Oral Anticancer Therapy: Management of Drug Interactions

Britny G. Rogala, PharmD; Margaret M. Charpentier, PharmD; Michelle K. Nguyen, PharmD; Kaitlin M. Landolf, PharmD; Lamya Hamad, RPh; Kelly M. Gaertner, PharmD


J Oncol Pract. 2019;15(2):81-90. 

In This Article

Drug Interaction Analysis

No one drug interaction database has been found to have 100% positive predictive value, sensitivity, or specificity for evaluating drug interactions with oral anticancer therapies.[52,53] When several drug databases were compared for sensitivity and other metrics, Lexi-Interact was the highest performing subscription database and Drugs.com was the highest performing freely available database.[53] Given these results, when possible, multiple drug databases as well as clinical judgment are needed for evaluation of prospective oral anticancer therapy DDI.

Given the increase in the number of approvals of oral anticancer therapies, the management of pharmacokinetic and pharmacodynamic DDIs is becoming increasingly relevant to clinical oncology practice. Here, we provide strategies for the management of commonly encountered oral anticancer therapy DDIs associated with medications that prolong the QT interval, anticoagulants, CYP3A4 inhibitors and inducers, antidepressants, and acidsuppressive therapy. It is prudent to acknowledge that the information provided herein is dynamic and it is pivotal to refer to the relevant prescribing information and druginteraction databases before intervention. Ongoing vigilance will be necessary and consideration should be given to the fact that dose adjustments may be required if an interacting drug is discontinued. Whenever possible, management should be conducted as an open discussion with all prescribers and a clinical pharmacist.