Drug-drug interactions between tyrosine kinase inhibitors and concomitance medications: Drug safety in cancer treatment
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DOI: https://doi.org/10.59294/HIUJS.VOL.6.2024.623Từ khóa:
ung bướu, thuốc ức chế tyrosine kinase, tương tác thuốcAbstract
Background: Tyrosine kinase inhibitors are increasingly used in the treatment of cancer. Drug interactions involving tyrosine kinase inhibitors are commonly encountered in clinical practice. Objectives: To analyze DDI between TKIs and the concomitant medication. Materials and Methods: Retrospective observational study carried out at Cho Ray hospital's oncology center. We evaluated the data of patients who were prescribed tyrosine kinase inhibitor from January 2023 to August 2023. Medication data were extracted from electronic medical records. Drug Interaction Checker (Drugs.com) and MicroMedex Drug Interaction (MM) were utilized to identify potential interactions between tyrosine kinase inhibitors and concomitant medications. Interactions were then assessed by the investigators for clinical significance. The main outcome was the frequency of significant drug interactions involving tyrosine kinase inhibitors and concomitant medications. Secondary outcomes included describing the nature and clinical impact of interactions and describing interactions by medication class. Results: A total of 250 patient files were included for analysis, in which 232 interactions were screened. 140 potential interactions were identified by Micromedex software, with 139 (49.1%) considered “major”. Interaction Checker (Drugs.com) detected 73 (25.8%) potential interactions classified as “major” and 159 (74.1%) as “moderate” level of interaction. Potential clinical consequences included QTc prolongation, decreased tyrosine kinase inhibitor concentrations, and increased concentration of concurrently used drugs due to tyrosine kinase being inhibitors of CYP3A4. Conclusions: Drug interactions in prescriptions for TKIs are common in clinical practice. Therefore, physicians prescribing TKI should be careful of this phenomenon. Short-acting agents should be preferred for gastric acid suppression because PPIs alter the bioavailability of several TKIs. Prolongation of QT, which is also a major effect of TKIs drug interactions, is a life-threatening consequence. Oncology pharmacists should play a role in screening for tyrosine kinase inhibitor-linked interactions, recommending alternative drugs or dose timing strategies, and monitoring concurrently used drugs toxicity.
Tài liệu tham khảo
[1] Backes, K., S. Greisbach, and S. Wilhelm, "Identification of drug therapy opportunities with oral chemotherapy." Special Pharm Times, pp. 1-10, 2013.
[2] Budha, N. R., A. Frymoyer, G. S. Smelick, J. Y. Jin, M. R. Yago, M. J. Dresser, S. N. Holden, L. Z. Benet, and J. A. Ware, "Drug absorption interactions between oral targeted anticancer agents and PPIs: is pH‐dependent solubility the Achilles heel of targeted therapy?" Clinical Pharmacology & Therapeutics Vol. 92, No. 2, pp. 203–213. 2012
DOI: https://doi.org/10.1038/clpt.2012.73[3] Chu MP, Ghosh S, Chambers CR, et al., “Gastric acid suppression is associated with decreased erlotinib efficacy in nonsmall cell lung cancer,” Clin Lung Cancer, Vol 16, No. 1, pp. 33–39, 2015.
DOI: https://doi.org/10.1016/j.cllc.2014.07.005[4] Deza EG, Morgenfeld EL, Rivarola EG, et al., “Polypharmacy in oncology patients”, J Clin Oncol, Vol. 32, pp. e17582, 2014.
DOI: https://doi.org/10.1200/jco.2014.32.15_suppl.e17582[5] Edwards SJ, Abbott R, Edwards J, et al., “Outcomes assessment of a pharmacist directed seamless care program in an ambulatory oncology clinic”, J Pharm Pract, Vol. 27, No.1, pp. 46–52, 2014.
DOI: https://doi.org/10.1177/0897190013504954[6] Egron A, Olivier P, Gouraud A, et al., “Preventable and potentially preventable serious adverse reactions induced by oral protein kinase inhibitors through a database of adverse drug reaction reports”, Targ Oncol, Vol.10, pp. 229-234, 2015.
DOI: https://doi.org/10.1007/s11523-014-0328-7[7] Keller KL, Franquiz MJ, Duffy AP, Trovato, “Drug-drug interactions in patients receiving tyrosine kinase inhibitors”, J Oncol Pharm Pract, Vol. 24, pp.110-115, 2018.
DOI: https://doi.org/10.1177/1078155216682311[8] Locatelli M, Criscitiello C, Esposito A, et al. “QT prolongation induced by targeted biotherapies used in clinical practice and under investigation: a comprehensive review,” Target Oncol, Vol. 10, pp. 27–43, 2015.
DOI: https://doi.org/10.1007/s11523-014-0325-x[9] Parsons LB, Edwards K, Perez A, et al., “Positive outcomes associated with a pharmacist driven oral chemotherapy program”, J Hematol Oncol Pharm, Vol.5, No.4, pp. 1-8, 2015.
[10] Shah RR, Morganroth J and Shah DR., “Cardiovascular safety of tyrosine kinase inhibitors: with a special focus on cardiac repolarization,” Drug Safe, 36, pp. 295-316, 2013.
DOI: https://doi.org/10.1007/s40264-013-0047-5[11] Ter Heine R, van den Bosch RT, Schaefer-Prokop CM, et al. “Fatal interstitial lung disease associated with high erlotinib and metabolite levels,” Lung Cancer, Vol. 75, pp. 391-397, 2012.
DOI: https://doi.org/10.1016/j.lungcan.2011.10.008[12] Van Erp NP, Guchelaar HJ., “Clinical pharmacokinetics of tyrosine kinase inhibitors,” Cancer Treat, Vol.35, No.8, pp. 692-706, 2010.
DOI: https://doi.org/10.1016/j.ctrv.2009.08.004[13] Van Leeuwen RF, Brundel DS, Neef C, et al., “Potential drug-drug interaction in cancer patients treated with oral anticancer drugs,” Br J Cancer, Vol.108, pp. 1071-1078, 2013.
DOI: https://doi.org/10.1038/bjc.2013.48[14] Van Leeuwen RW, van Gelder T, Mathijssen RH, et al., “Drug-drug interactions with tyrosine kinase inhibitors: a clinical perspective”. Lancet Oncol, Vol.15, pp. 315-326, 2014.
DOI: https://doi.org/10.1016/S1470-2045(13)70579-5[15] Vu B, Wilson DB, Modlin J, et al., “Implementation of a pharmacist-managed interdisciplinary oral chemotherapy program in a community cancer center,” J Hematol Oncol Pharm, Vol.1, No 2, pp. 1-7, 2011.
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