Irinotecan-induced diarrhea: functional significance of the polymorphic ABCC2 transporter protein

FA (Floris) de Jong, TJ Scott-Horton, DL Kroetz, HL McLeod, LE Friberg, RH Mathijssen, Jaap Verweij, S Marsh, A Sparreboom*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

161 Citations (Scopus)

Abstract

Interindividual pharmacokinetic variability of the anticancer agent irinotecan is high. Life-threatening diarrhea is observed in up to 25% of patients receiving irinotecan and has been related with irinotecan pharmacokinetics and UGT1A1 genotype status. Here, we explore the association of ABCC2 (MRP2) polymorphisms and haplotypes with irinotecan disposition and diarrhea. A cohort of 167 Caucasian cancer patients who were previously assessed for irinotecan pharmacokinetics (90-min infusion given every 21 days), toxicity, and UGT1A1*28 genotype were genotyped for polymorphisms in ABCC2 using Pyrosequencing. Fifteen ABCC2 haplotypes were identified in the studied patients. The haplotype ABCC2*2 was associated with lower irinotecan clearance (28.3 versus 31.6 l/h; P=0.020). In patients who did not carry a UGT1A1*28 allele, a significant reduction of severe diarrhea was noted in patients with the ABCC2*2 haplotype (10 versus 44%; odds ratio, 0.15; 95% confidence interval, 0.04-0.61; P=0.005). This effect was not observed in patients with at least one UGT1A1*28 allele (32 versus 20%; odds ratio, 1.87; 95% confidence interval, 0.49-7.05; P=0.354). This study suggests that the presence of the ABCC2*2 haplotype is associated with less irinotecan-related diarrhea, maybe as a consequence of reduced hepatobiliary secretion of irinotecan. As the association was seen in patients not genetically predisposed at risk for diarrhea due to UGT1A1*28, confirmatory studies of the relationships of ABCC2 genotypes and irinotecan disposition and toxicity are warranted.

Original languageEnglish
Pages (from-to)42-49
Number of pages8
JournalClinical Pharmacology & Therapeutics
Volume81
Issue number1
DOIs
Publication statusPublished - Jan 2007

Research programs

  • EMC MM-03-86-08
  • EMC OR-01-34-01

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