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Impact of bariatric surgery on oral anticancer drugs: an analysis of real-world data.
Lau, Cedric; Mohmaed Ali, Ma Ida; Lin, Lishi; van Balen, Dorieke E M; Jacobs, Bart A W; Nuijen, Bastiaan; Smeenk, Robert M; Steeghs, Neeltje; Huitema, Alwin D R.
Afiliación
  • Lau C; Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. s.f.lau@asz.nl.
  • Mohmaed Ali MI; Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. s.f.lau@asz.nl.
  • Lin L; Department of Clinical Pharmacy, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands. s.f.lau@asz.nl.
  • van Balen DEM; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. s.f.lau@asz.nl.
  • Jacobs BAW; Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
  • Nuijen B; Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
  • Smeenk RM; Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
  • Steeghs N; Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
  • Huitema ADR; Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Cancer Chemother Pharmacol ; 94(1): 25-34, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38427065
ABSTRACT

PURPOSE:

The number of patients with bariatric surgery who receive oral anticancer drugs is rising. Bariatric surgery may affect the absorption of oral anticancer drugs. Strikingly, no specific drug dosing recommendations are available. We aim to provide practical recommendations on the application of oral anticancer drugs in patients who underwent bariatric surgery.

METHODS:

Patients with any kind of bariatric surgery were extracted retrospectively in a comprehensive cancer center. In addition, a flowchart was proposed to assess the risk of inadequate exposure to oral anticancer drugs in patients who underwent bariatric surgery. Subsequently, the flowchart was evaluated retrospectively using routine Therapeutic drug monitoring (TDM) samples.

RESULTS:

In our analysis, 571 cancer patients (0.4% of 140.000 treated or referred patients) had previous bariatric surgery. Of these patients, 78 unique patients received 152 oral anticancer drugs equaling an overall number of 30 unique drugs. The 30 different prescribed oral anticancer drugs were categorized as low risk (13%), medium risk (67%), and high risk (20%) of underdosing. TDM plasma samples of 25 patients (82 samples) were available, of which 21 samples post-bariatric surgery (25%) were below the target value.

CONCLUSIONS:

The proposed flowchart can support optimizing the treatment with orally administered anticancer drugs in patients who underwent bariatric surgery. We recommend performing TDM in drugs that belong to BCS classes II, III, or IV. If more risk factors are present in BCS classes II or IV, a priori switches to other drugs may be advised. In specific cases, higher dosages can be provided from the start (e.g., tamoxifen).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Monitoreo de Drogas / Cirugía Bariátrica / Antineoplásicos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Cancer Chemother Pharmacol Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Monitoreo de Drogas / Cirugía Bariátrica / Antineoplásicos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Cancer Chemother Pharmacol Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos
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