Cytochrome P-450-mediated herb and food-drug interactions can be identified in cancer patients through patient self-reporting with a tablet application: results of a prospective observational study

P Gougis; A Géraud; M Hilmi; A Vozy; L Campedel; B Abbar; C Allio; S De Chatillon; A Portalier; F Lapray; S Choquet; J-P Spano; F Reyal; O Mir; C Funck-Brentano; A-S Hamy

doi:10.1016/j.esmoop.2022.100650

Cytochrome P-450-mediated herb and food-drug interactions can be identified in cancer patients through patient self-reporting with a tablet application: results of a prospective observational study

ESMO Open. 2022 Dec;7(6):100650. doi: 10.1016/j.esmoop.2022.100650. Epub 2022 Dec 6.

Authors

P Gougis¹, A Géraud², M Hilmi³, A Vozy⁴, L Campedel⁴, B Abbar⁴, C Allio⁵, S De Chatillon⁵, A Portalier⁶, F Lapray⁴, S Choquet⁶, J-P Spano⁴, F Reyal⁷, O Mir⁸, C Funck-Brentano⁹, A-S Hamy¹⁰

Affiliations

¹ Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, Paris, France; Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Investigation Center (CIC-1901), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France; Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France. Electronic address: paul.gougis@curie.fr.
² Department of Drug Development, Gustave Roussy Cancer Center, Villejuif, France.
³ Medical Oncology Department, Curie Institute, Versailles Saint-Quentin University (UVQ), Paris Saclay University, Saint-Cloud, France.
⁴ Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France.
⁵ Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Investigation Center (CIC-1901), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France; Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France.
⁶ Clinical Hematology Unit, Groupe Hospitalier Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France.
⁷ Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, Paris, France; Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université Paris, Paris, France; Department of Surgical Oncology, Institut Godinot, Reims, France.
⁸ Department of Ambulatory Care, Gustave Roussy Cancer Campus, Villejuif, France.
⁹ Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Investigation Center (CIC-1901), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France.
¹⁰ Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, Paris, France; Department of Medical Oncology, Institut Curie, Université Paris, Paris, France.

Abstract

Background: Consumption of herbs, food used as medicine and dietary supplements (HFDSs) is common in cancer patients. Herbs and food-drug interactions (HFDIs) can lead to serious adverse effects and can be prevented. We previously reviewed cytochrome P-450 (CYP)-mediated HFDI for 261 HFDSs and we classified the risk of CYP inhibition and induction on a level of evidence scale from 1 (high evidence, supported by several clinical studies) to 5 (low evidence, only limited preclinical data).

Patients and methods: We conducted a prospective, non-interventional study (NCT04128865) to assess whether self-assessment of patients could detect HFDI classified as 'probable' (i.e. level 1, 2 or 3 of the scale) in a population of cancer patients. Patients were invited through a tablet application to report their consumption of herbs, regular CYP-interacting food consumption and dietary supplements, as well as some clinical data and cancer treatments. The patient's completion of the survey could be supervised by a health care professional or not. A prespecified threshold of 5% of HFDIs classified as 'probable' detected with the application was deemed relevant.

Results: Between 29 March 2018 and 22 June 2018, 143 patients completed the survey. Ninety-five patients (66%) reported at least one current systemic cancer treatment and were included in the analyses. Seventy-four patients reported an intake of at least one HFDS (77.9%), while 21 patients reported no HFDS (22.1%). Twenty-two HFDIs classified as 'probable' were found in 16 patients (16.8%) with the application, which was significantly superior to the prespecified threshold (P = 0.02). The interactions were reported with food (n = 19, 86%) more frequently than with herbs (n = 3, 14%) or with dietary supplements (no interaction reported).

Conclusions: Self-assessment of HFDS interaction with cancer treatment with an application is feasible and should be considered in daily routine. Prospective interventional studies should be conducted to better assess the clinical benefits of this approach.

Keywords: anticancer drugs; connected devices; cytochromes; food–drug interaction; herb–drug interaction; patient-reported measures.

Publication types

Observational Study

MeSH terms

Cytochrome P-450 Enzyme System
Food-Drug Interactions*
Herb-Drug Interactions
Humans
Neoplasms* / drug therapy
Prospective Studies

Substances

Cytochrome P-450 Enzyme System