Oral Anticancer Therapy: Management of Drug Interactions

Rogala, B; Charpentier, Margaret M.; Nguyen, Michelle; Landolf, Kaitlin; Hamad, Lamya; Gaertner, Kelly M

doi:10.1200/jop.18.00483

Cited by 37 publications

(24 citation statements)

References 50 publications

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“…For vasomotor symptoms the pharmacological options include selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, clonidine and gabapentin. Clinicians should be aware of potential drug interactions with anticancer and adjuvant therapies (eg, see refs 21 22). Cognitive behavioral therapy may also improve menopause symptoms 23.…”

Section: Introductionmentioning

confidence: 99%

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

Rees

Angioli

Coleman

et al. 2020

Int J Gynecol Cancer

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Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569 847, corpus uteri 382 069, ovary 295 414, vulva 44 235, and vagina 17 600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy, and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45 years, early menopause. The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Our methods comprised a literature review and consensus of expert opinion. The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal, or vulvar cancer, as these tumors are not considered to be hormone dependent.

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Section: Introductionmentioning

confidence: 99%

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

Rees

Angioli

Coleman

et al. 2020

Int J Gynecol Cancer

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“…Based on manual pharmacist review, 7% of subjects had a DDI that was considered clinically relevant, further supporting the conclusion that improved DDI screening is necessary to prevent harm in clinical trial subjects and ensure accuracy of trial data. The vast majority of DDI detected in these trial subjects were DDI that prevent drug absorption [17]. Absorption DDI are common for oral medications, which are being used more often in cancer treatment due to their improved convenience over parenteral administration [18].…”

Section: Discussionmentioning

confidence: 99%

Drug-drug interactions in subjects enrolled in SWOG trials of oral chemotherapy

et al. 2021

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Background Patients with cancer are at increased risk of drug-drug interactions (DDI), which can increase treatment toxicity or decrease efficacy. It is especially important to thoroughly screen DDI in oncology clinical trial subjects to ensure trial subject safety and data accuracy. This study determined the prevalence of potential DDI involving oral anti-cancer trial agents in subjects enrolled in two SWOG clinical trials. Methods Completed SWOG clinical trials of commercially available agents with possible DDI that had complete concomitant medication information available at enrollment were included. Screening for DDI was conducted through three methods: protocol-guided screening, Lexicomp® screening, and pharmacist determination of clinical relevance. Descriptive statistics were calculated. Results SWOG trials S0711 (dasatinib, n = 83) and S0528 (everolimus/lapatinib, n = 84) were included. Subjects received an average of 6.6 medications (standard deviation = 4.9, range 0–29) at enrollment. Based on the clinical trial protocols, at enrollment 18.6% (31/167) of subjects had a DDI and 12.0% (20/167) had a DDI that violated a protocol exclusion criterion. According to Lexicomp®, 28.7% of subjects (48/167) had a DDI classified as moderate or worse, whereas pharmacist review indicated that 7.2% of subjects (12/167) had a clinically relevant interaction. The majority of clinically relevant DDI identified were due to the coadministration of acid suppression therapies with dasatinib (83.3%, 10/12). Conclusions The high DDI prevalence in subjects enrolled on SWOG clinical trials, including a high prevalence that violate trial exclusion criteria, support the need for improved processes for DDI screening to ensure trial subject safety and trial data accuracy.

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“…The fact that approximately 23% of cancer patients are reported to receive TKIs and PPIs concomitantly raises concerns around the clinical significance of this interaction [ 21 ]. A few reviews evaluated the clinical effect of this drug interaction and a similar consensus of mixed evidence was found [ 22 – 24 ]. For example, one study showed a negative effect on survival with concomitant use of acid suppressing agents and erlotinib [ 25 ].…”

Section: Introductionmentioning

confidence: 92%

Importance of medication reconciliation in cancer patients

Elbeddini

Tayefehchamani

et al. 2021

J of Pharm Policy and Pract

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Cancer patients are a complex and vulnerable population whose medication history is often extensive. Medication reconciliations in this population are especially essential, since medication discrepancies can lead to dire outcomes. This commentary aims to describe the significance of conducting medication reconciliations in this often-forgotten patient population. We discuss additional clinical interventions that can arise during this process as well. Medication reconciliations provide the opportunity to identify and prevent drug–drug and herb–drug interactions. They also provide an opportunity to appropriately adjust chemotherapy dosing according to renal and hepatic function. Finally, reconciling medications can also provide an opportunity to identify and deprescribe inappropriate medications. While clinical impact appears evident in this landscape, evidence of economic impact is lacking. As more cancer patients are prescribed a combination of oral chemotherapies, intravenous chemotherapies and non-anticancer medications, future studies should evaluate the advantages of conducting medication reconciliations in these patient populations across multiple care settings.

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Oral Anticancer Therapy: Management of Drug Interactions

Cited by 37 publications

References 50 publications

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

Drug-drug interactions in subjects enrolled in SWOG trials of oral chemotherapy

Importance of medication reconciliation in cancer patients

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