medwireNews: A French team has drawn attention to the potential for drug–drug interactions between anticancer medications and agents being used or tested for the treatment of COVID-19.
Writing in a letter to the European Journal of Cancer, Paul Gougis (Hôpital Pitié-Salpêtrière, Paris) and colleagues highlight not only the possible effects of immunosuppressive anticancer drugs in patients with COVID-19, but also the pharmacokinetic and pharmacodynamic interactions between nonimmunosuppressive cancer and COVID-19 treatments.
They note that multikinase inhibitors such as sunitinib, PARP inhibitors such as olaparib, and other drug classes have been associated with an increased risk for neutropenia and infections, and thus “it might be unsafe” to use these drugs to treat SARS-CoV-2–positive cancer patients.
The study authors also point out that anticancer and antiviral drugs “have a narrow therapeutic index and can have pharmacological interactions.”
For instance, enzalutamide, an antiandrogen used for the treatment of prostate cancer, and ritonavir, which is being investigated for COVID-19, have opposing effects on CYP3A4 and “could interfere with each other’s metabolism, decrease or increase each other’s clearance and be responsible for severe toxicities or decreased efficacy,” write Gougis et al.
Other anticancer drugs, such as crizotinib, tamoxifen, and abiraterone, are associated with QT interval prolongation, and giving these drugs alongside putative COVID-19 treatments with the same effect, such as hydroxychloroquine and azithromycin, “could lead to torsade de pointes and be fatal,” the team cautions.
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