Association of ALDH1A1 Polymorphism With Toxicity From Cyclophosphamide Treatment

Abstract

Purpose: Cyclophosphamide is a commonly used cancer agent that is metabolically activated by polymorphic enzymes. This study aims to investigate the association between genetic polymorphisms of candidate pharmacogenes with severe toxicity during cyclophosphamide treatment.Methods: Genetic data was collected from an institutional genetic data repository. Genetic polymorphisms in CYP2B6, CYP3A4, CYP2C9, CYP2C19, GSTA1, GSTP1, ALDH1A1, ALDH3A1, ABCC1, ABCB1, and ERCC1 were included in the analysis. Treatment and toxicity data were retrospectively collected from the patient’s medical record. The a priori selected primary hypothesis was that patients who have CYP2B6 reduced metabolizer activity (poor or intermediate metabolizer (PM/IM) vs. other) have higher risk of severe toxicity or cyclophosphamide treatment modification due to toxicity. Results: In the primary analysis of 510 cyclophosphamide-treated patients with available genetic data, there was no difference in the odds of severe toxicity or treatment modification due to toxicity in CYP2B6 PM/IM vs. other (Odds ratio=0.97, 95% Confidence Interval: 0.62-1.50, p=0.88). In an exploratory, statistically uncorrected secondary analysis, carriers of the ALDH1A1 rs8187996 variant had a lower risk of the primary toxicity endpoint compared with wild-type homozygous patients (Odds Ratio=0.31, 95% Confidence Interval: 0.09-0.78, p=0.028). None of the other tested phenotypes or genotypes were associated with the primary or secondary endpoints in unadjusted analysis (all p>0.05).Conclusion: Patients who carry ALDH1A1 rs8187996 may have a lower risk of cyclophosphamide toxicity than wild-type patients. Validation of this associations is necessary to justify development of personalized cyclophosphamide dosing strategies to optimize therapeutic outcomes in patients with cancer.