A review: drug-drug interactions of epithelial growth factor receptor-tyrosine kinase inhibitors / 中华肿瘤杂志

Mutations in the epithelial growth factor receptor (EGFR) is a driving factor that causes non-small cell lung carcinoma (NSCLC). The epithelial growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) is a crucial discovery in the treatment of lung cancer, particularly the efficacy of EGFR-TKIs is superior to that of the standard chemotherapy for patients with EGFR mutation-positive advanced NSCLC. Patients with NSCLC use EGFR-TKIs and other medications simultaneously is commonly seen, especially among those with comorbidities, which increases the risk of drug-drug interactions (DDIs) of EGFR-TKIs. The most common mechanisms underlying the DDIs of EGFR-TKIs are modulations of cytochrome P450 (CYP) and drug transporters [including P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP)], as well as gastrointestinal acid-inhibitory drugs [proton pump inhibitors (PPIs) and H(2) receptor antagonists (H(2)RA)]. Inhibitors or inducers of CYP enzymes and drug transporters can inhibit or accelerate the metabolism of EGFR-TKIs, which increase or reduce the exposure of EGFR-TKIs, thereby affect the efficacy and safety of EGFR-TKIs. In addition, PPIs or H(2)RA can decrease the solubility, bioavailability and efficacy of EGFR-TKIs. This review summarizes the mechanisms of DDIs of gefitinib, erlotinib, icotinib, afatinib, dacomitinib and osimertinib; the management recommendations for DDIs of those EGFR-TKIs from the Chinese and global guideline, as well as from the recent pre-clinical and clinical studies, which provide the reference and evidence for managing the combination therapies of EGFR-TKIs and other medications in clinics.

Clinical and pathological effect of acid inhibitory drugs and prokinetic agents for mycotic esophagitis / 重庆医科大学学报

Objective:To evaluate the curative effect of combination therapy of acid inhibitory drugs and prokinetic agents for mycotic esophagitis.Methods:60 patients with low-grade or moderate-grade mycotic esophagitis were randomly divided into two groups.The experimental group(30 cases)were treated with acid inhibitory drugs plus prokinetic agents;the control group(30 cases) were treated with antimycotic drugs.All of these patients were treated for 2 or 4 weeks.The clinical symptoms were observed at weeks 2 and 4 after treatment .The results were evaluated by gastric endoscopy,mycotic examination,and pathology.Results:The effective treatment results were observed and all clinical systoms in all these patients disappeared.The test for fungus was negative.In the experimental group,there were 21 cases of cure at week 2,8 cases of cure and 1 case of improvement at week 4.In the control group,there were 25 cases of cure at week 2,5 cases of cure at week 4.There was no significant different in clinical efficacy and pathological change between the experimental group and the control group.The side-effect in the experimental group was significantly lower than that in the control group(P