Impact of Curcumin (with or without Piperine) on the Pharmacokinetics of Tamoxifen

Tamoxifen is a prodrug that is primarily metabolized into the pharmacologically active metabolite endoxifen and eventually into inactive metabolites. The herb curcumin may increase endoxifen exposure by affecting phase II metabolism. We compared endoxifen and tamoxifen exposure in breast cancer patients with or without curcumin, and with addition of the bio-enhancer piperine. Tamoxifen (20&ndash
30mg per day (q.d.)) was either given alone, or combined with curcumin (1200 mg three times daily (t.i.d.)) +/&minus
piperine (10 mg t.i.d.). The primary endpoint of this study was the difference in geometric means for the area under the curve (AUC) of endoxifen. Genotyping was performed to determine CYP2D6 and CYP3A4 phenotypes. The endoxifen AUC0&ndash
24h decreased with 7.7% (95%CI: &minus
15.4 to 0.7%
p = 0.07) with curcumin and 12.4% (95%CI: &minus
21.9 to &minus
1.9%
p = 0.02) with curcumin and piperine, compared to tamoxifen alone. Tamoxifen AUC0&ndash
24h showed similar results. For patients with an extensive CYP2D6 metabolism phenotype (EM), effects were more pronounced than for intermediate CYP2D6 metabolizers (IMs). In conclusion, the exposure to tamoxifen and endoxifen was significantly decreased by concomitant use of curcumin (+/&minus
piperine). Therefore, co-treatment with curcumin could lower endoxifen concentrations below the threshold for efficacy (potentially 20&ndash
40% of the patients), especially in EM patients.