Meijerman I, Beijnen JH, Schellens JH: Herb-drug interactions in oncology: focus on mechanisms of induction.He SM, Yang AK, Li XT, et al.: Effects of herbal products on the metabolism and transport of anticancer agents.Collado-Borrell R, Escudero-Vilaplana V, Romero-Jiménez R, et al.: Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account.Currently, research on dietary supplement and cancer drug PK interactions is limited, but there is evidence for several possible interactions and adverse reactions. Various herbs and dietary supplements are known to influence the PK of certain drugs, such as St. The PK of a drug predicts therapeutic outcomes for the patient. Various anticancer drugs are substrates of P-gp thus, if P-gp or any CYP enzyme is impacted, the drug it is processing will also be impacted. P-gp works in the intestine as a drug efflux pump regulating the bioavailability of the drug. Another component involved in the metabolism and excretion of many drugs is the transport protein, P-glycoprotein (P-gp). These enzymes play an important role in the activation and inactivation of various drugs. One of the main group of enzymes involved in the metabolism of many cancer drugs is the cytochrome P450 (CYP) superfamily of enzymes. The FDA has not approved the use of dietary supplements as a treatment for cancer patients. Because dietary supplements are not formally reviewed for manufacturing consistency, ingredients may vary considerably from lot to lot and there is no guarantee that ingredients claimed on product labels are present (or are present in the specified amounts). Food and Drug Administration (FDA) are not required unless specific disease prevention or treatment claims are made. Therefore, premarket evaluation and approval of such supplements by the U.S. In the United States, dietary supplements are regulated as foods, not drugs. Reporting and studying these interactions is important, so health care professionals can help patients navigate CAM usage with standard cancer therapies, thus avoiding preventable adverse outcomes. Many drug interactions occur from the effects of the supplement on specific enzymes or on components involved in the PK of the drug, such as how the drug is metabolized and transported. When dietary supplements/herbs and cancer drugs are taken together, there is always a risk of the supplement having an impact on the pharmacokinetics (PK) or pharmacodynamics (PD) of the drug. It is possible that the combination of cancer drugs taken by these patients and the CAM they use may interact, causing adverse outcomes.
For adult cancer patients in the United States, the frequency of complementary and alternative medicine (CAM) use is approximately 36%.
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