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Clinical Pharmacology: Concise Drug Reviews |
Pharmacotherapy in oncology is rapidly changing, and there is, therefore, a continuous need for structured, up-to-date, practical information about drugs used to treat patients with cancer. It is as challenging to keep up with the drug profiles of new cytotoxic agents, such as oxaliplatin, as it is to recognize differences in the profiles of older agents, such as docetaxel, when administered in new ways.
Recently, anticancer therapy has become even more complex with the appearance of novel drugs that interfere with signal transduction pathways: imatinib, erlotinib, sorafenib, and sunitinib, or novel drugs that interfere with angiogenesis, such as bevacizumab. The outlined signal transduction inhibitors are all orally administered on a daily or intermittent basis. The oral route increases the complexity of pharmacotherapy because of the often higher inter-and intrapatient variability in pharmacokinetics and associated variability in side effects, possible food–drug, herb–drug, and drug–drug interactions, induced gastrointestinal toxicity, and last, but not least, poor compliance.
Another important therapeutic development is that many drugs have become available for support of patients, such as growth factors, novel anti-emetic NK1 receptor antagonists, and oral bisphosphonates. The expanded armamentarium has greatly served our patients with cancer, but for the treating physician as well as for the patients with cancer, it has also substantially increased the complexity of pharmacotherapy. Food– drug interactions with the oral bisphosphonates are a concern, and aprepitant, the registered NK1 receptor antagonist, shows significant drug–drug interactions by inhibiting the main drug-metabolizing enzyme cytochrome P450 3A (CYP3A).
Among doctors, nurses, and patients, frequently heard practical questions are (a) can this drug be given together with food; (b) can it be given with antipeptic drugs such as proton pump inhibitors, H2 receptor antagonists, or antacids; or (c) can it be given together with other anticancer therapies? In case of organ dysfunction, should the dose be reduced, and by how much? How should the drug be stored by the patient, are special safety measures necessary in the home setting, and if so, for how long after intake? If the patient shows unexpected severe side effects, could this be due to genetic variability in drug elimination?
It is for these and other reasons that the Editorial Board has decided to establish the Concise Drug Review series, which will address these issues and provide concise answers to practical questions on the basis of sound insight into the pharmacology of the drug or drugs under consideration. As with all published manuscripts in The Oncologist, this series will be strictly peer-reviewed. Each Concise Drug Review will consist of selected references, figures, and a table summarizing key data. The tables and figures of all articles may be easily downloaded as PowerPoint slides from The Oncologist’s website (http://www.TheOncologist.com) for teaching purposes. The Concise Drug Reviews will consist of oral anticancer drugs (novel and currently existing cytostatic/cytotoxic anticancer drugs and hormones) and intravenous anticancer drugs, as well as drugs used for supportive patient care.
We hope that the information provided will serve the readers of the Journal and thereby our cancer patients. We welcome your comments and suggestions.
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