Anti-Tumour TreatmentAnticancer oral therapy: Emerging related issues
Introduction
For several decades, medical oncologists have treated most of their patients with intravenous (iv) antitumoral drugs, and consequently hospital services and clinical activities have been organized on the basis of this type of administration. However, in the last five years the therapeutic scenario has been characterized by a steady increase in the availability of oral anticancer drugs with more than twenty oral anti-neoplastic drugs currently approved for use in United Stated and Europe.[1], [2] Moreover, one-quarter of all anticancer agents under development are oral drugs.3 The use of an oral anticancer therapy (AOT) affects many relevant aspects of the clinical practice. This review reports some considerations about patient and physician perspectives on the use of AOT, and possible differences in activity, toxicity, quality of life (QoL) issues, management and costs between iv and oral anticancer drugs.
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The patient and oncologist perspective
One of the most important reasons for the shift from iv to oral drug administration in oncology is patient preference (Table 1). Several surveys showed that most patients prefer oral to iv therapy.[4], [5], [6] Liu et al.4 reported 89% of patients preferring oral administration rather than iv one, primarily due to the convenience of a home-based therapy (57% of patients), therefore avoiding the insertion of a central venous catheter (55% of patients). Other reasons included previous negative
Possible differences in activity and toxicity between AOT and iv treatment
In order to properly consider possible differences in activity and safety between AOT and iv treatment, a preliminary distinction between oral anticancer drugs currently available can be done as follows:
- a)
oral formulations of the same iv drug (i.e. cyclophosphamide – CTX, methotrexate, vinorelbine – VNR, etoposide, paclitaxel);
- b)
oral alternatives to iv molecules of the same class (i.e. oral fluoropyrimidine such as CAP, idarubicin, temozolomide, new oral agents such as BMS-275183 – an oral taxane
Conflict of interest statement
None declared.
Acknowledgement
This paper was supported by an unrestricted grant by the Fondazione GSTU.
References (92)
- et al.
Patients’ preference for administration of endocrine treatments by injection or tablets: results from a study of women with breast cancer
Ann Oncol
(2006) - et al.
Patient preference for oral or intravenous chemotherapy: a randomised cross-over trial comparing capecitabine and Nordic fluorouracil/leucovorin in patients with colorectal cancer
Eur J Cancer
(2006) - et al.
A randomised cross-over trial comparing patient preference for oral capecitabine and 5-fluorouracil/leucovorin regimens in patients with advanced colorectal cancer
Ann Oncol
(2006) - et al.
Tumor selective delivery of 5-fluorouracil by capecitabine, a new oral fluoropyrimidine carbamate, in human cancer xenografts
Biochem Pharmacol
(1998) - et al.
Oral vinorelbine pharmacokinetics and absolute bioavailability study in patients with solid tumors
Ann Oncol
(2001) - et al.
Effective oral chemotherapy for breast cancer: pillars of strength
Ann Oncol
(2008) - et al.
Drug interactions in oncology
Lancet Oncol
(2004) - et al.
Drug interactions in oncology: how common are they?
Ann Oncol
(2009) - et al.
Medication compliance and persistence: terminology and definitions
Value Health
(2008) - et al.
Adjuvant capecitabine in combination with docetaxel and cyclophosphamide plus epirubicin for breast cancer: an open-label, randomised controlled trial
Lancet Oncol
(2009)
6LBA Addition of cetuximab to oxaliplatin-based combination chemotherapy (CT) in patients with KRAS wild-type advanced colorectal cancer (ACRC): a randomised superiority trial (MRC COIN)
Eur J Cancer
Benefits and drawbacks of the use of oral fluoropyrimidines as single-agent therapy in advanced colorectal cancer
Clin Colorectal Cancer
Phase I and pharmacokinetic study of weekly oral therapy with vinorelbine in patients with advanced breast cancer (ABC)
Ann Oncol
Oral vinorelbine: feasibility and safety profile
Ann Oncol
The vital role of education and information in patients receiving capecitabine (Xeloda)
Eur J Oncol Nurs
Metronomic low-dose oral cyclophosphamide and methotrexate plus or minus thalidomide in metastatic breast cancer: antitumor activity and biological effects
Ann Oncol
Combination of oral idarubicin and prednimustine in advanced breast cancer: a phase II study
Eur J Cancer
Capecitabine/vinorelbine: an effective and well-tolerated regimen for women with pretreated advanced-stage breast cancer
Clin Breast Cancer
Dose-finding and pharmacokinetic study of an all-oral combination regimen of oral vinorelbine and capecitabine for patients with metastatic breast cancer
Ann Oncol
A phase I study of an all-oral combination of vinorelbine/capecitabine in patients with metastatic breast cancer previously treated with anthracyclines and/or taxanes
Clin Breast Cancer
Global Lung Oncology Branch trial 3 (GLOB3): final results of a randomised multinational phase III study alternating oral and i.v. vinorelbine plus cisplatin versus docetaxel plus cisplatin as first-line treatment of advanced non-small-cell lung cancer
Ann Oncol
A study of quality of life in cancer patients receiving palliative chemotherapy
Soc Sci Med
Capecitabine (Xeloda) improves medical resource use compared with 5-fluorouracil plus leucovorin in a phase III trial conducted in patients with advanced colorectal carcinoma
Eur J Cancer
Cost-benefit analysis of capecitabine versus 5-fluorouracil/leucovorin in the treatment of colorectal cancer in the Netherlands
Clin Ther
Treatment of cancer with oral drugs: a position statement by the Spanish Society of Medical Oncology (SEOM)
Ann Oncol
Patient adherence and persistence with oral anticancer treatment
CA Cancer J Clin
NCCN task force report: oral chemotherapy
J Natl Compr Canc Netw
Modulation of oral drug bioavailability: from preclinical mechanism to therapeutic application
Cancer Invest
Patient preferences for oral versus intravenous palliative chemotherapy
J Clin Oncol
Preferences for oral, parenteral antitumor therapy: a survey of 260 patients with metastatic breast cancer
Proc Am Soc Clin Oncol
Perception that oral anticancer treatments are less efficacious: development of a questionnaire to assess the possible prejudices of patients with cancer
Breast Cancer Res Treat
Severe sequence-specific toxicity when capecitabine is given after Fluorouracil and leucovorin
J Clin Oncol
Oral cancer treatment: developments in chemotherapy and beyond
Br J Cancer
Opininions about the use of oral chemotherapy (CT) for cancer patients: results of a survey conducted among Italian oncologists
Ann Oncol
Systemic therapy for metastatic colorectal cancer: current options, current evidence
J Clin Oncol
Bioactivation of capecitabine in human liver: involvement of the cytosolic enzyme on 5′-deoxy-5-fluorocytidine formation
Drug Metab Dispos
The absolute bioavailability of oral vinorelbine in patients with solid tumors
Cancer Chemother Pharmacol
Clinical pharmacokinetics of topotecan
Clin Pharmacokinet
Inter- and intrapatient variability in etoposide kinetics with oral and intravenous drug administration
Clin Cancer Res
Population pharmacokinetics and pharmacodynamics of oral etoposide
Br J Clin Pharmacol
Increased oral bioavailability of topotecan in combination with the breast cancer resistance protein and P-glycoprotein inhibitor GF120918
J Clin Oncol
Co-administration of GF120918 significantly increases the systemic exposure to oral paclitaxel in cancer patients
Br J Cancer
Circumvention of breast cancer resistance protein (BCRP)-mediated resistance to camptothecins in vitro using non-substrate drugs or the BCRP inhibitor GF120918
Clin Cancer Res
Clinical pharmacology of 5-fluorouracil
Clin Pharmacokinet
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