Alterations of chemotherapeutic pharmacokinetic profiles by drug-drug interactions.
BACKGROUND
Drug interactions in oncology are common place and largely ignored as we tolerate high thresholds of 'toxic' drug responses in these patients. However, in the era of 'targeted' or seemingly 'less toxic' therapy, these interactions are more commonly flagged and contribute significantly towards poor 'quality of life' and medical fatalities.


OBJECTIVE
This review and opinion article focuses on alteration of chemotherapeutic pharmacokinetic profiles by drug interactions in the setting of polypharmacy. The assumption is that the drugs, with changes in their pharmacokinetics, will contribute towards changes in their pharmacodynamics.


METHODS
The examples cited for such drug-drug interactions are culled from published literature with an emphasis on those interactions that have been well characterized at the molecular level.


RESULTS
Although very few drug interaction studies have been performed on approved oncology based drugs, it is clear that drugs whose pharmacokinetics profiles are closely related to their pharmacodynamics will indeed result in clinically important drug interactions. Some newer mechanisms are described that involve interactions at the level of gene transcription, whereby, drug metabolism is significantly altered. However, for any given drug interaction, there does not seem to be a comprehensive model describing interactions.


CONCLUSIONS
Mechanisms based drug interactions are plentiful in oncology; however, there is an absolute lack of a comprehensive model that would predict drug-drug interactions.
Mani
Sridhar
S
Albert Einstein College of Medicine, Albert Einstein Cancer Center, Bronx, NY 10461, USA. smani@aecom.yu.edu
Ghalib
Mohammed
M
Chaudhary
Imran
I
Goel
Sanjay
S
D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D016503:Drug Delivery Systems; D004347:Drug Interactions; D006801:Humans; D008954:Models, Biological; D009369:Neoplasms / Q000188:drug therapy*; D019338:Polypharmacy; D011788:Quality of Life; D014158:Transcription, Genetic
D000970:Antineoplastic Agents