Abstract Toremifene (TOR) is a selective estrogen receptor modulator (SERM) used in adjuvant therapy for breast cancer, and more recently is in clinical trials for prostate cancer prevention in patients with high grade PIN. The chemical structure of TOR differs from tamoxifen (TAM) only by the presence of a chlorine atom in the ethyl side chain. That difference results in distinct breakdown products of the two drugs, which may provide for a more favorable toxicity spectrum with TOR compared to TAM. TOR has a similar mechanism of action to that of TAM, in that its 4-hydroxy metabolites bind specifically to estrogen receptors and, as an estrogen receptor-TOR complex, to chromatin. Interestingly, studies have indicated that a subset of patients who fail on TAM therapy benefit from high-dose TOR therapy, indicating that pharmacogenomics could be an important determinant of response to treatment with TOR. Several studies have indicated that functional genetic variants in the TAM metabolic pathway influence response to therapy, but to date, pharmacogenomic studies of patients treated with TOR are lacking. In order to perform candidate gene association studies, it is necessary to identify the enzymes involved in TOR metabolism. While the Phase I metabolism of TOR has been well-characterized, Phase II metabolism of the active 4-OH-TOR is not well-defined. In this study, we examined individual variability in sulfation of TOR, and found 20-fold variation in human liver cytosols from 100 subjects. Examination of recombinant sulfotransferases revealed that SULT1A1, SULT1E1, and to a lesser extent, SULT2A1 catalyzed the sulfation of TOR. SULT1A1 is the most highly expressed hepatic sulfotransferase, and there was a significant association between SULT1A1*1/*2 genotype and TOR sulfation in human liver cytosols (p=0.001). Since target tissue metabolism is also a critical determinant of clinical efficacy, we also examined the presence of sulfotransferase isoforms in normal prostate (n= 8), BPH tissue (n= 12), and prostate cancer (n=4). Quantitative RT-PCR analysis showed the presence of SULT1A1 and SULT2B1b in BPH and Prostate cancer tissues. These results indicate that variability in sulfation, in terms of both first-pass metabolism and target tissue metabolism, contributes to response to TOR for prostate cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2619.
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