Drug absorption interactions between oral targeted anticancer agents and PPIs: is pH-dependent solubility the Achilles heel of targeted therapy?

Clin Pharmacol Ther. 2012 Aug;92(2):203-13. doi: 10.1038/clpt.2012.73. Epub 2012 Jun 27.

Abstract

A majority of the novel orally administered, molecularly targeted anticancer therapies are weak bases that exhibit pH-dependent solubility, and suppression of gastric acidity with acid-reducing agents could impair their absorption. In addition, a majority of cancer patients frequently take acid-reducing agents to alleviate symptoms of gastroesophageal reflux disease, thereby raising the potential for a common but underappreciated drug-drug interaction (DDI) that could decrease the exposure of anticancer medication and result in subsequent failure of therapy. This article is a review of the available clinical literature describing the extent of the interaction between 15 orally administered, small-molecule targeted anticancer therapies and acid-reducing agents. The currently available clinical data suggest that the magnitude of this DDI is largest for compounds whose in vitro solubility varies over the pH range 1-4. This range represents the normal physiological gastric acidity (pH ~1) and gastric acidity while on an acid-reducing agent (pH ~4).

Publication types

  • Review

MeSH terms

  • Anticarcinogenic Agents / pharmacokinetics
  • Anticarcinogenic Agents / therapeutic use*
  • Drug Interactions
  • Gastric Acid
  • Gastric Acidity Determination
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / metabolism
  • Humans
  • Hydrogen-Ion Concentration
  • Intestinal Absorption
  • Neoplasms / drug therapy*
  • Neoplasms / metabolism
  • Proton Pump Inhibitors / pharmacokinetics
  • Proton Pump Inhibitors / therapeutic use*
  • Solubility

Substances

  • Anticarcinogenic Agents
  • Proton Pump Inhibitors