Genetic characterization to improve interpretation and clinical management of hepatotoxicity caused by tyrosine kinase inhibitors

Pharmacogenomics. 2013 Apr;14(5):541-54. doi: 10.2217/pgs.13.24.

Abstract

Tyrosine kinase inhibitors (TKIs) represent important therapeutic alternatives to, or combinations with, traditional cytotoxic chemotherapy. Despite their selective molecular targeting and demonstrated clinical benefit, TKIs produce a range of serious adverse events, including drug-induced liver injury, that require careful patient management to maintain treatment benefit without harm. Genetic characterization of serious adverse events can identify mechanisms of injury and improve safety risk management. This review presents pharmacogenetic comparisons of two approved TKIs, lapatinib and pazopanib, which reveal different mechanisms of injury and inform the characteristics and risk of serious liver injury in treated patients. The data presented demonstrate the utility of genetic studies to investigate drug-induced liver injury and potentially support its management in patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Biomarkers, Pharmacological
  • Chemical and Drug Induced Liver Injury / genetics*
  • Drug-Related Side Effects and Adverse Reactions / chemically induced
  • Drug-Related Side Effects and Adverse Reactions / genetics*
  • Gilbert Disease / drug therapy
  • Gilbert Disease / genetics
  • Glucuronosyltransferase / genetics*
  • Humans
  • Indazoles
  • Lapatinib
  • Protein Kinase Inhibitors / administration & dosage
  • Protein Kinase Inhibitors / toxicity*
  • Pyrimidines / administration & dosage
  • Pyrimidines / toxicity
  • Quinazolines / administration & dosage
  • Quinazolines / toxicity
  • Sulfonamides / administration & dosage
  • Sulfonamides / toxicity

Substances

  • Biomarkers, Pharmacological
  • Indazoles
  • Protein Kinase Inhibitors
  • Pyrimidines
  • Quinazolines
  • Sulfonamides
  • Lapatinib
  • pazopanib
  • UGT1A1 enzyme
  • Glucuronosyltransferase