Pazopanib-induced hyperbilirubinemia is associated with Gilbert's syndrome UGT1A1 polymorphism

Br J Cancer. 2010 Apr 27;102(9):1371-7. doi: 10.1038/sj.bjc.6605653. Epub 2010 Apr 13.

Abstract

Background: Pazopanib has shown clinical activity against multiple tumour types and is generally well tolerated. However, isolated elevations in transaminases and bilirubin have been observed. This study examined polymorphisms in molecules involved in pharmacokinetic and pharmacodynamic pathways of pazopanib and their association with hepatic dysfunction.

Methods: Twenty-eight polymorphisms in 11 genes were evaluated in pazopanib-treated renal cell carcinoma patients. An exploratory analysis was conducted in 116 patients from a phase II study; a replication study was conducted in 130 patients from a phase III study.

Results: No polymorphisms were associated with alanine aminotransferase elevation. The Gilbert's uridine-diphosphoglucuronate glucuronosyltransferase 1A1 (UGT1A1) TA-repeat polymorphism was significantly associated with pazopanib-induced hyperbilirubinemia in the phase II study. This association was replicated in the phase III study (P<0.01). Patients with TA6/TA6, TA6/TA7, and TA7/TA7 genotypes experienced median bilirubin increases of 0.31, 0.37, and 0.71 x upper limit of the normal range (ULN), respectively. Of the 38 patients with hyperbilirubinemia (> or = 1.5 x ULN), 32 (84%) were either TA7 homozygotes (n=18) or TA7 heterozygotes (n=14). For TA7 homozygotes, the odds ratio (95% CI) for developing hyperbilirubinemia was 13.1 (5.3-32.2) compared with other genotypes.

Conclusions: The UGT1A1 polymorphism is frequently associated with pazopanib-induced hyperbilirubinemia. These data suggest that some instances of isolated hyperbilirubinemia in pazopanib-treated patients are benign manifestations of Gilbert's syndrome, thus supporting continuation of pazopanib monotherapy in this setting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alanine Transaminase / metabolism
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Bilirubin / metabolism
  • Carcinoma, Renal Cell / drug therapy
  • Carcinoma, Renal Cell / surgery
  • Clinical Trials, Phase II as Topic
  • Clinical Trials, Phase III as Topic
  • Female
  • Genotype
  • Gilbert Disease / genetics*
  • Glucuronosyltransferase / antagonists & inhibitors
  • Glucuronosyltransferase / genetics*
  • Humans
  • Hyperbilirubinemia / chemically induced*
  • Hyperbilirubinemia / epidemiology
  • Hyperbilirubinemia / etiology
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / surgery
  • Liver / enzymology
  • Male
  • Middle Aged
  • Nephrectomy
  • Polymorphism, Genetic*
  • Pyrimidines / adverse effects*
  • Pyrimidines / therapeutic use
  • Sulfonamides / adverse effects*
  • Sulfonamides / therapeutic use

Substances

  • Antineoplastic Agents
  • Pyrimidines
  • Sulfonamides
  • pazopanib
  • UGT1A1 enzyme
  • Glucuronosyltransferase
  • Alanine Transaminase
  • Bilirubin