that nonpersistence with AI therapy was associated with symptoms that were present before treatment initiation. METHODS Postmenopausal women initiating AI therapy who were enrolled in a prospective clinical trial completed questionnaires at baseline to assess sleep, fatigue, mood, and pain. Reasons for treatment discontinuation during the first year of treatment were recorded. Associations between baseline patient-reported symptoms and treatment discontinuation because of toxicity were identified using logistic regression. RESULTS Four hundred forty-nine patients were evaluable. The odds of treatment discontinuation were higher in patients who reported a greater number of symptoms before AI initiation. Baseline poor sleep quality was associated with early treatment discontinuation, with an odds ratio (OR) of 1.91 (95% confidence interval [CI], 1.26-2.89; P = .002). Baseline presence of tired feeling and forgetfulness had similar ORs for discontinuation (tired feeling: OR, 1.76; 95% CI, 1.15-2.67; P = .009; forgetfulness: OR, 1.66; 95% CI, 1.11-2.48; P = .015). An increasing total number of baseline symptoms was associated with an increased likelihood of treatment discontinuation, with an OR of 1.89 (95% CI, 1.20-2.96; P = .006) for 3 to 5 symptoms versus 0 to 2 symptoms. CONCLUSIONS Symptom clusters in breast cancer survivors that are present before the initiation of adjuvant AI therapy may have a negative impact on a patient's persistence with therapy. Interventions to manage these symptoms may improve breast cancer outcomes and quality of life.
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Affiliation(s)
- Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
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Somogyi AA, Lewis LD, Cohen AF, Flockhart DA, Ferro A, Loke YK, Ritter JM. Editors' report, November 2013. Br J Clin Pharmacol 2014; 77:401-2. [DOI: 10.1111/bcp.12317] [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: 11/29/2022] Open
Affiliation(s)
- Andrew A. Somogyi
- Discipline of Pharmacology, School of Medical Sciences; University of Adelaide; Adelaide Australia
| | - Lionel D. Lewis
- Section of Clinical Pharmacology, Department of Medicine; Dartmouth Medical School; Dartmouth-Hitchcock Medical Center; Lebanon NH USA
| | - Adam F. Cohen
- Centre for Human Drug Research; Leiden The Netherlands
| | - David A. Flockhart
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine; Indiana University; Indianapolis IN USA
| | - Albert Ferro
- Department of Clinical Pharmacology; School of Medicine (Cardiovascular Division) King's College London; London UK
| | - Yoon K. Loke
- School of Medicine; University of East Anglia; Norwich UK
| | - James M. Ritter
- Department of Clinical Pharmacology; School of Medicine (Cardiovascular Division) King's College London; London UK
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Henry NL, Kidwell K, Hayes DF, Storniolo AM, Flockhart DA, Stearns V, Clauw D, Williams DA. Abstract S3-02: Associations between baseline patient-reported symptoms and discontinuation of adjuvant aromatase inhibitor (AI) therapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s3-02] [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: Non-adherence and non-persistence with AI therapy are common and have been associated with increased mortality. A major reason for premature discontinuation of therapy is toxicity of AI therapy. We performed an exploratory analysis to investigate associations between patient-reported symptoms at the time of AI initiation and discontinuation of AI therapy due to toxicity.
Methods: 503 postmenopausal women with early stage ER positive breast cancer were enrolled into a randomized open label clinical trial of exemestane versus letrozole for 2 years. Questionnaires about sleep quality (PSQI), mood disorders (CESD), and general symptoms (NSABP symptom questionnaire) were completed prior to AI initiation. For each item on the symptom questionnaire, responses were dichotomized as not at all vs any. To analyze total number of symptoms the following 4 symptoms were included: PSQI>5, CESD≥16, any degree of joint pain, and any degree of difficulty concentrating. Subjects were evaluated 1, 3, 6, 12, and 24 months after AI initiation. Reasons for treatment discontinuation were prospectively recorded. The primary endpoint of this exploratory analysis was treatment discontinuation due to toxicity ≤12 months following AI initiation. Linear and logistic regression analyses were performed to analyze associations between clinical factors and baseline symptoms and treatment discontinuation by 12 months.
Results: One hundred forty-two subjects (28.8%) discontinued therapy because of toxicity by or at 12 months. On univariate analysis, poor sleep quality (PSQI>5), depression (CESD≥16), forgetfulness, and total number of symptoms were statistically significantly associated with treatment discontinuation. On multivariable logistic regression, treatment discontinuation due to toxicity was statistically significantly associated with AI medication, and there was a trend towards an association with both younger age and increasing total number of symptoms present at baseline.
Univariate and multivariate analysis of baseline predictors of AI treatment discontinuation Univariate analysisMultivariate analysisSymptom/characteristic% subjectsOR (95% CI)P valueOR (95% CI)P valueAge (yrs) mean 58.0 (9.0)0.98 (0.96-1.00)0.060.98 (0.95-1.00)0.076Drug (vs letrozole) 49.5%1.47 (0.99-2.18)0.0541.57 (1.04-2.38)0.033Estradiol (BL, pg/ml) mean 10.6 (37.2)1.01 (0.997-1.02)0.151.01 (1.00-1.02)0.091Prior taxane (vs no) 32.7%1.23 (0.82-1.85)0.331.14 (0.73-1.78)0.57Total # symptoms1 vs 028.2%1.56 (0.89-2.73)0.0241.27 (0.70-2.31)0.092 2 vs 021.5%1.52 (0.84-2.77) 1.54 (0.83-2.88) ≥3 vs 023.7%2.41 (1.37-4.23) 2.10 (1.15-3.84) Depression 15.2%1.03 (1.01-1.06)0.012 Forgetfulness (vs none) 45.5%1.64 (1.11-2.43)0.014 Difficulty concentrating (vs none) 23.7%1.35 (0.86-2.11)0.19 Joint pain (vs none) 57.6%1.42 (0.95-2.12)0.09 Poor sleep quality (vs good) 47.4%1.84 (1.23-2.75)0.003 Vaginal dryness (vs none) 31.5%1.37 (0.91-2.08)0.14 CI: confidence interval; OR: odds ratio
Conclusions: Patient-reported symptoms present prior to initiation of AI therapy may predispose patients to early discontinuation of treatment. Pre-emptive management of these symptoms, rather than treatment of AI toxicity after its development, may improve adherence to and persistence with therapy.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S3-02.
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Affiliation(s)
- NL Henry
- University of Michigan; Indiana University; Johns Hopkins University; for the COBRA Investigators
| | - K Kidwell
- University of Michigan; Indiana University; Johns Hopkins University; for the COBRA Investigators
| | - DF Hayes
- University of Michigan; Indiana University; Johns Hopkins University; for the COBRA Investigators
| | - AM Storniolo
- University of Michigan; Indiana University; Johns Hopkins University; for the COBRA Investigators
| | - DA Flockhart
- University of Michigan; Indiana University; Johns Hopkins University; for the COBRA Investigators
| | - V Stearns
- University of Michigan; Indiana University; Johns Hopkins University; for the COBRA Investigators
| | - D Clauw
- University of Michigan; Indiana University; Johns Hopkins University; for the COBRA Investigators
| | - DA Williams
- University of Michigan; Indiana University; Johns Hopkins University; for the COBRA Investigators
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Santa-Maria CA, Dantzer J, Li L, Skaar T, Oesterreich S, Rae JM, Zeruesenay D, Nguyen AT, Henry NL, Storniolo AM, Hayes DF, Blumenthal RS, Ouyang P, Post W, Flockhart DA, Stearns V. Abstract P1-08-11: Association of variants in candidate genes on lipid profiles in women with early breast cancer on adjuvant aromatase inhibitor therapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-11] [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
Aromatase inhibitors (AI) can exert unfavorable effects on lipid profiles, but previous studies have reported inconsistent results. Given the intricate biological relationship between estrogen and lipid profiles, these mixed results may be explained in part by variation in genes encoding proteins involved in the drug's target and in estrogen metabolism and signaling. The purpose of this study was to investigate associations of single-nucleotide polymorphisms (SNP) in candidate genes with AI-mediated changes in lipid profiles.
Methods
We completed a prospective multicenter randomized observational open-label study to test the association of SNPs in candidate genes on biomarkers of estrogenic and anti-estrogenic activity in post-menopausal women with early breast cancer who were recommended adjuvant AI therapy. Eligible women were randomly assigned to exemestane or letrozole, and were followed for 2 years. We genotyped 137 SNPs from germ line DNA in the following candidate genes: ARVCF, COMT, CYP19A1, ESR1, ESR2, PGR, EP300, EZH2, NCOA1-3, NCOR1-2, NRIP, and PELP1. Lipid profiles including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG) were measured at baseline and 3 months after initiating AI. We conducted genetic association data analysis and multivariate linear regressions to analyze the genetic effects using dominant, recessive, and additive models. Multivariate analysis included age, body mass index, prior hormone replacement therapy, and prior tamoxifen. To adjust for multiple comparisons, only SNPs with a p<0.0003 were considered significant.
Results
We enrolled 502 women in to the study, but for this analysis we excluded women who did not have genetic data (n = 33), had incomplete data (n = 23), discontinued or crossed over AI therapy (n = 48), women not fasting at both time points (n = 89), or those on lipid-lowering medications (n = 162). A total of 200 women were evaluable (letrozole 107, exemestane 93). Lipid profiles in all patients (n = 200) at baseline and 3 months after initiating AI, respectively, were as follows: TC 204.9 and 203.3 (unchanged, p = 0.43); HDL 61.3 and 56.8 (decreased, p = 6.3E-10); LDL 122.2 and 124.6 (unchanged, p = 0.22); and TG 107.1 and 103.6 (unchanged, p = 0.26). Genetic association and multivariate analysis revealed that SNPs in ESR1 and NCOR1 are significantly associated with additional changes in lipid parameters as summarized in Table 1.
Table 1.Significant findings of multivariate linear regressions analyzing genetic associations between candidate gene SNPs and lipid profiles of AI-treated women.CohortNumberSNP (gene)Minor Allele FrequencyLipid ParameterModel UsedMean Absolute Change (mg/dL)P-valueAll patients184rs9340958 (ESR1)0.07TCRecessive-2.250.0003Letrozole96rs9340958 (ESR1)0.07TCRecessive5.280.00009 101rs3020368 (ESR1)0.09TCRecessive6.350.00007Exemestane93rs3798758 (ESR1)0.03HDLDominant, additive-7.970.00001 88rs926848 (ESR1)0.03HDLDominant, additive-7.970.00002 93rs61753150 (NCOR1)0.01TGDominant, additive-11.630.00003
Conclusions
Variants in genes involved in estrogen metabolism and signaling are associated with changes in lipid profiles in AI-treated women and should be validated in other studies.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-11.
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Affiliation(s)
- CA Santa-Maria
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - J Dantzer
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - L Li
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - T Skaar
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - S Oesterreich
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - JM Rae
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - D Zeruesenay
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - AT Nguyen
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - NL Henry
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - AM Storniolo
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - DF Hayes
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - RS Blumenthal
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - P Ouyang
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - W Post
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - DA Flockhart
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
| | - V Stearns
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Indiana University School of Medicine; University of Pittsburgh Cancer Institute; University of Michigan Comprehensive Cancer Center; Johns Hopkins University School of Medicine
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Kreutz RP, Owens J, Jin Y, Nystrom P, Desta Z, Kreutz Y, Breall JA, Li L, Chiang C, Kovacs RJ, Flockhart DA. Cytochrome P450 3A4*22, PPAR-α, and ARNT polymorphisms and clopidogrel response. Clin Pharmacol 2013; 5:185-92. [PMID: 24353446 PMCID: PMC3862586 DOI: 10.2147/cpaa.s53151] [Citation(s) in RCA: 6] [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] [Indexed: 11/23/2022] Open
Abstract
Recent candidate gene studies using a human liver bank and in vivo validation in healthy volunteers identified polymorphisms in cytochrome P450 (CYP) 3A4 gene (CYP3A4*22), Ah-receptor nuclear translocator (ARNT), and peroxisome proliferator-activated receptor-α (PPAR-α) genes that are associated with the CYP3A4 phenotype. We hypothesized that the variants identified in these genes may be associated with altered clopidogrel response, since generation of clopidogrel active metabolite is, partially mediated by CYP3A activity. Blood samples from 211 subjects, of mixed racial background, with established coronary artery disease, who had received clopidogrel, were analyzed. Platelet aggregation was determined using light transmittance aggregometry (LTA). Genotyping for CYP2C19*2, CYP3A4*22, PPAR-α (rs4253728, rs4823613), and ARNT (rs2134688) variant alleles was performed using Taqman® assays. CYP2C19*2 genotype was associated with increased on-treatment platelet aggregation (adenosine diphosphate 20 μM; P=0.025). No significant difference in on-treatment platelet aggregation, as measured by LTA during therapy with clopidogrel, was demonstrated among the different genotypes of CYP3A4*22, PPAR-α, and ARNT. These findings suggest that clopidogrel platelet inhibition is not influenced by the genetic variants that have previously been associated with reduced CYP3A4 activity.
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Affiliation(s)
- Rolf P Kreutz
- Krannert Institute of Cardiology, Indianapolis, Indiana, USA ; Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Janelle Owens
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yan Jin
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Perry Nystrom
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zeruesenay Desta
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yvonne Kreutz
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Lang Li
- Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Chienwei Chiang
- Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - David A Flockhart
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Ramamoorthy A, Liu Y, Philips S, Desta Z, Lin H, Goswami C, Gaedigk A, Li L, Flockhart DA, Skaar TC. Regulation of microRNA expression by rifampin in human hepatocytes. Drug Metab Dispos 2013; 41:1763-8. [PMID: 23935064 DOI: 10.1124/dmd.113.052886] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rifampin causes drug interactions by altering hepatic drug metabolism. Because microRNAs (miRNAs) have been shown to regulate genes involved in drug metabolism, we determined the effect of rifampin on the expression of hepatic miRNAs. Primary human hepatocytes from seven subjects were treated with rifampin, and the expression of miRNA and cytochrome P450 (P450) mRNAs was measured by TaqMan assays and RNA-seq, respectively. Rifampin induced the expression of 10 clinically important and 13 additional P450 genes and repressed the expression of 9 other P450 genes (P < 0.05). Rifampin induced the expression of 33 miRNAs and repressed the expression of 35 miRNAs (P < 0.05). Several of these changes were highly negatively correlated with the rifampin-induced changes in the expression of their predicted target P450 mRNAs, supporting the possibility of miRNA-induced regulation of P450 mRNA expression. In addition, several other miRNA changes were positively correlated with the changes in P450 mRNA expression, suggesting similar regulatory mechanisms. Despite the interindividual variability in the rifampin effects on miRNA expression, principal components analysis clearly separated the rifampin-treated samples from the controls. In conclusion, rifampin treatment alters miRNA expression patterns in human hepatocytes, and some of the changes were correlated with the rifampin-induced changes in expression of the P450 mRNAs they are predicted to target.
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Affiliation(s)
- Anuradha Ramamoorthy
- Department of Medicine, Division of Clinical Pharmacology (A.R., S.P., Z.D., D.A.F., T.C.S.), and Department of Medical and Molecular Genetics (A.R., Y.L., H.L., C.G., L.L.), Indiana University School of Medicine, Indianapolis, Indiana; and Division of Clinical Pharmacology and Innovative Therapeutics, the Children's Mercy Hospital and Clinics, Kansas City, Missouri (A.G.)
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Jiang F, Desta Z, Shon JH, Yeo CW, Kim HS, Liu KH, Bae SK, Lee SS, Flockhart DA, Shin JG. Effects of clopidogrel and itraconazole on the disposition of efavirenz and its hydroxyl metabolites: exploration of a novel CYP2B6 phenotyping index. Br J Clin Pharmacol 2013; 75:244-53. [PMID: 22554354 DOI: 10.1111/j.1365-2125.2012.04314.x] [Citation(s) in RCA: 20] [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] [Indexed: 11/30/2022] Open
Abstract
AIMS To evaluate the effects of clopidogrel and itraconazole on the disposition of efavirenz and its hydroxyl metabolites in relation to the CYP2B6*6 genotype and explore potential phenotyping indices for CYP2B6 activity in vivo using a low dose of oral efavirenz. METHODS We conducted a randomized three phase crossover study in 17 healthy Korean subjects pre-genotyped for the CYP2B6*6 allele (CYP2B6*1/*1, n = 6; *1/*6, n = 6; *6/*6, n = 5). Subjects were pretreated with clopidogrel (75 mg day(-1) for 4 days), itraconazole (200 mg day(-1) for 6 days), or placebo and then given a single dose of efavirenz (200 mg). The plasma (0-120 h) and urine (0-24 h) concentrations of efavirenz and its metabolites (7- and 8-hydroxyefavirenz and 8,14-dihydroxyefavirenz) were determined by LC/MS/MS. RESULTS This study is the first to delineate quantitatively the full (phase I and II) metabolic profile of efavirenz and its three hydroxyl metabolites in humans. Clopidogrel pretreatment markedly decreased AUC(0,48 h), C(max) and Ae(0,24 h) for 8,14-dihydroxyefavirenz, compared with placebo; 95% CI of the ratios were 0.55, 0.73, 0.30, 0.45 and 0.25, 0.47, respectively. The 8,14-dihydroxyefavirenz : efavirenz AUC(0,120 h) ratio was significantly correlated with the weight-adjusted CL/F of efavirenz (r(2) ≈ 0.4, P < 0.05), differed with CYP2B6*6 genotype and was affected by clopidogrel pretreatment (P < 0.05) but not by itraconazole pretreatment. CONCLUSIONS The disposition of 8,14-dihydroxy-EFV appears to be sensitive to CYP2B6 activity alterations in human subjects. The 8,14-dihydroxyefaviremz : efavirenz AUC(0,120 h) ratio is attractive as a candidate phenotyping index for CYP2B6 activity in vivo.
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Affiliation(s)
- Fen Jiang
- Department of Pharmacology and Pharmacogenomics Research Center, Inje University College of Medicine, Busan, South Korea
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Liu J, Flockhart PJ, Lu D, Lv W, Lu WJ, Han X, Cushman M, Flockhart DA. Inhibition of cytochrome p450 enzymes by the e- and z-isomers of norendoxifen. Drug Metab Dispos 2013; 41:1715-20. [PMID: 23824607 DOI: 10.1124/dmd.113.052506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Aromatase catalyzes the conversion of testosterone to estradiol and is the main source of endogenous estrogen in postmenopausal women. Aromatase inhibitors (AIs) are used to treat postmenopausal women with hormone receptor-positive breast cancer. Norendoxifen [4-(1-(4-(2-aminoethoxy)phenyl)-2-phenylbut-1-en-1-yl)phenol], an active metabolite of the selective estrogen receptor modulator tamoxifen, has been shown to be a potent competitive AI, with an IC50 of 90 nM. To obtain data relevant to the clinical use of norendoxifen, the primary objective of this study was to investigate norendoxifen's inhibitory capability on enzymes related to drug-drug interactions. We determined the inhibitory ability of norendoxifen against important drug-metabolizing cytochrome P450 enzymes, including CYP1A2, CYP2A6, CYP3A4, CYP3A5, and CYP2C19, to establish the potency of norendoxifen as a potential cause of drug-drug interactions. A second objective was to determine the effects of E- and Z-norendoxifen on the inhibition of these enzymes to further characterize the isomers' selectivity. The inhibitory abilities of E-, mixed, and Z-norendoxifen against recombinant aromatase (CYP19), CYP1A2, CYP3A4, CYP3A5, and CYP2C19 were tested using microsomal incubations. Mixed norendoxifen inhibited these enzymes with Ki values of 70 ± 9, 76 ± 3, 375 ± 6, 829 ± 62, and 0.56 ± 0.02 nM, respectively. E-Norendoxifen had a 9.3-fold-higher inhibitory ability than Z-norendoxifen against CYP19, while E- and Z-norendoxifen had similar potencies against CYP1A2, CYP3A4, CYP3A5, and CYP2C19. These results suggest that norendoxifen is able to act as a potent AI, and that its E-isomer is 9.3-fold more potent than the Z-isomer.
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Affiliation(s)
- Jinzhong Liu
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indiana Institute for Personalized Medicine, Indianapolis, Indiana 46202, USA.
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Weng L, Ziliak D, Im HK, Gamazon ER, Philips S, Nguyen AT, Desta Z, Skaar TC, Flockhart DA, Huang RS. Genome-wide discovery of genetic variants affecting tamoxifen sensitivity and their clinical and functional validation. Ann Oncol 2013; 24:1867-1873. [PMID: 23508821 PMCID: PMC3690911 DOI: 10.1093/annonc/mdt125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Beyond estrogen receptor (ER), there are no validated predictors for tamoxifen (TAM) efficacy and toxicity. We utilized a genome-wide cell-based model to comprehensively evaluate genetic variants for their contribution to cellular sensitivity to TAM. DESIGN Our discovery model incorporates multidimensional datasets, including genome-wide genotype, gene expression, and endoxifen-induced cellular growth inhibition in the International HapMap lymphoblastoid cell lines (LCLs). Genome-wide findings were further evaluated in NCI60 cancer cell lines. Gene knock-down experiments were performed in four breast cancer cell lines. Genetic variants identified in the cell-based model were examined in 245 Caucasian breast cancer patients who underwent TAM treatment. RESULTS We identified seven novel single-nucleotide polymorphisms (SNPs) associated with endoxifen sensitivity through the expression of 10 genes using the genome-wide integrative analysis. All 10 genes identified in LCLs were associated with TAM sensitivity in NCI60 cancer cell lines, including USP7. USP7 knock-down resulted in increasing resistance to TAM in four breast cancer cell lines tested, which is consistent with the finding in LCLs and in the NCI60 cells. Furthermore, we identified SNPs that were associated with TAM-induced toxicities in breast cancer patients, after adjusting for other clinical factors. CONCLUSION Our work demonstrates the utility of a cell-based model in genome-wide identification of pharmacogenomic markers.
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Affiliation(s)
| | | | - H K Im
- Health Studies, University of Chicago, Chicago
| | | | - S Philips
- Department of Medicine, Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, USA
| | - A T Nguyen
- Department of Medicine, Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, USA
| | - Z Desta
- Department of Medicine, Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, USA
| | - T C Skaar
- Department of Medicine, Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, USA
| | - D A Flockhart
- Department of Medicine, Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, USA
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