Severe CPT-11 toxicity in patients with Gilbert's syndrome: Two case reports |
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Authors: | E. Wasserman A. Myara F. Lokiec F. Goldwasser F. Trivin M. Mahjoubi J. L. Misset E. Cvitkovic |
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Affiliation: | (1) Fsmsit, Hop Paul Brousse, Villejuif, France;(2) Hop St. Joseph, Paris, France;(3) Centre René Huguenin, Saint Cloud, France;(4) Rhône Poulenc-Rorer, Neuilly, France |
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Abstract: | Background: CPT-11 is hydrolyzed to its active metabolite SN-38, which is mainly eliminated through conjugation by hepatic uridine diphosphate glucuronosyl transferases (UGTs) to the glucuronide (SN-38G) derivative. Preclinical studies showed that UGT*1.1 is the isozyme responsible for SN-38 glucuronidation. Patients with Gilbert's syndrome have deficient UGT*1.1 activity, therefore may have an increased risk for related CPT-11 toxicity.Patients and methods: Two patients with metastatic colon cancer and Gilbert's syndrome were treated with CPT-11 based chemotherapy. CPT-11, SN-38 and SN-38G pharmacokinetics parameters were obtained. Serum bilirubin was analysed by alkaline methanolysis and HPLC.Results: Both patients presented grade 4 neutropenia and/or diarrhea (NCI-CTC) in every treatment cycle. Biliary index (after Gupta et al) values were well above 4000.Conclusion: We present the first clinical evidence linking bilirubin glucuronidation status and CPT-11 related toxicity. The severe toxicity experienced by the two patients with Gilbert's syndrome treated with CPT-11 based chemotherapy has a genetic basis. Individuals with Gilbert's syndrome have an enhanced risk for CPT-11 toxicity. Unconjugated serum bilirubin could be predictive parameter of CPT-11 toxicity. |
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Keywords: | bilirubin CPT-11 Gilbert's syndrome glucuronidation SN-38 |
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