Abstract
Anthracyclines are very effective chemotherapeutic agents; however, their use is hampered by the treatment-induced cardiotoxicity. Genetic variants that help define patient's sensitivity to anthracyclines will greatly improve the design of optimal chemotherapeutic regimens. However, identification of such variants is hampered by the lack of analytical approaches that address the complex, multi-genic character of anthracycline induced cardiotoxicity (AIC). Here, using a multi-SNP based approach, we examined 60 genes coding for proteins involved in drug metabolism and efflux and identified the P450 oxidoreductase (POR) gene to be most strongly associated with daunorubicin induced cardiotoxicity in a population of acute myeloid leukemia (AML) patients (FDR adjusted p-value of 0.15). In this sample of cancer patients, variation in the POR gene is estimated to account for some 11.6% of the variability in the drop of left ventricular ejection fraction (LVEF) after daunorubicin treatment, compared to the estimated 13.2% accounted for by the cumulative dose and ethnicity. In post-hoc analysis, this association was driven by 3 SNPs—the rs2868177, rs13240755, and rs4732513—through their linear interaction with cumulative daunorubicin dose. The unadjusted odds ratios (ORs) and confidence intervals (CIs) for rs2868177 and rs13240755 were estimated to be 1.89 (95% CI: 0.7435–4.819; p = 0.1756) and 3.18 (95% CI: 1.223–8.27; p = 0.01376), respectively. Although the contribution of POR variants is expected to be overestimated due to the multiple testing performed in this small pilot study, given that cumulative anthracycline dose is virtually the only factor used clinically to predict the risk of cardiotoxicity, the contribution that genetic analyses of POR can make to the assessment of this risk is worthy of follow up in future investigations.
Highlights
Anthracyclines are very effective chemotherapeutic agents used in the treatment of a wide variety of leukemias, lymphomas, and solid tumors
Since the outcome under investigation was the cardiotoxic effect of anthracycline treatment and not general cardiac health of the patients, only patients with left ventricular ejection fraction (LVEF) measurements done before and after treatment were included in statistical analyses (114 patients)
Forward selection of the potential confounding variables found that anthracycline cumulative dose and the top two genetic principal components (PCs) are predictive of LVEF drop
Summary
Anthracyclines are very effective chemotherapeutic agents used in the treatment of a wide variety of leukemias, lymphomas, and solid tumors. In addition to limiting the dose of the drug administered, several other strategies, including liposomal encapsulation, modification of anthracycline structure, and concurrent administration of iron chelators, have been used as attempts to lessen the cardiotoxic effect of anthracycline treatment (Sawyer et al, 2010). Despite these efforts, chronic cardiomyopathy remains as a life-long threat with the risk for chronic heart failure ranging from 3 to 26% depending on the dose of the drug (Yeh and Bickford, 2009). These observations suggest that there is no truly “safe” anthracycline dose and www.frontiersin.org
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