Genolier Cancer Centre, Clinique de Genolier, 1272 Genolier, Switzerland.
Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa PI, Italy.
Oncologist. 2024 Nov 4;29(11):931-942. doi: 10.1093/oncolo/oyae094.
Concomitant use of multiple drugs in most patients with cancer may result in drug-drug interactions (DDIs), potentially causing serious adverse effects. These patients often experience unrelieved cancer-related pain (CRP) during and after cancer treatment, which can lead to a reduced quality of life. Opioids can be used as part of a multimodal pain management strategy when non-opioid analgesics are not providing adequate pain relief, not tolerated, or are contraindicated. However, due to their narrow therapeutic window, opioids are more susceptible to adverse events when a DDI occurs. Clinically relevant DDIs with opioids are usually pharmacokinetic, mainly occurring via metabolism by cytochrome P450 (CYP). This article aims to provide an overview of potential DDIs with opioids often used in the treatment of moderate-to-severe CRP and commonly used anticancer drugs such as chemotherapeutics, tyrosine kinase inhibitors (TKIs), or biologics. A DDI-checker tool was used to contextualize the tool-informed DDI assessment outcomes with clinical implications and practice. The findings were compared to observations from a literature search conducted in Embase and PubMed to identify clinical evidence for these potential DDIs. The limited results mainly included case studies and retrospective reviews. Some potential DDIs on the DDI-checker were aligned with literature findings, while others were contradictory. In conclusion, while DDI-checkers are useful tools in identifying potential DDIs, it is necessary to incorporate literature verification and comprehensive clinical assessment of the patient before implementing tool-informed decisions in clinical practice.
在大多数癌症患者中，同时使用多种药物可能会导致药物-药物相互作用（DDI），从而可能导致严重的不良反应。这些患者在癌症治疗期间和之后经常经历未缓解的癌症相关疼痛（CRP），这可能导致生活质量下降。当非阿片类镇痛药不能提供足够的疼痛缓解、不能耐受或禁忌时，阿片类药物可以作为多模式疼痛管理策略的一部分。然而，由于其治疗窗狭窄，当发生 DDI 时，阿片类药物更容易发生不良反应。与阿片类药物相关的临床相关 DDI 通常是药代动力学的，主要通过细胞色素 P450（CYP）代谢发生。本文旨在概述在治疗中重度 CRP 时常用的阿片类药物与通常用于治疗癌症的药物（如化疗药物、酪氨酸激酶抑制剂（TKIs）或生物制剂）之间可能发生的 DDI。使用 DDI 检查器工具将工具告知的 DDI 评估结果与临床意义和实践联系起来。将这些发现与在 Embase 和 PubMed 中进行的文献检索中的观察结果进行比较，以确定这些潜在 DDI 的临床证据。有限的结果主要包括病例研究和回顾性综述。DDI 检查器上的一些潜在 DDI 与文献发现一致，而另一些则相互矛盾。总之，虽然 DDI 检查器是识别潜在 DDI 的有用工具，但在将工具告知的决策付诸临床实践之前，有必要结合文献验证和对患者的全面临床评估。
