ABCG2 C421A polymorphisms affect exposure of the epidermal growth factor receptor inhibitor gefitinib
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PRECLINICAL STUDIES
ABCG2 C421A polymorphisms affect exposure of the epidermal growth factor receptor inhibitor gefitinib Sho Sakamoto 1 & Kazuhiro Sato 1 & Yuri Takita 1 & Yuka Izumiya 1 & Naho Kumagai 1 & Kazuhisa Sudo 1 & Yukiyasu Hasegawa 1 & Hayato Yokota 2 & Yumiko Akamine 2 & Yuji Okuda 1 & Mariko Asano 1 & Masahide Takeda 1 & Masaaki Sano 1 & Masatomo Miura 2 & Katsutoshi Nakayama 1 Received: 18 March 2020 / Accepted: 6 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract ATP-binding castle protein G2 (ABCG2) is thought to inhibit the activities of certain gefitinib transporters, thereby affecting drug pharmacokinetics. The C421A polymorphism affects the function and expression of ABCG2 on the cell membrane. Previous studies have shown that proton-pump inhibitors (PPIs) inhibit gefitinib absorption, as well as the function of ABCG2. We evaluated the plasma concentrations of gefitinib in patients with and without the ABCG2 C421A polymorphism, who were or were not taking PPIs. In total, 61 patients with advanced epidermal-growth-factor-positive non-small-cell lung cancer were enrolled in this study. They were treated with gefitinib at a dose of 250 mg per day. Plasma gefitinib concentration and ABCG2 C421A status were determined after 2 weeks. The patients were divided into CC- and CA/AA genotype groups. We compared the trough and peak gefitinib levels and the area under the curve (AUC) values for 24-h gefitinib concentrations. We also compared these parameters among four groups distinguished according to the presence or absence of the polymorphism and PPI use. The mean trough gefitinib level and AUC value for 24-h gefitinib concentration were significantly lower in the CA/AA group compared to the CC group (mean trough level: 333.2 vs. 454.5 ng/mL, respectively, P = 0.021; AUC: 9949.9 vs. 13,085.4 ng・h/mL, respectively, P = 0.034). Among patients taking PPIs, the mean trough gefitinib level was significantly lower in the CA/AA group than the CC group (220.1 vs. 340.5 ng/mL, respectively, P = 0.033). The CA/AA-type of ABCG2 C421A polymorphism may be associated with lower gefitinib plasma concentrations. Keywords Non-small-cell lung cancer . EGFR mutation . Gefitinib . ABCG2
Introduction Gefitinib is a first-generation oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI). This drug has been used clinically to treat patients with non-small-cell lung cancer (NSCLC) harboring EGFR mutations, and has been shown to possess strong antitumor activity. Gefitinib is clinically useful in elderly patients, and in those with poor World Health Organization (WHO) performance status (PS)
* Katsutoshi Nakayama [email protected] 1
Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
2
Department of Pharmacy, Akita University Hospital, Akita, Japan
[1, 2]; thus, it remains a standard therapy for NSCLC harboring EGFR mutations. The antitumor efficacy of gefitinib therapy shows varies greatly among patients, and it is
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