Sarcoma: 29% of major drug interactions involve alternative medicine

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Takeaway

  • Complementary and alternative medicine (CAM) is a major contributor to drug-drug interactions (DDIs) among patients with sarcoma receiving tyrosine kinase inhibitors (TKIs).
  • The study, to be presented at ESMO 2018, also showed a much higher prevalence of DDIs with TKIs vs chemotherapy.

Why this matters

  • Findings highlight the importance of pharmacist medication reconciliation (MR) that includes CAM.
  • “Risks of interactions with nonconventional drugs are the same as for other co-medications: mainly increased toxicity and loss of efficacy of anticancer treatments. However, we often have less information on the composition of these products and their risk of toxicity or interaction when used in combination with other agents,” lead author Audrey Bellesoeur, MD, from the University Paris Descartes, France, pointed out in an ESMO news release.

Study design

  • Study of 202 patients (51% male; median age, 50 years) with soft-tissue (n=122) or bone sarcoma (n=80) starting chemotherapy (86%) or TKIs (14%).
  • Potential DDIs were identified and categorized by pharmacist MR.
  • Funding: None disclosed.

Key results

  • Median number of medications, 3 (≥5, 32%); 17% of patients used CAM.
  • Marital status (P=.003) and ethnic origin (P=.03) predicted CAM use.
  • 37 potentially severe DDIs identified.
  • In multivariate analysis, DDI factors included use of TKIs, proton pump inhibitors, and antidepressants (P<.02>
  • 157 MRs were performed, leading to 71 interventions in 59 patients (24%).
    • 34 medications discontinued.
    • 16 medications replaced.
    • 2 dose adjustments.
    • 19 cases of drug monitoring.
  • Interventions were more common among patients receiving TKIs vs chemotherapy (63% vs 17%; P<.001 style="list-style-type:circle;">
  • 29% of those interventions involved CAM.

Limitations

  • Retrospective design.