Genetic Polymorphisms in CYP2C19 Cause Changes in Plasma Levels and Adverse Reactions to Anlotinib in Chinese Patients With Lung Cancer

Tingfei Tan; Gongwei Han; Ziwei Cheng; Jiemei Jiang; Li Zhang; Zitong Xia; Xinmeng Wang; Quan Xia

doi:10.3389/fphar.2022.918219

Genetic Polymorphisms in CYP2C19 Cause Changes in Plasma Levels and Adverse Reactions to Anlotinib in Chinese Patients With Lung Cancer

Front Pharmacol. 2022 Jun 22:13:918219. doi: 10.3389/fphar.2022.918219. eCollection 2022.

Authors

Tingfei Tan¹, Gongwei Han², Ziwei Cheng³, Jiemei Jiang¹, Li Zhang⁴, Zitong Xia², Xinmeng Wang¹, Quan Xia¹

Affiliations

¹ Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
² School of Pharmacy, Anhui Medical University, Hefei, China.
³ School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China.
⁴ Department of Pharmacy, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China.

Abstract

Background: Anlotinib is a small molecular multi-targeting tyrosine kinase inhibitor. Growing evidence indicates that treatment efficacy, and toxicity varies considerably between individuals. Therefore, this study aimed to investigate the relationship between cytochrome P450 (CYP450) gene polymorphisms, drug concentrations, and their adverse reactions in anlotinib-treated patients with lung cancer. Methods: We enrolled 139 patients with lung cancer, treated with anlotinib. Twenty loci in the following five genes of the CYP450 family were genotyped: CYP450 family 3 subfamily A member 5 (CYP3A5), 3 subfamily A member 4 (CYP3A4), 2 subfamily C member 9 (CYP2C9), 2 subfamily C member 19 (CYP2C19), and 1 subfamily A member 2 (CYP1A2). Data on adverse reactions were collected from patients, and plasma anlotinib concentrations were measured. Results: There were significant variances in plasma trough concentration (3.95-52.88 ng/ml) and peak plasma concentration (11.53-42.8 ng/ml) following administration of 8 mg anlotinib. Additionally, there were significant differences in the plasma trough concentration (5.65-81.89 ng/ml) and peak plasma concentration (18.01-107.18 ng/ml) following administration of 12 mg anlotinib. Furthermore, for CYP2C19-rs3814637, the peak plasma concentrations of mutant allele T carriers (TT+CT) were significantly higher than those of wildtypes (CC). For CYP2C19-rs11568732, the peak plasma concentrations of the mutant allele G carriers (GT+GG) were significantly higher than those of the wild-type (TT). More importantly, the incidence rates of hypertension and hemoptysis (peripheral lung cancer) with TT+CT in rs3814637 and GT+GG in rs11568732 were significantly higher than those with CC and TT. Conclusions: The plasma trough and peak concentrations varied significantly for both 8 and 12 mg of anlotinib. Single-nucleotide polymorphisms in CYP2C19 are significantly associated with hypertension, hemoptysis, and anlotinib peak concentrations. Polymorphisms in CYP450 may explain inter-individual differences in anlotinib-related adverse reactions.

Keywords: CYP450 gene polymorphisms; adverse reactions; anlotinib; lung cancer; plasma concentration.