Cedric Lau, Ma Ida Mohmaed Ali, Lishi Lin, Dorieke E M van Balen, Bart A W Jacobs, Bastiaan Nuijen, Robert M Smeenk, Neeltje Steeghs, Alwin D R Huitema
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引用次数: 0
摘要
目的:接受减肥手术并口服抗癌药物的患者人数正在增加。减肥手术可能会影响口服抗癌药物的吸收。令人吃惊的是,目前还没有具体的药物剂量建议。我们旨在为减肥手术患者应用口服抗癌药物提供实用建议:方法:我们在一家综合癌症中心对接受过各种减肥手术的患者进行了回顾性提取。此外,还提出了一个流程图,用于评估减肥手术患者口服抗癌药物暴露不足的风险。随后,利用常规治疗药物监测(TDM)样本对流程图进行了回顾性评估:在我们的分析中,571 名癌症患者(占 14 万名接受治疗或转诊患者的 0.4%)曾接受过减肥手术。在这些患者中,有 78 名患者接受了 152 种口服抗癌药物治疗,共计 30 种药物。这 30 种不同的处方口服抗癌药被分为用药不足的低风险(13%)、中风险(67%)和高风险(20%)。25 名患者(82 份样本)的 TDM 血浆样本可用,其中减肥手术后的 21 份样本(25%)低于目标值:建议的流程图有助于优化接受减肥手术患者的口服抗癌药物治疗。我们建议对属于 BCS II、III 或 IV 级的药物进行 TDM。如果 BCS II 级或 IV 级药物中存在更多的风险因素,则建议事先改用其他药物。在特殊情况下,可以从一开始就提供较大剂量的药物(如他莫昔芬)。
Impact of bariatric surgery on oral anticancer drugs: an analysis of real-world data.
Purpose: The number of patients with bariatric surgery who receive oral anticancer drugs is rising. Bariatric surgery may affect the absorption of oral anticancer drugs. Strikingly, no specific drug dosing recommendations are available. We aim to provide practical recommendations on the application of oral anticancer drugs in patients who underwent bariatric surgery.
Methods: Patients with any kind of bariatric surgery were extracted retrospectively in a comprehensive cancer center. In addition, a flowchart was proposed to assess the risk of inadequate exposure to oral anticancer drugs in patients who underwent bariatric surgery. Subsequently, the flowchart was evaluated retrospectively using routine Therapeutic drug monitoring (TDM) samples.
Results: In our analysis, 571 cancer patients (0.4% of 140.000 treated or referred patients) had previous bariatric surgery. Of these patients, 78 unique patients received 152 oral anticancer drugs equaling an overall number of 30 unique drugs. The 30 different prescribed oral anticancer drugs were categorized as low risk (13%), medium risk (67%), and high risk (20%) of underdosing. TDM plasma samples of 25 patients (82 samples) were available, of which 21 samples post-bariatric surgery (25%) were below the target value.
Conclusions: The proposed flowchart can support optimizing the treatment with orally administered anticancer drugs in patients who underwent bariatric surgery. We recommend performing TDM in drugs that belong to BCS classes II, III, or IV. If more risk factors are present in BCS classes II or IV, a priori switches to other drugs may be advised. In specific cases, higher dosages can be provided from the start (e.g., tamoxifen).
期刊介绍:
Addressing a wide range of pharmacologic and oncologic concerns on both experimental and clinical levels, Cancer Chemotherapy and Pharmacology is an eminent journal in the field. The primary focus in this rapid publication medium is on new anticancer agents, their experimental screening, preclinical toxicology and pharmacology, single and combined drug administration modalities, and clinical phase I, II and III trials. It is essential reading for pharmacologists and oncologists giving results recorded in the following areas: clinical toxicology, pharmacokinetics, pharmacodynamics, drug interactions, and indications for chemotherapy in cancer treatment strategy.