Prevalence of drug–drug interactions in sarcoma patients: key role of the pharmacist integration for toxicity risk management

Abstract

Background: The risk of drug drug interactions (DDI) has become a major issue in cancer patient care. However, data in sarcoma patients are scarce. We aimed to evaluate the frequency of DDI with antitumor treatments, identify the risk factors for DDI and evaluate the impact of a pharmacist evaluation before anticancer treatment.Patients and Methods: We performed a retrospective review of consecutive sarcoma patients starting chemotherapy (CT) or Tyrosine kinase inhibitor (TKI). A pharmacist performed medication reconciliation and established an early toxicity risk assessment. Potential DDI with antitumor drugs were identi ed using Micromedex electronic software.Results: One hundred twenty-two soft-tissue and 80 bone sarcoma patients (103 males, median age 50 years,) were included before chemotherapy (86%) or tyrosine kinase inhibitor (14%). The median number of medications was 3; 34 patients (22% of patients with medication reconciliation) reported complementary medicine use. 37 potential DDI classi ed as major, were identi ed (12% of the 243 pretherapeutic assessments). In multivariate analysis, TKI (p<0.0001), proton pump inhibitor (p=0.026) and antidepressant (p<0.001) were identi ed as risk factors of DDI (p<0.02). Marital status (p=0.003) was the single factor associated with complementary medicine use. A pharmacist performed 157 medication reconciliation and made 71 interventions among 59 patients (37%). In multivariate analysis, factors associated with pharmacist intervention were: complementary medicines (p= 0.004), drugs number (p=0.005) and treatment with TKI (p=0.0002) Conclusions:Clinical interventions on DDI are more frequently required among sarcoma patients treated with TKI than CT. Multidisciplinary risk assessment including a medication reconciliation by a pharmacist could be crucial to prevent DDI with TKI.

A Profile of Avelumab Plus Axitinib in the Treatment of Renal Cell Carcinoma

“… 21 , 129 Various factors, such as body composition, drug–drug interactions and self-medication, are likely to influence exposure as well. 130 Conversely, there is no demonstrated exposure–response relationship with anti-PD(L)1 therapies, which confirms that addressing host-related factors associated with response is crucial to derive the highest benefit of these therapies. 44 , 131 Therefore, a tailored pre-therapeutic pharmacological risk assessment, taking into account individual patient characteristics at the same level as the plasma concentration of the drug, should be the first step into decision-making.…”

Determination of drug–drug interaction in breast cancer patients receiving doxorubicin and cyclophosphamide regimen

“…10 Although cyclophosphamide and doxorubicin are favored drugs in the treatment of breast cancer patients, 11 they are associated with a high risk of developing DDI. 12 In a study by Laban et al, Drugs.com identified potential DDIs (pDDIs) in 129 (84.9%) patients, while Lexicomp identified pDDIs in 113 (74.3%) patients in Northern Cyprus. 13 However, the authors did not categorize drug interactions in cancer patients receiving doxorubicin and cyclophosphamide (AC) regimens according to interaction mechanism or severity.…”