Oral Chemotherapy
Many of the chemotherapy agents introduced in recent years come in the form of a tablet, capsule, or liquid. This is particularly true of the metabolic inhibitor drugs, such as kinase inhibitors. Indeed, of the 69 new drugs approved by the FDA for cancer treatment from 2015 through 2020, 44 are designated for oral administration. Cancer patients have long taken pills as chemoprotectants or to address side effects, but it is only in recent years that antineoplastic medications have come in pill form. While all patients should follow doctors’ orders in taking medicine of all sorts all the time, special attention should be given to chemotherapy medicine. It truly must be taken on time and the correct dose to fit in the prescribed regimen.
Patients often (perhaps subconsciously) think IV chemotherapy is the real deal, while oral preparations are less serious and/or effective. However, oral chemotherapy is a real treatment. Patients need to take it seriously.
When taking oral chemotherapy at home, patients usually get special instructions from the medical team and there are many precautions to be followed.
Sometimes the care team prefers that the patient take the oral chemotherapy in the office or clinic in the presence of a nurse. There are good reasons for this
Food with high fat content often helps medicines become more bioavailable – a greater percentage of absorbed in the digestive system – but often the medicine should be taken first thing in the morning, before breakfast. This kind of thing is determined in clinical trials and the manufacturer knows how to advise patients and doctors.
A review found that early stage trials usually give the patient the drug on an empty stomach and claimed many drugs got to approval without the right food studies to determine how they should be taken.
Even among kinase inhibitors, some are specified to be taken with a meal and some while fasting.
Researchers at the University of Chicago compared the labels of oncology drugs and other drugs and concluded that the instructions for “oncology drugs are in contradiction with fundamental pharmacologic principles,”
They found cases where it was known that food-drug interactions increased bioavailability of the active medicine but the label nevertheless told patients to take the pills after fasting.
- The high cost of oral chemo agents (many are expensive because they are still patent-protected) means some patients decline to get their prescription filled and do not follow doctors’ orders.
- Even if the patient has the medicine in his or her home, he or she may fail to take the medicine or take it at the wrong time or at the wrong dose. This might be due to forgetfulness or other reasons.
- The medical team does not want the patient to have an inventory of the drug, but instead receive it right as it is ingested.
- The other part of the combination regimen may include medicine that must be delivered at the clinic (e.g. intravenously)
Cytotoxic or inhibitor drugs
Afatinib Abemaciclib Abiraterone Acalabrutinib Alectinib Alpelisib Altretamine Apalutamide Arsenic Trioxide Avapritinib Axitinib Azacitidine Bicalutamide Binimetinib Brigatinib Busulfan Cabozantinib Capecitabine Capmatinib Carmustine Ceritinib Chlorambucil Cladribine Cobimetinib Copanlisib Crizotinib Cyclophosphamide Dabrafenib Dacomitinib Dasatinib Degarelix Duvelisib Enasidenib Encorafenib Entrectinib Enzalutamide Erlotinib Estramustine Estramustine Everolimus Flutamide Gefitinib Gilteritinib Glasdegib Goserelin Ibrutinib Idelalisib Ifosfamide Imatinib Isotretinoin Ivosidenib Ixazomib Lapatinib Larotrectinib Lenvatinib Leucovorin Megestrol Melphalan Mercaptopurine Midostaurin Mitotane Neratinib Nilotinib Nilutamide Niraparib Olaparib Osimertinib Palbociclib Panobinostat Pazopanib Pemigatinib Ponatinib Pralsetinib Procarbazine Regorafenib Ribociclib Ripretinib Rucaparib Ruxolitinib Selinexor Selpercatinib Sonidegib Sorafenib Sunitinib Talazoparib Tazemetostat Temozolomide Tepotinib Thioguanine Tivozanib Toremifene Trametinib Trifluridine/Tipiricil Tucatinib Umbralisib Vandetanib Vemurafenib Venetoclax Vismodegib Vorinostat ZanubrutinibHormone agonists or antagonists used in treatment of cancer
Abiraterone Apalutamide Bicalutamide Darolutamide Degarelix Estramustine Enzalutamide Flutamide Goserelin Mitotane Nilutamide Megestrol Tamoxifen ToremifeneAromatase inhibitors
All aromatase inhibitors given in adjuvant cancer therapy are oral. Anastrozole Aminoglutethimide Letrozole ExemestaneTaking the Drugs with Food
Should oral chemotherapy drugs be taken on an empty stomach or with food? As with any medicine, it is best for the patient to follow the instructions that come with the medicine and whatever the cancer care team (nurses and doctors) say. It is interesting, however, that different drugs have different instructions.