Enzalutamide Reduces Oxycodone Exposure in Men with Prostate Cancer

Clinically significant drug-drug interactions involving opioid analgesics used for pain treatment in patients with cancer: update of a systematic review

INTRODUCTION

Drug-drug interactions (DDIs) are among factors that may affect the efficacy and safety of opioid treatment. Data on clinically manifested DDIs are scarse, and recommendations that might guide physicians are presently lacking. The aim of this study was to update a systematic review (2015) on studies reporting clinically significant DDIs involving opioids used for pain treatment in adult patients with cancer.

METHODS

Systematic literature searches in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from the start of the databases through 18 September 2023.

RESULTS

Of the 1968 retrieved papers, 16 were included in the final analysis, together with five papers identified through hand-searching of reference lists. Nineteen publications were case reports or case series. Nine, sixteen, and eight patients presented adverse effects from opioids, impaired pain control, or opioid withdrawal, respectively. The main mechanisms underlying DDIs were alteration of cytochrome P450 3A4 activity and pharmacodynamic antagonism resulting from concurrent use of an opioid analgesic and a peripheral mu-opioid receptor antagonist (PAMORA).

CONCLUSION

Knowledge about clinically significant DDIs associated with opioids in cancer patients is currently mostly based upon case reports. These cases give information about drug combinations that should be recognized as potentially harmful by physicians prescribing opioids.

PROSPERO ID

CRD42023481103.

Androgen receptor pathway inhibitors and drug-drug interactions in prostate cancer

Prostate cancer represents a major global health challenge, necessitating efficacious therapeutic strategies. Androgen receptor pathway inhibitors (ARPIs) have become central to prostate cancer treatment, demonstrating significant effectiveness in both metastatic and non-metastatic contexts. Abiraterone acetate, by inhibiting androgen synthesis, deprives cancer cells androgens necessary for growth, while second-generation androgen receptor (AR) antagonists disrupt AR signaling by blocking AR binding, thereby impeding tumor progression. Given the predominance of prostate cancer in the elderly, who often present with multiple comorbidities requiring complex pharmacological regimens, the potential for drug-drug interactions with ARPIs is a critical concern. These interactions, particularly through pathways like CYP2D6 inhibition by abiraterone and CYP3A4 induction by enzalutamide and apalutamide, necessitate a thorough understanding to optimize therapeutic outcomes and minimize adverse effects. This review aims to delineate the efficacy of ARPIs in prostate cancer management and elucidate their interaction with common medications, highlighting the importance of vigilant drug management to optimize patient care.

Endogenous opiates and behavior: 2023

This paper is the forty-sixth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2023 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug and alcohol abuse (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).

A rapid and sensitive LC-MS/MS method for quantifying oxycodone, noroxycodone, oxymorphone and noroxymorphone in human plasma to support pharmacokinetic drug interaction studies of oxycodone

A sensitive and reliable LC-MS/MS method was developed and validated for the quantification of oxycodone and metabolites in human plasma. The method has a runtime of 6 min and a sensitivity of 0.1 μg/L for all analytes. Sample preparation consisted of protein precipitation. Separation was performed on a Kinetix biphenyl column (2.1 × 100 mm, 1.7 μm), using ammonium formate 5 mm in 0.1% aqueous formic acid and methanol LC-MS grade 100% in gradient elution at a flow rate of 0.4 ml/min. Detection was performed in multiple reaction monitoring mode using positive electrospray ionization. The method was linear over the calibration range of 0.1-25.0 μg/L for oxycodone, noroxycodone and noroxymorphone and 0.1-5.0 μg/L for oxymorphone. The method demonstrated good performance in terms of intra- and interday accuracy (86.5-110.3%) and precision (CV 1.7-9.3%). The criteria for the matrix effect were met (CV < 15%) except for noroxymorphone, for which an additional method was applied to compensate for the matrix effect. Whole blood samples were stable for 4 h at room temperature. Plasma samples were stable for 24 h at room temperature and 3 months at -20°C. Furthermore, the method was successfully applied in a pharmacokinetic drug interaction study of oxycodone and enzalutamide in patients with prostate cancer.