4.6 Article

Pharmacogenetic Analysis of BR.21, a Placebo-Controlled Randomized Phase III Clinical Trial of Erlotinib in Advanced Non-small Cell Lung Cancer

Journal

JOURNAL OF THORACIC ONCOLOGY
Volume 7, Issue 2, Pages 316-322

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/JTO.0b013e31824166c1

Keywords

Genetic polymorphism; Clinical trial; Pharmacogenetics; Survival; Toxicity

Funding

  1. Ontario Ministry of Health and Long Term Care (OMHLTC)
  2. Ontario Institute for Cancer Research
  3. Alan B Brown Chair in Molecular Genomics
  4. Cancer Care Ontario Chair in Experimental Therapeutics and Population Studies
  5. Posluns Family Foundation
  6. NCIC CTG Central Tissue Repository
  7. Ontario Cancer Institute AMPPEL (Applied Molecular Profiling Pharmacogenetic Epidemiology Laboratory)

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Background: BR. 21 is a double-blind, placebo-controlled trial of second-/third-line erlotinib in stage IIIB/IV non-small cell lung cancer patients. Predictive and prognostic analyses of epidermal growth factor receptor (EGFR), ABCG2, and AKT1 genetic polymorphisms were performed. Methods: Two hundred forty-two patients were genotyped for EGFR216G>T (EGFR216), EGFR-191C>A (EGFR191), EGFR intron 1 CA-dinucleotide-repeat (CADR), ABCG2+421C>A (ABCG2), and AKT1-SNP4G>A (AKT1). Cox proportional hazard and logistic regression models compared genotypes with overall survival (OS), progression-free survival (PFS), and presence/absence of skin toxicity. Results: Prognostic evaluation was based on the placebo arm: patients carrying at least one CADR long allele (>16 repeats) had a trend toward worse PFS: the adjusted hazard ratio was 1.7 (95% confidence interval [CI]: 1.0-3.0; p = 0.07). EGFR216, EGFR191, ABCG2, and AKT1 were not prognostic. Polymorphisms were not predictive for erlotinib effect (OS/PFS): no treatment-polymorphism interactions were demonstrated. Individuals carrying the rare T/T genotype of EGFR216 had an adjusted odds ratio of 8.8 (95% CI: 1.1-72; p = 0.04) of developing skin toxicity; no other significant polymorphic relationships with skin toxicity were found. Conclusions: In contrast to previous publications, carrying shorter alleles of the EGFR CADR polymorphism was not predictive of OS or PFS. EGFR216 homozygous variants were associated with greater skin toxicity from erlotinib.

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