Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account

Collado-Borrell, Roberto; Escudero‐Vilaplana, Vicente; Romero‐Jiménez, Rosa; Peinado, Irene Iglesias; Herranz-Alonso, Ana; Sanjurjo‐Sáez, María

doi:10.1007/s00432-016-2190-8

Cited by 42 publications

(25 citation statements)

References 34 publications

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“…A number of other drugs are also known inducers as shown in Table 2 . For example, St John’s wort is a well-established inducer of CYP enzymes and ABC transporters [ 42 – 44 ]. In addition to a well-documented induction of ABCB1, there is some evidence that it may also induce ABCC2 [ 45 , 46 ].…”

Section: Inducers Of Enzymes/transporters and Tamoxifen Efficacymentioning

confidence: 99%

The Underrated Risks of Tamoxifen Drug Interactions

Hansten

2018

Eur J Drug Metab Pharmacokinet

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Tamoxifen is a prodrug, and most of the therapeutic effect in treating breast cancer stems from its metabolite, endoxifen. Since cytochrome P450 (CYP) 2D6 is the most important enzyme in the production of endoxifen, drugs that inhibit CYP2D6 would be expected to reduce tamoxifen efficacy. In addition to drug–drug interactions (DDI) involving CYP2D6, there is growing evidence that enzyme inducers can substantially alter the disposition of endoxifen, reducing tamoxifen efficacy. Although the clinical evidence on the impact of CYP2D6 inhibitors on tamoxifen efficacy is mixed, there were serious flaws in many of the studies. Thus, there is a reasonable chance that CYP2D6 inhibitors do in fact inhibit tamoxifen efficacy. Tamoxifen has extraordinarily complex pharmacokinetics, with more than a dozen drug-metabolizing enzymes and transporters involved in its disposition. Enzyme inducers may increase the activity of several of these pathways, including phase II enzymes, ABC transporters, and various CYP enzymes other than CYP2D6. Based on current clinical evidence, one could argue that enzyme inducers are potentially more dangerous than CYP2D6 inhibitors in patients taking tamoxifen. Moreover, early evidence suggests that the combination of CYP2D6 inhibitors plus enzyme inducers may produce catastrophic inhibition of tamoxifen efficacy. One could argue that, given the available evidence, an agnostic “wait and see” position on tamoxifen DDI is ethically untenable, and that many women with breast cancer are currently being subjected to an unnecessary risk of cancer recurrence. Specific recommendations to reduce the risk of adverse tamoxifen DDI are offered for consideration.

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Section: Inducers Of Enzymes/transporters and Tamoxifen Efficacymentioning

confidence: 99%

The Underrated Risks of Tamoxifen Drug Interactions

Hansten

2018

Eur J Drug Metab Pharmacokinet

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“…The treatment for cancer has changed from controlled administration in the day hospital to administration at home without the supervision of a health care professional, thus requiring greater autonomy on the part of the patient [ 1 , 2 ]. However, these treatments are subject to drug-related problems (DRPs), such as adherence, interactions with the usual medication, and side effects [ 3 , 4 ]. The Institute for Safe Medication Practices classifies OAAs as high-risk medications [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of a Mobile App for the Pharmacotherapeutic Follow-Up of Patients With Cancer on Their Health Outcomes: Quasi-Experimental Study

Collado-Borrell¹,

Escudero‐Vilaplana²,

Ribed³

et al. 2020

JMIR Mhealth Uhealth

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Background Oral antineoplastic agents (OAAs) have revolutionized cancer management. However, they have been reported with adverse side effects and drug-drug interactions. Moreover, patient adherence to OAA treatment is critical. Mobile apps can enable remote and real-time pharmacotherapeutic monitoring of patients, while also promoting patient autonomy in their health care. Objective The primary objective was to analyze the effect of using a mobile app for the follow-up of patients with oncohematological malignancies undergoing treatment with OAAs on their health outcomes. The secondary objectives were to analyze the role of the app in communication with health care professionals and patient satisfaction with the app. Methods We performed a comparative, quasi-experimental study based on a prepost intervention with 101 patients (control group, n=51, traditional pharmacotherapeutic follow-up vs intervention group, n=50, follow-up through e-OncoSalud, a custom-designed app that promotes follow-up at home and the safety of patients receiving OAAs). The effect of this app on drug safety, adherence to treatment, and quality of life was evaluated. Results With regard to drug safety, 73% (37/51) of the patients in the control group and 70% (35/50) of the patients in the intervention group (P=.01) presented with drug-related problems. The probability of detecting an insufficiently treated health problem in the intervention group was significantly higher than that in the control group (P=.04). The proportion of patients who presented with side effects in the intervention group was significantly lower than that in the control group (P>.99). In the control group, 49% (25/51) of the patients consumed some health resources during the first 6 months of treatment compared with 36% (18/50) of the patients in the intervention group (P=.76). Adherence to treatment was 97.6% (SD 7.9) in the intervention group, which was significantly higher than that in the control group (92.9% [SD 10.0]; P=.02). The EuroQol-5D in the intervention group yielded a mean (SD) index of 0.875 (0.156), which was significantly higher than that in the control group (0.741 [0.177]; P<.001). Approximately 60% (29/50) of the patients used the messaging module to communicate with pharmacists. The most frequent types of messages were acknowledgments (77/283, 27.2%), doubts about contraindications and interactions with OAAs (70/283, 24.7%), and consultations for adverse reactions to treatment (39/283, 13.8%). The satisfaction with the app survey conducted in the intervention group yielded an overall mean (SD) score of 9.1 (0.4) out of 10. Conclusions Use of e-OncoSalud for the real-time follow-up of patients receiving OAAs facilitated the optimization of some health outcomes. The intervention group had significantly higher health-related quality of life and adherence to treatment than the control group. Further, the probability of the intervention group presenting with side effects was significantly lower than that of the control group.

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“…Group II was administered combinations of GTE (200 mg/kg) with PAL (5 mg/kg) immediately after 30 min and group III was designed such that administration of PAL was done after long-term (7 days) administration of GTE. The dose of GTE was fixed in terms of its EGCG content (100 mg/mL) in accordance with reported studies (Collado-Borrell et al, 2016;Ge et al, 2011). Mean PK parameters for PAL in each group after oral administration was estimated.…”

Section: Application To Pharmacokinetic Hdi Study In Sprague-dawleymentioning

confidence: 99%

“…Herbal supplement usage in combination with other anticancer agents in oncology practice may result in HDIs. Food–drug interactions or HDIs plays an important role in the alteration of the pharmacokinetics (PK) as well as pharmacodynamics of drugs (Collado‐Borrell et al, ). Ingestion of GTP naturally alters the PK of concomitantly administered drugs and is a serious matter concerning patient safety (Maher, Alzoman, Shehata, & Abahussain, ).…”

Section: Introductionmentioning

confidence: 99%

An assessment of the impact of green tea extract on palbociclib pharmacokinetics using a validated UHPLC–QTOF–MS method

Paul

Surendran

Chandrakala

et al. 2019

Biomedical Chromatography

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Green tea extracts (GTE) has been reported to be a kinase inhibitor and modulator for various drug metabolizing enzymes. It may give synergetic antioncogenic effect, but with a possibility of pharmacokinetic interactions with various co‐administered anticancer agents like palbociclib (PAL), a selective inhibitor of CDK‐4/6 primarily metabolized by CYP3A enzyme. To explore the impact of GTE on PAL pharmacokinetics in Sprague–Dawley rats, a rapid and sensitive UHPLC–QTOF–MS method was established. Chromatographic separation was carried out on an Acquity UPLC BEH C18 (100 × 2.1 mm, 1.7 μm) column using a gradient mobile phase system consisting of 0.1% formic acid and acetonitrile. Sample preparation was based on a simple protein precipitation method. Estimation of target ions [M + H]+ at m/z 448.2455 for PAL and m/z 441.2044 for ibrutinib (IS) was performed in selective ion mode ESI–HRMS. Good sensitivity (1.0 ng/mL) and linearity over a wide concentration range of 1–2000 ng/mL was exhibited by the method. The results indicated that the administration of GTE resulted in decreased oral bioavailability of PAL in both short‐ and long‐term conditions. However, when both conditions were compared, the variation was less for the peak concentration and area under the concentration–time curve level of PAL.

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Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account

Cited by 42 publications

References 34 publications

The Underrated Risks of Tamoxifen Drug Interactions

The Underrated Risks of Tamoxifen Drug Interactions

Effect of a Mobile App for the Pharmacotherapeutic Follow-Up of Patients With Cancer on Their Health Outcomes: Quasi-Experimental Study

An assessment of the impact of green tea extract on palbociclib pharmacokinetics using a validated UHPLC–QTOF–MS method

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