Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, Paris, France; Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Investigation Center (CIC-1901), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France; Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France.
Department of Drug Development, Gustave Roussy Cancer Center, Villejuif, France.
ESMO Open. 2022 Dec;7(6):100650. doi: 10.1016/j.esmoop.2022.100650. Epub 2022 Dec 6.
Consumption of herbs, food used as medicine and dietary supplements (HFDSs) is common in cancer patients. Herbs and food-drug interactions (HFDIs) can lead to serious adverse effects and can be prevented. We previously reviewed cytochrome P-450 (CYP)-mediated HFDI for 261 HFDSs and we classified the risk of CYP inhibition and induction on a level of evidence scale from 1 (high evidence, supported by several clinical studies) to 5 (low evidence, only limited preclinical data).
We conducted a prospective, non-interventional study (NCT04128865) to assess whether self-assessment of patients could detect HFDI classified as 'probable' (i.e. level 1, 2 or 3 of the scale) in a population of cancer patients. Patients were invited through a tablet application to report their consumption of herbs, regular CYP-interacting food consumption and dietary supplements, as well as some clinical data and cancer treatments. The patient's completion of the survey could be supervised by a health care professional or not. A prespecified threshold of 5% of HFDIs classified as 'probable' detected with the application was deemed relevant.
Between 29 March 2018 and 22 June 2018, 143 patients completed the survey. Ninety-five patients (66%) reported at least one current systemic cancer treatment and were included in the analyses. Seventy-four patients reported an intake of at least one HFDS (77.9%), while 21 patients reported no HFDS (22.1%). Twenty-two HFDIs classified as 'probable' were found in 16 patients (16.8%) with the application, which was significantly superior to the prespecified threshold (P = 0.02). The interactions were reported with food (n = 19, 86%) more frequently than with herbs (n = 3, 14%) or with dietary supplements (no interaction reported).
Self-assessment of HFDS interaction with cancer treatment with an application is feasible and should be considered in daily routine. Prospective interventional studies should be conducted to better assess the clinical benefits of this approach.
癌症患者常服用草药、药食同源物和膳食补充剂（HFDS）。草药与药物相互作用（HFDIs）可导致严重不良反应，是可以预防的。我们之前回顾了 261 种 HFDS 的细胞色素 P-450（CYP）介导的 HFDIs，并根据证据水平将 CYP 抑制和诱导的风险分为 1 级（高证据，有多项临床研究支持）到 5 级（低证据，仅有有限的临床前数据）。
我们开展了一项前瞻性、非干预性研究（NCT04128865），以评估在癌症患者人群中，自我评估能否检测到被归类为“可能”（即 1 级、2 级或 3 级）的 HFDI。通过平板电脑应用程序邀请患者报告他们的草药、常规 CYP 相互作用的食物摄入和膳食补充剂的使用情况，以及一些临床数据和癌症治疗情况。患者可以在医疗保健专业人员的监督下或不监督下完成调查。应用程序检测到 5%的被归类为“可能”的 HFDIs 被认为是相关的。
在 2018 年 3 月 29 日至 6 月 22 日期间，共有 143 名患者完成了调查。95 名（66%）患者报告正在接受至少一种当前的系统癌症治疗，并纳入分析。74 名患者报告至少摄入了一种 HFDS（77.9%），而 21 名患者报告没有摄入 HFDS（22.1%）。应用程序在 16 名患者（16.8%）中发现了 22 种被归类为“可能”的 HFDIs，显著优于预设阈值（P=0.02）。这些相互作用是通过食物（n=19，86%）报告的频率高于草药（n=3，14%）或膳食补充剂（未报告相互作用）。
使用应用程序对 HFDS 与癌症治疗的相互作用进行自我评估是可行的，应在日常工作中考虑。应开展前瞻性干预研究，以更好地评估这种方法的临床获益。
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