Skip to main content
Log in

Pharmacogenetics of irinotecan: A promoter polymorphism of UGT1A1 gene and severe adverse reactions to irinotecan

  • Published:
Investigational New Drugs Aims and scope Submit manuscript

Summary

This review focuses on a pharmacogenetic association between genetic polymorphism of UGT1A1 gene and severe adverse reactions to irinotecan. Although many studies used pharmacokinetic parameters as surrogate measures for predicting clinical outcomes of irinotecan chemotherapy, they have not produced consistent evidence. On the other hand, genotyping results of UGT1A1 gene appear to predict severe adverse reactions more straightforward than the pharmacokinetic parameters or the phenotypes of the enzymatic activity. A case-control study of Japanese cancer patients revealed that those with the variant UGT1A1 alleles were at significantly higher risk of severe adverse reactions to irinotecan, suggesting that the genotyping strategy would be clinically useful. Nevertheless, clinical importance of the pharmacogenetic testing should differ for different patient groups and for different clinical situations. We need to keep this issue in mind in applying the pharmacogenetic evidence in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jager W, Zembsch B, Wolschann P, Pittenauer E, Senderowicz AM, Sausville EA, Sedlacek HH, Graf J, Thalhammer T: Metabolism of the anticancer drug flavopiridol, a new inhibitor of cyclin dependent kinases, in rat liver. Life Sci 62: 1861–1873, 1998

    Article  CAS  PubMed  Google Scholar 

  2. Hagenauer B, Salamon A, Thalhammer T, Kunert O, Haslinger E, Klingler P, Senderowicz AM, Sausville EA, Jäger W: In vitro glucuronidation of the cyclin-dependent kinase inhibitor flavopiridol by rat and human liver microsomes: Involvement of UDP-glucuronosyltransferases 1A1 and 1A9. Drug Metab Dispos 29: 407–414, 2001

    CAS  PubMed  Google Scholar 

  3. Zhai S, Sausville EA, Senderowicz AM, Ando Y, Headlee D, Messmann RA, Arbuck S, Murgo AJ, Melillo G, Fuse E, Figg WD: Clinical pharmacology and pharmacogenetics of flavopiridol 1-h i.v. infusion in patients with refractory neoplasms. Anticancer Drugs 14: 125–135, 2003

    Article  CAS  PubMed  Google Scholar 

  4. Bosma PJ, Roy Chowdhury J, Bakker C, Gantla S, de Boer A, Oostra BA, Lindhout D, Tytgat GNJ, Jansen PLM, Oude Elferink RPJ, Roy Chowdhury N: The genetic basis of the reduced expression of bilirubin UDP-glucuronosyltransferase 1 in Gilbert's syndrome. N Engl J Med 333: 1171–1175, 1995

    Article  CAS  PubMed  Google Scholar 

  5. Monaghan G, Ryan M, Seddon R, Hume R, Burchell B: Genetic variation in bilirubin UDP-glucuronosyltransferase gene promoter and Gilbert's syndrome. Lancet 347: 578–581, 1996

    Article  CAS  PubMed  Google Scholar 

  6. Iyer L, King CD, Whitington PF, Green MD, Roy SK, Tephly TR, Coffman BL, Ratain MJ: Genetic predisposition to the metabolism of irinotecan (CPT-11): role of uridine diphosphate glucuronosyltransferase isoform 1A1 in the glucuronidation of its active metabolite (SN-38) in human liver microsomes. J Clin Invest 101: 847–854, 1998

    CAS  PubMed  Google Scholar 

  7. Iyer L, Hall D, Das S, Mortell MA, Ramírez J, Kim S, Di Rienzo A, Ratain MJ: Phenotype-genotype correlation of in vitro SN-38 (active metabolite of irinotecan) and bilirubin glucuronidation in human liver tissue with UGT1A1 promoter polymorphism. Clin Pharmacol Ther 65: 576–582, 1999

    CAS  PubMed  Google Scholar 

  8. Mathijssen RHJ, van Alphen RJ, Verweij J, Loos WJ, Nooter K, Stoter G, Sparreboom A: Clinical pharmacokinetics and metabolism of irinotecan (CPT-11). Clin Cancer Res 7: 2182–2194, 2001

    CAS  PubMed  Google Scholar 

  9. Negoro S, Fukuoka M, Masuda N, Takada M, Kusunoki Y, Matsui K, Takifuji N, Kudoh S, Niitani H, Taguchi T: Phase I study of weekly intravenous infusions of CPT-11, a new derivative of camptothecin, in the treatment of advanced non-small-cell lung cancer. J Natl Cancer Inst 83: 1164–1168, 1991

    CAS  PubMed  Google Scholar 

  10. Ohe Y, Sasaki Y, Shinkai T, Eguchi K, Tamura T, Kojima A, Kunikane H, Okamoto H, Karato A, Ohmatsu H: Phase I study and pharmacokinetics of CPT-11 with 5-day continuous infusion. J Natl Cancer Inst 84: 972–974, 1992

    CAS  PubMed  Google Scholar 

  11. Chabot GG, Abigerges D, Catimel G, Culine S, de Forni M, Extra JM, Mahjoubi M, Hérait P, Armand JP, Bugat R, Clavel M, Marty ME: Population pharmacokinetics and pharmacodynamics of irinotecan (CPT-11) and active metabolite SN-38 during phase I trials. Ann Oncol 6:141–151, 1995

    CAS  PubMed  Google Scholar 

  12. Pitot HC, Goldberg RM, Reid JM, Sloan JA, Skaff PA, Erlichman C, Rubin J, Burch PA, Adjei AA, Alberts SA, Schaaf LJ, Elfring G, Miller LL: Phases I dose-finding and pharmacokinetic trial of irinotecan hydrochloride (CPT-11) using a once-every-three-week dosing schedule for patients with advanced solid tumor malignancy. Clin Cancer Res 6:2236–2244, 2000

    CAS  PubMed  Google Scholar 

  13. de Jonge MJA, Verweij J, de Bruijn P, Brouwer E, Mathijssen RH, van Alphen RJ, de Boer-Dennert MM, Vernillet L, Jacques C, Sparreboom A: Pharmacokinetic, metabolic, and pharmacodynamic profiles in a dose-escalating study of irinotecan and cisplatin. J Clin Oncol 18:195–203, 2000

    CAS  PubMed  Google Scholar 

  14. Xie R, Mathijssen RHJ, Sparreboom A, Verweij J, Karlsson MO: Clinical pharmacokinetics of irinotecan and its metabolites in relation with diarrhea. Clin Pharmacol Ther 72: 265–275, 2002

    Article  CAS  PubMed  Google Scholar 

  15. Rivory LP, Haaz MC, Canal P, Lokiec F, Armand JP, Robert J: Pharmacokinetic interrelationships of irinotecan (CPT-11) and its three major plasma metabolites in patients enrolled in phase I/II trials. Clin Cancer Res 3:1261–1266, 1997

    CAS  PubMed  Google Scholar 

  16. Gong QH, Cho JW, Huang T, Potter C, Gholami N, Basu NK, Kubota S, Carvalho S, Pennington MW, Owens IS, Popescu NC: Thirteen UDP glucuronosyltransferase genes are encoded at the human UGT1 gene complex locus. Pharmacogenetics 11: 357–368, 2001

    Article  CAS  PubMed  Google Scholar 

  17. Ritter JK, Chen F, Sheen YY, Tran HM, Kimura S, Yeatman MT, Owens IS: A novel complex locus UGT1 encodes human bilirubin, phenol, and other UDP-glucuronosyltransferase isozymes with identical carboxyl termini. J Biol Chem 267: 3257–3261, 1992

    CAS  PubMed  Google Scholar 

  18. Mackenzie PI, Owens IS, Burchell B, Bock KW, Bairoch A, Bélanger A, Fournel-Gigleux S, Green M, Hum DW, Iyanagi T, Lancet D, Louisot P, Magdalou J, Roy Chowdhury JRitter JK, Schachter H, Tephly TR, Tipton KE, Nebert DW: The UDP glycosyltransferase gene superfamily: Recommended nomenclature update based on evolutionary divergence. Pharmacogenetics 7: 255–269, 1997

    CAS  PubMed  Google Scholar 

  19. Senafi SB, Clarke DJ, Burchell B: Investigation of the substrate specificity of a cloned expressed human bilirubin UDP-glucuronosyltransferase: UDP-sugar specificity and involvement in steroid and xenobiotic glucuronidation. Biochem J 303: 233–240, 1994

    CAS  PubMed  Google Scholar 

  20. Isselbacher KJ: Bilirubin metabolism and hyperbilirubinemia. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Long DL (eds) Harrision's Principles of Internal Medicine, 14th edition. New York, McGraw-Hill, 1997, pp 1672–1677

    Google Scholar 

  21. Ando Y, Saka H, Ando M, Sawa T, Muro K, Ueoka H, Yokoyama A, Saitoh S, Shimokata K, Hasegawa Y: Polymorphisms of UDP-glucuronosyltransferase gene and irinotecan adverse reactions: a pharmacogenetic analysis. Cancer Res 60: 6921– 6926, 2000

    CAS  PubMed  Google Scholar 

  22. Iyer L, Das S, Janisch L, Wen M, Ramirez J, Karrison T, Fleming GF, Vokes EE, Schilsky RL, Ratain MJ: UGT1A1*28 polymorphism as a determinant of irinotecan disposition and adverse reactions. Pharmacogenomics J 2:43–47, 2002

    Article  CAS  PubMed  Google Scholar 

  23. Innocenti F, Undevia SD, Iyer L, Chen PX, Das S, Kocherginsky M, Karrison T, Janisch L, Ramirez J, Rudin CM, Vokes EE, Ratain MJ: Genetic variants in the UDP-glucuronosyltransferase 1A1 gene predict the risk of severe neutropenia of irinotecan. J Clin Oncol 22:1382–1388, 2004

    Article  CAS  PubMed  Google Scholar 

  24. Marcuello E, Altés A, Menoyo A, del Rio E, Gómez-Pardo M, Baiget M: UGT1A1 gene variations and irinotecan treatment in patients with metastatic colorectal cancer. Br J Cancer 91: 678–682, 2004

    CAS  PubMed  Google Scholar 

  25. Rouits E, Boisdron-Celle M, Dumont A, Guerin O, Morel A, Gamelin E: Relevance of different UGT1A1 polymorphisms in irinotecan-induced toxicity: a molecular and clinical study of 75 patients. Clin Cancer Res 10: 5151–5159, 2004

    CAS  PubMed  Google Scholar 

  26. Kitagawa C, Ando M, Ando Y, Sekido Y, Wakai K, Imaizumi K, Shimokata K, Hasegawa Y: Genetic polymorphism in the phenobarbital-responsive enhancer module of the UDP-glucuronosyltransferase 1A1 gene and irinotecan toxicity. Pharmacogenetics and Genomics 15: 35–41, 2005

    Google Scholar 

  27. Japan Society for Cancer Therapy: Criteria for the evaluation of the clinical effects of solid cancer chemotherapy. J Jpn Soc Cancer Ther 28: 101–130, 1993

    Google Scholar 

  28. Tadokoro J, Hasegawa H, Hayakawa K, Takahashi M, Nakata H, Terada K, Sakata Y, Fukuoka M: Post-marketing surveillance (PMS) of all patients treated with irinotecan in Japan: clinical experience and ADR profile of 13,935 patients. Proc Am Soc Clin Oncol 21: 259, 2002 (Suppl; abstr 1033).

    Google Scholar 

  29. Pharmaceuticals and Cosmetics Division, Pharmaceutical Affairs Bureau, Ministry of Health and Welfare: Summary Basis of Approval (SBA) No. 1 (revised edition): Irinotecan hydrochloride. Yakuji Nippo, Ltd., Tokyo, 1996

  30. Wasserman E, Myara A, Lokiec F, Goldwasser F, Trivin F, Mahjoubi M, Misset JL, Cvitkovic E: Severe CPT-11 adverse reactions in patients with Gilbert's syndrome: two case reports. Ann Oncol 8: 1049–1051, 1997

    Article  CAS  PubMed  Google Scholar 

  31. Roses AD: Pharmacogenetics and the practice of medicine. Nature 405: 857–865, 2000

    Article  CAS  PubMed  Google Scholar 

  32. Ando Y, Saka H, Asai G, Sugiura S, Shimokata K, Kamataki T: UGT1A1 genotypes and glucuronidation of SN-38, the active metabolite of irinotecan. Ann Oncol 9: 845–847, 1998

    Article  CAS  PubMed  Google Scholar 

  33. Ando Y, Ueoka H, Sugiyama T, Ichiki M, Shimokata K, Hasegawa Y: Polymorphisms of UDP-glucuronosyltransferase and pharmacokinetics of irinotecan. Ther Drug Monit 24: 111–116, 2002

    Article  CAS  PubMed  Google Scholar 

  34. Mathijssen RH, Marsh S, Karlsson MO, Xie R, Baker SD, Verweij J, Sparreboom A, McLeod HL: Irinotecan pathway genotype analysis to predict pharmacokinetics. Clin Cancer Res 9: 3246–3253, 2003

    CAS  PubMed  Google Scholar 

  35. Sai K, Saeki M, Saito Y, Ozawa S, Katori N, Jinno H, Hasegawa R, Kaniwa N, Sawada J, Komamura K, Ueno K, Kamakura S, Kitakaze M, Kitamura Y, Kamatani N, Minami H, Ohtsu A, Shirao K, Yoshida T, Saijo N: UGT1A1 haplotypes associated with reduced glucuronidation and increased serum bilirubin in irinotecan-administered Japanese patients with cancer. Clin Pharmacol Ther 75: 501–515, 2004

    Article  CAS  PubMed  Google Scholar 

  36. Meyerhardt JA, Kwok A, Ratain MJ, McGovren JP, Fuchs CS: Relationship of baseline serum bilirubin to efficacy and toxicity of single-agent irinotecan in patients with metastatic colorectal cancer. J Clin Oncol 22: 1439–1446, 2004

    CAS  PubMed  Google Scholar 

  37. Beutler E, Gelbart T, Demina A: Racial variability in the UDP-glucuronosyltransferase 1 (UGT1A1) promoter: a balanced polymorphism for regulation of bilirubin metabolism? Proc Natl Acad Sci USA 95: 8170–8174, 1998

    CAS  PubMed  Google Scholar 

  38. Akaba K, Kimura T, Sasaki A, Tanabe S, Ikegami T, Hashimoto M, Umeda H, Yoshida H, Umetsu K, Chiba H, Yuasa I, Hayasaka K: Neonatal hyperbilirubinemia and mutation of the bilirubin uridine diphosphate-glucuronosyltransferase gene: A common missense mutation among Japanese, Koreans and Chinese. Biochem. Mol Biol Int 46: 21–26, 1998

    CAS  PubMed  Google Scholar 

  39. Ando Y, Chida M, Nakayama K, Saka H, Kamataki T: The UGT1A1*28 allele is relatively rare in a Japanese population. Pharmacogenetics 8: 357–360, 1998

    CAS  PubMed  Google Scholar 

  40. Sugatani J, Yamakawa K, Yoshinari K, Machida T, Takagi H, Mori M, Kakizaki S, Sueyoshi T, Negishi M, Miwa M: Identification of a defect in the UGT1A1 gene promoter and its association with hyperbilirubinemia. Biochem Biophys Res Commun 292: 492–497, 2002

    Article  CAS  PubMed  Google Scholar 

  41. Gagné JF, Montminy V, Belanger P, Journault K, Gaucher G, Guillemette C: Common human UGT1A polymorphisms and the altered metabolism of irinotecan active metabolite 7-ethyl- 10-hydroxycamptothecin (SN-38). Mol Pharmacol 62: 608–617, 2002

    PubMed  Google Scholar 

  42. Ando M, Ando Y, Sekido Y, Ando M, Shimokata K, Hasegawa Y: Genetic polymorphisms of the UDP-glucuronosyltransferase 1A7 gene and irinotecan adverse reactions in Japanese cancer patients. Jpn J Cancer Res 93: 591–597, 2002

    CAS  PubMed  Google Scholar 

  43. Kitagawa C, Ando M, Ando Y, Sekido Y, Usui M, Takahashi K, Shimokata K, Hasegawa Y: Genetic polymorphisms of the multidrug resistance-associated protein 2 gene (ABCC2) and irinotecan toxicity. J Clin Oncol 22: 129, 2004 (suppl; abstr 2009)

    Google Scholar 

  44. Paoluzzi L, Singh AS, Price DK, Danesi R, Mathijssen RH, Verweij J, Figg WD, Sparreboom A: Influence of genetic variants in UGT1A1 and UGT1A9 on the in vivo glucuronidation of SN-38. J Clin Pharmacol 44: 854–860, 2004

    CAS  PubMed  Google Scholar 

  45. de Jong FA, Marsh S, Mathijssen RH, King C, Verweij J, Sparreboom A, McLeod HL: ABCG2 pharmacogenetics: ethnic differences in allele frequency and assessment of influence on irinotecan disposition. Clin Cancer Res 10: 5889–5894, 2004

    CAS  PubMed  Google Scholar 

  46. Friedman HS, Petros WP, Friedman AH, Schaaf LJ, Kerby T, Lawyer J, Parry M, Houghton PJ, Lovell S, Rasheed K, Cloughsey T, Stewart ES, Colvin OM, Provenzale JM, McLendon RE, Bigner DD, Cokgor I, Haglund M, Rich J, Ashley D, Malczyn J, Elfring GL, Miller LL: Irinotecan therapy in adults with recurrent or progressive malignant glioma. J Clin Oncol 17: 1516–1525, 1999

    CAS  PubMed  Google Scholar 

  47. Mathijssen RH, Verweij J, de Bruijn P, Loos WJ, Sparreboom A: Effects of St. John's wort on irinotecan metabolism. J Natl Cancer Inst 94: 1247–1249, 2002

    CAS  PubMed  Google Scholar 

  48. Mathijssen RH, de Jong FA, van Schaik RH, Lepper ER, Friberg LE, Rietveld T, de Bruijn P, Graveland WJ, Figg WD, Verweij J, Sparreboom A: Prediction of irinotecan pharmacokinetics by use of cytochrome P450 3A4 phenotyping probes. J Natl Cancer Inst 96: 1585–1592, 2004

    CAS  PubMed  Google Scholar 

  49. Ando Y, Figg WD: Irinotecan in small-cell lung cancer N Engl J Med 346: 1414–1415, 2002

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yuichi Ando.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ando, M., Hasegawa, Y. & Ando, Y. Pharmacogenetics of irinotecan: A promoter polymorphism of UGT1A1 gene and severe adverse reactions to irinotecan. Invest New Drugs 23, 539–545 (2005). https://doi.org/10.1007/s10637-005-4022-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10637-005-4022-6

Key words

Navigation