Background:Potential drug–drug interactions (PDDIs) in patients with cancer are common, but have not previously been quantified for oral anticancer treatment. We assessed the prevalence and seriousness of potential PDDIs among ambulatory cancer patients on oral anticancer treatment.Methods:A search was conducted in a computer-based medication prescription system for dispensing oral anticancer drugs to outpatients in three Dutch centres. Potential drug–drug interactions were identified using electronic (Drug Interaction Fact software) and manual screening methods (peer-reviewed reports).Results:In the 898 patients included in the study, 1359 PDDIs were identified in 426 patients (46%, 95% confidence interval (CI)=42–50%). In 143 patients (16%), a major PDDI was identified. The drug classes most frequently involved in a major PDDI were coumarins and opioids. The majority of cases concerned central nervous system interactions, PDDIs that can cause gastrointestinal toxicity and prolongation of QT intervals. In multivariate analysis, concomitant use of more drugs (odds ratio (OR)=1.66, 95% CI=1.54–1.78, P<0001) and genito-urinary cancer (OR=0.25, 95% CI=0.12–0.52, P<0001) were risk factors.Conclusion:Potential drug–drug interactions are very common among cancer patients on oral cancer therapy. Physicians and pharmacists should be more aware of these potential interactions.

In the past decade, many tyrosine-kinase inhibitors have been introduced in oncology and haemato-oncology. Because this new class of drugs is extensively used, serious drug-drug interactions are an increasing risk. In this Review, we give a comprehensive overview of known or suspected drug-drug interactions between tyrosine-kinase inhibitors and other drugs. We discuss all haemato-oncological and oncological tyrosine-kinase inhibitors that had been approved by Aug 1, 2013, by the US Food and Drug Administration or the European Medicines Agency. Various clinically relevant drug interactions with tyrosine-kinase inhibitors have been identified. Most interactions concern altered bioavailability due to altered stomach pH, metabolism by cytochrome P450 isoenzymes, and prolongation of the QTc interval. To guarantee the safe use of tyrosine-kinase inhibitors, a drugs review for each patient is needed. This Review provides specific recommendations to guide haemato-oncologists, oncologists, and clinical pharmacists, through the process of managing drug-drug interactions during treatment with tyrosine-kinase inhibitors in daily clinical practice.

OBJECTIVE -Chromium treatment has been reported to improve glycemic control and insulin sensitivity in specific populations of patients with type 2 diabetes. The aim of this study was to determine the effect of chromium treatment on glycemic control in a Western population of insulin-dependent patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -In this 6-month double-blind study, patients with an HbA 1c (A1C) Ͼ8% and insulin requirements of Ͼ50 units/day were randomly assigned to receive treatment with placebo or 500 or 1,000 g chromium daily in the form of chromium picolinate. The primary efficacy parameter was a change in A1C. Secondary end points were changes in lipid profile, BMI, blood pressure, and insulin requirements.RESULTS -In this per-protocol analysis (n ϭ 46), the decrease in A1C was approximately equal across the three groups (0.4%). All patients had a BMI Ͼ25 kg/m 2 . No differences were found in the secondary end points. We found a weak relationship between an increasing serum chromium concentration and improvement of the lipid profile.CONCLUSIONS -There is no evidence that high-dose chromium treatment is effective in obese Western patients with type 2 diabetes. Diabetes Care 29:521-525, 2006W ith the ever-growing epidemic of type 2 diabetes, investigations are directed toward prevention and pharmaceutical and lifestyle interventions to treat type 2 diabetes. Since insulin resistance is seen as a major contributor to the development of overt type 2 diabetes, efforts are being directed toward the improvement of insulin sensitivity. One possible method to improve insulin sensitivity is chromium supplementation.In vitro and animal studies (1,2) have shown chromium to have a positive effect on insulin sensitivity. One of the intracellular proteins influencing the insulin receptor is the oligopeptide apolipoprotein, low molecular-weight, chromiumbinding substance (apo-chromomodulin) (2). In vitro, this peptide has the ability to increase tyrosine kinase activity eightfold, depending on the chromium concentration (3). This in turn promotes insulin receptor activity, thus eliciting improved insulin sensitivity. Therefore, for some time now, chromium has been thought to play a beneficial role in glucose metabolism and, as early as 1957, was referred to as a "glucose tolerance factor" (4). It has been marketed as such by some companies in the U.S.There are studies that support this proposed effect. Anderson et al. (5) studied the effects of chromium treatment in a group of Chinese patients with type 2 diabetes. They reported an average decrease in HbA 1c (A1C) of almost 2 percentage points after only 4 months of treatment with 1,000 g chromium daily. Since then, the effects of chromium on glycemic control, lipid profile, weight, and muscular strength have been investigated, both in nondiabetic healthy subjects and in patients with type 2 diabetes. Two systematic reviews (6,7) on the effects of chromium on glycemic control have been published. Both reviews concluded that based on the currently avail...