本研究旨在检测白血病细胞株及其耐药株中两种药物代谢相关基因的单核苷酸多态性。培养白血病细胞株K562及其耐药株K562/A02,采用QIAamp DNA Blood Minikit试剂盒提取基因组DNA,设计引物,应用PCR技术扩增相应目的片段;采用基于基质辅助...本研究旨在检测白血病细胞株及其耐药株中两种药物代谢相关基因的单核苷酸多态性。培养白血病细胞株K562及其耐药株K562/A02,采用QIAamp DNA Blood Minikit试剂盒提取基因组DNA,设计引物,应用PCR技术扩增相应目的片段;采用基于基质辅助激光解吸电离飞行时间质谱技术检测mthfr基因rs1801131、rs1801133、rs2274976及dpyd基因rs1801159、rs1801160、rs17376848的单核苷酸多态性。结果表明,在K562和K562/A02两种细胞中,mthfr基因rs1801131基因型均为CA、rs1801133均为CC、rs2274976均为GG;dpyd基因rs1801159基因型均为GG、rs1801160均为GG、rs17376848均为AA。结论:mthfr、dpyd基因上述位点在K562和K562/A02两种细胞中基因表达无差别。展开更多
目的检测晚期肠癌患者药物基因多态性,分析其与临床特征、以奥沙利铂或氟尿嘧啶为主化疗方案不良反应和预后的关系。方法收集2016年3月至2018年5月在中国解放军总医院肿瘤内科住院治疗的108例晚期结肠癌患者的外周血,以Life平台检测对D...目的检测晚期肠癌患者药物基因多态性,分析其与临床特征、以奥沙利铂或氟尿嘧啶为主化疗方案不良反应和预后的关系。方法收集2016年3月至2018年5月在中国解放军总医院肿瘤内科住院治疗的108例晚期结肠癌患者的外周血,以Life平台检测对DPYD、ABCB1、GSTP1、ERCC1基因进行单核苷酸多态性(SNP)分型,比较不同基因型与患者KRAS状态、肿瘤部位(左右)、不良反应和中位无进展生存时间(PFS)的差异。结果纳入晚期肠癌患者108例,DPYD 4个位点(rs3918290、rs55886062、rs67376798、rs2297595)均为野生型,ERCC1(rs11615)GG纯合型基因52例(48.1%),AG杂合型基因50例(46.3%),AA野生型基因6例(5.6%)。GSTP1(rs1695)AG杂合型突变36例(33.3%),AA野生型66例(66.1%),GG纯和突变型6例(5.6%)。ABCB1(rs1045642)AG杂合型基因58例(53.7%),GG纯合型基因42例(38.9%),AA野生型8例(7.4%)。肿瘤位于左右半结肠与ERCC1基因分布频率有关(χ~2=4.802,P=0.028),与GSTP1,ABCB1基因分布频率无关。KRAS突变患者ABCB1杂合突变率42.9%,未见突变患者为72.7%,两者差异具有统计学意义(χ~2=3.939,P=0.047)。GSTP1 AG型和GG型较AA型易产生2～3级全身不良反应高(77.8%vs. 45.5%,χ~2=5.193;P=0.023)。ABCB1 GG型和AA型患者发生3～4级不良反应率为32.9%,对比AG型患者发生不良反应率为62.1%,差异具有统计学意义(χ~2=4.862,P=0.027)。中位疾病进展时间PFS与ABCB1和GSTP1基因多态性无关,与不同ERCC1基因型有关,ERRC1杂合型突变(AG型)患者较纯和型(GG型+AA型)具有较短PFS(5.6 m vs. 8.0 m,P=0.029)。结论检测基因多态性具有临床价值,对晚期肠癌化疗的不良反应、预后及为患者调整化疗方案具有有效的指导作用。展开更多
BACKGROUND Fluoropyrimidines are metabolized in the liver by the enzyme dihydropyrimidine dehydrogenase(DPD),encoded by the DPYD gene.About 7%of the European population is a carrier of DPYD gene polymorphisms associat...BACKGROUND Fluoropyrimidines are metabolized in the liver by the enzyme dihydropyrimidine dehydrogenase(DPD),encoded by the DPYD gene.About 7%of the European population is a carrier of DPYD gene polymorphisms associated with reduced DPD enzyme activity.AIM To assess the prevalence of DPYD polymorphisms and their impact on fluoropyrimidine tolerability in Italian patients with gastrointestinal malignancies.METHODS A total of 300 consecutive patients with a diagnosis of gastrointestinal malignancy and treated with a fluoropyrimidine-based regimen were included in the analysis and divided into two cohorts:(1)149 patients who started fluoropyrimidines after DPYD testing;and(2)151 patients treated without DPYD testing.Among the patients in cohort A,15%tested only the DPYD2A polymorphism,19%tested four polymorphisms(DPYD2A,HapB3,c.2846A>T,and DPYD13),and 66%tested five polymorphisms including DPYD6.RESULTS Overall,14.8%of patients were found to be carriers of a DPYD variant,the most common being DPYD6(12.1%).Patients in cohort A reported≥G3 toxicities(P=0.00098),particularly fewer nonhematological toxicities(P=0.0028)compared with cohort B,whereas there was no statistically significant difference between the two cohorts in hematological toxicities(P=0.6944).Significantly fewer chemotherapy dose reductions(P=0.00002)were observed in cohort A compared to cohort B,whereas there was no statistically significant differences in chemotherapy delay.CONCLUSION Although this study had a limited sample size,it provides additional information on the prevalence of DPYD polymorphisms in the Italian population and highlights the role of pharmacogenetic testing to prevent severe toxicity.展开更多
Fluoropyrimidines(FP)are given in the combination treatment of the advanced disease or as monotherapy in the neo-adjuvant and adjuvant treatment of colorectal cancerand other solid tumors including breast,head and nec...Fluoropyrimidines(FP)are given in the combination treatment of the advanced disease or as monotherapy in the neo-adjuvant and adjuvant treatment of colorectal cancerand other solid tumors including breast,head and neck and gastric cancer.FP present a narrow therapeutic index with 10 to 26% of patients experiencing acute severe or life-threatening toxicity.With the high number of patients receiving FP-based therapies,and the significant effects of toxicities on their quality of life,the prevention of FP-related adverse events is of major clinical interest.Host genetic variants in the rate limiting enzyme dihydropyrimidine dehydrogenase(DPYD)gene are related to the occurrence of extremely severe,early onset toxicity in FP treated patients.The pre-treatment diagnostic test of 4 DPYD genetic polymorphisms is suggested by the currently available pharmacogenetic guidelines.Several prospective implementation projects are ongoing to support the introduction of up-front genotyping of the patients in clinical practice.Multiple pharmacogenetic studies tried to assess the predictive role of other polymorphisms in genes involved in the FP pharmacokinetics/pharmacodynamic pathways,TYMS and MTHFR,but no additional clinically validated genetic markers of toxicity are available to date.The development of next-generation sequencing platforms opens new possibilities to highlight previously unreported genetic markers.Moreover,the investigation of the genetic variation in the patients immunological system,a pivotal target in cancer treatment,could bring notable advances in the field.This review will describe the most recent literature on the use of pharmacogenetics to increase the safety of a treatment based on FP administration in colorectal cancer patients.展开更多
Fluoropyrimidines are widely used in the treatment of solid tumors, mainly gastrointestinal, head and neck and breast cancer. Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme for catabolism of 5-FU an...Fluoropyrimidines are widely used in the treatment of solid tumors, mainly gastrointestinal, head and neck and breast cancer. Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme for catabolism of 5-FU and it is encoded by DPYD gene. To date, many known polymorphisms cause DPD deficiency and subsequent increase of 5-FU toxicity. In addition, reduced inactivation of 5-FU could lead to increased 5-FU intracellular concentration and augmented efficacy of this drugs. Therefore DPD expression, particularly intratumoral, has been investigated as predictive and prognostic marker in 5-FU treated patients. There also seems to be a tendency to support the correlation between DPD expression and response/survival in patients treated with fluoropyrimidine even if definitive conclusions cannot be drawn considering that some studies are conflicting. Therefore, the debate on intratumoral DPD expression as a potential predictor and prognostic marker in patients treated with fluoropyrimidines is still open. Four DPD-polymorphisms are the most relevant for their frequency in population and clinical relevance. Many studies demonstrate that treating a carrier of one of these polymorphisms with a full dose of fluoropyrimidine can expose patient to a severe, even life-threatening, toxicity. Severe toxicity is reduced if this kind of patients received a dose-adjustment after being genotyped. CPIC (Clinical Pharmacogenetics Implementation Consortium) is an International Consortium creating guidelines for facilitating use of pharmacogenetic tests for patient care and helps clinicians ensuring a safer drug delivery to the patient. Using predictive DPD deficiency tests in patients receiving 5FU-based chemotherapy, in particular for colorectal cancer, has proven to be a cost-effective strategy.展开更多
文摘本研究旨在检测白血病细胞株及其耐药株中两种药物代谢相关基因的单核苷酸多态性。培养白血病细胞株K562及其耐药株K562/A02,采用QIAamp DNA Blood Minikit试剂盒提取基因组DNA,设计引物,应用PCR技术扩增相应目的片段;采用基于基质辅助激光解吸电离飞行时间质谱技术检测mthfr基因rs1801131、rs1801133、rs2274976及dpyd基因rs1801159、rs1801160、rs17376848的单核苷酸多态性。结果表明,在K562和K562/A02两种细胞中,mthfr基因rs1801131基因型均为CA、rs1801133均为CC、rs2274976均为GG;dpyd基因rs1801159基因型均为GG、rs1801160均为GG、rs17376848均为AA。结论:mthfr、dpyd基因上述位点在K562和K562/A02两种细胞中基因表达无差别。
文摘目的检测晚期肠癌患者药物基因多态性,分析其与临床特征、以奥沙利铂或氟尿嘧啶为主化疗方案不良反应和预后的关系。方法收集2016年3月至2018年5月在中国解放军总医院肿瘤内科住院治疗的108例晚期结肠癌患者的外周血,以Life平台检测对DPYD、ABCB1、GSTP1、ERCC1基因进行单核苷酸多态性(SNP)分型,比较不同基因型与患者KRAS状态、肿瘤部位(左右)、不良反应和中位无进展生存时间(PFS)的差异。结果纳入晚期肠癌患者108例,DPYD 4个位点(rs3918290、rs55886062、rs67376798、rs2297595)均为野生型,ERCC1(rs11615)GG纯合型基因52例(48.1%),AG杂合型基因50例(46.3%),AA野生型基因6例(5.6%)。GSTP1(rs1695)AG杂合型突变36例(33.3%),AA野生型66例(66.1%),GG纯和突变型6例(5.6%)。ABCB1(rs1045642)AG杂合型基因58例(53.7%),GG纯合型基因42例(38.9%),AA野生型8例(7.4%)。肿瘤位于左右半结肠与ERCC1基因分布频率有关(χ~2=4.802,P=0.028),与GSTP1,ABCB1基因分布频率无关。KRAS突变患者ABCB1杂合突变率42.9%,未见突变患者为72.7%,两者差异具有统计学意义(χ~2=3.939,P=0.047)。GSTP1 AG型和GG型较AA型易产生2～3级全身不良反应高(77.8%vs. 45.5%,χ~2=5.193;P=0.023)。ABCB1 GG型和AA型患者发生3～4级不良反应率为32.9%,对比AG型患者发生不良反应率为62.1%,差异具有统计学意义(χ~2=4.862,P=0.027)。中位疾病进展时间PFS与ABCB1和GSTP1基因多态性无关,与不同ERCC1基因型有关,ERRC1杂合型突变(AG型)患者较纯和型(GG型+AA型)具有较短PFS(5.6 m vs. 8.0 m,P=0.029)。结论检测基因多态性具有临床价值,对晚期肠癌化疗的不良反应、预后及为患者调整化疗方案具有有效的指导作用。
文摘BACKGROUND Fluoropyrimidines are metabolized in the liver by the enzyme dihydropyrimidine dehydrogenase(DPD),encoded by the DPYD gene.About 7%of the European population is a carrier of DPYD gene polymorphisms associated with reduced DPD enzyme activity.AIM To assess the prevalence of DPYD polymorphisms and their impact on fluoropyrimidine tolerability in Italian patients with gastrointestinal malignancies.METHODS A total of 300 consecutive patients with a diagnosis of gastrointestinal malignancy and treated with a fluoropyrimidine-based regimen were included in the analysis and divided into two cohorts:(1)149 patients who started fluoropyrimidines after DPYD testing;and(2)151 patients treated without DPYD testing.Among the patients in cohort A,15%tested only the DPYD2A polymorphism,19%tested four polymorphisms(DPYD2A,HapB3,c.2846A>T,and DPYD13),and 66%tested five polymorphisms including DPYD6.RESULTS Overall,14.8%of patients were found to be carriers of a DPYD variant,the most common being DPYD6(12.1%).Patients in cohort A reported≥G3 toxicities(P=0.00098),particularly fewer nonhematological toxicities(P=0.0028)compared with cohort B,whereas there was no statistically significant difference between the two cohorts in hematological toxicities(P=0.6944).Significantly fewer chemotherapy dose reductions(P=0.00002)were observed in cohort A compared to cohort B,whereas there was no statistically significant differences in chemotherapy delay.CONCLUSION Although this study had a limited sample size,it provides additional information on the prevalence of DPYD polymorphisms in the Italian population and highlights the role of pharmacogenetic testing to prevent severe toxicity.
文摘Fluoropyrimidines(FP)are given in the combination treatment of the advanced disease or as monotherapy in the neo-adjuvant and adjuvant treatment of colorectal cancerand other solid tumors including breast,head and neck and gastric cancer.FP present a narrow therapeutic index with 10 to 26% of patients experiencing acute severe or life-threatening toxicity.With the high number of patients receiving FP-based therapies,and the significant effects of toxicities on their quality of life,the prevention of FP-related adverse events is of major clinical interest.Host genetic variants in the rate limiting enzyme dihydropyrimidine dehydrogenase(DPYD)gene are related to the occurrence of extremely severe,early onset toxicity in FP treated patients.The pre-treatment diagnostic test of 4 DPYD genetic polymorphisms is suggested by the currently available pharmacogenetic guidelines.Several prospective implementation projects are ongoing to support the introduction of up-front genotyping of the patients in clinical practice.Multiple pharmacogenetic studies tried to assess the predictive role of other polymorphisms in genes involved in the FP pharmacokinetics/pharmacodynamic pathways,TYMS and MTHFR,but no additional clinically validated genetic markers of toxicity are available to date.The development of next-generation sequencing platforms opens new possibilities to highlight previously unreported genetic markers.Moreover,the investigation of the genetic variation in the patients immunological system,a pivotal target in cancer treatment,could bring notable advances in the field.This review will describe the most recent literature on the use of pharmacogenetics to increase the safety of a treatment based on FP administration in colorectal cancer patients.
文摘Fluoropyrimidines are widely used in the treatment of solid tumors, mainly gastrointestinal, head and neck and breast cancer. Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme for catabolism of 5-FU and it is encoded by DPYD gene. To date, many known polymorphisms cause DPD deficiency and subsequent increase of 5-FU toxicity. In addition, reduced inactivation of 5-FU could lead to increased 5-FU intracellular concentration and augmented efficacy of this drugs. Therefore DPD expression, particularly intratumoral, has been investigated as predictive and prognostic marker in 5-FU treated patients. There also seems to be a tendency to support the correlation between DPD expression and response/survival in patients treated with fluoropyrimidine even if definitive conclusions cannot be drawn considering that some studies are conflicting. Therefore, the debate on intratumoral DPD expression as a potential predictor and prognostic marker in patients treated with fluoropyrimidines is still open. Four DPD-polymorphisms are the most relevant for their frequency in population and clinical relevance. Many studies demonstrate that treating a carrier of one of these polymorphisms with a full dose of fluoropyrimidine can expose patient to a severe, even life-threatening, toxicity. Severe toxicity is reduced if this kind of patients received a dose-adjustment after being genotyped. CPIC (Clinical Pharmacogenetics Implementation Consortium) is an International Consortium creating guidelines for facilitating use of pharmacogenetic tests for patient care and helps clinicians ensuring a safer drug delivery to the patient. Using predictive DPD deficiency tests in patients receiving 5FU-based chemotherapy, in particular for colorectal cancer, has proven to be a cost-effective strategy.
