Potential Interactions with Anticancer Agents: A Cross-Sectional Study

Abstract

Background: Patients with cancer are particularly susceptible to drug interactions (DIs), but the extent of the problem has received limited attention. We aimed to evaluate the frequency of interactions with anticancer agents in a group of cancer patients. Methods: The study was performed in a Belgian teaching hospital. One hundred and twenty-two patients with solid malignancies were included. A comprehensive drug history was performed by a clinical pharmacist. Three renowned DI compendia were used to identify DIs. Results: Forty-one potential interactions involving an anticancer agent and considered to be clinically significant were identified among 25% of patients. The anticancer drugs mostly involved were cisplatin and methotrexate, and the most frequent co-medications involved were vitamin K antagonists, proton pump inhibitors and diuretics. In the majority of cases, the potential adverse consequence was increased toxicity of the anticancer agent and/or of the co-medication. Less than 10% of DIs were identified by the three compendia. Conclusions: Preventive measures should be taken to avoid increased toxicity or decreased efficacy of the drugs. Most of the time, this simply involves surveillance of biological or clinical parameters. Collaboration with a clinical pharmacist may be useful for the prescribing physician.

Cancer Stem Cells, Wnt, Hedgehog and Notch Signaling, the Role of Dietary Phytochemicals: New Insights for Cancer Therapy

“…Chemoprevention may not be possible by application of single agents and so compounds having pleiotropic actions are often recommended but studies with garlic (Allium sativum), ginkgo (Ginkgo biloba), echinacea (Echinacea purpurea), ginseng (Panax ginseng), St John' s wort (Hypericum perforatum), and kava (Piper methysticum) show undesired effects in cancer treatment. These phytochemicals interact with drug transporter P-gp, and other oxidative enzymes leading to phytokinetic alteration of commonly used chemotherapeutic drugs like cisplatin and methotrexate resulting in their low absorption and high elimination [24]. Such unfavorable drug interactions can do more evil than good in cancer patients stipulating more focus to be directed in unraveling the molecular mechanisms imparted by a phytochemical before being used in alliance with other agents.…”

Anti-CCR4 Monoclonal Antibody Mogamulizumab Followed by the GDP (Gemcitabine, Dexamethasone and Cisplatin) Regimen in Primary Refractory Angioimmunoblastic T-Cell Lymphoma

“…In our case, dose-modified GDP therapy after administration of mogamulizumab achieved an objective response. The treatment was generally well tolerated [5,7,8]. Since AITL affects relatively elderly patients (median age of 67 years) [9], GDP therapy could be useful as salvage therapy in elderly patients.…”

Concomitant drugs with low risks of drug–drug interactions for use in oncology clinical trials

“…It has been suggested that significant clinical interactions are less frequently observed and reported than PK drug interactions; although, this depends on the intrinsic potency of inhibitors or inducers and if the therapeutic indices of co-administered drugs are wide [4,33,85,86]. Thus, PK drug interactions may not affect efficacy or lead to clinically evident toxic effects [82].…”

“…The potassiumsparing diuretics, such as spironolactone, can be involved in significant DDIs leading to arrhythmia or fatal hyperkalemia [66]. Diuretics were recently reported as one of the main causes of drug interaction in cancer patients [4].…”

“…It has been reported that 20-30% of all adverse reactions observed in clinical trials are caused by drug-drug interactions (DDIs) [2][3][4]. These interactions can potentially compromise patient safety, given the usually small therapeutic index of anti-cancer drugs.…”