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Clinical and Genome-Wide Analysis of Cisplatin-Induced Peripheral Neuropathy in Survivors of Adult-Onset Cancer M

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Clinical and Genome-Wide Analysis of Cisplatin-Induced Peripheral Neuropathy in Survivors of Adult-Onset Cancer M Published OnlineFirst June 13, 2017; DOI: 10.1158/1078-0432.CCR-16-3224 Personalized Medicine and Imaging Clinical Cancer Research Clinical and Genome-Wide Analysis of Cisplatin-Induced Peripheral Neuropathy in Survivors of Adult-Onset Cancer M. Eileen Dolan1, Omar El Charif1, Heather E. Wheeler2, Eric R. Gamazon3, Shirin Ardeshir-Rouhani-Fard4, Patrick Monahan4, Darren R. Feldman5, Robert J. Hamilton6, David J. Vaughn7, Clair J. Beard8, Chunkit Fung9, Jeri Kim10, Sophie D. Fossa11, Daniel L Hertz12, Taisei Mushiroda13, Michiaki Kubo13, Lawrence H. Einhorn4, Nancy J. Cox3, and Lois B. Travis4; for the Platinum Study Group Abstract Purpose: Our purpose was to characterize the clinical influ- Results: Eight sensory items formed a subscale with good ences, genetic risk factors, and gene mechanisms contributing to internal consistency (Cronbach a ¼ 0.88). Variables signifi- persistent cisplatin-induced peripheral neuropathy (CisIPN) in cantly associated with CisIPN included age at diagnosis (OR À testicular cancer survivors (TCSs). per year, 1.06; P ¼ 2 Â 10 9), smoking (OR, 1.54; P ¼ 0.004), Experimental Design: TCS given cisplatin-based therapy com- excess drinking (OR, 1.83; P ¼ 0.007), and hypertension pleted the validated EORTC QLQ-CIPN20 questionnaire. An (OR, 1.61; P ¼ 0.03). CisIPN was correlated with lower À ordinal CisIPN phenotype was derived, and associations with self-reported health (OR, 0.56; P ¼ 2.6 Â 10 9) and weight age, smoking, excess drinking, hypertension, body mass index, gain adjusted for years since treatment (OR per Dkg/m2, diabetes, hypercholesterolemia, cumulative cisplatin dose, and 1.05; P ¼ 0.004). PrediXcan identified lower expres- self-reported health were examined for 680 TCS. Genotyping was sions of MIDN and RPRD1B, and higher THEM5 expression À performed on the Illumina HumanOmniExpressExome chip. as associated with CisIPN (P value for each < 5 Â 10 6)with Following quality control and imputation, 5.1 million SNPs in replication of RPRD1B meeting significance criteria (Fisher 680 genetically European TCS formed the input set. GWAS and combined P ¼ 0.0089). PrediXcan were used to identify genetic variation and genetically Conclusions: CisIPN is associated with age, modifiable risk determined gene expression traits, respectively, contributing to factors, and genetically determined expression level of CisIPN. We evaluated two independent datasets for replication: RPRD1B. Further study of implicated genes could elucidate Vanderbilt's electronic health database (BioVU) and the CALGB the pathophysiologic underpinnings of CisIPN. Clin Cancer Res; 90401 trial. 23(19); 5757–68. Ó2017 AACR. 1Department of Medicine, University of Chicago, Chicago, Illinois. 2Departments Introduction of Biology and Computer Science, Loyola University Chicago, Chicago, Illinois. 3Division of Genetic Medicine, Vanderbilt University, Nashville, Tennessee. Chemotherapy-induced peripheral neuropathy (CIPN) is one 4Department of Medical Oncology, Indiana University, Indianapolis, Indiana. of the most common and often debilitating adverse effects of 5Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, modern chemotherapy (1, 2). Platinum analogues, taxanes, vinca 6 New York, New York. Department of Surgical Oncology, Princess Margaret alkaloids, thalidomide, and epothilones are associated with 7 Cancer Centre, Toronto, Ontario, Canada. Department of Medicine, University CIPN, although with different clinical manifestations, which of Pennsylvania, Philadelphia, Pennsylvania. 8Department of Radiation Oncol- ogy, Dana-Farber Cancer Institute, Boston, Massachusetts. 9J.P. Wilmot Cancer include sensory, motor, and autonomic symptoms (1). Mechan- Institute, University of Rochester Medical Center, Rochester, New York. isms underlying CIPN remain largely unclear (2). Unlike taxane- 10Department of Genitourinary Medical Oncology, The University of Texas MD related CIPN, which can be reversible (2), cisplatin-induced Anderson Cancer Center, Houston, Texas. 11Department of Oncology, Oslo peripheral neuropathy (CisIPN) can be cumulative and progres- 12 University Hospital, Radiumhospital, Oslo, Norway. Department of Clinical sive and cause long-term effects on overall quality of life (QoL) 13 Pharmacy, University of Michigan, Ann Arbor, Michigan. RIKEN Center for and physical function (3). Studies have suggested that age, race, Integrative Medical Science, Yokohama, Japan. diabetes, and obesity may be risk factors for CIPN (4, 5), but Note: Supplementary data for this article are available at Clinical Cancer results have been conflicting (6–11). Research Online (http://clincancerres.aacrjournals.org/). No agents are currently available to prevent or treat CIPN Corresponding Author: M. Eileen Dolan, The University of Chicago, 900 East (12). Management of CIPN is complicated by the lack of 57th St, Room 7100, Chicago, IL 60637-1470. Phone: 773-702-4441; Fax: 773- reliable means to identify at-risk patients. While genetic var- 702-9268; E-mail: [email protected] iants could address unexplained phenotypic variability, het- doi: 10.1158/1078-0432.CCR-16-3224 erogeneity of treatment regimens and the lack of long-term Ó2017 American Association for Cancer Research. patient follow-up complicate pharmacogenetic studies of www.aacrjournals.org 5757 Downloaded from clincancerres.aacrjournals.org on October 2, 2021. © 2017 American Association for Cancer Research. Published OnlineFirst June 13, 2017; DOI: 10.1158/1078-0432.CCR-16-3224 Dolan et al. procedures were approved by the Human Subjects Review Board Translational Relevance at each institution. All patients provided written consent for Cisplatin is one of the most commonly prescribed che- participation in study procedures, including genetic analyses. motherapeutics worldwide, but it is associated with multiple toxicities that adversely impact survivors' quality of life. One Data collection such toxicity, cisplatin-induced peripheral neuropathy TCSs visiting the clinic for follow-up and who provided written (CisIPN), often persists and can be debilitating. We identified consent for participation underwent a brief physical examination, strong effects of long-term CisIPN on self-reported health and including measurement of height and weight. Body mass index showed associations of CisIPN with age, hypertension, and (BMI; kg/m2) was defined as normal, overweight, obese, or modifiable risk factors such as smoking, excess drinking, morbidly obese (<25, 25–<30, 30–<40, and 40 kg/m2, respec- and weight gain since treatment. We found CisIPN to be highly tively). Supplementary Fig. S1 illustrates the data collection heritable, indicating that genetic variants could explain pipeline. Patients completed questionnaires with regard to neu- phenotypic variability. We implicated lower (genetically deter- rotoxic symptoms, comorbidities, lifestyle behaviors, perceived mined) expression of RPRD1B and MIDN and higher expres- health, and medication use at the time of enrollment (range, 1–30 sion of THEM5 as associated with CisIPN. RPRD1B was rep- years after treatment completion). These included the EORTC- licated in an independent cohort of patients who developed QLQ-CIPN20 questionnaire with questions listed in Supplemen- drug-induced polyneuropathy and was of borderline signifi- tary Table S1 (20). Data abstracted from medical records with cance in a clinical trial of docetaxel-induced neuropathy. standardized forms included all variables related to GCT diagno- RPRD1B functions in DNA repair, transcription, and cell-cycle sis and treatment. For each administered cytotoxic drug, infor- control and may be a target for drug development. Our data mation was collected on name, dose, date(s) of administration, indicate the importance of both clinical characteristics and number of cycles, and cumulative dose. genetic variation in the development of long-term CisIPN. Phenotype analysis We evaluated the frequency of sensory neuropathy using nine items in the EORTC-CIPN20 (19). We assessed inter-item associations as well as relationships with motor and autonomic chemotherapeutic toxicities, including CIPN. However, cisplat- neuropathy by variance analysis using principal component in-based chemotherapy for testicular cancer is relatively homo- analysis (PCA), following conversion of the Likert scale to a geneous and curative (13). Testicular cancer survivors (TCSs) 0–3 numeric scale: 0 for "none," 1 for "a little," 2 for "quite are typically young at diagnosis, and the period of survivorship a bit," 3 for "very much." We evaluated subscale internal can span upwards of 50 years, providing an ideal model to consistency using Cronbach a (21). Following exclusion of the investigate long-term adverse effects of cisplatin-based chemo- hearing impairment item, we created a summary statistic of therapy. These include hearing impairment, tinnitus, renal CisIPN mathematically equivalent to the standard scoring dysfunction, cardiovascular disease, secondary malignancies, algorithm (22): rather than summing item scores and scaling CisIPN, and others (14). CisIPN most commonly presents as a to 0–100, we took the mean of the scores, effectively summing sensory neuropathy in a stocking-glove distribution with scoresandscalingto0–3 and imputing missing data points numbness, tingling, paresthesias, loss of proprioception, hyper- from available ones (11 samples were missing one response, algesia, and/or allodynia (3). and two samples were missing three responses). The ceiling Although cisplatin is one of the
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