PMID- 37381038
OWN - NLM
STAT- MEDLINE
DCOM- 20230630
LR  - 20230702
IS  - 2047-783X (Electronic)
IS  - 0949-2321 (Print)
IS  - 0949-2321 (Linking)
VI  - 28
IP  - 1
DP  - 2023 Jun 29
TI  - First reported double drug-drug interaction in a cancer renal patient under 
      everolimus treatment: therapeutic drug monitoring and review of literature.
PG  - 202
LID - 10.1186/s40001-023-01172-w [doi]
LID - 202
AB  - Everolimus is an inhibitor of mammalian target of rapamycin (mTOR) used in both 
      transplantation and cancer treatment (breast, renal and neuroendocrine). In 
      transplantation, therapeutic drug monitoring (TDM) is recommended due to the 
      potential drug-drug interactions with chronic medications, which can affect 
      everolimus pharmacokinetics. In cancer treatment, everolimus is used at higher 
      doses than in transplantation and without a systematic drug monitoring.We present 
      a case report of a 72-year-old woman with epilepsy history to whom everolimus 
      10 mg QD was prescribed as third line of treatment for renal cell carcinoma 
      (RCC). The potential drug interactions between everolimus and the patient's 
      chronic medications, carbamazepine and phenytoin, are significant as both are 
      known as strong inducers CYP3A4 metabolism, potentially leading to underexposure 
      to everolimus.TDM of everolimus was recommended by the pharmacist. The literature 
      suggests that a minimum plasma concentration (Cminss) of everolimus over 10 ng/ml 
      is associated with better response to treatment and progression-free survival 
      (PFS). The patient's everolimus dose had to be increased until 10 mg BID, and 
      regular monitoring of everolimus levels showed an increase in Cminss from 
      3.7 ng/ml to 10.8 ng/ml.This case highlights the importance of checking for 
      potential drug interactions and monitoring everolimus levels in patients on 
      chronic medication, especially those with several inducers or inhibitors of 
      CYP3A4 metabolism. TDM can help to ensure that patients are treated with their 
      optimal dose, which can improve the effectiveness of the treatment or minimize 
      the risk of toxicities.
CI  - (c) 2023. The Author(s).
FAU - Fort-Casamartina, Eduard
AU  - Fort-Casamartina E
AD  - Pharmacy Service, Hospital Duran and Reynals (Catalan Institute of Oncology), 
      Gran Via de l'Hospitalet 199-203, Hospitalet de Llobregat, 08908, Barcelona, 
      Spain. efort@iconcologia.net.
FAU - Munoz-Sanchez, Carme
AU  - Munoz-Sanchez C
AD  - Pharmacy Service, Hospital Duran and Reynals (Catalan Institute of Oncology), 
      Gran Via de l'Hospitalet 199-203, Hospitalet de Llobregat, 08908, Barcelona, 
      Spain.
FAU - Rigo-Bonnin, Raul Francisco
AU  - Rigo-Bonnin RF
AD  - Clinical Laboratory, University Bellvitge Hospital, Carrer de La Feixa Llarga 
      S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain.
FAU - Del Valle-Celiz, Pamela Maria
AU  - Del Valle-Celiz PM
AD  - Medical Oncology, Hospital Duran and Reynals (Catalan Institute of Oncology), 
      Gran Via de l'Hospitalet 199-203, Hospitalet de Llobregat, 08908, Barcelona, 
      Spain.
FAU - Gonzalo-Diego, Nuria
AU  - Gonzalo-Diego N
AD  - Pharmacy Service, Hospital Duran and Reynals (Catalan Institute of Oncology), 
      Gran Via de l'Hospitalet 199-203, Hospitalet de Llobregat, 08908, Barcelona, 
      Spain.
FAU - Otero-Torres, Sara
AU  - Otero-Torres S
AD  - Pharmacy Service, Hospital Duran and Reynals (Catalan Institute of Oncology), 
      Gran Via de l'Hospitalet 199-203, Hospitalet de Llobregat, 08908, Barcelona, 
      Spain.
FAU - Bleda-Perez, Carmen
AU  - Bleda-Perez C
AD  - Pharmacy Service, Hospital Duran and Reynals (Catalan Institute of Oncology), 
      Gran Via de l'Hospitalet 199-203, Hospitalet de Llobregat, 08908, Barcelona, 
      Spain.
FAU - Prats-Jimenez, Judith
AU  - Prats-Jimenez J
AD  - Pharmacy Service, Hospital Duran and Reynals (Catalan Institute of Oncology), 
      Gran Via de l'Hospitalet 199-203, Hospitalet de Llobregat, 08908, Barcelona, 
      Spain.
FAU - Fontanals-Martinez, Sandra
AU  - Fontanals-Martinez S
AD  - Pharmacy Service, Hospital Duran and Reynals (Catalan Institute of Oncology), 
      Gran Via de l'Hospitalet 199-203, Hospitalet de Llobregat, 08908, Barcelona, 
      Spain.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20230629
PL  - England
TA  - Eur J Med Res
JT  - European journal of medical research
JID - 9517857
RN  - 9HW64Q8G6G (Everolimus)
RN  - EC 1.14.14.1 (Cytochrome P-450 CYP3A)
SB  - IM
MH  - Female
MH  - Humans
MH  - Aged
MH  - *Everolimus/adverse effects
MH  - Drug Monitoring
MH  - Cytochrome P-450 CYP3A
MH  - Drug Interactions
MH  - *Kidney Neoplasms
PMC - PMC10308769
OTO - NOTNLM
OT  - CYP3A4 metabolism
OT  - Drug-drug interaction
OT  - Everolimus
OT  - Personalized treatment
OT  - Pharmaceutical care
OT  - Pharmacokinetic
OT  - Targeted drugs
OT  - Therapeutic drug monitoring
COIS- No interests to disclose.
EDAT- 2023/06/29 01:08
MHDA- 2023/06/30 06:42
PMCR- 2023/06/29
CRDT- 2023/06/28 23:39
PHST- 2023/03/30 00:00 [received]
PHST- 2023/06/14 00:00 [accepted]
PHST- 2023/06/30 06:42 [medline]
PHST- 2023/06/29 01:08 [pubmed]
PHST- 2023/06/28 23:39 [entrez]
PHST- 2023/06/29 00:00 [pmc-release]
AID - 10.1186/s40001-023-01172-w [pii]
AID - 1172 [pii]
AID - 10.1186/s40001-023-01172-w [doi]
PST - epublish
SO  - Eur J Med Res. 2023 Jun 29;28(1):202. doi: 10.1186/s40001-023-01172-w.