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CYP2C19*2 polymorphism is associated with increased survival in breast cancer patients using tamoxifen

    Rikje Ruiter

    Department of Epidemiology, PO Box 2040, 3000 CA, Rotterdam, The Netherlands and Drug Safety Unit, Inspectorate for Health Care, The Hague, The Netherlands

    ,
    Monique J Bijl

    Department of Epidemiology, PO Box 2040, 3000 CA, Rotterdam, The Netherlands and Department of Hospital Pharmacy, Rotterdam, The Netherlands

    ,
    Ron HN van Schaik

    Department of Clinical Chemistry, Rotterdam, The Netherlands

    ,
    Els MJJ Berns

    Department of Medical Oncology/Josephine Nefkens Institute, Rotterdam, The Netherlands

    ,
    Albert Hofman

    Department of Epidemiology, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    ,
    Jan-Willem W Coebergh

    Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

    ,
    Charlotte van Noord

    Department of Epidemiology, PO Box 2040, 3000 CA, Rotterdam, The Netherlands and Dutch Medicines Evaluation Board, The Hague, The Netherlands

    ,
    Loes E Visser

    Department of Hospital Pharmacy, Rotterdam, The Netherlands and Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

    &
    Bruno HCh Stricker

    † Author for correspondence

    Department of Epidemiology, PO Box 2040, 3000 CA, Rotterdam, The Netherlands and Drug Safety Unit, Inspectorate for Health Care, The Hague, The Netherlands and Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.

    Published Online:https://doi.org/10.2217/pgs.10.112

    Aims: Variant alleles of the CYP2C19 gene were recently associated with survival in breast cancer patients on tamoxifen therapy. CYP2C19 is one of the enzymes involved in the metabolism of tamoxifen into active metabolites. We investigated the hypothesis that CYP2C19*2 and *3 variants, known for their lack of enzyme activity, are associated with an increased breast cancer mortality rate in patients using tamoxifen. Materials & methods: In the prospective population based Rotterdam study, the association between CYP2C19*2 carriers and breast cancer mortality was studied among 80 incident users of tamoxifen. Survival was analyzed with life tables and Cox regression analysis, with drug exposure as a time-dependent variable. Adjustments were made for calendar time, average tamoxifen dose, age, the indication for tamoxifen, CYP2D6 genotype and concomitant use of CYP2C19 inhibitors or inducers. Results: In patients on tamoxifen, CYP2C19*2 carriers were associated with a significantly longer breast cancer survival rate than patients with the wild-type (hazard ratio 0.26, 95%CI: 0.08–0.87). Conclusion: This study suggests that CYP2C19 genotype may possibly be a predictive factor for survival in breast cancer patients using tamoxifen.

    Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

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