Background/Objectives: Abiraterone acetate, apalutamide, darolutamide, and enzalutamide, which make up the androgen receptor axis-targeted therapies (ARATs) drug class, are commonly used in the management of prostate cancer. Many patients on ARATs also receive oral antithrombotic therapy (i.e., anticoagulants or antiplatelets). The concomitant use of ARATs and antithrombotic therapies creates the potential for clinically relevant drug-drug interactions, but the literature regarding the actual consequences of these interactions, and guidance for co-prescribing, is limited. We assembled a multidisciplinary panel of experts and provided them with clinical information derived from a comprehensive literature review regarding the drug-drug interactions between ARATs and antithrombotic therapies. Methods: A three-stage modified electronic Delphi process was used to gather and consolidate opinions from the panel. Each stage consisted of up to three rounds of voting to achieve consensus on which ARAT/antithrombotic therapy drug pairs warrant attention, the possible clinical consequences of drug-drug interactions, and suggested actions for management. Results: The panel achieved consensus to avoid 11 ARAT/antithrombotic therapy drug pairs and modify therapy for eight pairs. Assessments relied heavily on pharmacokinetic data and extrapolation from drug-drug interaction studies of similarly metabolized drugs. Conclusions: This e-Delphi process highlights the need for further research into the clinical impact of ARAT/antithrombotic drug interactions. Nonetheless, the suggested actions aim to provide clinicians with a practical framework for therapeutic decision making.
Cancers. 2024 Sep 29*** epublish ***
Kori Leblanc, Scott J Edwards, George Dranitsaris, Darryl P Leong, Marc Carrier, Shawn Malone, Ricardo A Rendon, Alison M Bond, Troy D Sitland, Pawel Zalewski, Michelle Wang, Urban Emmenegger
Department of Pharmacy, University Health Network, Toronto, ON M5G 2C4, Canada., Cancer Care Program, Eastern Health, St. John's, NL A1B 3V6, Canada., Department of Public Health, Falk College, Syracuse University, Syracuse, NY 13244, USA., Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON L8L 2X2, Canada., The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada., The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada., Queen Elizabeth II Health Sciences Centre, Halifax, NS B3H 3A7, Canada., Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada., Department of Urology, Dalhousie University, Halifax, NS B3H 1Y6, Canada., Durham Regional Cancer Centre, Oshawa, ON L1G 2B9, Canada., Bayer Inc., Mississauga, ON L4W 5R6, Canada., Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.