Consensus-based evaluation of clinical significance and management of anticancer drug interactions
Frank G A Jansman1, An K L Reyners, Eric N van Roon
1Department of Clinical Pharmacy, Deventer Ziekenhuis, the Netherlands. f.g.a.jansman@dz.nl
Background:
Anticancer drug interactions can affect the efficacy and toxicity of anticancer treatment and that of the interacting drugs. However, information on the significance, prevention, and management of these interactions is currently lacking.
Objective:
The purpose of this study was to assess the clinical significance of interaction among anticancer agents and comedications and to provide recommendations for the management of clinically significant interactions.
Methods:
Members of a multidisciplinary expert group of hospital and community pharmacists, medical oncologists, internists, and clinical pharmacologists were selected by their professional organizations, which participated in this consensus project. Literature was extensively searched for any drug interactions with anticancer agents using registration files, reference books, handbooks, and electronic databases. Interactions between anticancer agents were not considered. Interactions were classified by level of best available evidence for the interaction and by severity of the clinical effect, according to a structured assessment procedure. This assessment distinguished 5 levels for the amount and quality of evidence available and 6 severity levels for classification of potential drug-to-drug interactions.
Results:
A total of 88 drug interactions with anticancer agents were identified from 146 combinations of drugs with anticancer agents found in literature. For 58 combinations, there was insufficient evidence of an interaction. Of the identified interactions, 38 were classified as clinically significant, defined as necessitating an alert or intervention, such as dose adaptation, comedication, discontinuation of treatment, or additional monitoring of treatment. Recommendations were made for management of these interactions.
Conclusion:
Numerous interactions with anticancer agents are clinically significant and should be considered by pharmacists and doctors in daily oncology practice.
Insights
Clinicians must recognize numerous clinically significant drug interactions involving anticancer agents. This study identified 38 significant interactions, offering management recommendations for improved patient safety and treatment efficacy.
Area of Science:
- Oncology
- Clinical Pharmacology
- Drug Interactions
Background:
- Anticancer drug interactions impact treatment efficacy and toxicity.
- Limited information exists on managing these significant drug interactions.
Purpose of the Study:
- Assess the clinical significance of drug interactions between anticancer agents and comedications.
- Provide evidence-based recommendations for managing clinically significant interactions.
Main Methods:
- Multidisciplinary expert panel convened.
- Extensive literature search for drug interactions with anticancer agents.
- Interactions classified by evidence level and clinical severity.
Main Results:
- Identified 88 drug interactions with anticancer agents.
- Classified 38 interactions as clinically significant, requiring intervention.
- Developed management recommendations for significant interactions.
Conclusions:
- Clinically significant drug interactions with anticancer agents are frequent.
- Pharmacists and physicians should integrate findings into daily oncology practice.
Related Concept Videos
01:30Drug toxicity: Drug–Drug Interaction
01:25Pharmacokinetics: Drug–Drug Interactions
01:14Agonism and Antagonism: Quantification
To quantify these effects, researchers use a dose-response curve, which provides valuable information about the potency and efficacy of a drug. Potency refers to...
01:30Combined Effects of Drugs: Antagonism
The most common type is receptor antagonism, where one drug acts as an antagonist to block the effects of another drug by...
01:29Therapeutic Drug Monitoring: Affecting Factors
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...