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Prevalence of drug–drug interactions in sarcoma patients: key role of the pharmacist integration for toxicity risk management

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Abstract

Background

The risk of drug–drug interactions (DDI) has become a major issue in cancer patients. However, data in sarcoma patients are scarce. We aimed to evaluate the frequency and the factors associated with DDI with antitumor treatments, and to evaluate the impact of a pharmacist evaluation before anticancer treatment.

Patients and methods

We performed a retrospective review of consecutive sarcoma patients starting chemotherapy (CT) or Tyrosine kinase inhibitor (TKI). A pharmacist performed medication reconciliation and established an early toxicity risk assessment. Potential DDI with antitumor drugs were identified using Micromedex electronic software.

Results

One hundred and twenty-two soft-tissue and 80 bone sarcoma patients (103 males, median age 50 years,) were included before CT (86%) or TKI (14%). The median number of medications was 3; 34 patients (22% of patients with medication reconciliation) reported complementary medicine use. 37 potential DDI classified as major, were identified (12% of the 243 pre-therapeutic assessments). In multivariate analysis, TKI (p < 0.0001), proton pump inhibitor (p = 0.026) and antidepressant (p < 0.001) were identified as risk factors of DDI (p < 0.02). Only marital status (p = 0.003) was associated with complementary medicine use. A pharmacist performed 157 medication reconciliations and made 71 interventions among 59 patients (37%). In multivariate analysis, factors associated with pharmacist intervention were: complementary medicines (p = 0.004), drugs number (p = 0.005) and treatment with TKI (p = 0.0002)

Conclusions

Clinical interventions on DDI are more frequently required among sarcoma patients treated with TKI than CT. Multidisciplinary risk assessment including a medication reconciliation by a pharmacist could be crucial to prevent DDI with TKI.

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Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Abbreviations

ALP:

Alkaline phosphatase

ALT:

ALanine transaminase

AST:

ASpartate transaminase

CRP:

C-reactive protein

CT:

Chemotherapy

CM:

Complementarymedicine

DDI:

Drug–drug interactions

IQR:

Interquartile range

MR:

Medication reconciliation

PPI:

Proton pump inhibitor

STS:

Soft tissue sarcoma

TKI:

Tyrosine kinase inhibitor

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Acknowledgements

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Author information

Author notes

  1. Pascaline Boudou-Rouquette and Audrey Thomas-Schoemann contributed equally to the work.

  2. Audrey Bellesoeur and Ithar Gataa contributed equally to the work.

Authors and Affiliations

  1. Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France

    Audrey Bellesoeur, Ithar Gataa, Anne Jouinot, Anne-Catherine Piketty, Camille Tlemsani, Sixtine de Percin, Clémentine Villeminey, Jérôme Alexandre, François Goldwasser, Pascaline Boudou-Rouquette & Audrey Thomas-Schoemann

  2. University of Paris Descartes, ARIANE, CARPEM, Paris, France

    Audrey Bellesoeur, Ithar Gataa, Anne Jouinot, Anne-Catherine Piketty, Camille Tlemsani, Sixtine de Percin, Clémentine Villeminey, Jérôme Alexandre, François Goldwasser, Pascaline Boudou-Rouquette & Audrey Thomas-Schoemann

  3. Department of Pharmacokinetics and Pharmacochemisty, Cochin Hospital, AP-HP, Paris, France

    David Balakirouchenane, Michel Vidal & Benoit Blanchet

  4. CARPEM, Paris, France

    David Balakirouchenane, Michel Vidal & Benoit Blanchet

  5. Department of Clinical Pharmacy, Cochin Hospital, AP-HP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France

    Sarah El Mershati, Anthia Monribot, Rui Batista & Audrey Thomas-Schoemann

  6. UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France

    David Balakirouchenane, Michel Vidal, Benoit Blanchet & Audrey Thomas-Schoemann

  7. Cochin Institute, INSERM U1016, Paris, France

    Jérôme Alexandre & François Goldwasser

Authors
  1. Audrey Bellesoeur
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  2. Ithar Gataa
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  17. Audrey Thomas-Schoemann
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Contributions

Conception or design of the work: AB, IG, AJ, PBR, ATS. Data collection: AB, IG, SEM, ACP, CT, DB, AM, SDP, CV, JA, FG, PBR, ATS. Data analysis and interpretation; AB, IG, AJ, ATS, FG, BB, PBR. Drafting the article: AB, IG, AJ, SEM, ACP, CT, DB, AM, FG, BB, ATS, PBR. Critical revision of the article: AB, IG, AJ, SEM, ACP, CT, DB, AM, MV, RB, SDP, CV, JA, FG, BB, PBR, ATS. Final approval of the version to be published: AB, IG, AG, SEM, ACP, CT, DB, AM, MV, RB, SDP, CV, JA, FG, PBR, ATS.

Corresponding author

Correspondence to Audrey Thomas-Schoemann.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethic approval and consent to participate

The studies involving human participants were reviewed and approved by Local ethical committee for oncology of Cochin Hospital (AP-HP), CARPEM, university of Paris, France (number:578AB88). The patients/participants provided their written informed consent to participate in this study. All methods were carried out in accordance with relevant guidelines and regulations.

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Bellesoeur, A., Gataa, I., Jouinot, A. et al. Prevalence of drug–drug interactions in sarcoma patients: key role of the pharmacist integration for toxicity risk management. Cancer Chemother Pharmacol 88, 741–751 (2021). https://doi.org/10.1007/s00280-021-04311-4

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