Association of CYP2D6 genotype and tamoxifen metabolites with breast cancer recurrence in a low-dose trial

• Published in: NPJ breast cancer Vol. 7; no. 1; pp. 34 - 5
• Main Authors: DeCensi, Andrea, Johansson, Harriet, Helland, Thomas, Puntoni, Matteo, Macis, Debora, Aristarco, Valentina, Caviglia, Silvia, Webber, Tania Buttiron, Briata, Irene Maria, D’Amico, Mauro, Serrano, Davide, Guerrieri-Gonzaga, Aliana, Bifulco, Ersilia, Hustad, Steinar, Søiland, Håvard, Boni, Luca, Bonanni, Bernardo, Mellgren, Gunnar
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 25.03.2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4028/67/1347; 692/4028/67/2195; Biomarkers; Biomedical and Life Sciences; Biomedicine; Breast cancer; Brief Communication; Cancer Research; Cell Biology; Drug dosages; Endometrial cancer; Genotype & phenotype; Human Genetics; Laboratories; Metabolism; Metabolites; Oncology; Patients; Prevention; Womens health
• ISSN: 2374-4677; 2374-4677
• DOI: 10.1038/s41523-021-00236-6

Low-dose tamoxifen halves recurrence in non-invasive breast cancer without significant adverse events. Some adjuvant trials with tamoxifen 20 mg/day had shown an association between low endoxifen levels (9–16 nM) and recurrence, but no association with CYP2D6 was shown in the NSABP P1 and P2 prevention trials. We studied the association of CYP2D6 genotype and tamoxifen metabolites with tumor biomarkers and recurrence in a randomized phase III trial of low-dose tamoxifen. Median (IQR) endoxifen levels at year 1 were 8.4 (5.3–11.4) in patients who recurred vs 7.5 (5.1–10.2) in those who did not recur ( p  = 0.60). Tamoxifen and metabolites significantly decreased C-reactive protein (CRP, p  < 0.05), and a CRP increase after 3 years was associated with higher risk of recurrence (HR = 4.37, 95% CI, 1.14–16.73, P  = 0.03). In conclusion, endoxifen is below 9 nM in most subjects treated with 5 mg/day despite strong efficacy and there is no association with recurrence, suggesting that the reason for tamoxifen failure is not poor drug metabolism. Trial registration: ClinicalTrials.gov, Identifier: NCT01357772 .