Cabozantinib Induces Isolated Hyperbilirubinemia in Renal Cell Carcinoma Patients carrying the UGT1A1*28 Polymorphism

IF 2.3 3区医学 Q3 ONCOLOGY Clinical genitourinary cancer Pub Date : 2024-07-27 DOI:10.1016/j.clgc.2024.102180

Sajedeh Mobaraki , Peter Henrik Nissen , Frede Donskov , Agnieszka Wozniak , Yannick Van Herck , Lina Coosemans , Tine van Nieuwenhuyse , Diether Lambrechts , Oliver Bechter , Marcella Baldewijns , Eduard Roussel , Annouschka Laenen , Benoit Beuselinck

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Abstract

Background

Genetic variants of UGT1A1, involved in glucuronidation and clearance of bilirubin, are associated with reduced bilirubin metabolization and drug-induced isolated hyperbilirubinemia. We studied the impact of the UGT1A1*28 polymorphism on drug-induced isolated hyperbilirubinemia in metastatic renal cell carcinoma patients treated with pazopanib, cabozantinib, and axitinib.

Methods

We genotyped the UGT1A1*28 TA6/TA6-TA6/TA7-TA7/TA7 polymorphism and correlated with median baseline, on-treatment and peak bilirubin levels during therapy, incidence of grade-1- or -2 (G1/2)-hyperbilirubinemia and time-to-G1-hyperbilirubinemia.

Results

Of the 66 patients treated with pazopanib, 29 received axitinib and 28 cabozantinib upon progression. Median baseline bilirubin was higher in TA7/TA7-carriers versus TA6/TA6+TA6/TA7-carriers at start of pazopanib (P < .0001), cabozantinib (P < .0001), and axitinib (P = .007). During pazopanib therapy, median bilirubin increased 1.4-fold in TA7/TA7+TA6/TA7-carriers but not in TA6/TA6-carriers. On cabozantinib, bilirubin increased 1.5-fold in TA7/TA7-carriers but not in TA6/TA6+TA6/TA7-carriers. Axitinib did not increase bilirubin in any genotype. Peak bilirubin in TA7/TA7- versus TA6/TA6+TA6/TA7-carriers was higher on pazopanib (P < .0001) or cabozantinib (P < .0001). With pazopanib, G1-hyperbilirubinemia occurred in 57% of TA7/TA7- and 12% of TA6/TA6+TA6/TA7-carriers (P = .0009) and G2-hyperbilirubinemia in 36% and 6% of the patients, respectively (P = .004). On cabozantinib, G1-hyperbilirubinemia occurred in 100% of TA7/TA7- and 5% of TA6/TA6+TA6/TA7-carriers (P < .0001) and G2-hyperbilirubinemia in 33% and 0% of the patients, respectively (P = .04). On axitinib, no correlation between the genotypes and G1/2-hyperbilirubinemia was observed.

Conclusion

We validate the previously described impact of the UGT1A1*28 polymorphism on isolated bilirubin increase on pazopanib. We report for the first time that cabozantinib also interferes with UGT1A1 and causes isolated bilirubin increase.

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卡博替尼会诱发携带 UGT1A1*28 多态性的肾细胞癌患者出现孤立的高胆红素血症

背景参与胆红素葡萄糖醛酸化和清除的 UGT1A1 基因变异与胆红素代谢减少和药物诱导的孤立性高胆红素血症有关。我们研究了 UGT1A1*28 多态性对接受帕唑帕尼、卡博替尼和阿昔替尼治疗的转移性肾细胞癌患者药物诱导的孤立性高胆红素血症的影响。方法我们对UGT1A1*28 TA6/TA6-TA6/TA7-TA7/TA7多态性进行了基因分型，并将其与中位基线、治疗中和治疗期间的胆红素峰值水平、1级或2级（G1/2）高胆红素血症的发生率以及发生G1级高胆红素血症的时间相关联。开始接受帕唑帕尼治疗时，TA7/TA7携带者的中位胆红素高于TA6/TA6+TA6/TA7携带者（P = .0001）、卡博赞替尼（P = .0001）和阿昔替尼（P = .007）。在帕唑帕尼治疗期间，TA7/TA7+TA6/TA7携带者的胆红素中位数增加了1.4倍，而TA6/TA6携带者的胆红素中位数没有增加。服用卡博替尼后，TA7/TA7携带者的胆红素增加了1.5倍，但TA6/TA6+TA6/TA7携带者的胆红素没有增加。阿西替尼不会增加任何基因型的胆红素。TA7/TA7-与TA6/TA6+TA6/TA7-携带者相比，帕唑帕尼（P < .0001）或卡博赞替尼（P < .0001）的胆红素峰值更高。服用帕唑帕尼后，57%的TA7/TA7-携带者和12%的TA6/TA6+TA6/TA7-携带者出现G1-高胆红素血症（P = .0009），36%的患者出现G2-高胆红素血症，6%的患者出现G2-高胆红素血症（P = .004）。服用卡博替尼时，100%的TA7/TA7-携带者和5%的TA6/TA6+TA6/TA7-携带者出现G1-高胆红素血症（P <.0001），33%的患者出现G2-高胆红素血症，0%的患者出现G2-高胆红素血症（P = .04）。结论我们验证了之前描述的 UGT1A1*28 多态性对帕唑帕尼的孤立胆红素升高的影响。我们首次报道了卡博替尼也会干扰 UGT1A1 并导致孤立胆红素升高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.