CYP2D6 Genotype and Tamoxifen Response in Postmenopausal Women with Endocrine-Responsive Breast Cancer: The Breast International Group 1-98 Trial

• Published in: JNCI : Journal of the National Cancer Institute Vol. 104; no. 6; pp. 441 - 451
• Main Authors: REGAN, Meredith M, LEYLAND-JONES, Brian, DITZEL, Henrik J, NEVEN, Patrick, DEBLED, Marc, MAIBACH, Rudolf, PRICE, Karen N, GELBER, Richard D, COATES, Alan S, GOLDHIRSCH, Aron, RAE, James M, VIALE, Giuseppe, BOUZYK, Mark, PAGANI, Olivia, TANG, Weining, KAMMLER, Roswitha, DELL'ORTO, Patrizia, OLIVIA BIASI, Maria, THÜRLIMANN, Beat, LYNG, Maria B
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 21-03-2012; Oxford Publishing Limited (England)
• Subjects: Aged; Antineoplastic Agents, Hormonal - administration & dosage; Antineoplastic Agents, Hormonal - therapeutic use; Aromatase Inhibitors - therapeutic use; Biological and medical sciences; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - enzymology; Breast Neoplasms - genetics; Clinical trials; Cytochrome P-450 CYP2D6 - genetics; Disease-Free Survival; Drug Administration Schedule; Female; Genotype; Genotype & phenotype; Gynecology. Andrology. Obstetrics; Humans; International Cooperation; Kaplan-Meier Estimate; Letrozole; Mammary gland diseases; Medical sciences; Menopause; Middle Aged; Nitriles - administration & dosage; Nitriles - therapeutic use; Polymerase Chain Reaction; Polymorphism; Polymorphism, Genetic; Polymorphism, Single Nucleotide; Postmenopause; Tamoxifen - administration & dosage; Tamoxifen - therapeutic use; Treatment Outcome; Triazoles - administration & dosage; Triazoles - therapeutic use; Tumors; Womens health; Human; Antineoplastic agent; Breast disease; Enzyme; Cytochrome P450; Treatment efficiency; Antiestrogen; Genotype; Breast cancer; Antihormone; Malignant tumor; Tamoxifene; Mammary gland diseases; Chemotherapy; Selective estrogen receptor modulator; Treatment; Cancerology; Postmenopause; Adult; Female; Non steroid compound; Cancer; Hormonal receptor
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djs125

Adjuvant tamoxifen therapy is effective for postmenopausal women with endocrine-responsive breast cancer. Cytochrome P450 2D6 (CYP2D6) enzyme metabolizes tamoxifen to clinically active metabolites, and CYP2D6 polymorphisms may adversely affect tamoxifen efficacy. In this study, we investigated the clinical relevance of CYP2D6 polymorphisms.
We obtained tumor tissues and isolated DNA from 4861 of 8010 postmenopausal women with hormone receptor-positive breast cancer who enrolled in the randomized, phase III double-blind Breast International Group (BIG) 1-98 trial between March 1998 and May 2003 and received tamoxifen and/or letrozole treatment. Extracted DNA was used for genotyping nine CYP2D6 single-nucleotide polymorphisms using polymerase chain reaction-based methods. Genotype combinations were used to categorize CYP2D6 metabolism phenotypes as poor, intermediate, and extensive metabolizers (PM, IM, and EM, respectively; n = 4393 patients). Associations of CYP2D6 metabolism phenotypes with breast cancer-free interval (referred to as recurrence) and treatment-induced hot flushes according to randomized endocrine treatment and previous chemotherapy were assessed. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). All statistical tests were two-sided.
No association between CYP2D6 metabolism phenotypes and breast cancer-free interval was observed among patients who received tamoxifen monotherapy without previous chemotherapy (P = .35). PM or IM phenotype had a non-statistically significantly reduced risk of breast cancer recurrence compared with EM phenotype (PM or IM vs EM, HR of recurrence = 0.86, 95% CI = 0.60 to 1.24). CYP2D6 metabolism phenotype was associated with tamoxifen-induced hot flushes (P = .020). Both PM and IM phenotypes had an increased risk of tamoxifen-induced hot flushes compared with EM phenotype (PM vs EM, HR of hot flushes = 1.24, 95% CI = 0.96 to 1.59; IM vs EM, HR of hot flushes = 1.23, 95% CI = 1.05 to 1.43).
CYP2D6 phenotypes of reduced enzyme activity were not associated with worse disease control but were associated with increased hot flushes, contrary to the hypothesis. The results of this study do not support using the presence or absence of hot flushes or the pharmacogenetic testing of CYP2D6 to determine whether to treat postmenopausal breast cancer patients with tamoxifen.