title: A carboxylesterase 2 gene polymorphism as predictor of capecitabine on response and time to progression.
abstract: Capecitabine is a drug that requires the consecutive action of three enzymes: carboxylesterase 2 (CES 2), cytidine deaminase (CDD), and thymidine phosphorylase (TP) for transformation into 5-fluorouracil (5FU). The metabolism of 5FU requires the activity of thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) among other enzymes. The present study prospectively examined the possible relationship between the toxicity and efficacy of capecitabine and 14 different polymorphisms in CES 2, CDD, TS and DPD. Between 2003 and 2005, a total of 136 patients with advanced breast or colorectal cancer treated with capecitabine were prospectively enrolled. The presence of two polymorphisms (CDD 943insC and CES 2 Exon3 6046 G/A) were associated with a non-statistically significant higher incidence of grade 3 hand-foot syndrome (HFS) (p=0.07) and grade 3-4 diarrhoea (p=0.09), respectively. Patients heterozygous or homozygous for the polymorphism CES 2 5'UTR 823 C/G exhibited a significantly greater response rate to capecitabine, and time to progression of disease (59%, 8.7 months) than patients with the wild type gene sequence (32%, p=0.015; 5.3 months, p=0.014). For the first time, an association between a polymorphism in the CES2 gene and the efficacy of capecitabine has been described, providing preliminary evidence of its predictive and prognostic value.
authors.affiliation: Medical Oncology Service, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga, Spain. nuriaribelles@gmail.com
authors.forename: N
authors.initials: N
authors.lastname: Ribelles
authors.forename: J
authors.initials: J
authors.lastname: López-Siles
authors.forename: A
authors.initials: A
authors.lastname: Sánchez
authors.forename: E
authors.initials: E
authors.lastname: González
authors.forename: M J
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: F
authors.initials: F
authors.lastname: Carabantes
authors.forename: P
authors.initials: P
authors.lastname: Sánchez-Rovira
authors.forename: A
authors.initials: A
authors.lastname: Márquez
authors.forename: R
authors.initials: R
authors.lastname: Dueñas
authors.forename: I
authors.initials: I
authors.lastname: Sevilla
authors.forename: E
authors.initials: E
authors.lastname: Alba
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000069287:Capecitabine; D043182:Carboxylesterase / Q000235:genetics*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D004273:DNA, Neoplasm / Q000235:genetics; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D042943:Dihydrouracil Dehydrogenase (NADP) / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005838:Genotype; D006801:Humans; D015999:Multivariate Analysis; D010865:Pilot Projects; D011110:Polymorphism, Genetic / Q000235:genetics; D011237:Predictive Value of Tests; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013940:Thymidylate Synthase / Q000378:metabolism
chemical_list: D000964:Antimetabolites, Antineoplastic; D004273:DNA, Neoplasm; D003841:Deoxycytidine; D000069287:Capecitabine; D042943:Dihydrouracil Dehydrogenase (NADP); D013940:Thymidylate Synthase; C517204:CES2 protein, human; D043182:Carboxylesterase; D005472:Fluorouracil