Elsevier

Cancer Treatment Reviews

Volume 36, Issue 8, December 2010, Pages 595-605
Cancer Treatment Reviews

Anti-Tumour Treatment
Anticancer oral therapy: Emerging related issues

https://doi.org/10.1016/j.ctrv.2010.04.005Get rights and content

Abstract

The use of oral anticancer drugs has shown a steady increase. Most patients prefer anticancer oral therapy to intravenous treatment primarily for the convenience of a home-based therapy, although they require that the efficacy of oral therapy must be equivalent and toxicity not superior than those expected with the intravenous treatment. A better patient compliance, drug tolerability, convenience and possible better efficacy for oral therapy as compared to intravenous emerge as the major reasons to use oral anticancer agents among oncologists. Inter- and intra-individual pharmacokinetic variations in the bioavailability of oral anticancer drugs may be more relevant than for intravenous agents. Compliance is particularly important for oral therapy because it determines the dose-intensity of the treatment and ultimately treatment efficacy and toxicity. Patient stands as the most important determinant of compliance. Possible measures for an active and safe administration of oral therapy include a careful preliminary medical evaluation and selection of patients based on possible barriers to an adequate compliance, pharmacologic issues, patient-focused education, an improvement of the accessibility to healthcare service, as well as the development of home-care nursing symptom-focused interventions. Current evidences show similar quality of life profile between oral and intravenous treatments, although anticancer oral therapy seems to be more convenient in terms of administration and reduced time lost for work or other activities. Regarding cost-effectiveness, current evidences are in favor of oral therapy, mainly due to reduced need of visits and/or day in hospital for the administration of the drug and/or the management of adverse events.

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.

Section snippets

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.

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