Julia C F Quintanilha1, Jin Wang2, Alexander B Sibley3, Chen Jiang3, Amy S Etheridge1, Fei Shen4, Guanglong Jiang5, Flora Mulkey6, Jai N Patel7, Daniel L Hertz8, Elizabeth Claire Dees9, Howard L McLeod10, Monica Bertagnolli11, Hope Rugo12, Hedy L Kindler13, William Kevin Kelly14, Mark J Ratain13, Deanna L Kroetz15, Kouros Owzar3,16, Bryan P Schneider4, Danyu Lin2, Federico Innocenti17. 1. Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 2. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 3. Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA. 4. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. 5. Department of BioHealth Informatics, Indiana University-Purdue University, Indianapolis, IN, USA. 6. Alliance Statistics and Data Center, Duke University, Durham, NC, USA. 7. Levine Cancer Institute, Charlotte, NC, USA. 8. College of Pharmacy, University of Michigan, Ann Arbor, MI, USA. 9. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 10. Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA. 11. Dana Farber Cancer Institute, Boston, MA, USA. 12. Department of Medicine, Hematology/Oncology, University of California at San Francisco, San Francisco, CA, USA. 13. University of Chicago Comprehensive Cancer Center, Chicago, IL, USA. 14. Department of Medical Oncology, Yale School of Medicine, New Haven, CT, USA. 15. Department of Bioengineering and Therapeutic Sciences, University of California at San Francisco, San Francisco, CA, USA. 16. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA. 17. Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. innocent@email.unc.edu.
Abstract
BACKGROUND: Hypertension and proteinuria are common bevacizumab-induced toxicities. No validated biomarkers are available for identifying patients at risk of these toxicities. METHODS: A genome-wide association study (GWAS) meta-analysis was performed in 1039 bevacizumab-treated patients of European ancestry in four clinical trials (CALGB 40502, 40503, 80303, 90401). Grade ≥2 hypertension and proteinuria were recorded (CTCAE v.3.0). Single-nucleotide polymorphism (SNP)-toxicity associations were determined using a cause-specific Cox model adjusting for age and sex. RESULTS: The most significant SNP associated with hypertension with concordant effect in three out of the four studies (p-value <0.05 for each study) was rs6770663 (A > G) in KCNAB1, with the G allele increasing the risk of hypertension (p-value = 4.16 × 10-6). The effect of the G allele was replicated in ECOG-ACRIN E5103 in 582 patients (p-value = 0.005). The meta-analysis of all five studies for rs6770663 led to p-value = 7.73 × 10-8, close to genome-wide significance. The most significant SNP associated with proteinuria was rs339947 (C > A, between DNAH5 and TRIO), with the A allele increasing the risk of proteinuria (p-value = 1.58 × 10-7). CONCLUSIONS: The results from the largest study of bevacizumab toxicity provide new markers of drug safety for further evaluations. SNP in KCNAB1 validated in an independent dataset provides evidence toward its clinical applicability to predict bevacizumab-induced hypertension. ClinicalTrials.gov Identifier: NCT00785291 (CALGB 40502); NCT00601900 (CALGB 40503); NCT00088894 (CALGB 80303) and NCT00110214 (CALGB 90401).
BACKGROUND: Hypertension and proteinuria are common bevacizumab-induced toxicities. No validated biomarkers are available for identifying patients at risk of these toxicities. METHODS: A genome-wide association study (GWAS) meta-analysis was performed in 1039 bevacizumab-treated patients of European ancestry in four clinical trials (CALGB 40502, 40503, 80303, 90401). Grade ≥2 hypertension and proteinuria were recorded (CTCAE v.3.0). Single-nucleotide polymorphism (SNP)-toxicity associations were determined using a cause-specific Cox model adjusting for age and sex. RESULTS: The most significant SNP associated with hypertension with concordant effect in three out of the four studies (p-value <0.05 for each study) was rs6770663 (A > G) in KCNAB1, with the G allele increasing the risk of hypertension (p-value = 4.16 × 10-6). The effect of the G allele was replicated in ECOG-ACRIN E5103 in 582 patients (p-value = 0.005). The meta-analysis of all five studies for rs6770663 led to p-value = 7.73 × 10-8, close to genome-wide significance. The most significant SNP associated with proteinuria was rs339947 (C > A, between DNAH5 and TRIO), with the A allele increasing the risk of proteinuria (p-value = 1.58 × 10-7). CONCLUSIONS: The results from the largest study of bevacizumab toxicity provide new markers of drug safety for further evaluations. SNP in KCNAB1 validated in an independent dataset provides evidence toward its clinical applicability to predict bevacizumab-induced hypertension. ClinicalTrials.gov Identifier: NCT00785291 (CALGB 40502); NCT00601900 (CALGB 40503); NCT00088894 (CALGB 80303) and NCT00110214 (CALGB 90401).
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