A client with breast cancer has had genetic testing that shows she is a CYP2D6 ultra-rapid metabolizer. How would the nurse explain this result?
1. "You do not have the functional enzyme to break down tamoxifen."
2. "Your ability to break tamoxifen down to active metabolites is normal."
3. "Your body will break down tamoxifen to its active metabolites very quickly, which increases your ability to fight your cancer."
4. "You will break tamoxifen down so quickly that it will be metabolized out of your system before it can work on cancer cells."
3
Rationale 1: A client who is a poor metabolizer does not have the functional enzyme to break tamoxifen down to active metabolites.
Rationale 2: This statement describes a CYP2D6 extensive metabolizer.
Rationale 3: Ultra-rapid metabolizers break tamoxifen down to endoxifen very quickly. This results in high plasma concentrations of this metabolite, which has stronger anticancer properties.
Rationale 4: Ultra-rapid metabolizers do break down tamoxifen rapidly, but the result is high plasma concentrations of endoxifen, which has stronger anticancer properties.
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