Medication guide for the perioperative management of oral antineoplastic agents in cancer patients

ABSTRACT

Background

Oral antineoplastic agents (OAAs) are high-risk drugs that may increase the risk of bleeding, difficulty in wound healing, or produce alterations in coagulation and/or platelet aggregation. These aspects had to be highly considered throughout the entire perioperative process. Our aim was to create a comprehensive management medication guide based on reconciliation and dose adjustment recommendations for OAAs in patients undergoing a surgical intervention.

Research design and methods

We analyzed all OAAs approved by the EMA in November 2020. We assessed data related to dose adjustment, drug reconciliation, coagulation disturbances, or anticoagulant interactions from the FDA and EMA summary of product characteristics.

Results

We analyzed 67 OAAs. We identified that 51 (76.2%) OAAs can produce alteration in the platelet count, 12 (17.9%) affect the wound healing and recovery process, and 32 (47.8%) require control and monitoring in case of combination with anticoagulants. Only 13 (19.4%) OAAs, most of them antiangiogenics, have specific recommendations for temporary suspension before surgery.

Conclusions

Most OAAs require perioperative monitoring. This review can serve as an easy (simple, effective) tool to help healthcare professionals involved in patient care to manage OAAs during the perioperative process.

KEYWORDS:

• Cancer
• perioperative
• posology
• oncology
• oral antineoplastic agents
• reconciliation
• safety
• surgery

Declaration of interest

V Escudero-Vilaplana received support to continuing education/advisory fees from Abbvie, Astellas, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Merck Sharp & Dohme, Novartis, and Pfizer, outside the submitted work. R Collado-Borrell received support to continuing education/advisory fees from Amgen, Boehringer Ingelheim, GlaxoSmithKline, Roche, Merck Sharp & Dohme, Bristol-Myers Squibb, Janssen, and Pfizer, outside the submitted work. A Gimenez-Manzorro received support to continuing education/advisory fees from Boehringer Ingelheim, Gilead, Pfizer, and Servier, outside the submitted work. A Ribed received advisory fees from Abbvie, outside the submitted work. B Marzal-Alfaro received support to continuing education/advisory fees from GlaxoSmithKline, Roche, Abbvie, Pfizer, and Bayer, outside the submitted work. E Gonzalez-Haba received advisory fees from Bayer, Bristol-Myers Squibb, and Novartis, outside the submitted work. A Herranz received advisory fees from Amgen, Astellas, Janssen, Kern, and Novartis, outside the submitted work. M Sanjurjo received advisory fees from Abbvie, AstraZeneca, and Roche, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.