Gruppo Oncologico Ricercatori Italiani GORI, 33100 Pordenone, Italy.
Department of Medical Oncology, National Cancer Institute, CRO 33018 Aviano, Italy.
Cells. 2019 May 30;8(6):522. doi: 10.3390/cells8060522.
Angiogenesis inhibitors (AIs) have become established as an effective cancer treatment. Whereas their interactions with antineoplastic drugs have extensively been investigated, little is known of the effect of their co-administration with nutraceuticals/dietary supplements (N/DSs), which are often self-prescribed. N/DSs comprise a wide range of products such as herbs, nutrients, vitamins, minerals, and probiotics. Assessment of their interactions with cancer drugs, particularly AIs, is hampered by the difficulty of gauging the amount of active substances patients actually take. Moreover, there is no agreement on which approach should be used to determine which N/DSs are most likely to influence AI treatment efficacy. We present a comprehensive review of the metabolic routes of the major AIs and their possible interactions with N/DSs. The PubMed and Cochrane databases were searched for papers describing the metabolic routes of the main AIs and N/DSs. Data from the 133 studies thus identified were used to compile a diagnostic table reporting known and expected AI-N/DS interactions based on their metabolization pathways. AIs and N/DSs sharing the cytochrome P450 pathway are at risk of negative interactions. Recent advances in pharmacogenetics offer exceptional opportunities to identify prognostic and predictive markers to enhance the efficacy of individualized AI treatments. The table provides a guide to genotyping patients who are due to receive AIs and is a promising tool to prevent occult AI-N/DS interactions in poor metabolizers. N/DS use by cancer patients receiving AIs is a topical problem requiring urgent attention from the scientific community.
血管生成抑制剂（AIs）已成为一种有效的癌症治疗方法。虽然它们与抗肿瘤药物的相互作用已经得到了广泛的研究，但对于它们与营养保健品/膳食补充剂（N/DSs）联合使用的效果却知之甚少，而这些补充剂通常是患者自行服用的。N/DS 包括各种产品，如草药、营养素、维生素、矿物质和益生菌。评估它们与癌症药物（特别是 AIs）的相互作用受到阻碍，因为难以衡量患者实际服用的有效物质的数量。此外，对于应该使用哪种方法来确定哪些 N/DS 最有可能影响 AI 治疗效果，目前尚无共识。我们对主要 AIs 的代谢途径及其与 N/DSs 可能的相互作用进行了全面综述。在 PubMed 和 Cochrane 数据库中搜索了描述主要 AIs 和 N/DSs 代谢途径的论文。根据由此确定的 133 项研究的数据，编制了一个诊断表，根据其代谢途径报告已知和预期的 AI-N/DS 相互作用。与细胞色素 P450 途径共享的 AIs 和 N/DSs 存在发生负相互作用的风险。最近在药物遗传学方面的进展为识别预后和预测标志物提供了绝佳的机会，以增强个体化 AI 治疗的疗效。该表为接受 AIs 治疗的患者提供了基因分型指南，是预防代谢不良患者隐匿性 AI-N/DS 相互作用的有前途的工具。接受 AIs 治疗的癌症患者使用 N/DS 是一个亟待科学界关注的问题。
