title: The Effect of Undaria pinnatifida Fucoidan on the Pharmacokinetics of Letrozole and Tamoxifen in Patients With Breast Cancer.
abstract: Although the use of complementary and alternative medicines is widespread in cancer patients, clinical evidence of their benefits is sparse. Furthermore, while they are often assumed to be safe with regard to concurrent use of anticancer therapies, few studies have been carried out to investigate possible interactions. Fucoidans are a group of sulfated carbohydrates, derived from marine brown algae, which have long been used as dietary supplements due to their reported medicinal properties, including anticancer activity. The aim of this study was to investigate the effect of co-administration of fucoidan, derived from Undaria pinnatifida, on the pharmacokinetics of 2 commonly used hormonal therapies, letrozole and tamoxifen, in patients with breast cancer.
  
  
  
  This was an open label non-crossover study in patients with active malignancy taking letrozole or tamoxifen (n = 10 for each group). Patients took oral fucoidan, given in the form of Maritech extract, for a 3-week period (500 mg twice daily). Trough plasma concentrations of letrozole, tamoxifen, 4-hydroxytamoxifen, and endoxifen were measured using HPLC-CAD (high-performance liquid chromatography charged aerosol detector), at baseline and after concomitant administration with fucoidan.
  
  
  
  No significant changes in steady-state plasma concentrations of letrozole, tamoxifen, or tamoxifen metabolites were detected after co-administration with fucoidan. In addition, no adverse effects of fucoidan were reported, and toxicity monitoring showed no significant differences in all parameters measured over the study period.
  
  
  
  Administration of Undaria pinnatifida fucoidan had no significant effect on the steady-state trough concentrations of letrozole or tamoxifen and was well tolerated. These results suggest that fucoidan in the studied form and dosage could be taken concomitantly with letrozole and tamoxifen without the risk of clinically significant interactions.
authors.affiliation: 1 Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Shreya
authors.initials: S
authors.lastname: Tocaciu
authors.affiliation: 1 Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Lesley J
authors.initials: LJ
authors.lastname: Oliver
authors.affiliation: 2 University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Ray M
authors.initials: RM
authors.lastname: Lowenthal
authors.affiliation: 2 University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Peterson
authors.affiliation: 2 University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Rahul
authors.initials: R
authors.lastname: Patel
authors.affiliation: 2 University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Madhur
authors.initials: M
authors.lastname: Shastri
authors.affiliation: 2 University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Georgia
authors.initials: G
authors.lastname: McGuinness
authors.affiliation: 3 Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia.
authors.forename: Inger
authors.initials: I
authors.lastname: Olesen
authors.affiliation: 4 Marinova Pty Ltd, Cambridge, Tasmania, Australia.
authors.forename: J Helen
authors.initials: JH
authors.lastname: Fitton
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000494:pharmacology*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy*; D005260:Female; D041743:Herb-Drug Interactions; D006801:Humans; D000077289:Letrozole; D008875:Middle Aged; D009570:Nitriles / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D008517:Phytotherapy; D011134:Polysaccharides / Q000008:administration & dosage / Q000009:adverse effects; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000097:blood / Q000493:pharmacokinetics*; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D044648:Undaria
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D011134:Polysaccharides; D014230:Triazoles; D013629:Tamoxifen; C016601:afimoxifene; C055492:4-hydroxy-N-desmethyltamoxifen; D000077289:Letrozole; C007789:fucoidan
keywords: CAM; Undaria; clinical trial; complementary medicines; drug interactions; fucoidan; letrozole; tamoxifen