As breast cancer continues to take the lives of women all over the world, targeted therapies have become the standard of care for many metastatic and end stage cancers. Tucatinib is a recently FDA-approved tyrosine kinase inhibitor, which targets the HER2 receptor and is used in combination to treat advanced or metastatic HER2-positive breast cancer. Preliminary studies indicate that tucatinib is metabolized primarily by cytochrome P450 (CYP) 2C8, with minor contributions from CYP3A and aldehyde oxidase (AO). The goal of this study was to identify the metabolites formed from tucatinib in vitro, and to determine the enzymatic contributions to tucatinib metabolism. To characterize CYP-mediated and AO-mediated metabolites of tucatinib, in vitro reaction phenotyping assays were performed. Tucatinib was incubated with human liver microsomes (HLM), human liver S9 fractions (HLS9), and recombinant CYP enzymes over time in the presence and absence of cofactor, NADPH. Incubations were also conducted in HLS9 in the presence and absence of the non-selective CYP inhibitor 1-aminobenzotriazole (ABT) to estimate the overall CYP contribution. Reaction products were analyzed using LC/MS-MS. Two tucatinib metabolites, M1 and M2, were detected from initial reaction phenotyping experiments; M1 was the primary metabolite generated by recombinant CYP2C8, and M2 was formed in part by CYP3A4. These metabolites were further separated by LC-MS/MS into distinct peaks: M1a, M1b, M2a, and M2b. M1a and M2b were generated in an NADPH-dependent manner, and formation was reduced by ABT. M2a appeared to be formed through a non-CYP, NADPH-independent route. Interestingly, M2a formation was higher in the presence of ABT compared to control incubations without the CYP inhibitor. Collectively, these data suggest that M1a and M2b are CYP-mediated metabolites of tucatinib, while M2a may have partial contribution from AO. Due to an impurity in the tucatinib standard, M1b could not be fully characterized. Further experiments are needed to confirm the metabolic pathways of tucatinib and identify the source of M1b. Future investigations using individual donor tissues will provide insight into the interindividual variability in metabolism of tucatinib, which has relevance for HER2-positive breast cancer treatment.
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