Drug Interactions in the Treatment of Malignancy in HIV-Infected Patients

Welz, Tanya; Wyen, Christoph; Hensel, Manfred

doi:10.1159/000458443

Cited by 17 publications

(17 citation statements)

References 57 publications

(81 reference statements)

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“…The PI, atazanavir, and several tyrosine kinase inhibitors have the potential to inhibit UGT1A1 and alter the exposure of its substrates. 15,[39][40][41] One of the evolving areas in pharmacokinetics is the role of drug transporters in DDIs. The P-glycoprotein (P-gp) efflux transporter is widely distributed in the body and is directly responsible for the transport and elimination of many ART and antineoplastics, with some of the drugs also having the potential to modulate P-gp activity via induction or inhibition.…”

Section: Art and Antineoplastic Drug Interactionsmentioning

confidence: 99%

“…In addition to inhibiting the CYP system, ritonavir and cobicistat also inhibit P-gp, which can lead to increased exposure of antineoplastics that depend on the P-gp for their metabolism, absorption, and/or transport. 15,39,41,42 Hepatic, renal, and biliary clearance of drugs may also be affected by other drug transporters, such as the multidrug resistance-associated proteins, the breast cancer resistance protein, the organic anion-transporting polypeptides, and the organic anion and cation transporters. Evolving data with ARTs and antineoplastics suggest that many of these drugs can be substrates, inducers, and/or inhibitors of these transporters.…”

Section: Art and Antineoplastic Drug Interactionsmentioning

confidence: 99%

“…Such combinations should be avoided or very closely monitored to avoid the risks of ventricular arrhythmias and sudden death. 15,40,41 Given the toxicity profiles of antineoplastics and their potential narrow therapeutic indices, clinical PK studies are not ethical to conduct in many cases, and data with most combinations are lacking. The potential DDIs of the most commonly used ART with selected injectable and oral antineoplastics are described in Tables 3 and 4.…”

Section: Art and Antineoplastic Drug Interactionsmentioning

confidence: 99%

“…The PI, atazanavir, and several tyrosine kinase inhibitors have the potential to inhibit UGT1A1 and alter the exposure of its substrates. 15,39-41…”

Section: Management Of Hiv Infection In the Patient With Cancermentioning

confidence: 99%

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Managing Pharmacotherapy in People Living With HIV and Concomitant Malignancy

et al. 2019

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Objective: To describe data with selected malignancies in people living with HIV (PLWH) and HIV in individuals affected by both conditions and to summarize drug-drug interactions (DDIs) with clinical recommendations for point-of-care review of combination therapies. Data Sources: Literature searches were performed (2005 to December 2018) in MEDLINE and EMBASE to identify studies of malignancies in PLWH in the modern era. Study Selection and Data Extraction: Article bibliographies and drug interaction databases were reviewed. Search terms included HIV, antiretroviral therapy, antineoplastic agents, malignancies, and drug interactions. Data Synthesis: In the pre–antiretroviral therapy (ART) era, malignancies in PLWH were AIDS-defining illnesses, and life expectancy was shorter. Nowadays, PLWH are living longer and developing malignancies, including lung, anal, and prostate cancers. Concurrently, the oncology landscape has evolved, with novel oral targeted agents and immunotherapies becoming routine elements of care. The increased need for and complexity with antineoplastics in PLWH has led to recommendations for multidisciplinary care of this unique population. Evaluation of DDIs requires review of metabolic pathways, absorption mechanisms, and various drug transporters associated with antineoplastics and ART. Relevance to Patient Care and Clinical Practice: This review summarizes available data of non–AIDS-defining malignancies, principles of HIV care in the patient with malignancy, and guidance for assessing DDIs between antineoplastics and ART. Summary DDI tables provide point-of-care recommendations. Conclusions: The availability of ART has transformed AIDS into a chronic medical condition, and PLWH are experiencing age-related malignancies. Pharmacists play an important role in the management of this patient population.

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Section: Art and Antineoplastic Drug Interactionsmentioning

confidence: 99%

Section: Art and Antineoplastic Drug Interactionsmentioning

confidence: 99%

Section: Art and Antineoplastic Drug Interactionsmentioning

confidence: 99%

“…The PI, atazanavir, and several tyrosine kinase inhibitors have the potential to inhibit UGT1A1 and alter the exposure of its substrates. 15,39-41…”

Section: Management Of Hiv Infection In the Patient With Cancermentioning

confidence: 99%

See 2 more Smart Citations

Managing Pharmacotherapy in People Living With HIV and Concomitant Malignancy

et al. 2019

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“…Hentrich and Pfister [10] review data on urogenital tumors. Finally, Welz et al [11] discuss important drug interactions which may not only increase toxicities but also may influence the overall prognosis of the patient.…”

mentioning

confidence: 99%