Most oral antineoplastic drugs approved in the past six years are associated with multiple, clinically significant drug-drug interactions (DDIs). Therefore, the onus remains on oncologists to be more of aware DDIs with newer oral antineoplastic agents, said authors from the University of Chicago in an article published in JAMA Oncology.
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This new era in personalized cancer treatment has brought a “welcome surge” in the number of approved antineoplastic drugs. “However, this paradigmatic change requires prescribers to be much more knowledgeable about drug absorption, metabolism, and transport as the potential for DDIs is high,” wrote Sandeep Parsad, PharmD, and Mark J Ratain, MD.
Concurrent medications prescribed for preexisting chronic diseases common in the aging oncology population increases the risk of DDIs. Also, the complexity associated with obtaining these costly oral chemotherapy agents through special access programs contribute to the increased risk, they explained.
“Chronic medications may be prescribed by the patient’s primary care physician who may be unaffiliated with the oncologist. It is the responsibility of the oncologist to communicate with these additional clinicians to understand the patient’s full medication list,” advised Drs Parsad and Ratain. Furthermore, the oncologist and/or other members of the health care team should educate patients about the threat of DDIs and potential perpetrators, including over-the-counter agents, cannabinoids, and nutraceuticals. Patients should also be informed not to start any new medications for nonemergent indications without discussion with the oncologist.
They encouraged health care systems “to apply the same level of detailed institutional policies currently applied to weight-based anticancer drug calculations to the amelioration and prevention of DDIs that may result in dramatic effects on drug exposure. Ideally, this would include automated checking of potential DDIs (via the electronic medical record) and/or careful medication review by an experienced pharmacist.”
